Saturday, October 31, 2009

Disincentives from Health Reform

Here is my column in tomorrow's NY Times about the marginal tax rates implicit in the health reform bill making its ways through Congress. Let me add a few additional observations on the topic.

1. Here are the CBO numbers on which the article is based. Unfortunately, the Times did not run the table of implicit marginal tax rates that I gave them based on the CBO numbers. But the example I used in the piece (an implicit tax rate of 23 percent) is representative. For lower income levels, the implicit marginal tax rate is even higher. Between $42,000 and $54,000, the implicit marginal tax rate from health reform is 34 percent.

2. When CBO estimates the budgetary cost of such bills, it holds GDP constant. If you think (as I do) that large increases in marginal tax rates tend to depress labor effort and thus GDP, then you should be wary of claims based on CBO scores that the health reform bill is deficit neutral. Lower GDP will mean lower tax revenue and thus a larger budget deficit.

3. How much do people respond to tax rates? Economists differ in their answer to this question. The latest thinking on this topic, by my Harvard colleague Raj Chetty, indicates that the elasticity of taxable income with respect to (1-tax rate) is about one half. So, for example, if a person starts with a marginal tax rate t of 0.3 and health reform raises it to 0.5, the percentage change in 1-t, using the midpoint method, is .2/.6, or 33 percent. With an elasticity of one half, his taxable income will fall by 17 percent. Thus, the economic impacts from these implicit tax hikes are sizable.

4. In my Times piece, I wrote, "None of this necessarily means that health reform is not worth doing. President Obama’s push for reform is premised on the belief that access to good health care should be a right of all Americans — a proposition better judged by political philosophers than economists. But we should not forget the cost of translating that noble aspiration into practical policy."

This passage may seem a bit passive-aggressive, as I appear to be criticizing the bill without really taking a stand. My aim, however, is to emphasize that economics alone cannot settle the debate.

Behind the healthcare debate is the classic tradeoff between equality and efficiency. Consider the following question, which is not about healthcare per se: Would you favor a substantial increase in marginal tax rates for millions of middle and upper income Americans to provide more resources for those toward the bottom of the economic ladder?

Your answer to this question cannot be determined by positive economics without adding in some normative judgments. But your answer should strongly influence your view of the health reform bill. The bill moves us closer to much of Western Europe by favoring equality and paying the price of reduced efficiency from much higher marginal tax rates.

That may be a policy choice Americans want to make. But before buying the merchandise being offered by Congress, I hope we all take a close look at the price tag.

How well known are economists?



Thanks to Tyler Cowen for the pointer.

Kuwaiti Chicken Mechbous and Saffron Cardamom cake


Glad I'm thinking beyond hummus and falafel from the Middle eastern cuisine.For October the Walima Cooking club chose to celebrate the Kuwaiti cuisine .
a little intro...
Located in the north-east corner of the Arabian Peninsula, Kuwait is one of the smallest countries in the world in terms of land area. The flat, sandy Arabian Desert covers most of Kuwait. Food plays a large part in Kuwaiti culture. The National Dish of Kuwait known as Mechboos (Arabic: مكبوس‎) consists mainly of mutton, chicken or fish placed over or mixed in a large mass of well-cooked and prepared rice. Food is almost always prepared and served in large amounts, and it is extremely common for households to invite guests over to share meals

Kabsa (Arabic: كبسة‎) is a family of rice dishes that are served mostly in Saudi Arabia - where it is commonly regarded as a national dish - and the other Arab States of the Persian Gulf. In places like Qatar, Bahrain and Kuwait the dish is popularly known as Majboos (Arabic: مجبوس‎) and in the United Arab Emirates as Machboos (Arabic: مكبوس‎), but with different spices and cooked in a different way.

These dishes are mainly made from a mixture of spices, rice (usually long-grain basmati), meat and vegetables. There are many kinds of Kabsa and each kind has a uniqueness about it. Pre-mixed Kabsa spices are now available under several brand names. These reduce preparation time but may have a flavour distinct from traditional Kabsa. The spices used in Kabsa are largely responsible for its taste; these are generally Black Pepper, Cloves, Cardamom, Saffron, Cinnamon, Black Lime, Bay Leaves and Nutmeg. The main ingredient that accompanies the spices is the meat, such as chicken, goat, lamb, camel, or sometimes beef, fish, and shrimp. In chicken machboos, a whole chicken is used. The spices, rice and meat may be augmented with Almond, Pine Nuts, Onions and Tomatoes. The dish can be garnished with Hashu (Arabic: حشو‎) and served hot with Dakkous (Arabic: دقوس‎) - homemade tomato sauce.

Meat for Kabsa can be cooked in various ways. A popular way of preparing meat is called Mandi. This is an ancient technique, whereby meat is barbecued in a deep hole in the ground that is covered while the meat cooks. Another way of preparing and serving meat for Kabsa is Mathbi, where seasoned meat is grilled on flat stones that are placed on top of burning embers. A third technique, Madghoot, involves cooking the meat in a Pressure Cooker.


Kuwaiti Chicken Mechbous
Flavored with a special citrusy spice called "Loomi"[ripe limes boiled in salt water and sun-dried until their interior turns dark.].This palatable rice and chicken dish is considered the authentic Kuwaiti food.Now "Loomi" is hard to find stores here,unless its a middle eastern store or if you order it online(search for loomi).If that sounds a lot of work then the next best substitute for loomi is the lemon zest.


For Chicken Broth
1 whole skinless chicken or 2 pounds skinless chicken with bones,trim any white excess fat
1/2 teaspoon turmeric
1 inch fresh ginger root,sliced
2-3 cloves garlic
3/4 teaspoon sea Salt
1 cinnamon stick
2 cardamom pods
2 or 3 whole cloves
5 black peppercorns

For Pan searing the Cooked chicken
1 tablespoon all purpose flour
1 tablespoon canola oil
1 teaspoon of spice mix(I used garam masala)

Rice
3 cups long grain basmati rice


Onion-spice topping (hashu):
1 large yellow onion, finely sliced
1 Tbsp. canola oil
¼ cup golden raisins, soaked in water
¼ tsp. ground cardamom
¼ tsp. dried black lime (loomi), or ½ tsp. lime zest
¼ tsp. ground black pepper
Can also sprinkle with fresh pomegranate and chopped roasted beets(not in Original recipe though)


Tomato sauce (duqqus):
2 large tomatoes, chopped
2 Tbsp. water
2 cloves garlic, crushed
1 Tb. tomato paste

Method
Cook the chicken
Rinse chicken inside and out. Place in a stockpot with enough water to cover along with all the spices in the broth list. Cover and bring to a slow boil, and continue to boil uncovered over medium heat until chicken is done (approximately 45 minutes). Remove and drain the chicken,discard the spices, reserve the broth. scoop out the fat off the top of the broth.
Cook the Rice in the Broth
Rinse the rice 3-4 times and soak for 10-15 minutes.
Meanwhile bring the broth(need 4 cups,add little water if needed) to a boil in a large pot,drain all the water from the soaking rice and add to the broth.Season with salt.

Prepare the Topping
While rice is cooking, cook onions in a nonstick skillet over medium heat, stirring frequently, until clear. Sprinkle with a little water and stir quickly until onions are brown and the water has evaporated. Stir in oil, drained raisins, and spices. Cook for one minute. Remove mixture from skillet and set aside.

Flavor and sear the chicken
Lightly dust the boiled, drained chicken with flour and spices. Heat a pan over medium-high heat, lightly brown the chicken, turning frequently, until the outside is light brown.

Make the Tomato sauce
For the tomato sauce, add water, chopped tomatoes, crushed garlic, and tomato paste in a small skillet or saucepan, and sauté until tomatoes are soft and the sauce well blended.

Assemble
When the rice is done, spread it on a serving platter. Sprinkle the onion-spice mixture over the rice, and place the chicken on top. Pass the tomato sauce to spoon onto individual plates.

Low calorie Low sugar Saffron Cardamom Cake
I had to make this lower calorie and lower sugar than the Original recipe after the sweet trials of the macaroons.Can also be made eggless with butter milk as the substitute.And more importantly use fresh ground cardamom to get the best aroma of the spice.

Recipe

Ingredients
3/4 cup all purpose flour
3/4 cup wheat flour(not coarse ground)
Pinch of saffron threads,crushed and soaked in 2 tablespoon warm milk for 20 minutes
Pinch of turmeric
*1 Organic Egg(original recipe had 5,substituted with butter milk),separated
1 cup butter milk
1/4 cup Agave nectar or 3/4 cup brown sugar or replace half the quantity of syrup or sugar with finely chopped dates or date paste
1 teaspoon fresh ground cardamom
2 teaspoons baking powder
1 tablespoon canola oil
1/4 cup chopped walnuts or almonds

*For a complete eggless cake use 1/2 cup of butter milk instead of the one egg used.

Method
Heat the oven to 350F. Grease a round 8-inch cake pan with light butter and line with parchment paper.

In a medium mixing bowl whisk together the egg white until light and fluffy with soft peaks.Using spatula gently fold in the syrup used or the sugar along with cardamom and turmeric.
Beat the yolk separately in another mixing bowl with the butter milk,the saffron infused milk and the oil.

Sift together the flours and baking powder together in to a large mixing bowl, then slowly fold in the egg white mixture and york mixture.

Pour in the prepared pan and sprinkle the top with the nuts.Bakes for about 25 minutes until the top is light brown in color.Cool completely and slice.



To join in the Walima Club and celebrate the Middle eastern cuisine ,write to Arlette(phoeniciangourmet@sympatico.ca). >

Antioxidant study is garbage

Reports in the NZ media this week have claimed that taking supplements can be as dangerous as passive smoking.

This is wrong and those involved with the TV programme making these claims have acted irresponsibly and will cause ill health if it stops people taking supplements with proven benefits.

It is junk science...badly performed research that draws unreliable conclusions, reported uncritically and as fact by the media.

Media reporting on health issues is often poor...but this is a new low.

The reports are based on 2 similar papers by the same authors -
http://jama.ama-assn.org/cgi/content/abstract/297/8/842 and http://www.cochrane.org/reviews/en/ab007176.html

Its hard to know where to start in terms of the problems with this research. Here are just some of the criticisms that have been reported....

Interestlingly, we learn upon reading the full-text that the researchers specifically excluded studies that reported no deaths during a trial period or follow-up. A meta-analysis that seeks to establish effects on mortality but excludes studies with no reported deaths from the pool of data to be analyzed? Hmmm...

...the studies used are all over the place, looking at different antioxidants, at different doses, at different durations, with different lengths of follow-up, in different populations - ranging from folks who were incredibly healthy to people with different diseases, with different combinations administered in different trials.

A closer look at the studies included shows that the dosage was all over the place for vitamin A - from 2000IU per day to twenty-times the upper tolerable limit (UTL) at 200,000IU per day; and beta-carotene dose ranged from a low of 1.2mg per day to 50mg per day.

Interestingly the researchers didn't take the data even further - they didn't investigate causes of death, so no one knows if deaths were related to taking antioxidants, accidents, diagnosed disease or something else. They also did not analyze for potential outcome differences between primary prevention and secondary prevention trials - basically they didn't ask if being sick (secondary prevention trials) influenced mortality outcome differently than being healthy (primary prevention trials) while taking antioxidants.

I think the point that has to be made is that this is a ‘data dredge’. The researchers did absolutely no original work, did not see a single patient, study an actual disease process. Instead, they fed data into computers, which churned out statistics this way and that.

But with all the benefits of antioxidants already well known to the well-informed, how did the Cochrane Library arrive at such a conclusion? It's easy: The researchers considered 452 studies on these vitamins, and they threw out the 405 studies where nobody died! That left just 47 studies where subjects died from various causes (one study was conducted on terminal heart patients, for example). From this hand-picked selection of studies, these researchers concluded that antioxidants increase mortality.

Just in case the magnitude of the scientific fraud taking place here has not yet become apparent, let me repeat what happened: These scientists claimed to be studying the effects of vitamins on mortality, right? They were conducting a meta-analysis based on reviewing established studies. But instead of conducting an honest review of all the studies, they arbitrarily decided to eliminate all studies in which vitamins prevented mortality and kept people alive! They did this by "excluding all studies in which no participants died." What was left to review? Only the studies in which people died from various causes.

Brilliant, huh? This sort of bass-ackward science would earn any teenager an "F" in high school science class. But apparently it's good enough for the Cochrane Library, not to mention all the mainstream press outlets that are now repeating these silly conclusions as scientific fact.

The study has been slammed by the US-based Council for Responsible Nutrition, who said the researchers "misuse[d] meta-analysis methods to create generalized conclusions that may inappropriately confuse and alarm consumers who can benefit from supplementing with antioxidants."

Moreover, Andrew Shao, Ph.D., CRN's vice president, scientific and regulatory affairs said that the combined studies were far too diverse and different in terms of dosage, duration, study population and nutrients tested that the results of the analysis were "compromised".

Additionally, Dr. Shao noted that most of the trials included in the meta-analysis tested for secondary prevention, looking at how a nutrient works in diseased populations, instead of primary prevention studies in healthy populations.

"Combining secondary prevention and primary prevention trials and then making conclusions for the entire population is an unsound scientific approach," said Shao. "Additionally, many of the trials had limitations, including the expectation that a simple antioxidant vitamin could be expected to overturn serious illness, such as cancer or heart disease. These trials likely statistically skewed the results."

Daniel Fabricant, vice president of scientific affairs for Natural Products Association (NPA), another US-based trade association, supported this view.

"Despite the authors' contention, this analysis is assessing mortality of at-risk and diseased populations - versus a healthy population - in prevention trials. The risk of mortality must be attributed to the appropriate population studied, those with an existing health condition, which it isn't in this case. Instead, those findings are generalized to a healthy general population, which is wrong on many levels," said Fabricant.

"But what's most troubling is that people who are safely and beneficially taking vitamins might stop, which may actually put their health at greater risk."

Fabricant also stated that if a true mortality risk had been apparent in any of these clinical studies using antioxidants, the study would have been halted, but none were.

"Nearly 160 million people in North America and Europe use the attributed supplements. If antioxidants were a significant public health risk, as the authors speculate, it would have become clearly apparent by now," he said. "This is obviously not the case: the negative effect they refer to has not been seen in the population."

Read more detailed comments here:

Antioxidant Supplements Dangerous?

Friday, October 30, 2009

Coenzyme Q10 for heart failure

Coenzyme Q10; an adjunctive therapy for congestive heart failure?

Abstract
Coenzyme Q10 (CoQ10) is essential for electron transport within the mitochondria and hence for ATP generation and cellular energy production. We recently demonstrated that plasma levels of CoQ10 are an independent predictor of survival in a cohort of 236 patients with chronic heart failure (CHF) followed for a median of 2.69 years. This is consistent with previous studies which have shown myocardial CoQ10 depletion in CHF, and correlated with the severity of the underlying disorder.
Several intervention studies have been undertaken with CoQ10 in CHF, including randomized controlled trials with mostly positive outcomes in relation to improvement in plasma levels of CoQ10. A meta-analysis showed that CoQ10 resulted in an improvement in ejection fraction of 3.7% (95%CI 1.59–5.77) and the mean increase in cardiac output was 0.28 L/minute (95%CI 0.03–0.53). In a subgroup analysis, studies with patients not taking ACE inhibitors found a 6.7% increase in ejection fraction.
The ongoing Q-SYMBIO trial will address whether CoQ10 supplementation improves survival in CHF patients. CoQ10 depletion may also be a contributory factor for why statin intervention has not improved outcomes in CHF. There is an emerging evidence base in support of CoQ10 as an adjunctive therapy in CHF.


Journal of the New Zealand Medical Association
30-October-2009, Vol 122 No 1305

Convenience vegetarian food

More and more people wnat to be vegetarian but feel they don't have time to cook a nut roast, so this year's UK Vegetarain Society awards are a good reminder that there are some excellent convenience products out there.

This year's short list consisted of:
  • Macsween Vegetarian Haggis 
  • Cauldron Cumberland Sausages
  • Tesco Vegetarian Cheese and Leek Sausages
  • Goodlife Fairtrade Nut Cutlet 
  • Linda McCartney Sausages
The winner was Macsween Vegetarian Haggis.

I've never tried this but I do like the Goodlife Nut Cutlets and our house is definitely a fan of Linda McCartney sausages.

Capitol Hill visit

It was an exciting time to be in DC yesterday. Our health policy class was able to attend the House press conference on the West Steps of the Capitol releasing their health reform bill that is expected to go to the floor next week. We heard from a panel of very tired health policy staffers from across the spectrum including Sarah Dash from Congresswoman Rosa DeLauro’s office, who I spoke with at length later about the bill. In the afternoon I visited all the offices of CT’s delegation. CTHPP Board member Congressman Joe Courtney and his health staffer, Maija Welton, were very gracious. Joe had just left the House Caucus and full of details about the bill. Senate staff in Sen. Dodd’s HELP committee were less sanguine about the chances of getting 60 votes for many of the House bill’s best provisions but very helpful in explaining where they are. Asked what we can do to help them, Joe asked that advocates work to clear up the myths being sold to seniors that health reform will harm Medicare. In fact, the House bill reduces and eventually eliminates the donut hole in prescription coverage, adds coverage for more preventive services, includes demonstrations for important initiatives that could vastly improve access to care, care coordination, and would help stabilize the program’s financial stability (which without reform is tenuous). My visit was energizing and exciting – I haven’t said that about a visit to DC in a very long time. It is very possible that something historic is about to happen.
Ellen Andrews

Average Marginal Tax Rate

From Barro and Redlick.

Thursday, October 29, 2009

Coenzyme Q10 helps children with cardiomyopathy

Coenzyme Q10 improves diastolic function in children with idiopathic dilated cardiomyopathy
Cardiology in the Young (2009), 19:501-506

Abstract
We aimed to determine the effect of supplementation with coenzyme Q10 on conventional therapy of children with cardiac failure due to idiopathic dilated cardiomyopathy. In a prospective, randomized, double-blinded, placebo-controlled trial, we randomized 38 patients younger than 18 years with idiopathic dilated cardiomyopathy to receive either coenzyme Q10, chosen for 17 patients, or placebo, administered in the remaining 21. Echocardiographic systolic and diastolic function parameters were determined for every patient at baseline, and after 6 months of supplementation. The index score for cardiac failure in children as established in New York was used for assessing the functional class of the patients. After 6 months supplementation, 10 patients randomized to receive coenzyme Q10 showed improvements in the grading of diastolic function, this being significantly more than that achieved by those randomized to the placebo group (p value = 0.011). The mean score for the index of cardiac failure index for those receiving coenzyme Q10 was also lower than the control group (p value = 0.024).

Our results, therefore, indicate that administration of coenzyme Q10 is useful in ameliorating cardiac failure in patients with idiopathic dilated cardiomyopathy through its significant effect on improving diastolic function.

Immune boosting Foods.Vegetarian Lasagna (with Kale,Zucchini and Broccoli).

The Flu scare sure has spooked us all more than ever this season.Besides the preventive measures such as getting the flu shot, washing hands often ,disinfecting and avoiding contact with sick people be sure to consume nutrient rich foods to build a good defense against infections.

Eating from variety of fresh fruits and vegetables builds strong immune system.With flu season in full swing,it becomes all the more essential to make that right choice.Here are the important nutrients and good foods proven to build a strong defense against the infections and diseases.

*Beside the juicy oranges ,vegetables like broccoli, kale,peppers,tomatoes, berries,peaches and apples are good sources of Vitamin C .

*Vitamin E and Omega-3 fatty acids together are also essential for boosting the immunity.Almonds,dark leafy greens,broccoli and tomatoes are common foods rich in vitamin E.Flax oil,Extra virgin olive oil and fish like salmon are rich in omega-3.

*Minerals Zinc and Selenium are need in just the right quantities to build immunity.Wheat germ,wheat bran ,nuts like cashews,pine nuts and pecans are rich in zinc.Mushrooms,chicken and seafood like shrimp ,salmon and tuna is rich in selenium.

*Spices like fresh garlic and ginger ,dry spices like turmeric ,cumin ,coriander and cinnamon are wonderful immune enhancers.

*Flavonoids and probiotics are becoming ever so popular for building strong body defense.Yogurts with live cultures are best source of probiotics.Flavonoids are present in foods like Cocoa,Dark leafy greens, beans and fresh cranberries.

*Cartenoids like beta-carotene found in Sweet potatoes,carrots and dark leafy greens are also counted as immune boosters.

[Book referred for immunity foods Super Immunity foods and WHFoods ]

Find this veggie rich recipe of Vegetarian Lasagna (with Kale,Zucchini and Broccoli) at Wandering Chopsticks,the featured blog of month for Tried and Tasted Event.The Host of the month is Trupti of Trupti´s Food Corner .I used low fat ricotta instead of mozzarella,although one can used both kind of cheeses.The juicy vegetables fill in perfectly,truly a wholesome alternative to those on no meat diet.

Is Amazon predatory?

Chapter 17 of my favorite textbook has a section on controversies over antitrust policy, including a discussion of predatory pricing. This topic is in the news again: The American Booksellers Association says Amazon, Wal-Mart, and Target "are using these predatory pricing practices to attempt to win control of the market for hardcover bestsellers" and that this behavior "is damaging to the book industry and harmful to consumers."

Read more about the case here and here.

The so-called predatory price cuts have not spilled over to the sale of textbooks. Is that good news for students (as the Booksellers' argument suggests) or bad news?

More Competition

Steve Landsburg is blogging.

Last day of policy training classes

Yesterday was our last day of classroom federal health policy training. Our “classroom” has been the Kaiser Family Foundation’s Barbara Jordan conference center in downtown DC – a fantastic facility. We had an intriguing breakfast discussion with a registered lobbyist who has worked for Academy Health, the health research think tank that is running the training, and GAO. We had backgrounders on Medicare and state health policy and a session on how to communicate with policy leaders. Not surprisingly, advocacy at the federal level is a lot like the states – same motivations, same dynamics – but slower and more deliberative. This training is primarily for health services researchers; my classmates are very frustrated that research isn’t the only factor that drives health policymaking. It’s far worse at the state level. Today we go to the Hill for our last day of training.
Ellen Andrews

Wednesday, October 28, 2009

Leading CHRISTUS in the New Economic Environment, Part 1

Early this week, I met with two representatives from IBM who asked to hear my thoughts for their 2010 Global CEO study entitled, “Leading in the New Economic Environment.” IBM publishes a CEO report every two years, and interviews 1,200 CEOs across the world regarding how they will lead into the future. This is useful for IBM, as it also provides them with a chance to survey their audience

Leading CHRISTUS in the New Economic Environment, Part 1

Early this week, I met with two representatives from IBM who asked to hear my thoughts for their 2010 Global CEO study entitled, “Leading in the New Economic Environment.” IBM publishes a CEO report every two years, and interviews 1,200 CEOs across the world regarding how they will lead into the future. This is useful for IBM, as it also provides them with a chance to survey their audience

The Value of Human (?) Capital

A fun story from NPR about how monkeys value skills, as long as those skills are in scarce supply.

Is the efficient markets hypothesis kaput?

No, says Wharton economist Jeremy Siegel.

Overweight And Old Age

A new study by Harvard School of Public Health (HSPH) and Brigham and Women's Hospital (BWH) researchers has found that, among a large study population of women who lived until at least age 70, being overweight in mid-life was associated with having more health problems later in life, including multiple chronic diseases, and impaired cognitive function, physical function and mental health. Women who were lean at age 18 and maintained a healthy weight through mid-life had the best odds of achieving optimal health later in life. It is the first study to show the role adiposity may play in the overall health of women who survive to older ages.

Read more on this research>>

Check out our weight loss remedies - 60-day money-back guarantee

More health policy training in DC

Yesterday we heard about polling, federal budgeting, the role of the judiciary in health policy and a capstone panel with an overview of policymaking from beginning to end using regulation and rule making for electronic health information breach notification in the federal stimulus bill as a case study. The panel on the role of the judiciary was fascinating. We heard the differences (courts don’t care about data or statistics, it is all driven by individual cases or anecdotes) and similarities (politics decides alot) with policymaking in other branches. The bioethics underlying the law came up repeatedly – medical marijuana and assisted suicide cases. But the one that fascinated me most was a hospital in rural Maine that sued recently claiming that the requirement that hospitals treat everyone who enters their doors (at least to stabilize them) regardless of ability to pay was an unreimbursed “taking.” Something like when government takes your home to build a highway, they have to pay you a fair price. The hospital claimed that the government was requiring them to provide uncompensated care and not reimbursing them. This hospital provided only a very small amount of uncompensated care – 0.5% of revenue -- the national average is ten times that. The Courts found against them, but the reasoning was that the hospital’s trustees didn’t have to run a hospital. They could have chosen to convert it to another purpose (a hotel maybe?) and then nothing would be “taken”. I can’t wait to see what we’ll learn today.
Ellen Andrews

Tuesday, October 27, 2009

Heart Attack Risk Reduction: The Low-Hanging Fruit

Dr. Yongsoon Park and colleagues recently published a great article in the British Journal of Nutrition titled "Erythrocyte fatty acid profiles can predict acute non-fatal myocardial infarction". Stated simply, the title says that the fat in your red blood cell membranes, which reflects dietary fat composition, can predict your likelihood of having a heart attack*. More accurately than standard measures of heart attack risk such as blood cholesterol.

Let's cut to the data. The investigators examined the fat composition of red blood cells in people who had suffered a heart attack, versus an equal number who had not. Participants who had heart attacks had less omega-3, more long-chain omega-6, and particularly higher trans fat in their red blood cells. In fact, 96% of the heart attack patients had elevated trans fat levels, compared to 34% of those without heart attacks. This is consistent with a number of other studies showing a strong association between blood levels of trans fat and heart attack risk (ref).

92% of heart attack patients were in the lowest category of EPA in their red blood cells, as opposed to 32% of those without heart attacks. EPA is an omega-3 fat that comes from fish, and is also made by the body if there's enough omega-3 alpha-linolenic acid (think flax and greens) around and not too much linoleic acid (industrial vegetable oil) to inhibit its production. 96% of heart attack patients were in the lowest category for alpha-linolenic acid, compared to 34% of the comparison group. 0% of the heart attack patients were in the highest category for alpha-linolenic acid.

62% of heart attack patients were in the highest category of arachidonic acid (AA), compared to 34% of the comparison group. AA is made from linoleic acid, and is also found in animal foods such as eggs and liver. Animal foods from pasture-raised animals are lower in AA than their conventionally-raised counterparts, and also contain more omega-3 fats to balance it.

The investigators found that low omega-3, high AA and high trans fats in red blood cells associate with heart attack risk far better than the Framingham risk score, a traditional and widely-used measure that incorporates age, sex, smoking status, total cholesterol, HDL, hypertension and diabetes.

If the associations in this study represent cause-and-effect, which I believe they do based on their consistency with other observational studies and controlled trials, they imply that we can have a very powerful effect on heart attack risk by taking a few simple steps:
  1. Avoid trans fat. It's found in margarine, shortening, refined soy and canola oils, many deep fried foods and processed foods in general.
  2. Avoid industrial vegetable oils and other sources of excess omega-6. Eating pastured or omega-3 eggs, rather than conventional eggs, can help reduce dietary AA as well.
  3. Ensure a regular intake of omega-3 fats from seafood, or small doses of high-vitamin cod liver oil or fish oil. Flax oil is also helpful, but it's an inferior substitute for fish oil.
This study was conducted in Korea. It's a striking confirmation that basic nutritional principles span races and cultures, likely affecting disease risk in all humans.

In the future, I hope that most doctors will measure blood fatty acids to predict heart attack risk, with more success than current approaches. Instead of measuring cholesterol and prescribing a statin drug, doctors will prescribe fish oil and easy-to-follow diet advice**. Fortunately, some doctors are beginning to measure red blood cell fatty acid levels in their patients. The forward-thinking cardiologist Dr. William Davis has discussed this on his blog here. Take a good look at the graphs he posted if you get the chance.


*The title of the study is misleading because it implies a prospective design, in which blood fatty acids would be measured and volunteers followed to see who develops heart disease at a later time point. This study was cross-sectional (also called case-control), meaning they found people who had just had a heart attack and measured their blood fatty acids retrospectively. The other study I referenced above was prospective, which is a nice confirmation of the principle.

**"Eat butter on your toast. Ditch the margarine."

Heart Attack Risk Reduction: The Low-Hanging Fruit

Dr. Yongsoon Park and colleagues recently published a great article in the British Journal of Nutrition titled "Erythrocyte fatty acid profiles can predict acute non-fatal myocardial infarction". Stated simply, the title says that the fat in your red blood cell membranes, which reflects dietary fat composition, can predict your likelihood of having a heart attack*. More accurately than standard measures of heart attack risk such as blood cholesterol.

Let's cut to the data. The investigators examined the fat composition of red blood cells in people who had suffered a heart attack, versus an equal number who had not. Participants who had heart attacks had less omega-3, more long-chain omega-6, and particularly higher trans fat in their red blood cells. In fact, 96% of the heart attack patients had elevated trans fat levels, compared to 34% of those without heart attacks. This is consistent with a number of other studies showing a strong association between blood levels of trans fat and heart attack risk (ref).

92% of heart attack patients were in the lowest category of EPA in their red blood cells, as opposed to 32% of those without heart attacks. EPA is an omega-3 fat that comes from fish, and is also made by the body if there's enough omega-3 alpha-linolenic acid (think flax and greens) around and not too much linoleic acid (industrial vegetable oil) to inhibit its production. 96% of heart attack patients were in the lowest category for alpha-linolenic acid, compared to 34% of the comparison group. 0% of the heart attack patients were in the highest category for alpha-linolenic acid.

62% of heart attack patients were in the highest category of arachidonic acid (AA), compared to 34% of the comparison group. AA is made from linoleic acid, and is also found in animal foods such as eggs and liver. Animal foods from pasture-raised animals are lower in AA than their conventionally-raised counterparts, and also contain more omega-3 fats to balance it.

The investigators found that low omega-3, high AA and high trans fats in red blood cells associate with heart attack risk far better than the Framingham risk score, a traditional and widely-used measure that incorporates age, sex, smoking status, total cholesterol, HDL, hypertension and diabetes.

If the associations in this study represent cause-and-effect, which I believe they do based on their consistency with other observational studies and controlled trials, they imply that we can have a very powerful effect on heart attack risk by taking a few simple steps:
  1. Avoid trans fat. It's found in margarine, shortening, refined soy and canola oils, many deep fried foods and processed foods in general.
  2. Avoid industrial vegetable oils and other sources of excess omega-6. Eating pastured or omega-3 eggs, rather than conventional eggs, can help reduce dietary AA as well.
  3. Ensure a regular intake of omega-3 fats from seafood, or small doses of high-vitamin cod liver oil or fish oil. Flax oil is also helpful, but it's an inferior substitute for fish oil.
This study was conducted in Korea. It's a striking confirmation that basic nutritional principles span races and cultures, likely affecting disease risk in all humans.

In the future, I hope that most doctors will measure blood fatty acids to predict heart attack risk, with more success than current approaches. Instead of measuring cholesterol and prescribing a statin drug, doctors will prescribe fish oil and easy-to-follow diet advice**. Fortunately, some doctors are beginning to measure red blood cell fatty acid levels in their patients. The forward-thinking cardiologist Dr. William Davis has discussed this on his blog here. Take a good look at the graphs he posted if you get the chance.


*The title of the study is misleading because it implies a prospective design, in which blood fatty acids would be measured and volunteers followed to see who develops heart disease at a later time point. This study was cross-sectional (also called case-control), meaning they found people who had just had a heart attack and measured their blood fatty acids retrospectively. The other study I referenced above was prospective, which is a nice confirmation of the principle.

**"Eat butter on your toast. Ditch the margarine."

Heart Attack Risk Reduction: The Low-Hanging Fruit

Dr. Yongsoon Park and colleagues recently published a great article in the British Journal of Nutrition titled "Erythrocyte fatty acid profiles can predict acute non-fatal myocardial infarction". Stated simply, the title says that the fat in your red blood cell membranes, which reflects dietary fat composition, can predict your likelihood of having a heart attack*. More accurately than standard measures of heart attack risk such as blood cholesterol.

Let's cut to the data. The investigators examined the fat composition of red blood cells in people who had suffered a heart attack, versus an equal number who had not. Participants who had heart attacks had less omega-3, more long-chain omega-6, and particularly higher trans fat in their red blood cells. In fact, 96% of the heart attack patients had elevated trans fat levels, compared to 34% of those without heart attacks. This is consistent with a number of other studies showing a strong association between blood levels of trans fat and heart attack risk (ref).

92% of heart attack patients were in the lowest category of EPA in their red blood cells, as opposed to 32% of those without heart attacks. EPA is an omega-3 fat that comes from fish, and is also made by the body if there's enough omega-3 alpha-linolenic acid (think flax and greens) around and not too much linoleic acid (industrial vegetable oil) to inhibit its production. 96% of heart attack patients were in the lowest category for alpha-linolenic acid, compared to 34% of the comparison group. 0% of the heart attack patients were in the highest category for alpha-linolenic acid.

62% of heart attack patients were in the highest category of arachidonic acid (AA), compared to 34% of the comparison group. AA is made from linoleic acid, and is also found in animal foods such as eggs and liver. Animal foods from pasture-raised animals are lower in AA than their conventionally-raised counterparts, and also contain more omega-3 fats to balance it.

The investigators found that low omega-3, high AA and high trans fats in red blood cells associate with heart attack risk far better than the Framingham risk score, a traditional and widely-used measure that incorporates age, sex, smoking status, total cholesterol, HDL, hypertension and diabetes.

If the associations in this study represent cause-and-effect, which I believe they do based on their consistency with other observational studies and controlled trials, they imply that we can have a very powerful effect on heart attack risk by taking a few simple steps:
  1. Avoid trans fat. It's found in margarine, shortening, refined soy and canola oils, many deep fried foods and processed foods in general.
  2. Avoid industrial vegetable oils and other sources of excess omega-6. Eating pastured or omega-3 eggs, rather than conventional eggs, can help reduce dietary AA as well.
  3. Ensure a regular intake of omega-3 fats from seafood, or small doses of high-vitamin cod liver oil or fish oil. Flax oil is also helpful, but it's an inferior substitute for fish oil.
This study was conducted in Korea. It's a striking confirmation that basic nutritional principles span races and cultures, likely affecting disease risk in all humans.

In the future, I hope that most doctors will measure blood fatty acids to predict heart attack risk, with more success than current approaches. Instead of measuring cholesterol and prescribing a statin drug, doctors will prescribe fish oil and easy-to-follow diet advice**. Fortunately, some doctors are beginning to measure red blood cell fatty acid levels in their patients. The forward-thinking cardiologist Dr. William Davis has discussed this on his blog here. Take a good look at the graphs he posted if you get the chance.


*The title of the study is misleading because it implies a prospective design, in which blood fatty acids would be measured and volunteers followed to see who develops heart disease at a later time point. This study was cross-sectional (also called case-control), meaning they found people who had just had a heart attack and measured their blood fatty acids retrospectively. The other study I referenced above was prospective, which is a nice confirmation of the principle.

**"Eat butter on your toast. Ditch the margarine."

Heart Attack Risk Reduction: The Low-Hanging Fruit

Dr. Yongsoon Park and colleagues recently published a great article in the British Journal of Nutrition titled "Erythrocyte fatty acid profiles can predict acute non-fatal myocardial infarction". Stated simply, the title says that the fat in your red blood cell membranes, which reflects dietary fat composition, can predict your likelihood of having a heart attack*. More accurately than standard measures of heart attack risk such as blood cholesterol.

Let's cut to the data. The investigators examined the fat composition of red blood cells in people who had suffered a heart attack, versus an equal number who had not. Participants who had heart attacks had less omega-3, more long-chain omega-6, and particularly higher trans fat in their red blood cells. In fact, 96% of the heart attack patients had elevated trans fat levels, compared to 34% of those without heart attacks. This is consistent with a number of other studies showing a strong association between blood levels of trans fat and heart attack risk (ref).

92% of heart attack patients were in the lowest category of EPA in their red blood cells, as opposed to 32% of those without heart attacks. EPA is an omega-3 fat that comes from fish, and is also made by the body if there's enough omega-3 alpha-linolenic acid (think flax and greens) around and not too much linoleic acid (industrial vegetable oil) to inhibit its production. 96% of heart attack patients were in the lowest category for alpha-linolenic acid, compared to 34% of the comparison group. 0% of the heart attack patients were in the highest category for alpha-linolenic acid.

62% of heart attack patients were in the highest category of arachidonic acid (AA), compared to 34% of the comparison group. AA is made from linoleic acid, and is also found in animal foods such as eggs and liver. Animal foods from pasture-raised animals are lower in AA than their conventionally-raised counterparts, and also contain more omega-3 fats to balance it.

The investigators found that low omega-3, high AA and high trans fats in red blood cells associate with heart attack risk far better than the Framingham risk score, a traditional and widely-used measure that incorporates age, sex, smoking status, total cholesterol, HDL, hypertension and diabetes.

If the associations in this study represent cause-and-effect, which I believe they do based on their consistency with other observational studies and controlled trials, they imply that we can have a very powerful effect on heart attack risk by taking a few simple steps:
  1. Avoid trans fat. It's found in margarine, shortening, refined soy and canola oils, many deep fried foods and processed foods in general.
  2. Avoid industrial vegetable oils and other sources of excess omega-6. Eating pastured or omega-3 eggs, rather than conventional eggs, can help reduce dietary AA as well.
  3. Ensure a regular intake of omega-3 fats from seafood, or small doses of high-vitamin cod liver oil or fish oil. Flax oil is also helpful, but it's an inferior substitute for fish oil.
This study was conducted in Korea. It's a striking confirmation that basic nutritional principles span races and cultures, likely affecting disease risk in all humans.

In the future, I hope that most doctors will measure blood fatty acids to predict heart attack risk, with more success than current approaches. Instead of measuring cholesterol and prescribing a statin drug, doctors will prescribe fish oil and easy-to-follow diet advice**. Fortunately, some doctors are beginning to measure red blood cell fatty acid levels in their patients. The forward-thinking cardiologist Dr. William Davis has discussed this on his blog here. Take a good look at the graphs he posted if you get the chance.


*The title of the study is misleading because it implies a prospective design, in which blood fatty acids would be measured and volunteers followed to see who develops heart disease at a later time point. This study was cross-sectional (also called case-control), meaning they found people who had just had a heart attack and measured their blood fatty acids retrospectively. The other study I referenced above was prospective, which is a nice confirmation of the principle.

**"Eat butter on your toast. Ditch the margarine."

Cocoa Dark Chocolate Macaroons.....with no feet?


Despite the missing "feet"(the ruffled bottoms) these Classic French Macaroons tasted delectable,were still chewy and brittle in texture.Over half a dozen attempts,I couldn't figure out the reason why the bottoms did not develop each time as it were supposed to, in spite of taking all the care and caution as recommended by the expert bakers.May be its just a matter of practice,hopefully I'll have good macaroon days in the future.

I tried flavoring them with saffron,instant coffee but my favorite has to be the cocoa.There is a subtle difference between cocoa and chocolate.I use 100 % cocoa for the sandwiches and the filling is just Dark chocolate.


The 2009 October Daring Bakers’ challenge was brought to us by Ami S. She chose macarons from Claudia Fleming’s The Last Course: The Desserts of Gramercy Tavern as the challenge recipe.


Macarons, from Claudia Flemming' The Last Course: The Desserts Of Gramercy Tavern.

Confectioners’ (Icing) sugar: 2 ¼ cups (225 g, 8 oz.)
Almond flour: 2 cups (190 g, 6.7 oz.)
Granulated sugar: 2 tablespoons (25 g , .88 oz.)
Egg whites: 5 (Have at room temperature)

3 tablespoon of Dutch processed Cocoa powder for flavoring.Use any other dry powders like crushed saffron,Instant coffee,macha tea or lavender.

Preheat the oven to 200°F (93°C). Combine the confectioners’ sugar and almond flour in a medium bowl. If grinding your own nuts, combine nuts and a cup of confectioners’ sugar in the bowl of a food processor and grind until nuts are very fine and powdery.
Beat the egg whites in the clean dry bowl of a stand mixer until they hold soft peaks. Slowly add the granulated sugar and beat until the mixture holds stiff peaks.
Sift a third of the almond flour mixture into the meringue and fold gently to combine. If you are planning on adding zest or other flavorings to the batter, now is the time.I added the coco powder. Sift in the remaining almond flour in two batches. Be gentle! Don’t overfold, but fully incorporate your ingredients.
Spoon the mixture into a pastry bag fitted with a plain half-inch tip (Ateco #806). You can also use a Ziploc bag with a corner cut off. It’s easiest to fill your bag if you stand it up in a tall glass and fold the top down before spooning in the batter.
Pipe one-inch-sized (2.5 cm) mounds of batter onto baking sheets lined with nonstick liners (or parchment paper).
Bake the macaroon for 5 minutes. Remove the pan from the oven and raise the temperature to 375°F (190°C). Once the oven is up to temperature, put the pans back in the oven and bake for an additional 7 to 8 minutes, or lightly colored.
Cool on a rack before filling.

Dark chocolate Filling
1 cup dark chocolate ,chopped

Melt the chocolate over double broiler,fill about a teaspoon between each of the cookies.



Peek in some of the perfect looking macaroons at the Daring Bakers Blog roll.

Massage therapy for osteoarthritis

The Facts:
* Almost 70 patients with osteoarthritis of the knee either underwent massage therapy for 8 weeks or had no treatment.
* The patients who had massage therapy had reduced pain and more flexibility than those who had no treatment.
* Further studies are recommended to assess appropriate length of treatment and whether this type of therapy is cost-effective.

Shaun’s comment: These are interesting findings and potentially very useful given the potential side effects of many of the medications that are used to treat arthritis. In addition, we are likely to see more and more people suffering from arthritis as the population ages. The authors are quite right to state that further studies are needed, but this well-performed study is a great starting point.

Study reference:
http://archinte.ama-assn.org/cgi/content/abstract/166/22/2533

Economics Rap

I have previously alerted readers to the rap version of Ten Principles of Economics. If you liked that, you might enjoy this as well.

A Tribute to John Meyer


Cough Remedies - The Natural Approach

Coughs can vary from dry, tickling coughs to what are known as productive coughs, where you produce lots of mucus. Any unexplained cough that goes on and on should be investigated by properly qualified health professionals, but here are remedies and nutrition supplements for those irritating coughs that can make you feel miserable and unhappy.
  •    Zinc lozenges with Vitamin C and propolis can soothe a tickly cough caused by a dry throat.
  •    Lobelia Herbal compound works to loosen mucus and help get rid of it from your chest, sinuses and throat.
  •  A nervous cough may be helped by magnesium - this mineral can be helpful for stress and anxiety.
  •  The Australian Flower remedy Calm And Clear can also help you relax and feel more confident.
Check out these cough remedies here.

DC health policy training

This week I am learning about how health policy gets made at the federal level, thanks to funding from the Council of State Governments/Eastern Region. Yesterday we heard the basics – White House offices and staff dynamics, how Congress works, then how it really works, agencies and their roles in developing policy, and how it all interacts. My head still hurts from the complexity, but the parallels to state policymaking help. Everything is framed in the context of the current health reform debate. It is an extremely exciting time to be here.
Ellen Andrews

From the CEA Chair

Health Care Reform and the Budget Deficit.

Monday, October 26, 2009

Rosehip for osteoarthritis

Rosehip is more effective than glucosamine, a leading treatment, at easing the pain and symptoms of arthritis sufferers, scientists claim.

The pain-relieving properties of rosehip, which has previously been linked to reduced inflammation in osteoarthritis, have been suggested for decades.
Now scientists have found that powder made from a wild variety of rosehip, Rosa canina, is better at reducing pain in patients than glucosamine, a treatment prescribed by some GPs.

Read more here...

The Public Plan, Again

The possibility of including a public plan in the health reform bill is on the table again. Here are a few viewpoints on the topic: Robert Samuelson, Paul Krugman, Richard Thaler, and me.

What Happens If You Don't Get Enough Vitamin D

Here's a neat summary of all the health problems of being short of Vitamin D

Vitamin D deficiency may precipitate or exacerbate osteopenia, osteoporosis, muscle weakness, fractures, common cancers, autoimmune diseases, infectious diseases and cardiovascular diseases. There is also some evidence that the vitamin may reduce the incidence of several types of cancer and type 1 diabetes.

Buy a vitamin D supplement >>

Weekend Herb Blogging #206 Round Up.

Basil,rocket leaves and Chervil

Graziana of Erbe in Cucina(Italy) made Herbed Grilled Salmon with blend of delicate herbs ,oil and lemon.


Broccoli

Anna(Sydney, Australia) of Morsels & Musings prepared simply delicious Broccoli & Stilton Soup with inexpensive ingredients using broccoli ,garlic oil,dried thyme and Stilton cheese.


Rainbow Swiss Chard

MangoCheeks(Scotland) of Allotment2Kitchen baked the glamorous ornamental garden greens,theRainbow Swiss Chard Bundles with spicy potato and puy stuffing.


Dried Chinese cabbage

Radha(Hongkong) of Urban Bites prepared an aromatic Chinese Chicken Soup with key ingredient as dried Chinese cabbage along with parsley, cherry tomato, mini lettuce, radish and a variety of green leafy vegetables.


Watercress

Tigerfish(California,USA) of teczcape - an escape to food made a soothing Watercress Soup with other exotic ingredients gojiberry and red dates.


Tomatoes

Sweatha(India) of TastyCurryLeaf prepared a warming winter soup,Tomato & Cilantro Soup with spices,lots of fresh cilantro and tomatoes .


Sage

Pam(USA) of Sidewalk Shoescanned a relishing homemade mustard with Lemon- Sage and Wine .


Red Lentils

Kalyn(USA) of Kalyn's Kitchen served a hearty Spicy Red Lentil and Chickpea Stew with perfect combination of spicy flavors .


Radish Greens

SE(MD, USA) of Denufood-Delicious & Nutritious Food made a simple and nutritious Radish Greens Pasta spiced with garlic and green chillies.


Concord Grapes

Winnie Abramson(New Paltz, NY USA) of Healthy Green Kitchen prepared a coolingUva (Grape) Sorbet flavored with pomegranate juice and figs.



Amla(Indian Gooseberry)


My Experiments & Food(India) of My Experiments & Foodprepared a tangyAmla(Indian gooseberry) Chutney seasoned with green chillies and fresh cilantro.


Carrots

Diane(Melbourne) of Disingenuous Mountebank prepared the crowding pleasing fudgy Carrot Halwa


Baby Broad Beans

Haalo(Australia) of Cook(Almost) Anything At Least Once blogged about tender Baby broad beans,the nutritious young fava beans,which can simply be steamed and savored in many ways.


Ripe Fruits

Cinzia(Lake Garda, Italy) of Cindystarput together a fragrant juicy after meal treat,Fruit Grappa,with all sweet ripe fruits.


Apples

Adriano Petrich(Sao Paulo,Brazil) of Secret Food Project made Scrumptious Whole Wheat Apple pancakes with a different approach using marinated apples,pure maple syrup and well beaten eggs in the batter.


Bottle gourd skin

Sharmistha(Hyderabad India) of COOK-A-DOODLE-DO shared with us how to use the fiber rich peel of bottle gourd by making a tasty LAU ER KHOSHA BHAJA with pumpkin and lots of spices.


Rucola(also known as rocket or arugula)

Brii(Lake Garda, Italy) of Brii Blog prepared an enticing Rucola Pesto with fresh Rucola,aged asiago cheese and nuts,served with fennel risotto.

Pumpkins

Me(Columbus OH USA) at Health Nut surprised my self with a whole new spicy approach to eat a pumpkin with South Indian Style Spicy Pumpkin Chutney, it was not my original recipe though,thanks to Anudivya,I can enjoy pumpkins this season with spicy flavors.



Thank you Participants!.18 unique entries,this was certainly yet another good food learning experience for me.Thanks to Haalo for successfully managing the event and Kalyn for starting the whole idea of Weekend Herb Blogging.

The host next week is Katie from Eat This