Talking Yourself to Sleep
"Talking Yourself to Sleep
Behavioral Therapies Teach Insomniacs to Snooze Without Relying on Drugs
By JENNIFER CORBETT DOOREN, DOW JONES NEWSWIRES, March 29, 2005; Page D1
Amid new evidence about the health benefits of a good night's sleep, and growing concern about drug side effects, a number of nondrug approaches to treating insomnia are gaining traction.
Nearly half of adults have experienced insomnia -- the inability to fall asleep and stay asleep most nights -- at some point in their lives, and an estimated 10% to 15% of the population suffers from chronic insomnia, according to the National Institutes of Health.
With complaints on the rise, the medical profession is stepping up its focus on the treatment of sleep disorders. Earlier this month the American Board of Medical Specialties recognized sleep medicine as an official subspecialty for physicians in a number of areas, including internal medicine and neurology. Specialists are finding success with a range of behavior-based therapies that offer long-term solutions to insomnia. With these methods, doctors say they can teach patients to alter their thoughts and actions and break the cycle of sleeplessness, with little or no reliance on drugs.
Insomnia is an age-old problem, for which medicine has had few solutions. Patients have been given sleeping pills or low-dose antidepressants, which have side effects and -- because of the risk of addiction -- provided only temporary solutions. Newer, safer sleeping pills are still only useful in the short term because they lose their effectiveness over time. Even sleep experts concede that advice to cut out caffeine and sleep in a dark room has done little to help.
One of the most-promising treatments is a form of talk therapy used in many areas of mental health known as cognitive behavioral therapy, or CBT. The goal is to change negative thought patterns that keep insomniacs awake. Instead of counting sheep and thinking, 'I won't be able to function tomorrow,' patients are told to practice thinking more positive thoughts like, 'I'm probably getting more sleep than I think.'"
Read the entire article
Tuesday, March 29, 2005
Sunday, March 27, 2005
Geo-Greening by Example
Geo-Greening by Example
"Geo-Greening by Example
By THOMAS L. FRIEDMAN, The New York Times, March 27, 2005
How will future historians explain it? How will they possibly explain why President George W. Bush decided to ignore the energy crisis staring us in the face and chose instead to spend all his electoral capital on a futile effort to undo the New Deal, by partially privatizing Social Security? We are, quite simply, witnessing one of the greatest examples of misplaced priorities in the history of the U.S. presidency.
'Ah, Friedman, but you overstate the case.' No, I understate it. Look at the opportunities our country is missing - and the risks we are assuming - by having a president and vice president who refuse to lift a finger to put together a 'geo-green' strategy that would marry geopolitics, energy policy and environmentalism.
By doing nothing to lower U.S. oil consumption, we are financing both sides in the war on terrorism and strengthening the worst governments in the world. That is, we are financing the U.S. military with our tax dollars and we are financing the jihadists - and the Saudi, Sudanese and Iranian mosques and charities that support them - through our gasoline purchases. The oil boom is also entrenching the autocrats in Russia and Venezuela, which is becoming Castro's Cuba with oil. By doing nothing to reduce U.S. oil consumption we are also setting up a global competition with China for energy resources, including right on our doorstep in Canada and Venezuela. Don't kid yourself: China's foreign policy today is very simple - holding on to Taiwan and looking for oil.
Finally, by doing nothing to reduce U.S. oil consumption we are only hastening the climate change crisis, and the Bush officials who scoff at the science around this should hang their heads in shame. And it is only going to get worse the longer we do nothing. Wired magazine did an excellent piece in its April issue about hybrid cars, which get 40 to 50 miles to the gallon with very low emissions. One paragraph jumped out at me: 'Right now, there are about 800 million cars in active use. By 2050, as cars become ubiquitous in China and India, it'll be 3.25 billion. That increase represents ... an almost unimaginable threat to our environment. Quadruple the cars means quadruple the carbon dioxide emissions - unless cleaner, less gas-hungry vehicles become the norm.'
All the elements of what I like to call a geo-green strategy are known:
We need a gasoline tax that would keep pump prices fixed at $4 a gallon, even if crude oil prices go down. At $4 a gallon (premium gasoline averages about $6 a gallon in Europe), we could change the car-buying habits of a large segment of the U.S. public, which would make it profitable for the car companies to convert more of their fleets to hybrid or ethanol engines, which over time could sharply reduce our oil consumption.
We need to start building nuclear power plants again. The new nuclear technology is safer and cleaner than ever. 'The risks of climate change by continuing to rely on hydrocarbons are much greater than the risks of nuclear power,' said Peter Schwartz, chairman of Global Business Network, a leading energy and strategy consulting firm. 'Climate change is real and it poses a civilizational threat that [could] transform the carrying capacity of the entire planet.'
And we need some kind of carbon tax that would move more industries from coal to wind, hydro and solar power, or other, cleaner fuels. The revenue from these taxes would go to pay down the deficit and the reduction in oil imports would help to strengthen the dollar and defuse competition for energy with China.
It's smart geopolitics. It's smart fiscal policy. It is smart climate policy. Most of all - it's smart politics! Even evangelicals are speaking out about our need to protect God's green earth. 'The Republican Party is much greener than George Bush or Dick Cheney,' remarked Mr. Schwartz. 'There is now a near convergence of support on the environmental issue. Look at how popular [Arnold] Schwarzenegger, a green Republican, is becoming because of what he has done on the environment in California.'
Imagine if George Bush declared that he was getting rid of his limousine for an armor-plated Ford Escape hybrid, adopting a geo-green strategy and building an alliance of neocons, evangelicals and greens to sustain it. His popularity at home - and abroad - would soar. The country is dying to be led on this. Instead, he prefers to squander his personal energy trying to take apart the New Deal and throwing red meat to right-to-life fanatics. What a waste of a presidency. How will future historians explain it?"
Read at the original source
"Geo-Greening by Example
By THOMAS L. FRIEDMAN, The New York Times, March 27, 2005
How will future historians explain it? How will they possibly explain why President George W. Bush decided to ignore the energy crisis staring us in the face and chose instead to spend all his electoral capital on a futile effort to undo the New Deal, by partially privatizing Social Security? We are, quite simply, witnessing one of the greatest examples of misplaced priorities in the history of the U.S. presidency.
'Ah, Friedman, but you overstate the case.' No, I understate it. Look at the opportunities our country is missing - and the risks we are assuming - by having a president and vice president who refuse to lift a finger to put together a 'geo-green' strategy that would marry geopolitics, energy policy and environmentalism.
By doing nothing to lower U.S. oil consumption, we are financing both sides in the war on terrorism and strengthening the worst governments in the world. That is, we are financing the U.S. military with our tax dollars and we are financing the jihadists - and the Saudi, Sudanese and Iranian mosques and charities that support them - through our gasoline purchases. The oil boom is also entrenching the autocrats in Russia and Venezuela, which is becoming Castro's Cuba with oil. By doing nothing to reduce U.S. oil consumption we are also setting up a global competition with China for energy resources, including right on our doorstep in Canada and Venezuela. Don't kid yourself: China's foreign policy today is very simple - holding on to Taiwan and looking for oil.
Finally, by doing nothing to reduce U.S. oil consumption we are only hastening the climate change crisis, and the Bush officials who scoff at the science around this should hang their heads in shame. And it is only going to get worse the longer we do nothing. Wired magazine did an excellent piece in its April issue about hybrid cars, which get 40 to 50 miles to the gallon with very low emissions. One paragraph jumped out at me: 'Right now, there are about 800 million cars in active use. By 2050, as cars become ubiquitous in China and India, it'll be 3.25 billion. That increase represents ... an almost unimaginable threat to our environment. Quadruple the cars means quadruple the carbon dioxide emissions - unless cleaner, less gas-hungry vehicles become the norm.'
All the elements of what I like to call a geo-green strategy are known:
We need a gasoline tax that would keep pump prices fixed at $4 a gallon, even if crude oil prices go down. At $4 a gallon (premium gasoline averages about $6 a gallon in Europe), we could change the car-buying habits of a large segment of the U.S. public, which would make it profitable for the car companies to convert more of their fleets to hybrid or ethanol engines, which over time could sharply reduce our oil consumption.
We need to start building nuclear power plants again. The new nuclear technology is safer and cleaner than ever. 'The risks of climate change by continuing to rely on hydrocarbons are much greater than the risks of nuclear power,' said Peter Schwartz, chairman of Global Business Network, a leading energy and strategy consulting firm. 'Climate change is real and it poses a civilizational threat that [could] transform the carrying capacity of the entire planet.'
And we need some kind of carbon tax that would move more industries from coal to wind, hydro and solar power, or other, cleaner fuels. The revenue from these taxes would go to pay down the deficit and the reduction in oil imports would help to strengthen the dollar and defuse competition for energy with China.
It's smart geopolitics. It's smart fiscal policy. It is smart climate policy. Most of all - it's smart politics! Even evangelicals are speaking out about our need to protect God's green earth. 'The Republican Party is much greener than George Bush or Dick Cheney,' remarked Mr. Schwartz. 'There is now a near convergence of support on the environmental issue. Look at how popular [Arnold] Schwarzenegger, a green Republican, is becoming because of what he has done on the environment in California.'
Imagine if George Bush declared that he was getting rid of his limousine for an armor-plated Ford Escape hybrid, adopting a geo-green strategy and building an alliance of neocons, evangelicals and greens to sustain it. His popularity at home - and abroad - would soar. The country is dying to be led on this. Instead, he prefers to squander his personal energy trying to take apart the New Deal and throwing red meat to right-to-life fanatics. What a waste of a presidency. How will future historians explain it?"
Read at the original source
Saturday, March 26, 2005
Fight against junk food at school
Fight against junk food at school
"Jamie Oliver launches fight against junk food at school
Mon Mar 7,12:28 PM ET
LONDON (AFP) - Celebrity chef Jamie Oliver has launched a crusade against junk food served up in school canteens, forcing the government to reassess children's nutritional standards.
The trendy, young cook, who shot to fame with a self-styled television cooking show, urged parents to: "start the revolution in the schools' dining halls".
Hoping to spread the word, he takes over a school canteen in Greenwich, south-east London, in a new television series on Channel Four called "Jamie's school dinners".
The floppy-haired 28-year-old, himself a father of two, is tasked with serving up healthy food at a low price and encouraging some 1,400 pupils to ditch the chips and hamburgers and tuck in.
"Twenty years ago, the government gave up responsibility for the nutrition and dealings with school dinners, and over 20 years the food went down, down, down to what we have now," said the baby-faced chef, who has also written a number of popular cook books and runs a London restaurant.
Some 15 percent of children under the age of 11 suffer from obesity, according to Jamie Oliver's campaign -- "Feed me better".
His campaign, which can be accessed on the web site "Feed me better"
, has published a manifesto and a petition that has already attracted more than 3,000 signatures.
In addition, Jamie has encouraged parents to visit their children's school to see for themselves what they are eating.
And he urged canteen staff to alert pupils to healthy items on the menu, calling on people to petition school heads and their local authorities.
The initiative only started recently, but results have already started to show.
The local authorities in Greenwich have decided to raise the amount of money allocated to school meals to 50 pence per child. Furthermore, processed food has been taken off the menu in 25 schools in the borough and 55 others must follow suit by the end of the school year.
Check out Jamie Oliver's site "Feed me better".
Read the entire article
"Jamie Oliver launches fight against junk food at school
Mon Mar 7,12:28 PM ET
LONDON (AFP) - Celebrity chef Jamie Oliver has launched a crusade against junk food served up in school canteens, forcing the government to reassess children's nutritional standards.
The trendy, young cook, who shot to fame with a self-styled television cooking show, urged parents to: "start the revolution in the schools' dining halls".
Hoping to spread the word, he takes over a school canteen in Greenwich, south-east London, in a new television series on Channel Four called "Jamie's school dinners".
The floppy-haired 28-year-old, himself a father of two, is tasked with serving up healthy food at a low price and encouraging some 1,400 pupils to ditch the chips and hamburgers and tuck in.
"Twenty years ago, the government gave up responsibility for the nutrition and dealings with school dinners, and over 20 years the food went down, down, down to what we have now," said the baby-faced chef, who has also written a number of popular cook books and runs a London restaurant.
Some 15 percent of children under the age of 11 suffer from obesity, according to Jamie Oliver's campaign -- "Feed me better".
His campaign, which can be accessed on the web site "Feed me better"
, has published a manifesto and a petition that has already attracted more than 3,000 signatures.
In addition, Jamie has encouraged parents to visit their children's school to see for themselves what they are eating.
And he urged canteen staff to alert pupils to healthy items on the menu, calling on people to petition school heads and their local authorities.
The initiative only started recently, but results have already started to show.
The local authorities in Greenwich have decided to raise the amount of money allocated to school meals to 50 pence per child. Furthermore, processed food has been taken off the menu in 25 schools in the borough and 55 others must follow suit by the end of the school year.
Check out Jamie Oliver's site "Feed me better".
Read the entire article
Saturday, March 19, 2005
Middle-age stress causes weight gain
Middle-age stress causes weight gain
"Middle-age stress causes weight gain
By MARILYN ELIAS, USA TODAY, 3/09/05
Bruising experiences in middle age -- the cruel boss, ill parents, divorce -- cause women to gain weight, and it's not just because they eat more or exercise less, a large study reports Thursday.
'Under stress, people conserve more fat, and we think that may be what's going on here,' says psychologist Tene Lewis of Rush University Medical Center in Chicago.
The study tracks the health and mental health of pre-menopausal women from their 40s through menopause. Researchers asked more than 2,000 women about unhappy life events they had experienced in the past year. They also gathered information on diets, exercise habits, smoking and menstrual periods.
But even after taking into account many factors that could influence weight, four years later the women who faced lots of stress weighed significantly more than the less stressed. The more bad things they reported in the year before the study, the more weight they had gained over the four years, the researchers found.
That doesn't mean diet or exercise don't matter, Lewis says. But the link between personal trouble and weight gain held for all middle-age women, regardless of race, income and education.
Diet also probably played a role in putting on the weight, Epel says. 'You just don't crave carrots when you're stressed. You want comfort foods that are high in fat and sugar.'
Women can't control many typical mid-life stressors, such as ailing parents, she adds. But building strong friendships and developing new goals and priorities often can help curb stress, Epel says.
Exercise also is a great stress reliever, Lewis says, 'and it helps you lose weight, so it's a two-for-one. But whatever relaxation techniques work for you and improve your mood, those are the ones to do at this time of life.'"
Read the entire article
"Middle-age stress causes weight gain
By MARILYN ELIAS, USA TODAY, 3/09/05
Bruising experiences in middle age -- the cruel boss, ill parents, divorce -- cause women to gain weight, and it's not just because they eat more or exercise less, a large study reports Thursday.
'Under stress, people conserve more fat, and we think that may be what's going on here,' says psychologist Tene Lewis of Rush University Medical Center in Chicago.
The study tracks the health and mental health of pre-menopausal women from their 40s through menopause. Researchers asked more than 2,000 women about unhappy life events they had experienced in the past year. They also gathered information on diets, exercise habits, smoking and menstrual periods.
But even after taking into account many factors that could influence weight, four years later the women who faced lots of stress weighed significantly more than the less stressed. The more bad things they reported in the year before the study, the more weight they had gained over the four years, the researchers found.
That doesn't mean diet or exercise don't matter, Lewis says. But the link between personal trouble and weight gain held for all middle-age women, regardless of race, income and education.
Diet also probably played a role in putting on the weight, Epel says. 'You just don't crave carrots when you're stressed. You want comfort foods that are high in fat and sugar.'
Women can't control many typical mid-life stressors, such as ailing parents, she adds. But building strong friendships and developing new goals and priorities often can help curb stress, Epel says.
Exercise also is a great stress reliever, Lewis says, 'and it helps you lose weight, so it's a two-for-one. But whatever relaxation techniques work for you and improve your mood, those are the ones to do at this time of life.'"
Read the entire article
Laughing helps arteries and boosts blood flow
Laughing helps arteries and boosts blood flow
"Laughing helps arteries and boosts blood flow
By Andy Coghlan, NewScientist.com, 07 March 2005
Laughing appears to be almost as beneficial as a workout in boosting the health of blood vessels, a new study suggests.
'Thirty minutes of exercise three times a week and 15 minutes of hearty laughter each day should be part of a healthy lifestyle,' says Michael Miller of the University of Maryland Medical Center in Baltimore, US, whose team has shown that laughter relaxes arteries and boosts blood flow."
Read the entire article
"Laughing helps arteries and boosts blood flow
By Andy Coghlan, NewScientist.com, 07 March 2005
Laughing appears to be almost as beneficial as a workout in boosting the health of blood vessels, a new study suggests.
'Thirty minutes of exercise three times a week and 15 minutes of hearty laughter each day should be part of a healthy lifestyle,' says Michael Miller of the University of Maryland Medical Center in Baltimore, US, whose team has shown that laughter relaxes arteries and boosts blood flow."
Read the entire article
Thursday, March 17, 2005
Obesity will reverse life expectancy gains
Obesity will reverse life expectancy gains
"Report: Obesity will reverse life expectancy gains
CHICAGO, Illinois (AP), March 16, 2005 -- U.S. life expectancy will fall dramatically in coming years because of obesity, a startling shift in a long-running trend toward longer lives, researchers contend in a report published Thursday.
By their calculations -- disputed by skeptics as shaky and overly dire -- within 50 years obesity likely will shorten the average life span of 77.6 years by at least two to five years. That's more than the impact of cancer or heart disease, said lead author S. Jay Olshansky, a longevity researcher at the University of Illinois at Chicago.
This would reverse the mostly steady increase in American life expectancy that has occurred in the past two centuries and would have tremendous social and economic consequences that could even inadvertently help "save" Social Security, Olshansky and colleagues contend.
"We think today's younger generation will have shorter and less healthy lives than their parents for the first time in modern history unless we intervene," Olshansky said.
The report appears in the New England Journal of Medicine. In an accompanying editorial, University of Pennsylvania demography expert Samuel H. Preston calls the projections "excessively gloomy."
Opposing forecasts, projecting a continued increase in U.S. longevity, assume that obesity will continue to worsen, but also account for medical advances, Preston said.
Still, failure to curb obesity "could impede the improvements in longevity that are otherwise in store," he said. Americans' current life expectancy already trails more than 20 other developed countries.
Dr. David Ludwig of Children's Hospital Boston, a study co-author, cited sobering obesity statistics:
-Two-thirds of U.S. adults are overweight or obese; one-third of adults qualify as obese.
- Up to 30 percent of U.S. children are overweight, and childhood obesity has more than doubled in the past 25 years.
- Childhood diabetes has increased 10-fold in the past 20 years.
"It's one thing for an adult of 45 or 55 to develop type 2 diabetes and then experience the life-threatening complications of that -- kidney failure, heart attack, stroke -- in their late 50s or 60s. But for a 4-year-old or 6-year-old who's obese to develop Type 2 diabetes at 14 or 16" raises the possibility of devastating complications before reaching age 30, Ludwig said. "It's really a staggering prospect."
While national attention is starting to focus on contributors to obesity, including the prevalence of fast-food, soft drinks in schools and cuts in physical education classes, "what we presently lack is a clear, comprehensive national vision for addressing the obesity epidemic," Ludwig said. "
Read the entire article
"Report: Obesity will reverse life expectancy gains
CHICAGO, Illinois (AP), March 16, 2005 -- U.S. life expectancy will fall dramatically in coming years because of obesity, a startling shift in a long-running trend toward longer lives, researchers contend in a report published Thursday.
By their calculations -- disputed by skeptics as shaky and overly dire -- within 50 years obesity likely will shorten the average life span of 77.6 years by at least two to five years. That's more than the impact of cancer or heart disease, said lead author S. Jay Olshansky, a longevity researcher at the University of Illinois at Chicago.
This would reverse the mostly steady increase in American life expectancy that has occurred in the past two centuries and would have tremendous social and economic consequences that could even inadvertently help "save" Social Security, Olshansky and colleagues contend.
"We think today's younger generation will have shorter and less healthy lives than their parents for the first time in modern history unless we intervene," Olshansky said.
The report appears in the New England Journal of Medicine. In an accompanying editorial, University of Pennsylvania demography expert Samuel H. Preston calls the projections "excessively gloomy."
Opposing forecasts, projecting a continued increase in U.S. longevity, assume that obesity will continue to worsen, but also account for medical advances, Preston said.
Still, failure to curb obesity "could impede the improvements in longevity that are otherwise in store," he said. Americans' current life expectancy already trails more than 20 other developed countries.
Dr. David Ludwig of Children's Hospital Boston, a study co-author, cited sobering obesity statistics:
-Two-thirds of U.S. adults are overweight or obese; one-third of adults qualify as obese.
- Up to 30 percent of U.S. children are overweight, and childhood obesity has more than doubled in the past 25 years.
- Childhood diabetes has increased 10-fold in the past 20 years.
"It's one thing for an adult of 45 or 55 to develop type 2 diabetes and then experience the life-threatening complications of that -- kidney failure, heart attack, stroke -- in their late 50s or 60s. But for a 4-year-old or 6-year-old who's obese to develop Type 2 diabetes at 14 or 16" raises the possibility of devastating complications before reaching age 30, Ludwig said. "It's really a staggering prospect."
While national attention is starting to focus on contributors to obesity, including the prevalence of fast-food, soft drinks in schools and cuts in physical education classes, "what we presently lack is a clear, comprehensive national vision for addressing the obesity epidemic," Ludwig said. "
Read the entire article
Homeland Insecurity
Homeland Insecurity
"Homeland Insecurity
By THOMAS L. FRIEDMAN, The New York Times, March 17, 2005
Bush officials have always been eager to pose as the tough guys willing to make the tough decisions. On Iraq and Afghanistan, they did. But when it comes to China, the Bush administration is engaged in one of the greatest acts of unilateral disarmament ever seen in U.S. foreign policy.
National security is about so much more than just military deployments. It is also about our tax, energy and competitiveness policies. And if you look at all these areas, the Bush team has not only been steadily eroding America's leverage and room for maneuver vis-à-vis its biggest long-term competitor - China - but it has actually been making us more dependent than ever on Beijing. Indeed, if the Bush policies were wrapped into a single legislative bill it could be called "The U.S.-China Dependency Act."
The excessive tax cuts for the rich, combined with a total lack of discipline on spending by the Bush team and its Republican-run Congress, have helped China become the second-largest holder of U.S. debt, with a little under $200 billion worth. No, I don't think China will start dumping its T-bills on a whim. But don't tell me that as China buys up more and more of our debt - and that is the only way we can finance the tax holiday the Bush team wants to make permanent - it won't limit our room to maneuver with Beijing, should it take aggressive steps toward Taiwan.
What China might do with all its U.S. T-bills in the event of a clash over Taiwan is a total wild card that we have put in Beijing's hands.
On energy, the Bush team's obsession with drilling in the Alaskan wilderness to increase supply is mind-boggling. "I am sure China will be thrilled with the Bush decision to drill in Alaska," said the noted energy economist Philip Verleger Jr. "Oil in Alaska cannot easily or efficiently be shipped to our Gulf Coast refineries. The logical markets are on the West Coast of the United States and in Asia. Consumers in China and Japan, not the U.S., will be the real beneficiaries of any big Alaska find.
"With a big find, China and Japan will be able to increase imports from a dependable supplier - the U.S. - while consumers in the U.S. will still be at the mercy of unreliable suppliers, such as Venezuela and Saudi Arabia. It is simple geography. [Also], a big find will lead to lower prices in the short term, promoting more emissions and more warming."
Moreover, focusing exclusively on squeezing out a little more supply will only discourage conservation, Mr. Verleger added, setting the stage for higher prices again in three or four years - "when exhausting oil reserves and burgeoning demand from China and India will drive the price of oil to well above $100 a barrel." That will put even more money in the pockets of some of the world's worst governments.
That's why America urgently needs what I call a "geo-green" strategy, which combines geopolitics with environmentalism. Geo-greenism starts with a $1-per-gallon gasoline tax, which would help close our budget gap and force the U.S. auto industry to convert more of its fleet to hybrid and ethanol technology, thereby reducing the amount of money going to Sudan, Saudi Arabia and Iran for oil. It would also reduce our dependence on China to finance our debt and the chances that we will end up in a global struggle with China for energy.
Finally, on competition policy, the Bush team and Congress cut the budget of the National Science Foundation for this fiscal year by $105 million. I could not put it better than Congressman Vern Ehlers, one of the few dissenting Republicans, who said: "This decision shows dangerous disregard for our nation's future ... at a time when other nations continue to surpass our students in math and science and consistently increase their funding of basic research. We cannot hope to fight jobs lost to international competition without a well-trained and educated work force."
In addition, at a time when China is encouraging its new companies to offer employees stock options to get Chinese innovators to stay at home and start new firms, the Bush team has been mutely going along with a change in accounting standards that will force U.S. companies to expense stock options by June 2005. This is likely to dampen the growth of our own high-tech companies and encourage U.S.-educated Indian and Chinese techies to go back home.
I am not a China basher. We need to engage China, and help accommodate its rising power with the world system, but the only way to do that is from a position of strength. But everything the Bush team is doing is ensuring that it will be from a position of weakness. "
Read at the original source
"Homeland Insecurity
By THOMAS L. FRIEDMAN, The New York Times, March 17, 2005
Bush officials have always been eager to pose as the tough guys willing to make the tough decisions. On Iraq and Afghanistan, they did. But when it comes to China, the Bush administration is engaged in one of the greatest acts of unilateral disarmament ever seen in U.S. foreign policy.
National security is about so much more than just military deployments. It is also about our tax, energy and competitiveness policies. And if you look at all these areas, the Bush team has not only been steadily eroding America's leverage and room for maneuver vis-à-vis its biggest long-term competitor - China - but it has actually been making us more dependent than ever on Beijing. Indeed, if the Bush policies were wrapped into a single legislative bill it could be called "The U.S.-China Dependency Act."
The excessive tax cuts for the rich, combined with a total lack of discipline on spending by the Bush team and its Republican-run Congress, have helped China become the second-largest holder of U.S. debt, with a little under $200 billion worth. No, I don't think China will start dumping its T-bills on a whim. But don't tell me that as China buys up more and more of our debt - and that is the only way we can finance the tax holiday the Bush team wants to make permanent - it won't limit our room to maneuver with Beijing, should it take aggressive steps toward Taiwan.
What China might do with all its U.S. T-bills in the event of a clash over Taiwan is a total wild card that we have put in Beijing's hands.
On energy, the Bush team's obsession with drilling in the Alaskan wilderness to increase supply is mind-boggling. "I am sure China will be thrilled with the Bush decision to drill in Alaska," said the noted energy economist Philip Verleger Jr. "Oil in Alaska cannot easily or efficiently be shipped to our Gulf Coast refineries. The logical markets are on the West Coast of the United States and in Asia. Consumers in China and Japan, not the U.S., will be the real beneficiaries of any big Alaska find.
"With a big find, China and Japan will be able to increase imports from a dependable supplier - the U.S. - while consumers in the U.S. will still be at the mercy of unreliable suppliers, such as Venezuela and Saudi Arabia. It is simple geography. [Also], a big find will lead to lower prices in the short term, promoting more emissions and more warming."
Moreover, focusing exclusively on squeezing out a little more supply will only discourage conservation, Mr. Verleger added, setting the stage for higher prices again in three or four years - "when exhausting oil reserves and burgeoning demand from China and India will drive the price of oil to well above $100 a barrel." That will put even more money in the pockets of some of the world's worst governments.
That's why America urgently needs what I call a "geo-green" strategy, which combines geopolitics with environmentalism. Geo-greenism starts with a $1-per-gallon gasoline tax, which would help close our budget gap and force the U.S. auto industry to convert more of its fleet to hybrid and ethanol technology, thereby reducing the amount of money going to Sudan, Saudi Arabia and Iran for oil. It would also reduce our dependence on China to finance our debt and the chances that we will end up in a global struggle with China for energy.
Finally, on competition policy, the Bush team and Congress cut the budget of the National Science Foundation for this fiscal year by $105 million. I could not put it better than Congressman Vern Ehlers, one of the few dissenting Republicans, who said: "This decision shows dangerous disregard for our nation's future ... at a time when other nations continue to surpass our students in math and science and consistently increase their funding of basic research. We cannot hope to fight jobs lost to international competition without a well-trained and educated work force."
In addition, at a time when China is encouraging its new companies to offer employees stock options to get Chinese innovators to stay at home and start new firms, the Bush team has been mutely going along with a change in accounting standards that will force U.S. companies to expense stock options by June 2005. This is likely to dampen the growth of our own high-tech companies and encourage U.S.-educated Indian and Chinese techies to go back home.
I am not a China basher. We need to engage China, and help accommodate its rising power with the world system, but the only way to do that is from a position of strength. But everything the Bush team is doing is ensuring that it will be from a position of weakness. "
Read at the original source
Wednesday, March 16, 2005
How much exercise do I need?
People need 30 minutes of physical activity on most days to ward off chronic disease
WASHINGTON (AP) -- Sixty to 90 minutes of exercise? Every day? That's what the government now suggests.
Even people working out at the gym say most folks won't consider that, and the experts behind the government's recommendation say 30 minutes a day is enough for most.
The panel of doctors and scientists that developed the recommendations put an emphasis on getting 30 minutes of exercise. But its 25 pages of recommendations were scaled down to three when they were released as part of the government's new dietary guidelines in January. Those guidelines gave equal billing to the 60- and 90-minute suggestions.
"There's an enormous need to clarify that," said Russell Pate, a panel member and professor of exercise science at the University of South Carolina school of public health. "I have no doubt that if we all met that 30-minute guideline, we'd have a lot fewer of us that have weight problems."
The guidelines are being used to update the government's food pyramid, which is due out this spring. This is what they say about exercise:
- People need 30 minutes of physical activity on most days to ward off chronic disease.
- To prevent unhealthy weight gain, people should spend 60 minutes on physical activity on most days.
- Previously overweight people who have lost weight may need 60 to 90 minutes of exercise to keep the weight off.
Pate said it was a mistake not to tie the half-hour recommendation to people's weight.
"It probably would have helped if, in the release of the guidelines, the 30-minute recommendation had been connected to the weight issue as the 60- and 90-minute recommendations were," he said.
Weight is an issue throughout the guidelines, which tell people how to eat to be healthy. Overall, the guidelines advise eating fewer calories, more fruits, vegetables and whole grains. People should also drink more lowfat milk, eat less fat and salt and get more exercise.
The number of overweight and obese Americans is growing at an alarming rate, the panel said, which is why they included the advice recommending 60 and 90-minute daily exercise regimes in their report.
"Because we have 60 percent of Americans overweight and 30 percent obese, we have a lot of people trying to lose weight and keep it off, and we know how difficult it is to lose weight and keep it off," said Dr. Xavier Pi-Sunyer, a panel member and director of obesity research at St. Luke's-Roosevelt Hospital Center in New York.
Up to 90 minutes a day is required for people who, since they were overweight, may have a more demanding metabolism, said Dr. Janet King, the panel's chair and a scientist at Children's Hospital Oakland Research Institute.
About two-thirds of Americans each year try to start regular exercise programs, according to a 2004 Associated Press-Ipsos poll. That contrasts with how many stay with it. Nearly 40 percent of adults said they didn't do physical activity during leisure time in 2002 data from the federal Centers for Disease Control and Prevention.
People trying to fit the new exercise advice into their day don't have to start all at once. It's fine to break your activity into bouts of 10 or 15 minutes. But the idea is still to do at least 30 minutes of moderate physical activity -- the equivalent of walking briskly, at about 3.5 miles an hour.
Try walking your dog in the park for 15 minutes in the morning and walking on a treadmill for 15 minutes in the evening, or take a walk at lunchtime, Pi-Sunyer said. "You don't have to change, put on a sweat suit, take a shower. You're not going to work up a big sweat, and you can go back to work," he said.
And it doesn't have to be walking. The panel gave several examples of moderate exercise: Hiking, light gardening or yard work, dancing, golf, bicycling, a light workout of weight lifting. Stretching also counts.
More vigorous activity is even better, the committee said. That could include running or jogging at 5 miles an hour, walking at 4.5 miles an hour, bicycling at 10 miles an hour, swimming, aerobics, heavy yard work such as chopping wood, more vigorous weight lifting or playing basketball.
"The idea here is small steps," said Eric Hentges, director of the Agriculture Department's Center for Nutrition Policy and Promotion, which helped write the guidelines. "Get the 30 minutes first, because independent of any of the other aspects, the 30 minutes alone will have benefits."
Read the entire article
WASHINGTON (AP) -- Sixty to 90 minutes of exercise? Every day? That's what the government now suggests.
Even people working out at the gym say most folks won't consider that, and the experts behind the government's recommendation say 30 minutes a day is enough for most.
The panel of doctors and scientists that developed the recommendations put an emphasis on getting 30 minutes of exercise. But its 25 pages of recommendations were scaled down to three when they were released as part of the government's new dietary guidelines in January. Those guidelines gave equal billing to the 60- and 90-minute suggestions.
"There's an enormous need to clarify that," said Russell Pate, a panel member and professor of exercise science at the University of South Carolina school of public health. "I have no doubt that if we all met that 30-minute guideline, we'd have a lot fewer of us that have weight problems."
The guidelines are being used to update the government's food pyramid, which is due out this spring. This is what they say about exercise:
- People need 30 minutes of physical activity on most days to ward off chronic disease.
- To prevent unhealthy weight gain, people should spend 60 minutes on physical activity on most days.
- Previously overweight people who have lost weight may need 60 to 90 minutes of exercise to keep the weight off.
Pate said it was a mistake not to tie the half-hour recommendation to people's weight.
"It probably would have helped if, in the release of the guidelines, the 30-minute recommendation had been connected to the weight issue as the 60- and 90-minute recommendations were," he said.
Weight is an issue throughout the guidelines, which tell people how to eat to be healthy. Overall, the guidelines advise eating fewer calories, more fruits, vegetables and whole grains. People should also drink more lowfat milk, eat less fat and salt and get more exercise.
The number of overweight and obese Americans is growing at an alarming rate, the panel said, which is why they included the advice recommending 60 and 90-minute daily exercise regimes in their report.
"Because we have 60 percent of Americans overweight and 30 percent obese, we have a lot of people trying to lose weight and keep it off, and we know how difficult it is to lose weight and keep it off," said Dr. Xavier Pi-Sunyer, a panel member and director of obesity research at St. Luke's-Roosevelt Hospital Center in New York.
Up to 90 minutes a day is required for people who, since they were overweight, may have a more demanding metabolism, said Dr. Janet King, the panel's chair and a scientist at Children's Hospital Oakland Research Institute.
About two-thirds of Americans each year try to start regular exercise programs, according to a 2004 Associated Press-Ipsos poll. That contrasts with how many stay with it. Nearly 40 percent of adults said they didn't do physical activity during leisure time in 2002 data from the federal Centers for Disease Control and Prevention.
People trying to fit the new exercise advice into their day don't have to start all at once. It's fine to break your activity into bouts of 10 or 15 minutes. But the idea is still to do at least 30 minutes of moderate physical activity -- the equivalent of walking briskly, at about 3.5 miles an hour.
Try walking your dog in the park for 15 minutes in the morning and walking on a treadmill for 15 minutes in the evening, or take a walk at lunchtime, Pi-Sunyer said. "You don't have to change, put on a sweat suit, take a shower. You're not going to work up a big sweat, and you can go back to work," he said.
And it doesn't have to be walking. The panel gave several examples of moderate exercise: Hiking, light gardening or yard work, dancing, golf, bicycling, a light workout of weight lifting. Stretching also counts.
More vigorous activity is even better, the committee said. That could include running or jogging at 5 miles an hour, walking at 4.5 miles an hour, bicycling at 10 miles an hour, swimming, aerobics, heavy yard work such as chopping wood, more vigorous weight lifting or playing basketball.
"The idea here is small steps," said Eric Hentges, director of the Agriculture Department's Center for Nutrition Policy and Promotion, which helped write the guidelines. "Get the 30 minutes first, because independent of any of the other aspects, the 30 minutes alone will have benefits."
Read the entire article
Friday, March 11, 2005
Understanding USA - Public information made public
Understanding USA - Home
"Public Information should be made public. This site is a celebration and a visual demonstration of questions and answers leading to understanding. Understanding information is power."
Buy this book
"Public Information should be made public. This site is a celebration and a visual demonstration of questions and answers leading to understanding. Understanding information is power."
Buy this book
Monday, March 07, 2005
Milk alone not best for bones
Milk alone not best for bones
"Report: Milk alone not best for bones
Tofu, oats, broccoli, juice cited as alternatives
Monday, March 7, 2005
CHICAGO, Illinois (Reuters) -- Children who drink more milk do not necessarily develop healthier bones, researchers said on Monday in a report that stresses exercise and modest consumption of calcium-rich foods such as tofu.
The U.S. government has gradually increased recommendations for daily calcium intake, largely from dairy products, to between 800 and 1,300 milligrams to promote healthy bones and prevent osteoporosis.
But the report, published in the journal Pediatrics, said said boosting consumption of milk or other dairy products was not necessarily the best way to provide the minimal calcium intake of at least 400 milligrams per day.
Other ways to obtain the absorbable calcium found in one cup of cow's milk include a cup of fortified orange juice, a cup of cooked kale or turnip greens, two packages of instant oats, two-thirds cup of tofu, or 1 2/3 cups of broccoli, the report said.
In a review of 37 studies examining the impact of calcium consumption on bone strength in children older than 7, researchers at the Physicians Committee for Responsible Medicine in Washington found 27 did not support drinking more milk to boost calcium."
Read the entire article
"Report: Milk alone not best for bones
Tofu, oats, broccoli, juice cited as alternatives
Monday, March 7, 2005
CHICAGO, Illinois (Reuters) -- Children who drink more milk do not necessarily develop healthier bones, researchers said on Monday in a report that stresses exercise and modest consumption of calcium-rich foods such as tofu.
The U.S. government has gradually increased recommendations for daily calcium intake, largely from dairy products, to between 800 and 1,300 milligrams to promote healthy bones and prevent osteoporosis.
But the report, published in the journal Pediatrics, said said boosting consumption of milk or other dairy products was not necessarily the best way to provide the minimal calcium intake of at least 400 milligrams per day.
Other ways to obtain the absorbable calcium found in one cup of cow's milk include a cup of fortified orange juice, a cup of cooked kale or turnip greens, two packages of instant oats, two-thirds cup of tofu, or 1 2/3 cups of broccoli, the report said.
In a review of 37 studies examining the impact of calcium consumption on bone strength in children older than 7, researchers at the Physicians Committee for Responsible Medicine in Washington found 27 did not support drinking more milk to boost calcium."
Read the entire article
Florida schools testing healthier menus
Florida schools testing healthier menus
"Florida schools testing healthier menus
KISSIMMEE, Florida (AP) Sunday, March 6, 2005
Nine-year-old Kelly Ferrer no longer gets the waffles, pancakes and sugar cereals that she loved eating for breakfast last year in her school cafeteria.
This year, instead, she is served whole-wheat bread, lowfat cheese and fruit.
Does she like it? No.
'I want to go back to the old menu,' said the fourth-grader at Mill Creek Elementary School. 'We had better food last year.'
Kelly's is one of six schools in this Orlando suburb taking part in a study by a research center founded by Dr. Arthur Agatston, the author of 'The South Beach Diet.'
The goal of the study is to figure out whether school cafeterias are capable of serving more nutritious food, whether kids will eat it and whether their health will improve.
The program underscores growing concerns across the nation about childhood obesity. Government data suggest about 15 percent of U.S. youngsters are severely overweight or obese, a problem that may lead to diabetes, high blood pressure and heart disease. Some state surveys indicate the obesity rate could be higher.
'We're not putting the children on the South Beach Diet,' said Danielle Hollar, deputy director of research at the Agatston Research Institute. 'We're trying to provide healthier options for these children, and in the long run we hope they learn to eat healthier and incorporate that into their daily living.'
Although the 3,000 students in the study haven't been put on the low-carb diet per se, many of the diet's guiding principles have been incorporated into school menus.
White bread has been stricken and replaced with whole-wheat. White potatoes were subbed with sweet potatoes. French fries were abolished. Grilled chicken replaced breaded chicken. Fruits serve as dessert.
Students at the beginning of the school year were weighed, their height measured and their blood pressure and pulse recorded. Those same measurements will be taken in April. The institute has paid for the $10,000 extra cost. Hollar said the obesity rate at the school hadn't been calculated.
The new menus were 'a little bit slow catching on, but now the students seem to be enjoying the meals,' said Jean Palmore, food service director for the Osceola County School District. Four of the schools have changed their menus and the other two are being used as controls with unchanged menus.
It was rough going at first. As many as half of the students at the test schools didn't eat their lunches at the beginning of the year. Now just 15 percent are in that category after tweaks to the menu and weeks of exposure."
Read the entire article
"Florida schools testing healthier menus
KISSIMMEE, Florida (AP) Sunday, March 6, 2005
Nine-year-old Kelly Ferrer no longer gets the waffles, pancakes and sugar cereals that she loved eating for breakfast last year in her school cafeteria.
This year, instead, she is served whole-wheat bread, lowfat cheese and fruit.
Does she like it? No.
'I want to go back to the old menu,' said the fourth-grader at Mill Creek Elementary School. 'We had better food last year.'
Kelly's is one of six schools in this Orlando suburb taking part in a study by a research center founded by Dr. Arthur Agatston, the author of 'The South Beach Diet.'
The goal of the study is to figure out whether school cafeterias are capable of serving more nutritious food, whether kids will eat it and whether their health will improve.
The program underscores growing concerns across the nation about childhood obesity. Government data suggest about 15 percent of U.S. youngsters are severely overweight or obese, a problem that may lead to diabetes, high blood pressure and heart disease. Some state surveys indicate the obesity rate could be higher.
'We're not putting the children on the South Beach Diet,' said Danielle Hollar, deputy director of research at the Agatston Research Institute. 'We're trying to provide healthier options for these children, and in the long run we hope they learn to eat healthier and incorporate that into their daily living.'
Although the 3,000 students in the study haven't been put on the low-carb diet per se, many of the diet's guiding principles have been incorporated into school menus.
White bread has been stricken and replaced with whole-wheat. White potatoes were subbed with sweet potatoes. French fries were abolished. Grilled chicken replaced breaded chicken. Fruits serve as dessert.
Students at the beginning of the school year were weighed, their height measured and their blood pressure and pulse recorded. Those same measurements will be taken in April. The institute has paid for the $10,000 extra cost. Hollar said the obesity rate at the school hadn't been calculated.
The new menus were 'a little bit slow catching on, but now the students seem to be enjoying the meals,' said Jean Palmore, food service director for the Osceola County School District. Four of the schools have changed their menus and the other two are being used as controls with unchanged menus.
It was rough going at first. As many as half of the students at the test schools didn't eat their lunches at the beginning of the year. Now just 15 percent are in that category after tweaks to the menu and weeks of exposure."
Read the entire article
Sunday, March 06, 2005
Understanding Healthcare
Understanding Healthcare - Project Page
"Understanding Healthcare
The book Understanding Healthcare is intended for the general public. It covers a wide array of health topics, including guidance on how to make effective use of the Internet and other high-tech tools to improve personal health. In supporting development of the book, the Markle Foundation furthered its goal of empowering consumers, through information technology-and through information generally-to become more active participants in their own care."
Buy this book
"Understanding Healthcare
The book Understanding Healthcare is intended for the general public. It covers a wide array of health topics, including guidance on how to make effective use of the Internet and other high-tech tools to improve personal health. In supporting development of the book, the Markle Foundation furthered its goal of empowering consumers, through information technology-and through information generally-to become more active participants in their own care."
Buy this book
Saturday, March 05, 2005
Can Prayers Heal? Critics Say Studies Go Past Science's Reach
Can Prayers Heal? Critics Say Studies Go Past Science's Reach
"Can Prayers Heal? Critics Say Studies Go Past Science's Reach
By Benedict Carey, The New York Times
In 2001, two researchers and a Columbia University fertility expert published a startling finding in a respected medical journal: women undergoing fertility treatment who had been prayed for by Christian groups were twice as likely to have a successful pregnancy as those who had not.
Three years later, after one of the researchers pleaded guilty to conspiracy in an unrelated business fraud, Columbia is investigating the study and the journal reportedly pulled the paper from its Web site.
No evidence of manipulation has yet surfaced, and the study's authors stand behind their data.
But the doubts about the study have added to the debate over a deeply controversial area of research: whether prayer can heal illness."
Read the entire article
"Can Prayers Heal? Critics Say Studies Go Past Science's Reach
By Benedict Carey, The New York Times
In 2001, two researchers and a Columbia University fertility expert published a startling finding in a respected medical journal: women undergoing fertility treatment who had been prayed for by Christian groups were twice as likely to have a successful pregnancy as those who had not.
Three years later, after one of the researchers pleaded guilty to conspiracy in an unrelated business fraud, Columbia is investigating the study and the journal reportedly pulled the paper from its Web site.
No evidence of manipulation has yet surfaced, and the study's authors stand behind their data.
But the doubts about the study have added to the debate over a deeply controversial area of research: whether prayer can heal illness."
Read the entire article
Thursday, March 03, 2005
The Vision of Eco-Effectiveness
The Vision of Eco-Effectiveness
"While current strategies of eco-efficiency seek to reduce and minimize the unintended negative consequences of processes of production and consumption, the concept of eco-effectiveness presents a positive agenda based on maximizing the ability of industry to truly support the natural and human world around it. The successfully interdependent nature of biological systems suggests that achieving a sustainable system of consumption and production is not a matter of reducing the footprint of our activities on this planet, but transforming this footprint into a source of replenishment for those systems that depend on it."
Read more about the entire vision of Eco-Effectiveness
Buy this book
"While current strategies of eco-efficiency seek to reduce and minimize the unintended negative consequences of processes of production and consumption, the concept of eco-effectiveness presents a positive agenda based on maximizing the ability of industry to truly support the natural and human world around it. The successfully interdependent nature of biological systems suggests that achieving a sustainable system of consumption and production is not a matter of reducing the footprint of our activities on this planet, but transforming this footprint into a source of replenishment for those systems that depend on it."
Read more about the entire vision of Eco-Effectiveness
Buy this book
Cradle to Cradle Design is a fundamental conceptual shift away from the flawed system design of the Industrial Revolution
Cradle to Cradle Design
"Cradle to Cradle Design is a fundamental conceptual shift away from the flawed system design of the Industrial Revolution. Instead of designing products and systems based on the take-make-waste model of the last century ('cradle to grave'), MBDC's Cradle to Cradle Design paradigm is powering the Next Industrial Revolution, in which products and services are designed based on patterns found in nature, eliminating the concept of waste entirely and creating an abundance that is healthy and sustaining. Eco-Effectiveness is MBDC's design strategy for realizing these results by optimizing materials to be food either for nature's ecosystems or for humans' industrial systems -perpetually circulating in closed systems that create value and are inherently healthy and safe."
Read more about Cradle-to-Cradle Design
Buy this book
"Cradle to Cradle Design is a fundamental conceptual shift away from the flawed system design of the Industrial Revolution. Instead of designing products and systems based on the take-make-waste model of the last century ('cradle to grave'), MBDC's Cradle to Cradle Design paradigm is powering the Next Industrial Revolution, in which products and services are designed based on patterns found in nature, eliminating the concept of waste entirely and creating an abundance that is healthy and sustaining. Eco-Effectiveness is MBDC's design strategy for realizing these results by optimizing materials to be food either for nature's ecosystems or for humans' industrial systems -perpetually circulating in closed systems that create value and are inherently healthy and safe."
Read more about Cradle-to-Cradle Design
Buy this book
Cradle-to-Cradle New Housing Competition
C2C-Home.org
"The new housing competition based on a revolutionary idea.
No matter how you look at it, the C2C Home design and construction competition is different. Design will lead to actual construction. Jurors are Alexander Garvin, Daniel Libeskind, Bill McDonough, Randall Stout, and Sarah Susanka. And homes will be built with a goal of achieving the new standards of sustainability set up in Cradle to Cradle: Remaking the Way We Make Things. Turn your ideas into reality and turn the world of design and construction upside down."
See the Winning Designs
"The new housing competition based on a revolutionary idea.
No matter how you look at it, the C2C Home design and construction competition is different. Design will lead to actual construction. Jurors are Alexander Garvin, Daniel Libeskind, Bill McDonough, Randall Stout, and Sarah Susanka. And homes will be built with a goal of achieving the new standards of sustainability set up in Cradle to Cradle: Remaking the Way We Make Things. Turn your ideas into reality and turn the world of design and construction upside down."
See the Winning Designs
Sea boosts hope of finding signs of life on Mars
Sea boosts hope of finding signs of life on Mars
"Sea boosts hope of finding signs of life on Mars
By Peter N. Spotts, The Christian Science Monitor, February 28, 2005
Hopes of finding evidence that organic life gained a toe-hold on Mars appear to be brightening.
To be sure, no one yet has uncovered direct evidence for life there. An experiment designed to look for it, the European Space Agency's Beagle 2 lander, failed on arrival at Mars in December 2003.
But results from US and European orbiters circling the Red Planet and the discovery of another new species of ice-happy microbes on Earth leave many researchers convinced that it is just a matter of time - and money - before they come up with the 'smoking guns.'"
Read the entire article
"Sea boosts hope of finding signs of life on Mars
By Peter N. Spotts, The Christian Science Monitor, February 28, 2005
Hopes of finding evidence that organic life gained a toe-hold on Mars appear to be brightening.
To be sure, no one yet has uncovered direct evidence for life there. An experiment designed to look for it, the European Space Agency's Beagle 2 lander, failed on arrival at Mars in December 2003.
But results from US and European orbiters circling the Red Planet and the discovery of another new species of ice-happy microbes on Earth leave many researchers convinced that it is just a matter of time - and money - before they come up with the 'smoking guns.'"
Read the entire article
Wednesday, March 02, 2005
Digital Rx: Take Two Aspirins and E-Mail Me in the Morning
The Digital Rx: Take Two Aspirins and E-Mail Me in the Morning
"Digital Rx: Take Two Aspirins and E-Mail Me in the Morning
By MILT FREUDENHEIM, The New York Times, March 2, 2005
Doctors may no longer make house calls, but they are answering patient e-mail messages - and being paid for it.
In a move to improve efficiency and control costs, health plans and medical groups around the country are now beginning to pay doctors to reply by e-mail, just as they pay for office visits. While some computer-literate doctors have been using e-mail to communicate informally with patients for years, most have never been paid for that service.
Blue Shield of California pays his doctor $25 for each online exchange, the same as it pays for an office visit. Some insurers pay a bit less for e-mailing, and patients in some health plans are charged a $5 or $10 co-payment that is billed to their credit card and relayed to the doctor.
For doctors, the convenience of online exchanges can be considerable. They say they can offer advice about postsurgical care, diet, changing a medication and other topics that can be handled safely and promptly without an office visit or a frustrating round of telephone tag. And surveys have shown that e-mail, by reducing the number of daily office visits, gives physicians more time to spend with patients who need to be seen face to face.
For patients, e-mail allows them to send their medical questions from home in the evening, without missing work and spending time in a doctor's waiting room. In fact, many say exchanges in the more relaxed, conversational realm of e-mail make them feel closer to their doctors.
This shift toward online doctor-patient communication is important for another reason. Physicians and health care technology specialists say they believe that it could help spur the changeover to electronic health care information systems, which government officials and industry leaders say is needed to reduce medical errors and promote better care."
Read the entire article
"Digital Rx: Take Two Aspirins and E-Mail Me in the Morning
By MILT FREUDENHEIM, The New York Times, March 2, 2005
Doctors may no longer make house calls, but they are answering patient e-mail messages - and being paid for it.
In a move to improve efficiency and control costs, health plans and medical groups around the country are now beginning to pay doctors to reply by e-mail, just as they pay for office visits. While some computer-literate doctors have been using e-mail to communicate informally with patients for years, most have never been paid for that service.
Blue Shield of California pays his doctor $25 for each online exchange, the same as it pays for an office visit. Some insurers pay a bit less for e-mailing, and patients in some health plans are charged a $5 or $10 co-payment that is billed to their credit card and relayed to the doctor.
For doctors, the convenience of online exchanges can be considerable. They say they can offer advice about postsurgical care, diet, changing a medication and other topics that can be handled safely and promptly without an office visit or a frustrating round of telephone tag. And surveys have shown that e-mail, by reducing the number of daily office visits, gives physicians more time to spend with patients who need to be seen face to face.
For patients, e-mail allows them to send their medical questions from home in the evening, without missing work and spending time in a doctor's waiting room. In fact, many say exchanges in the more relaxed, conversational realm of e-mail make them feel closer to their doctors.
This shift toward online doctor-patient communication is important for another reason. Physicians and health care technology specialists say they believe that it could help spur the changeover to electronic health care information systems, which government officials and industry leaders say is needed to reduce medical errors and promote better care."
Read the entire article
Side Effects of the Drug Scares
Commentary: Side Effects Of The Drug Scares
"Side Effects Of The Drug Scares
New fears give rise to a more honest look at the risks for a pill-popping nation BusinessWeek, March 7, 2005
It's enough to make your head spin. In September, Merck & Co. (MRK ) pulled its blockbuster painkiller Vioxx from the market because a study linked it to heart attacks and strokes. Another study fingered Celebrex, a similar drug made by rival Pfizer Inc. (PFE ). The Food & Drug Administration quickly came under attack for failing to protect the public from these dangerous drugs. At a three-day FDA advisory committee hearing in late February, 32 outside experts agreed that these relatively new nonsteroidal anti-inflammatory drugs (NSAIDs) do pose serious risks.
But wait. Despite the hazards, the panel also concluded that some older NSAIDs could be just as dangerous as Celebrex -- and that all should stay on the market. The committee even decided that Vioxx, which may have caused thousands of deaths, is useful enough that it shouldn't be banned.
Is this Solomonic wisdom or simply more confusion? Both. The saga starkly illuminates larger underlying problems in drug regulation and use -- and the implications go far beyond painkillers. Here are some of the key insights and issues:
MEDICINES ARE NEVER HARMLESS 'Clearly all drugs have risks. That is the price we pay for the benefits,' says Dr. Alastair J.J. Wood, associate dean of the Vanderbilt University Medical Center and chair of the advisory meeting. That point has been often forgotten as new drugs appear on the market promising to make life better for tens of millions of Americans. And while the FDA is charged with ensuring that benefits exceed the risks, it's not easy to do. Even when done right, people will be hurt. 'Drugs may have a positive risk balance but cause grievous harm,' says Dr. Steven Galson, acting director of the FDA's Center for Drug Evaluation & Research.
A classic case: The agency yanked Lotronex, GlaxoSmithKline PLC's (GSK ) drug for irritable bowel syndrome, off the market in 2000 after five deaths -- only to allow limited use two years later when patients demanded it. The thorny question for the Cox-2 painkillers like Vioxx is whether reductions they may offer in stomach and intestinal bleeding, compared with older NSAIDs, outweigh their increased cardiovascular risks.
KNOWLEDGE GAPS MAKE THE TASK HARDER 'For most drugs, we know little about how well they work and less about how safe they are,' says Dr. David J. Graham, the FDA drug safety official who helped blow the whistle on Vioxx. The FDA's advisory committee was faced with the uncomfortable fact that the risks of the older NSAIDs aren't known either. In fact, epidemiological studies suggest that some of those drugs, such as diclofenac (Cataflam and Voltaren), meloxicam (Mobic), or even over-the-counter ibuprofen (Advil or Motrin), are as dangerous as Celebrex. Putting limits or warnings on Celebrex thus 'risks bringing about an enormous migration from this drug to others we don't know much about,' warned New York University rheumatologist Dr. Steven Abramson at the hearing.
PATIENTS MISCALCULATE THE ODDS Studies show that people typically overestimate the benefits of drugs and underestimate their risks, especially for heavily advertised medicines. That's why direct-to-consumer ads contribute to the mistaken notion that there is a safe pill for every problem. The FDA's Cox-2 panel called for an end to ads for the drugs.
ANSWERS ARE HARD TO COME BY On Feb. 16, another FDA panel advised putting black-box warnings -- the strongest possible -- on two eczema creams: Novartis' (NVS ) Elidel and Fujisawa's Protopic. Recent monkey studies show that the drugs, which suppress the immune system, may promote lymphoma. So will Elidel, the leading prescription eczema drug in the U.S., cause cancer? We won't know unless researchers follow its users for years or decades.
Rare cancers take years to develop, but at least an increase in cases is relatively easy to spot. Uncovering dangers with Cox-2 painkillers is tougher, because heart attacks and strokes are common. And the increase in risk seen in the studies is small. Often doctors don't consider a safety problem proven unless there is a two- or three-fold increase in a side effect, Dr. Robert J. Temple, FDA's associate director for medical policy, said. But with some of the painkillers, 'we're talking about [10%] differences. What do we make of these small differences?'
To pin down the actual risk, a clinical trial would have to be long and huge. Vioxx and Celebrex can't be tested against placebos in arthritis patients, because it's unethical to deny these people pain relief. And testing newer drugs against older NSAIDs is problematic, since their risks and benefits aren't known. 'Asking for clinical trials is not the answer,' says Arthur Levin, director of the Center for Medical Consumers.
Is there a way out of this mess? Doctors need to better inform patients about risks and benefits, and ads should be more balanced. But part of the solution is getting out the message that regulators don't have all the answers. One benefit of the meeting, says FDA's Dr. John Jenkins, is that 'it's good for the public to see how the science evolves and how challenging these decisions can be.' Agency watchers also see an increased willingness by the FDA to acknowledge uncertainty by slapping black-box warnings on drugs even when risks aren't proven. 'Putting concerns on labels treats physicians and consumers in a more adult fashion,' says pediatrician Dr. Richard Gorman.
The next part of the solution is working harder to get answers. The FDA should require companies to collect information on patients receiving medicines and put far more effort into analyzing the data. Beyond that, new genetic technologies offer the promise of being able to identify individuals who will be most helped or hurt by any particular drug. Until then, the best advice comes from Wood. 'Hopefully this will make people think about taking any drug,' he says. All drugs are potent substances that must be used with respect and caution. The more we take that to heart, the safer we will be.
By John Carey with Kerry Capell in London"
Read at the source
"Side Effects Of The Drug Scares
New fears give rise to a more honest look at the risks for a pill-popping nation BusinessWeek, March 7, 2005
It's enough to make your head spin. In September, Merck & Co. (MRK ) pulled its blockbuster painkiller Vioxx from the market because a study linked it to heart attacks and strokes. Another study fingered Celebrex, a similar drug made by rival Pfizer Inc. (PFE ). The Food & Drug Administration quickly came under attack for failing to protect the public from these dangerous drugs. At a three-day FDA advisory committee hearing in late February, 32 outside experts agreed that these relatively new nonsteroidal anti-inflammatory drugs (NSAIDs) do pose serious risks.
But wait. Despite the hazards, the panel also concluded that some older NSAIDs could be just as dangerous as Celebrex -- and that all should stay on the market. The committee even decided that Vioxx, which may have caused thousands of deaths, is useful enough that it shouldn't be banned.
Is this Solomonic wisdom or simply more confusion? Both. The saga starkly illuminates larger underlying problems in drug regulation and use -- and the implications go far beyond painkillers. Here are some of the key insights and issues:
MEDICINES ARE NEVER HARMLESS 'Clearly all drugs have risks. That is the price we pay for the benefits,' says Dr. Alastair J.J. Wood, associate dean of the Vanderbilt University Medical Center and chair of the advisory meeting. That point has been often forgotten as new drugs appear on the market promising to make life better for tens of millions of Americans. And while the FDA is charged with ensuring that benefits exceed the risks, it's not easy to do. Even when done right, people will be hurt. 'Drugs may have a positive risk balance but cause grievous harm,' says Dr. Steven Galson, acting director of the FDA's Center for Drug Evaluation & Research.
A classic case: The agency yanked Lotronex, GlaxoSmithKline PLC's (GSK ) drug for irritable bowel syndrome, off the market in 2000 after five deaths -- only to allow limited use two years later when patients demanded it. The thorny question for the Cox-2 painkillers like Vioxx is whether reductions they may offer in stomach and intestinal bleeding, compared with older NSAIDs, outweigh their increased cardiovascular risks.
KNOWLEDGE GAPS MAKE THE TASK HARDER 'For most drugs, we know little about how well they work and less about how safe they are,' says Dr. David J. Graham, the FDA drug safety official who helped blow the whistle on Vioxx. The FDA's advisory committee was faced with the uncomfortable fact that the risks of the older NSAIDs aren't known either. In fact, epidemiological studies suggest that some of those drugs, such as diclofenac (Cataflam and Voltaren), meloxicam (Mobic), or even over-the-counter ibuprofen (Advil or Motrin), are as dangerous as Celebrex. Putting limits or warnings on Celebrex thus 'risks bringing about an enormous migration from this drug to others we don't know much about,' warned New York University rheumatologist Dr. Steven Abramson at the hearing.
PATIENTS MISCALCULATE THE ODDS Studies show that people typically overestimate the benefits of drugs and underestimate their risks, especially for heavily advertised medicines. That's why direct-to-consumer ads contribute to the mistaken notion that there is a safe pill for every problem. The FDA's Cox-2 panel called for an end to ads for the drugs.
ANSWERS ARE HARD TO COME BY On Feb. 16, another FDA panel advised putting black-box warnings -- the strongest possible -- on two eczema creams: Novartis' (NVS ) Elidel and Fujisawa's Protopic. Recent monkey studies show that the drugs, which suppress the immune system, may promote lymphoma. So will Elidel, the leading prescription eczema drug in the U.S., cause cancer? We won't know unless researchers follow its users for years or decades.
Rare cancers take years to develop, but at least an increase in cases is relatively easy to spot. Uncovering dangers with Cox-2 painkillers is tougher, because heart attacks and strokes are common. And the increase in risk seen in the studies is small. Often doctors don't consider a safety problem proven unless there is a two- or three-fold increase in a side effect, Dr. Robert J. Temple, FDA's associate director for medical policy, said. But with some of the painkillers, 'we're talking about [10%] differences. What do we make of these small differences?'
To pin down the actual risk, a clinical trial would have to be long and huge. Vioxx and Celebrex can't be tested against placebos in arthritis patients, because it's unethical to deny these people pain relief. And testing newer drugs against older NSAIDs is problematic, since their risks and benefits aren't known. 'Asking for clinical trials is not the answer,' says Arthur Levin, director of the Center for Medical Consumers.
Is there a way out of this mess? Doctors need to better inform patients about risks and benefits, and ads should be more balanced. But part of the solution is getting out the message that regulators don't have all the answers. One benefit of the meeting, says FDA's Dr. John Jenkins, is that 'it's good for the public to see how the science evolves and how challenging these decisions can be.' Agency watchers also see an increased willingness by the FDA to acknowledge uncertainty by slapping black-box warnings on drugs even when risks aren't proven. 'Putting concerns on labels treats physicians and consumers in a more adult fashion,' says pediatrician Dr. Richard Gorman.
The next part of the solution is working harder to get answers. The FDA should require companies to collect information on patients receiving medicines and put far more effort into analyzing the data. Beyond that, new genetic technologies offer the promise of being able to identify individuals who will be most helped or hurt by any particular drug. Until then, the best advice comes from Wood. 'Hopefully this will make people think about taking any drug,' he says. All drugs are potent substances that must be used with respect and caution. The more we take that to heart, the safer we will be.
By John Carey with Kerry Capell in London"
Read at the source
Tuesday, March 01, 2005
The Next Einstein? Applicants Welcome
The Next Einstein? Applicants Welcome
"The Next Einstein? Applicants Welcome
By Dennis Overbye, The New York Times, March 1, 2005
He didn't look like much at first. He was too fat and his head was so big his mother feared it was misshapen or damaged. He didn't speak until he was well past 2, and even then with a strange echolalia that reinforced his parents' fears. He threw a small bowling ball at his little sister and chased his first violin teacher from the house by throwing a chair at her.
There was in short, no sign, other than the patience to build card houses 14 stories high, that little Albert Einstein would grow up to be 'the new Copernicus,' proclaiming a new theory of nature, in which matter and energy swapped faces, light beams bent, the stars danced and space and time were as flexible and elastic as bubblegum. No clue to suggest that he would help send humanity lurching down the road to the atomic age, with all its promise and dread, with the stroke of his pen on a letter to President Franklin D. Roosevelt in 1939, certainly no reason to suspect that his image would be on T- shirts, coffee mugs, posters and dolls.
Einstein's modest beginnings are a perennial source of comfort to parents who would like to hope, against the odds, that their little cutie can grow up to be a world beater. But they haunt people like me who hanker for a ringside seat for the Next Great Thing and wonder whether somewhere in the big haystack of the world there could be a new Einstein, biding his or her time running gels in a biology lab, writing video game software or wiring a giant detector in the bowels of a particle accelerator while putting the finishing touches on a revolution in our perception of reality.
'Einstein changed the way physicists thought about the universe in a way the public could appreciate,' said Dr. Michael Turner, a cosmologist from the University of Chicago and the director of math and physical sciences at the National Science Foundation.
Could it happen again? 'Who or where is the next Einstein?' ..."
Read the entire article
"The Next Einstein? Applicants Welcome
By Dennis Overbye, The New York Times, March 1, 2005
He didn't look like much at first. He was too fat and his head was so big his mother feared it was misshapen or damaged. He didn't speak until he was well past 2, and even then with a strange echolalia that reinforced his parents' fears. He threw a small bowling ball at his little sister and chased his first violin teacher from the house by throwing a chair at her.
There was in short, no sign, other than the patience to build card houses 14 stories high, that little Albert Einstein would grow up to be 'the new Copernicus,' proclaiming a new theory of nature, in which matter and energy swapped faces, light beams bent, the stars danced and space and time were as flexible and elastic as bubblegum. No clue to suggest that he would help send humanity lurching down the road to the atomic age, with all its promise and dread, with the stroke of his pen on a letter to President Franklin D. Roosevelt in 1939, certainly no reason to suspect that his image would be on T- shirts, coffee mugs, posters and dolls.
Einstein's modest beginnings are a perennial source of comfort to parents who would like to hope, against the odds, that their little cutie can grow up to be a world beater. But they haunt people like me who hanker for a ringside seat for the Next Great Thing and wonder whether somewhere in the big haystack of the world there could be a new Einstein, biding his or her time running gels in a biology lab, writing video game software or wiring a giant detector in the bowels of a particle accelerator while putting the finishing touches on a revolution in our perception of reality.
'Einstein changed the way physicists thought about the universe in a way the public could appreciate,' said Dr. Michael Turner, a cosmologist from the University of Chicago and the director of math and physical sciences at the National Science Foundation.
Could it happen again? 'Who or where is the next Einstein?' ..."
Read the entire article
America’s buildings create as much pollution as cars and industry combined
"How Green is My Architecture?
Newsweek, 10/27/2003
America's buildings create as much pollution as cars and industry
combined. U.S. architects and inventors are trying to catch up to
standards long prevalent in Europe.
David L. Lawrence Convention Center, Pittsburgh. Billed as the
first "green" convention center, this $370 million complex, on the
banks of the Allegheny River, makes the most of daylight and
uses a roof system that allows for natural air flow. Not bad for a
former steel town. The architect: Rafael Viñoly, whose THINK
team was runner-up-to design the World Trade Center site."
Newsweek, 10/27/2003
America's buildings create as much pollution as cars and industry
combined. U.S. architects and inventors are trying to catch up to
standards long prevalent in Europe.
David L. Lawrence Convention Center, Pittsburgh. Billed as the
first "green" convention center, this $370 million complex, on the
banks of the Allegheny River, makes the most of daylight and
uses a roof system that allows for natural air flow. Not bad for a
former steel town. The architect: Rafael Viñoly, whose THINK
team was runner-up-to design the World Trade Center site."
The Secret Genocide Archive - Darfur
The Secret Genocide Archive - Darfur
"Genocide in Darfur: A Promise Unkept
By Nicholas D. Kristof, The New York Times, February 23, 2005
Through October 2004, the genocide in Sudan had killed 100,000, but little had been done to stop the crisis.
Photos don't normally appear on this page. But it's time for all of us to look squarely at the victims of our indifference. These are just four photos in a secret archive of thousands of photos and reports that document the genocide under way in Darfur. The materials were gathered by African Union monitors, who are just about the only people able to travel widely in that part of Sudan.
This African Union archive is classified, but it was shared with me by someone who believes that Americans will be stirred if they can see the consequences of their complacency.
The photo at the upper left was taken in the village of Hamada on Jan. 15, right after a Sudanese government-backed militia, the janjaweed, attacked it and killed 107 people. One of them was this little boy. I'm not showing the photo of his older brother, about 5 years old, who lay beside him because...
...Web sites like www.darfurgenocide.org and www.savedarfur.org are trying to galvanize Americans, but the response has been pathetic.
I'm sorry for inflicting these horrific photos on you. But the real obscenity isn't in printing pictures of dead babies - it's in our passivity, which allows these people to be slaughtered.
During past genocides against Armenians, Jews and Cambodians, it was possible to claim that we didn't fully know what was going on. This time, President Bush, Congress and the European Parliament have already declared genocide to be under way. And we have photos.
This time, we have no excuse."
Read the entire article
"Genocide in Darfur: A Promise Unkept
By Nicholas D. Kristof, The New York Times, February 23, 2005
Through October 2004, the genocide in Sudan had killed 100,000, but little had been done to stop the crisis.
Photos don't normally appear on this page. But it's time for all of us to look squarely at the victims of our indifference. These are just four photos in a secret archive of thousands of photos and reports that document the genocide under way in Darfur. The materials were gathered by African Union monitors, who are just about the only people able to travel widely in that part of Sudan.
This African Union archive is classified, but it was shared with me by someone who believes that Americans will be stirred if they can see the consequences of their complacency.
The photo at the upper left was taken in the village of Hamada on Jan. 15, right after a Sudanese government-backed militia, the janjaweed, attacked it and killed 107 people. One of them was this little boy. I'm not showing the photo of his older brother, about 5 years old, who lay beside him because...
...Web sites like www.darfurgenocide.org and www.savedarfur.org are trying to galvanize Americans, but the response has been pathetic.
I'm sorry for inflicting these horrific photos on you. But the real obscenity isn't in printing pictures of dead babies - it's in our passivity, which allows these people to be slaughtered.
During past genocides against Armenians, Jews and Cambodians, it was possible to claim that we didn't fully know what was going on. This time, President Bush, Congress and the European Parliament have already declared genocide to be under way. And we have photos.
This time, we have no excuse."
Read the entire article
The classical Chinese physician received a fee only as long as the patient remained in good health
The issue of grading doctors that has again become a hot topic of conversation reminds me of a passage from Bill Moyers' book, Healing and the Mind.
"The classical Chinese physician received a fee only as long as the patient remained in good health. Payments stopped when sickness began. The task was to teach patients to stay healthy by living correctly; temperament, diet, thoughts, emotions, and exercise were all important in a system in which the patient took primary responsibility for sickness or health." [Page 253]
Buy this book
"The classical Chinese physician received a fee only as long as the patient remained in good health. Payments stopped when sickness began. The task was to teach patients to stay healthy by living correctly; temperament, diet, thoughts, emotions, and exercise were all important in a system in which the patient took primary responsibility for sickness or health." [Page 253]
Buy this book
Essay: Report Cards for Doctors? Grades Are Likely to Be A, B, C . . . and I
Report Cards for Doctors? Grades Are Likely to Be A, B, C . . . and I
"Report Cards for Doctors? Grades Are Likely to Be A, B, C . . . and I
By Abigail Zuger, M.D., The New York Times, March 1, 2005
She was an internist by training, but privately I always called her the eye doctor.
Ask her about any of her patients, and the answer would come back starting with 'I.' How was Mr. Jones? 'I got him to start taking his insulin, and I'm working on his cholesterol.'
Mr. Smith? 'Wonderful. I fixed up that anemia, and I got him to Weight Watchers.'
Mrs. Brown? 'I finally got her mammogram done.'
All medical information was subtly refracted, worded to reflect the doctor's role as prime mover and chief puppeteer. Health and illness might be considered random evolutionary events elsewhere; her practice was clearly ruled by intelligent design.
When her patients did well, she beamed with pride. When they did badly, she was full of excuses. They had ignored her advice or somehow misled her. She had to make sure you understood it wasn't her fault.
I think of her often now that we are apparently heading straight into an era when doctors will receive report cards for their work. Are we are all now destined to become something like her?
Past efforts to grade doctors have been clumsy at best. The names on all the 'Best Doctor' lists tend to reflect old boys' networks rather than actual merit. Internet sites posting doctors' credentials let consumers weed out true miscreants, but not evaluate the remaining multitudes.
But far more precise rankings lie just over the horizon, with doctors publicly graded and paid by the good results they achieve.
Medicare announced the first such program this winter: a pilot 'pay for performance initiative' will reward large group practices with bonuses for keeping their elderly patients vaccinated, their cardiac patients properly medicated and their diabetics well controlled. It is only a matter of time before individual doctors are similarly ranked and paid.
Any attempt to improve the quality of medical practice deserves a shot, and this idea seems as reasonable as any. Still, it is bound to jar the doctor-patient relationship slightly, altering it just as subtly as the eye doctor's peculiar syntax altered the truth.
All doctors suffer from that 'I' disease to some extent: the success of the enterprise depends on it. Most, though, retain some necessary emotional distance as well - not only distance from tragedy and suffering, but also from the innumerable humdrum snafus, habits and idiosyncrasies that invariably stand between people and their health. When we start getting scores in health maintenance, that distance will be hard to maintain.
The prospect of a report card in my future always reminds me of a diabetic woman from my past. She spent the year after her divorce sitting on her couch eating ice cream straight from the carton. Her medications went untouched. She still came in to see us quite a bit, but she refused to be weighed, refused to have her blood pressure measured, refused antidepressants, refused to see a psychiatrist. Her blood sugar ran so high the lab invariably called us in a panic. We tried everything; nothing worked.
I felt terrible for her, but had anyone been grading me on my management of diabetes that year, I would have felt even worse for myself because I would have flunked. She would have brought me right down with her. With my reputation (or a cash bonus) at stake, would I have done better at taking care of her? Or would I instead have begun to hate her for bringing down my 'diabetes' grade and lowering my income? Would I eventually have told her just to stay home until she could behave, so at least my failure to make her better was not so visible in the record? Would we have lost her trust then for good?
Eventually the patient pulled herself together and got her sugar back under control. She thanked us for all we had done for her in the interim. We thought we hadn't done much, and certainly the quality mavens would have agreed. But sometimes quality of care transcends the usual markers.
Rewarding doctors for good outcomes may well work out fine. Still, I can't quite forget the edge in the eye doctor's voice when she spoke about patients who weren't doing quite as well as she would have liked. A real dislike hid behind all her cheery disclaimers. Her failures, as she saw them, badly interfered with her self-image. She wanted nothing to do with them.
Of course, when she and all the rest of us are prodded to pursue good outcomes with grades and merit bonuses, we will all still have our failures. Will we have the strength to stand by them, or will we just tell them all to stay home?"
"Report Cards for Doctors? Grades Are Likely to Be A, B, C . . . and I
By Abigail Zuger, M.D., The New York Times, March 1, 2005
She was an internist by training, but privately I always called her the eye doctor.
Ask her about any of her patients, and the answer would come back starting with 'I.' How was Mr. Jones? 'I got him to start taking his insulin, and I'm working on his cholesterol.'
Mr. Smith? 'Wonderful. I fixed up that anemia, and I got him to Weight Watchers.'
Mrs. Brown? 'I finally got her mammogram done.'
All medical information was subtly refracted, worded to reflect the doctor's role as prime mover and chief puppeteer. Health and illness might be considered random evolutionary events elsewhere; her practice was clearly ruled by intelligent design.
When her patients did well, she beamed with pride. When they did badly, she was full of excuses. They had ignored her advice or somehow misled her. She had to make sure you understood it wasn't her fault.
I think of her often now that we are apparently heading straight into an era when doctors will receive report cards for their work. Are we are all now destined to become something like her?
Past efforts to grade doctors have been clumsy at best. The names on all the 'Best Doctor' lists tend to reflect old boys' networks rather than actual merit. Internet sites posting doctors' credentials let consumers weed out true miscreants, but not evaluate the remaining multitudes.
But far more precise rankings lie just over the horizon, with doctors publicly graded and paid by the good results they achieve.
Medicare announced the first such program this winter: a pilot 'pay for performance initiative' will reward large group practices with bonuses for keeping their elderly patients vaccinated, their cardiac patients properly medicated and their diabetics well controlled. It is only a matter of time before individual doctors are similarly ranked and paid.
Any attempt to improve the quality of medical practice deserves a shot, and this idea seems as reasonable as any. Still, it is bound to jar the doctor-patient relationship slightly, altering it just as subtly as the eye doctor's peculiar syntax altered the truth.
All doctors suffer from that 'I' disease to some extent: the success of the enterprise depends on it. Most, though, retain some necessary emotional distance as well - not only distance from tragedy and suffering, but also from the innumerable humdrum snafus, habits and idiosyncrasies that invariably stand between people and their health. When we start getting scores in health maintenance, that distance will be hard to maintain.
The prospect of a report card in my future always reminds me of a diabetic woman from my past. She spent the year after her divorce sitting on her couch eating ice cream straight from the carton. Her medications went untouched. She still came in to see us quite a bit, but she refused to be weighed, refused to have her blood pressure measured, refused antidepressants, refused to see a psychiatrist. Her blood sugar ran so high the lab invariably called us in a panic. We tried everything; nothing worked.
I felt terrible for her, but had anyone been grading me on my management of diabetes that year, I would have felt even worse for myself because I would have flunked. She would have brought me right down with her. With my reputation (or a cash bonus) at stake, would I have done better at taking care of her? Or would I instead have begun to hate her for bringing down my 'diabetes' grade and lowering my income? Would I eventually have told her just to stay home until she could behave, so at least my failure to make her better was not so visible in the record? Would we have lost her trust then for good?
Eventually the patient pulled herself together and got her sugar back under control. She thanked us for all we had done for her in the interim. We thought we hadn't done much, and certainly the quality mavens would have agreed. But sometimes quality of care transcends the usual markers.
Rewarding doctors for good outcomes may well work out fine. Still, I can't quite forget the edge in the eye doctor's voice when she spoke about patients who weren't doing quite as well as she would have liked. A real dislike hid behind all her cheery disclaimers. Her failures, as she saw them, badly interfered with her self-image. She wanted nothing to do with them.
Of course, when she and all the rest of us are prodded to pursue good outcomes with grades and merit bonuses, we will all still have our failures. Will we have the strength to stand by them, or will we just tell them all to stay home?"
Dentistry Without Drills: Paint Your Cavities Away
Dentistry Without Drills: Paint Your Cavities Away
"Dentistry Without Drills: Paint Your Cavities Away
By Nicholas Bakalar, The New York Times, March 1, 2005
Japanese researchers say they have found a way to produce an artificial tooth enamel that is chemically like the real thing.
The discovery, they report in the current issue of Nature, may allow dentists to fill some cavities without using a drill.
Getting even a small filling can be destructive: that high-pitched whine you hear when drill meets tooth is the sound of healthy enamel being pulverized.
Dentists try to damage as little healthy tissue as possible, but even a skilled one has to destroy a large amount of the tooth to create a surface that will bond with the filling.
Dr. Kazue Yamagishi of Tokyo's FAP Dental Institute and colleagues introduced fluorine ions into hydroxyapatite, the crystalline material of enamel, and then dissolved the product in acid to make a paste.
This creates a substance that can be painted on a tooth. After it is applied, the material crystallizes, forming a seamless bond.
Because it contains fluorine, it also offers protection against decay.
The material is highly durable, and although it is also subject to decay, it is somewhat more resistant to acid than natural enamel.
It bonds so perfectly with the natural enamel that even when viewed with an electron microscope there is no apparent gap at the interface between the artificial substances and the actual ones.
So far, the procedure has been used only for cavities that are not large enough to penetrate the one to two millimeters of enamel that cover a normal tooth.
The manufactured material grows crystals perfectly oriented to the tooth surface, essentially becoming an integral part of it.
The paste is whiwhitish, and blends fairly well with the color of teeth, but it probably cannot be dyed to match.
'I could mix something into it to change the color,' Dr. Yamagishi said, 'but that would cause the crystal to change its structure, so I don't recommend it.'
But before the paste is used commercially, Dr. Yamagishi said, 'We need to study it more to confirm the safety of the therapy.'"
"Dentistry Without Drills: Paint Your Cavities Away
By Nicholas Bakalar, The New York Times, March 1, 2005
Japanese researchers say they have found a way to produce an artificial tooth enamel that is chemically like the real thing.
The discovery, they report in the current issue of Nature, may allow dentists to fill some cavities without using a drill.
Getting even a small filling can be destructive: that high-pitched whine you hear when drill meets tooth is the sound of healthy enamel being pulverized.
Dentists try to damage as little healthy tissue as possible, but even a skilled one has to destroy a large amount of the tooth to create a surface that will bond with the filling.
Dr. Kazue Yamagishi of Tokyo's FAP Dental Institute and colleagues introduced fluorine ions into hydroxyapatite, the crystalline material of enamel, and then dissolved the product in acid to make a paste.
This creates a substance that can be painted on a tooth. After it is applied, the material crystallizes, forming a seamless bond.
Because it contains fluorine, it also offers protection against decay.
The material is highly durable, and although it is also subject to decay, it is somewhat more resistant to acid than natural enamel.
It bonds so perfectly with the natural enamel that even when viewed with an electron microscope there is no apparent gap at the interface between the artificial substances and the actual ones.
So far, the procedure has been used only for cavities that are not large enough to penetrate the one to two millimeters of enamel that cover a normal tooth.
The manufactured material grows crystals perfectly oriented to the tooth surface, essentially becoming an integral part of it.
The paste is whiwhitish, and blends fairly well with the color of teeth, but it probably cannot be dyed to match.
'I could mix something into it to change the color,' Dr. Yamagishi said, 'but that would cause the crystal to change its structure, so I don't recommend it.'
But before the paste is used commercially, Dr. Yamagishi said, 'We need to study it more to confirm the safety of the therapy.'"
Subscribe to:
Posts (Atom)