Will the ACA lower the deficit?

08/10/2012 11:18 AM |

“For starters, Obamacare was originally estimated by the CBO to add $1.3 trillion in new spending over ten years. Doesn’t that just beg the question of how a massive spending increase can reduce some $16 trillion in accumulated deficits caused by, you guessed it, massive spending? But wait, the latest CBO estimate adds ‘only’ $1.2 trillion in spending for Obamacare—a ‘savings’ of zero-point-one trillion dollars that we’re supposed to believe is slashing deficits.

“That’s like a person already deeply in debt planning to buy a $50,000 car and finance it over ten years. Thanks to a dealer rebate, he pays $46,000. He has not reduced his debt by $4,000 but increased it by $46,000—plus interest.”

Read more here.  Read More & Comment...

Hold the Mayo

08/09/2012 08:25 AM |

According to a new report in the Mayo Clinic Proceedings, many patients who are being treated with "off-label" drugs are unaware that the medications they have been prescribed by their doctor aren't being used in ways that would meet U.S. Food and Drug Administration approval, research shows.

Quelle surprise.

"Health care providers and patients should educate themselves about off-label drugs to weigh the risks and benefits before a physician prescribes one or a patient takes one,” says study lead author Dr. Christopher Wittich, an internal medicine physician at the Mayo Clinic in Rochester, Minn.

While this report states the obvious, the more important question is what are physicians telling their patients about the medicines they prescribe … and where is that information coming from.

Now that industry detailers are getting the cold shoulder and many inveigh against industry supported CME – wither knowledge about off label or, for that matter, on label indications?

It’s time for pharma detailers to start detailing the label – with such a detail aid being developed and approved by the FDA at launch.

The researchers also surmise that the high costs and lengthy process of obtaining FDA approval may deter drug companies from seeking approval for a new drug indication,.

How insightful.

  Read More & Comment...

The Obsession With Pharmaceutical Pricing

08/07/2012 10:13 AM |

Market economics are driven by pricing information.  Prices not only reflect values (willingness to pay, economic justice, etc) but also the underlying reality that it costs something to make something.    

Thomas Sowell said it best: " Prices are perhaps the most misunderstood thing in economics. Whenever prices are “too high” — whether these are prices of medicines or of gasoline or all sorts of other things — many people think the answer is for the government to force those prices down.

It so happens there is a history of price controls and their consequences in countries around the world, going back literally thousands of years. But most people who advocate price controls are as unaware of, and uninterested in, that history as I was in the law of gravity.

Prices are not just arbitrary numbers plucked out of the air or numbers dependent on whether sellers are “greedy” or not. In the competition of the marketplace, prices are signals that convey underlying realities about relative scarcities and relative costs of production.

Those underlying realities are not changed in the slightest by price controls. You might as well try to deal with someone’s fever by putting the thermometer in cold water to lower the reading.  

Costs don’t go away because you refuse to pay them, any more than gravity goes away if you refuse to acknowledge it. You usually pay more in different ways, through taxes as well as prices, and by deterioration in quality when political processes replace economic process."

With that as a context, the upcoming Great Oxford Debate on drug prices seems to frame the issue in ways that go beyond the usual sophmoric level attained by policymakers and pundits... 

Medicines and cost: what does GOD think?
UK NEWS | AUGUST 07, 2012

The problem with pharmaceutical policy is that it has become “over-focused to the point of obsession on issues of price and cost”, Professor Richard Sullivan, Director, Institute of Cancer Policy, will argue during the PharmaTimes Great Oxford Debate on 20 September at Oxford University, UK.
Professor Sullivan, who is also a member of the Kings Health Partners Integrated Cancer Centre, will join Eric Low, chief executive of Myeloma UK, and Stephen Whitehead, chief executive of the Association of the British Pharmaceutical Industry, at the prestigious annual debating event to propose that ‘patients have the right to the best medicines, regardless of cost’.

“The argument is not that we should pay whatever a company demands for a licensed medicine irrespective of how little benefit it bestows, rather that value is a much more subtle and complex issue than price alone,” Professor Sullivan says.

However, Professor Sullivan and co will have their work cut out for them as arguing against the motion, will be the Rt Hon Stephen Dorrell, MP, Chairman of the Health Select Committee, Professor Mike Pringle, President Elect of the Royal College of General Practitioners and Laura Weir, Head of Policy & Campaigns, MS Society and Chair, Patients Involved in NICE.

Says Dorrell: “I am strongly in favour of using the NHS budget to secure the best possible outcome for patients, but not in favour of a motion that appears to give treatments based on pharmaceutical products a higher priority than other forms of treatment, nor am I in favour of implying that decisions about healthcare should never be constrained by a real life requirement to decide about priorities.”

But isn’t it society’s moral and ethical duty to ensure that as new medicines are researched and developed they find their way to patients to prolong and improve patients’ wellbeing?

What do you believe? Do patients have the right to the best medicines under the NHS Constitution? If the best medicine is the NICE approved medicine, just what are patients' rights? Are those aged over 65 being discriminated against? Or is it that the NHS simply cannot afford the best medicines?
Join the debate on 20 September at the Oxford Union. For more details and to register your attendance click here or contact Hannah Smith hannah@pharmatimes.com or phone 0208 487 9119.
  Read More & Comment...

The life of the Part D

08/07/2012 09:19 AM |

What?  A large government entitlement program that comes in under budget and has high participant satisfaction rates?

That would be Medicare Part D. User satisfaction rates push 90 percent and the program’s cost is below budget, with an anticipated price tag of nearly $120 billion less than originally estimated over the next decade.

And here’s another gold to add to the Part D Olympic medal count – according to HHS, Medicare beneficiaries will pay almost the same premium for prescription drugs next year as they did this year.

Part D is the Michael Phelps of healthcare reform – providing victories today and a policy roadmap towards real healthcare evolution.

Premiums for drug plans that accompany basic Medicare coverage for the elderly and disabled will be an average of $30 in 2013, the department said today in a statement. The estimate is based on bids from private insurers who offer the plans to Medicare patients.

Smart partnership between government and the free market works   Read More & Comment...

Facing Lung Cancer

08/06/2012 12:47 PM |

A post by Middle East expert Barry Rubin about his recent diagnosis of lung cancer..

SATURDAY, AUGUST 4, 2012
Why I've Always Written So Much With Such Intensity And why I won't stop now.
By Barry Rubin

Nothing is stranger than having a normal life and then within a few hours knowing that it might end at almost any moment. That’s what happened to me when I was just diagnosed with what is called inoperable lung cancer. I am still waiting final results of the tests and the choice of therapies.

I have no desire to make this my focus but it’s been suggested that I write something about it that might be of broader interest.

First, for those of us whose understanding of cancer is based on past information, it is very important to understand that a lot has changed. That diagnosis twenty or thirty years ago would have given a person only a few months to live. Today, with many of the new therapies invented, one has a fighting chance. Still, it is tough to have your life expectancy lowered from around twenty years to a minimum of two within moments.

People always asked me why I wrote so much and so intensively. I never told them one of the real reasons: I always expected my life would be limited. My grandfathers died, respectively, at 42 and 44, both of things that could have been cured today. My father died of a heart attack at 62, and his life probably could have been extended many years today by all the new tests and drugs available. But I felt that once I passed that birthday, less than a year ago, I might be living on borrowed time.

They say that when you are fighting cancer that becomes a full-time job in itself. Supported by my truly wonderful family, I’m working on it. Right away one starts paring things down: unsubscribing to lots of things; knowing that I will never again have time for hobbies. The decision to start reading a book is like a major life choice.

And I know I won’t be going canoeing down the Jordan River with an old friend in August. In fact, having passed out briefly about a half-dozen times—though we think we’ve solved that problem—I’ll probably never drive again nor, after cancelling two trips, travel internationally. In fact, the way things are going at the moment, I might never eat solid food again.

The best thing to do is to accept everything calmly—bargaining, hysteria, rage, won’t do any good--and then decide that one is going to fight with the object of beating the disease. Unlike much of political life, this is not caused by malevolent forces.

This is not, however, the only transformative event I’ve had this week. I don’t want this to come out wrong but I have been touched and encouraged by an outpouring of emails from friends, acquaintances, and readers about how much they appreciated my work. Up until now, I’ve really thought that my articles have gone into a void.

As you know, we live in an era where many ideas, much truth, and certainly the kind of things that I think are largely barred from the most prestigious (although daily less so) media and institutions.  We are either ignored or vilified. Now, though, the counter-audience has grown so long and people are so hungry for accuracy and cutting through the nonsense that our ranks have grown into the millions. When someone tells you that you’ve helped them, informed them, encouraged them, or even changed their lives it is an immeasurable feeling.

And while I wouldn’t go so far as to say that the cost has been worth receiving these messages, it is closer than one might ever believe.

There are some constructs I’ve come up with that I find comforting. Briefly:

Every living thing that has ever existed has died, at least in terms of being on this earth. If they could do it I can do it.
I feel like I have been captured by an enemy force (you all can insert specific names) and they want to execute me. I hope to escape or to be rescued by my friends.

Even if I didn’t have this disease, I could leave life on any day due to many causes without warning.

For 2000 years my ancestors dreamed of returning to their homeland and reestablishing their sovereignty. I have had the privilege of living that dream. How amazing is that?

We have to judge ourselves by whether we’ve lived up to our ideals and done our best. Not by the accumulation of power, wealth or fame; not for failing to achieve the impossible.

A famous Jewish story about that is the tale of Rabbi Zosia who said that he did not expect God to berate him for not having been Moses—who he wasn’t—but for not having been Zosia.

To me, that means we must do the best to be ourselves while trying to make ourselves as good as possible. I’ve really tried to do that. I don’t have big regrets, nor bitterness, nor would I have done things very differently.

And I’ve discovered the brave community of those who are supporting and encouraging each other in the battle against this disease.

Finally, I find myself identifying with a poem by a Turkish writer named Ilhami Bekir that goes like this:

“Neither vineyards, nor gardens
Do I ask.
Nor horses, nor sheep.
Don't take my soul away,
O God!
I am curious.
I must see how this game ends!”

The game, of course, doesn’t end and I don’t expect to live to see utopia realized. But it would be nice to live long enough to see America and the world pass out from this current dreadful era, to see some restoration of sanity and reality, some kind of victory for goodness, some kind of restoration of intellectual standards, and a higher level of justice.

Some friends tell me they think we’ve turned the corner and that there’s real hope of beating the terrible forces that have messed up our societies and insulted our intelligence and tried to sully our reputations.

That’s something worth living for and fighting for. I hope to do it with you people as long as possible.  Read More & Comment...

Academic Detailing: Help Wanted

08/06/2012 08:51 AM |

Just who are these “academic detailers” anyway?  And what are their qualifications?

(For more on this topic see this article from the May 2012 edition of Drug Information Journal.)

Well, here’s an actual job description as created by Total Therapeutics Management, the company AHRQ is paying $11,680,060 to recruit, train, and field what we should more appropriately call “government detailers.”

Patient Centered Outcomes Consultant

Our Part-Time Patient Centered Outcomes Consultant positions provide a distinctive opportunity for pharmacists looking for the perfect balance between professional challenge and work/life without practicing in a traditional healthcare workplace. This part-time position provides flexibility and is perfect for self-motivated individuals who thrive in a fast paced environment with an emphasis on personal accountability. Your success will be determined by the number and quality of the details you achieve, not only the amount of time you log.

Essential Job Duties and Responsibilities:

* Schedule and conduct 250 details annually to targeted healthcare providers

* Develop relationships to facilitate ongoing success of academic detailing program

* Document meeting & communication feedback in relationship management software

* Complete accurate and timely administrative reports and required documentation requests.

Minimum Qualifications:

* Pharmacy, degree with current, active license.

* Five years clinical experience.

* Therapeutic competency.

* Personal computer skills including advanced knowledge of word processing, database management, and reporting is required.

* Excellent scientific presentation and public speaking skills.

* Ability to plan, prioritize and execute multiple responsibilities.

* Ability to travel 60%-70% day travel; some overnight possible

* Clean and valid driver's license.

* Dedicated home office with internet and phone connectivity.

250 details annually?  Sounds more like academic retailing. Are former pharmaceutical company representatives welcome to apply?

  Read More & Comment...

You're Welcome

08/03/2012 08:09 AM |

According to a new IMS report (funded by the Generic Pharmaceutical Association) use of generic medicines has reduced U.S. health care spending by more than $1 trillion over the past decade.

The report notes that using inexpensive generic versions of pricier brand-name prescription drugs now saves the country about $1 billion every other day. Drugs for heart conditions and central nervous system disorders such as depression and convulsions account for 57 percent of the annual savings.

What’s missing in the report is a big “thank you” to the innovator companies who, through their scientific ingenuity, perseverance, and financial investment made the generics industry both possible and profitable.

Just sayin'.

Silent gratitude isn’t much use to anyone.

-- Gertrude Stein

  Read More & Comment...

The Structure of Dysfunctional Health Claims

08/02/2012 08:26 AM |

Is that pomegranate juice in your glass or are you just happy to see me?

According to DSHEA, dietary supplements are foods. And now a food (or in this case, a fruit juice) is behaving like a dietary supplement -- making false health claims.

Makers of POM Wonderful (a pomegranate juice drink) have been warned by both the FDA and the FTC to stop making unsubstantiated claims about the drink's health benefits.

Among the claims made by the company is that POM is "40% as effective as Viagra" because it improves blood flow and promotes healthy blood vessels. The firm also claim POM is "proven to fight cardiovascular, prostate and erectile health" and that "clinical studies prove that POM Juice prevents, reduces the risk of, and treats, erectile dysfunction."

A randomized, placebo-controlled, double-blind, crossover pilot study examined the efficacy of pomegranate juice versus placebo in improving erections in 61 male subjects. The study did not achieve overall statistical significance, but the authors (from the Keck School of Medicine, University of Southern California,) conclude that additional studies with more patients and longer treatment periods may in fact reach statistical significance.

And then again -- it may not.

The Federal Trade Commission has filed a lawsuit against the makers of POM Wonderful. This comes six months after the FDA told POM to stop misleading consumers with claims of “super health powers.”

There’s a punchline in there somewhere   Read More & Comment...

"Safer" Vaccines Endangers Health Of Children

08/01/2012 04:28 PM |

News accounts of the effect of a weaker DTP vaccine ignore the fact that it was 'diluted" in response to panic about the vaccine's safety that was bogus.  The Precautionary Principle has harmed thousands of children...
http://abcnews.go.com/Health/Wellness/whooping-cough-vaccine-effective-early-form-study-finds/story?id=16898211#.UBmQU8j3v5h


  Read More & Comment...

Jonca returns to the Bull-y Pulpit

08/01/2012 07:35 AM |

Jonca Bull returns to the agency after stints at Novartis and Genentech to become director of the Office of Minority Health.

Great choice.

Good luck, Jonca.

  Read More & Comment...

(Lap) Band on the Run

07/31/2012 08:43 AM |

Doctors behaving badly -- very badly.

The FDA has sent a warning letter to Lap-Band VIP warning them to change their billboard and television marketing or face disciplinary action. Lap-Band VIP, based in Tarzana, has promoted its weight-loss surgery on television, the Internet and freeway billboards throughout Southern California. One billboard featured a photograph of a thin woman with the pitch: "Tiffany lost over 100 lbs. Actual patient. Results may vary."

Those ads were misleading, the FDA said in a June 25 letter, because they failed to include adequate warnings about the surgery's risks. The agency said Lap-Band VIP "should take prompt action to correct the violations" or risk "regulatory action."

Dr. Shahram Salimitari, a co-owner of Lap-Band VIP, told the Los Angeles Times that the company was pulling the billboards down. "Most of my patients come through referral," Salimitari said. "We don't need to advertise like that to get patients. We do it by taking care of patients."

It seems that Dr. Salimitari has an interesting way of taking care of thngs.

He’s described on the Lap-Band VIP website as a specialist in "gastric banding procedures," but the website does not mention that Salimitari was arrested by Los Angeles County sheriff's deputies in 2008 and charged with threatening to kill a sheriff's deputy and a flower shop owner.

Talk about violative behavior!

The trouble started after the store owner asked Salimitari to move his black BMW 323i, which he had double-parked outside her store in a Valencia strip mall, according to a sheriff's arrest report.

Salimitari swore at the woman and said, "If you do anything to my car, I'll kill you," the store owner, Myra Harbour, testified at a hearing in Los Angeles County Superior Court in San Fernando. The woman later obtained a restraining order, which is still in effect, that prohibits Salimitari from coming within 100 yards of her.

Sheriff's Deputy Thomas Babiracki said Salimitari threatened to kill him after he arrived at the flower shop. The deputy said he used pepper spray to control the irate surgeon and that he needed another deputy's help to handcuff the 220-pound Salimitari.

"I felt threatened," the deputy testified. "He's larger than I am."

Results, it seems, may vary.

  Read More & Comment...

Bay State Abeyance

07/30/2012 07:49 AM |

Massachusetts has lifted its ban against pharmaceutical co-pay coupons.

State Representative Steven Walsh, a Lynn Democrat who chairs the Legislature’s Joint Committee on Health Care Financing and leads House efforts to tamp down health costs, supported lifting the ban. He believes it is wrong to deny patients access to the coupons, even for a limited time. “To not allow families to get coupons ... for life-saving drugs seems pretty Draconian,” Walsh said.

Co-pay coupons are prohibited if a generic is available.

The law expires in 2015 unless it is renewed. Under it, the state must conduct a detailed analysis to determine if health care costs rise after the lifting of the coupon ban. The review will examine whether patients are more faithful about taking their medications and whether there are changes in the use of generic, versus brand name, drugs.

  Read More & Comment...

Everybody in the Pool

07/27/2012 08:07 AM |

The Mandate.  It sounds like an epithet from Jersey Shore.

It’s time to stop debating (or celebrating or bemoaning) the legality of the individual mandate. The Supremes have spoken.  Now it’s time to start discussing, seriously discussing, why it’s important – and flawed.

You can’t have an insurance-based healthcare system without healthy young people in it. We have many millions who are not and many of them can well afford it. They choose not to have coverage. The mandate’s penalty (or, if you prefer, the tax) is a limp noodle. It’s less than the cost of an annual premium. And to further weaken the desire of healthy young adults to buy health insurance – they can’t be denied if and when they get ill.

This important cohort isn’t going to be threatened into the insurance pool. They are going to have to be enticed. Alas, that’s not something Uncle Sam is very good at -- but the private sector is. And since insurance companies can’t sell policies across state lines (a travesty that should be fixed) it’s going to have to happen on a state-by-state basis.

We can evolve healthcare by recognizing that it must be done locally — state-by-state. When it comes to reform, states are the laboratories of invention.

If the key goal of healthcare evolution is broader coverage at lower costs, one national program that offers valuable lessons for the path forward is Medicare Part D (the Medicare prescription drug benefit). Part D applies free-enterprise principles to the nation's health care system (letting competition drive down prices and increase choice and quality) rather than operating it like a government-managed utility. That’s the fundamental debate.

When it comes to the future of the Affordable Care Act (or, if you prefer, ObamaCare) there are many crystal balls.

But what we need are balls of a different consistency.

  Read More & Comment...

When "Over There" is "Over Here"

07/26/2012 08:06 AM |

Regulators (especially those of the FDA variety) love ambiguity – because ambiguity is power. But regulatory ambiguity invariably leads to mission creep.

Presented for your examination, this short codicil from the recently signed PDUFA legislation:

SEC. 311. EXTRATERRITORIAL JURISDICTION.

‘‘There is extraterritorial jurisdiction over any violation of this Act relating to any article regulated under this Act if such article was intended for import into the United States or if any act in furtherance of the violation was committed in the United States.’’

Whether this was written incorrectly or intentionally written in an overbroad fashion, it’s now the law of the land.  But what does it mean?

To answer that question we need to address ambiguity’s regulatory cousin -- intent.  Here’s a what-if scenario: 

Acme Pharmaceutical Company has a drug that is both EMA and FDA approved.  Acme wants to report on the results of a new clinical trial conducted for EMA appraisal. The clinical trial is for a use not currently approved by the FDA.  Acme sends out a press release to European media. The story runs in European newspapers. The New York Times (via its London bureau) picks up the story.

Could Acme (because of the story in the New York Times) be accused by the FDA of off-label promotion?

Here’s the key question – was Acme’s intent to have the story picked up by a US media outlet?

Internal company debates often focus on responsibility for an FDA violation after the fact.  Section 311 makes it clear that more wide-ranging discussions need to happen beforehand. What is the intent? Is it marketing-driven or is it being done in the best interest of a patient or the broader public health? (PS/ these two things are not mutually exclusive.)  Intent counts.  Just as the FDA has asked whether or not the speaker and the audience matters when it comes to the issue of “scientific exchange,” so too is this relevant in helping to determine “responsibility” for “extraterritorial” off-label conversations.

As the FDA asked in its December Federal Register notice, “How do companies generally separate scientific roles and promotional roles within their corporate structures?” How indeed?

To paraphrase the proverb, ““The smallest intention is more important than the greatest deed.”

  Read More & Comment...

The Soda Mandate

07/25/2012 07:11 AM |

There was so much righteous rhetoric at yesterday’s New York City Board of Health hearing on the Mayor’s proposal to ban high calorie drinks that it was a miracle the floor didn’t collapse from all of the, um, earnestness.

The major sound bite for the pro-ban crowd seemed to be that the theses of the anti-ban representatives were “the same arguments used by Big Tobacco.”  “Sugar,” they repeated ad nauseam, “is the new tobacco.” Sure.

Specifically the pro-ban zealots (led by that old war horse himself, Michael Jacobson) were referring to the “empty arguments” of jobs, choice, government intrusion, and economic impact.

The hearing also featured five New York City Council members and Brooklyn Borough President Marty Markowitz who all voiced their opposition to the proposed measure.  Why, they asked, isn’t this measure up for debate and vote in front of the City Council – the elected representatives of the people of the City of New York? 

The phrase “arbitrary and capricious” was mentioned more than once -- a lot more than once.

As Councilman Dan Halloran commented to me, “Mayor Bloomberg always knows best – just ask him.”

My testimony (which can be found here) concluded as follows:

New York City has not filed a physical education plan with the state since 1982. It’s time for Mayor Bloomberg to step down from the bully pulpit long enough to get our kids back into the gym.

It’s time for the Mayor to take a big gulp, stop talking about fizz and start focusing on phys ed.

The Mayor’s proposal will be voted on by the entire NYC Board of Health – all of whom are Bloomberg appointees.

Ladies and Gentlemen: The ends do not justify the means.

  Read More & Comment...

Illegal To Carry Your Own Cup In NYC?

07/24/2012 03:02 PM |

Just thought of something.. What if you use your own container (much like coffee refills).  


Here's the proposed reg again:

The limits would apply to cups and containers used for sugary drinks. The limits would
also apply to all self-service cups and containers, regardless of intended contents. Without such limitation,
a self-service cup exceeding the maximum size could be used for either non-sugary or sugary drinks. This
rule will not limit the amount of sweetener a customer may add to his or her own drink


So is using your own cup or container illegal?  Would someone be fined for carrying a 20oz reusable (environmentally friendly!!) container.   
  Read More & Comment...

Bloomberg Limits Cup Sizes in NYC

07/24/2012 02:56 PM |

You see,  if you give people a choice of cup sizes they wouldn't behave as the city intended.  If this is not an intrusion into the lives and livelihood of individuals, what is?   This will pave the way to portion and packaging control.. . Unreal.  

The limits would apply to cups and containers used for sugary drinks. The limits would
also apply to all self-service cups and containers, regardless of intended contents. Without such limitation,
a self-service cup exceeding the maximum size could be used for either non-sugary or sugary drinks. This
rule will not limit the amount of sweetener a customer may add to his or her own drink.
The rule will not take effect until 6 months after adoption by the Board of Health. It establishes a fine of
$200 for each occasion that it is violated. By addressing the increasing size of sugary drinks and
reacquainting New Yorkers with more appropriate portion sizes, the City is taking an important step in
reducing sugary drink consumption and combating obesity and its resulting morbidity and mortality.
The following specific amendments are proposed:
 Set a maximum size for sugary drinks: Non-alcoholic sugary drinks may not be offered or sold in
cups or containers that can contain more than 16 fluid ounces.
 Set a maximum size for self-service cups: Food service establishments may not offer or sell selfservice cups that can contain more than 16 fluid ounces. 
 Set a fine for violations:  No more than two hundred dollars for each violation as described in the
proposed rule.  Read More & Comment...

The Big Apple on Big Gulps

07/24/2012 07:35 AM |

Sometimes even “Big L” New York Liberals understand that more government isn’t always the answer.  Here is a brief video offering a sample of the Big Apple’s opinion on Mayor Bloomberg’s suggested treatment for “Big Gulp Disease.

http://youtu.be/quzl5_zFejY

I am getting ready to testify today in front of the New York City Health Department on this issue.  My takeaway message?  The Mayor should focus less on fizz and more on getting New York City kids more phys ed.

  Read More & Comment...

Aurora, Colorado and Risk Perception

07/23/2012 05:34 PM |

In Amos Tversky and Daniel Kahneman conducted a study and wrote a paper demonstrating  that "if you can think of it, it must be important."   Tversky, A; Kahneman (1973). "Availability: A heuristic for judging frequency and probability". Cognitive Psychology 5 (1): 207–233. DOI:10.1016/0010-0285(73)90033-9

Put another way,  the two scientists demonstrated that we often assume something happening more often than it is or explain an event not it terms of the frequency or the facts but by what is most easily called to mind.  Hence, after the evil massacre of this past week the first reaction many of us had (the killer was crazy,  gun control laws are too weak,  media is too violent and too real in its depiction of violence) was based on the beliefs, events and images that most easily come to mind.   

There is another element of  this horrible event:  The way in which people acted to save the lives of others -- perfect strangers and family members alike -- without regard to their own well-being or survival.   Our moral sense is shaped by another aspect of availability:  that life is precious and we must do what we can to preserve it when it is threatened.    None of us can know how we would have acted with certainty.  But it is equally certain that most would seek to protect and help.  

  Read More & Comment...

Soda Ban Supporters Silence Science

07/23/2012 03:18 PM |

Dumb and Dumber: Hey guys, whoa, big gulps huh? Alright. Well ...

Tomorrow the NYC Department of Health holds hearings on its proposal to ban more than 16 oz servings of sugar sweetened soft drinks.

To paraphrase Abraham Lincoln’s statement about Prohibition: to control human appetite thourhg legislation by making a crime out of something that is not a crime is beyond reason…”

But then again  the war against soft drinks and sugar shaping up to be a nutritional Climategate.

Climate change researchers and scientists who do not sing from the global warming hymnal – even if they acknowledge that human activity contributes to changes in our environment – are silenced and sanctioned.  They are attacked in public, denied opportunities to publish and participate in conferences and savaged for receiving funding from private companies.  The true believers control the message and the policy response to global warming.   As Bjorn Lomborg has noted this is leading to” elaborate and expensive actions…to stop global warming  that will cost hundreds of billions of dollars, are often based on emotional rather than strictly scientific assumptions, and may very well have little impact on the world's temperature.”

The same thing is going on in the public crusade against sugar and sugar sweetened soft drinks.   The attacks that claim sugar is as dangerous as smoking or alcohol are not scientific.  Those leading the charge are attacking and silencing anyone who dares to challenge this viewpoint.  And it’s leading to policies and actions like the soda ban that   limit freedom without having any impact on our health. 

The effort to restrict the size of soft drinks consumption flows from an obesity arena that Jeffrey Friedman  -- a pioneer in the genetics of obesity – has described as “so political, so rife with misinformation and disinformation.”

As Friedman told the New York Times in 2004, scientific data shows “..that body weight, in animals and humans, is not under conscious control. Body weight, he says, is genetically determined, as tightly regulated as height. Genes control not only how much you eat but also the metabolic rate at which you burn food. “  As Friedman notes,  ''People live in the moment.  They lose weight over the short term and say that they have exercised willpower.” But over the long term, the body's intrinsic controls win out. And just as willpower cannot make fat people thin, a lack of it does not make thin people fat.”

Indeed, research by the Centers for Disease Control and Prevention shows that the increase in obesity is a result of people who are programmed to gain weight doing so and pulling the average weight of the nation upward.   In 1991, 23 percent of Americans fell into the obese category; now 31 percent do, a more than 30 percent increase. But the average weight of the population has increased by just 7 to 10 pounds since 1991.

The same data shows that while “prevalence of obesity in the United States increased during the last decades of the 20th century.. “More recently there appears to have been a slowing of the rate of increase or even a leveling off.  The decline is most pronounced in younger adults, primarily women.  

Further, previous increases in weight gain are inversely related to the decline in smoking.  In fact much of the death associated with obesity is actually related to smoking.  So much for Mayor Bloomberg’s assertion that obesity related deaths will soon exceed smoking related mortality.  

Last week another study said inactivity is the leading cause of preventable deaths.  Set aside the problems of assuming all death is related to inactivity or any other single factor:  If inactivity is the leading cause of preventable deaths, can obesity or smoking or anything else be the leading reason too?  In fact, several epidemiological studies show that being heavier or even obese is not associated with higher mortality rates.  Indeed,  a  higher BMI in both sexes and WC in men were associated with increased survival in older adults, while a higher WHR or WTR either decreased or did not influence risk of death.

So why focus on sugar or sugar sweetened soft drinks as the biggest public health menace?

Those who do so claim it’s because sugar consumption is out of control and even addictive.   (I guess more so than drinking.)  But the addiction assertion has little evidence to support it.

And it’s undercut in any event by Department of Agriculture data showing that consumption of sugar and soft drinks has declined over the past decade as fruit, vegetable and fiber consumption as a percent of daily caloric intake has increased.   So has the number of people who are not only told by their doctor to exercise but also go out and “just do it.”

New York City is part of this trend.  According to data from the Centers for Disease Control and Prevention, New York City kids – across every borough --  follow this national trend.  In NYC the adoption of healthy lifestyles by teenagers  started in 1997 well before the ban was proposed and well before soda and snack foods were banned from schools.  The same goes with exercise.   Since 1997, high school students in the city have been watching less television and exercising.  Yet under Bloomberg physical education classes have been cut throughout the school system.  

http://www.nytimes.com/2012/07/11/education/even-as-schools-battle-obesity-physical-education-is-sidelined.html?pagewanted=all


The ban on soda makes sense only as an emotional response by people whose minds are made up.  Otherwise it’s silly.   Hence if the soda ban is enacted, you can go to happy hour for NYC 24 oz. tallboys  (as well as free jello shots) but not a 20 oz Pepsi.  But guess which is a bigger public health problem in the NYC?

Here’s what the NYC Department of Health said about alcohol in NYC:  "alcohol-related deaths are among the leading causes of death in NYC; in 2008, an estimated 1,537 NYC adults died of alcohol-related causes. These included deaths from chronic alcohol use, such as alcoholism, and deaths from acute alcohol use, such as binge drinking. Liver disease accounts for one fifth (22%) of all alcohol-related deaths and is the most common chronic cause.”   http://www.nyc.gov/html/doh/downloads/pdf/survey/survey-2010alcohol.pdf


Silencing those who disagree with the anti-sugar crusaders will lead to failed polices that distract from more effective solutions and real problems.  The soda size ban is just the start down that wrong direction.
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