August 31, 2013

Apparently Avocado Consumption Can Lower Risk of Stroke

@ IRNewscom | YOUR fan of avocado? Not one of you love this fruit. In addition to having good taste, this green fruit has many benefits for health.

Results of recent research published in the Journal of Nutrition explains avocado consumption was able to improve diet quality and nutrient intake levels, reduce sugar intake, lose weight, BMI, and waist circumference. Avocados are also rich in good fatty acids and can reduce the risk of metabolic syndrome.

In particular, survey data from the National Health and Nutrition Examination Survey (NHANES) involving 17 567 U.S. adults aged over 19 years, revealed that 347 adults (50 percent women) who ate avocados in any amount as long as 24 hours have nutrient levels a better and more positive health indicators than those who do not eat avocados.

The avocado eaters also have a certain intake of essential nutrients higher, including 36 percent of fiber, 23 percent of vitamin E, 13 percent magnesium, 16 percent potassium, and 48 percent of vitamin K.

Not only that, the avocado eaters also have a higher intake of healthy fats (18 percent monounsaturated and 12 percent polyunsaturated fat) and total fat (11 percent more) than non-eaters avocado, although the average calorie intake of both the group is the same.

The study found that the avocado eaters had a 50 percent lower rate of developing metabolic syndrome than non-eaters avocado. Metabolic syndrome is a cluster of risk factors that, when occurring together thus increasing the risk of coronary artery disease, stroke, and type 2 diabetes

Turns Drinking four cups Tea a Day Can Reduce Stroke Risk

TEA has many benefits for health. Based on recent research, drinking four cups of tea a day is efficacious in reducing the risk of stroke.

Scientists at the Karolinska Institute, Stockholm, Sweden, studied how the consumption of black tea - the type of tea that most Britons drink - associated with stroke. The study involved nearly 75,000 men and women. Similarly, reported Dailymail.co.uk

The Swedish team studied many as 74 961 adults who were in good health when signing up for long-term health study in 1997. Over the next ten years, more than 4,000 of the volunteers suffered a stroke, especially ischemic.

As part of this study, researchers also monitor the habit of drinking tea. The result? Researchers found that at least 4 cups per day may reduce the risk of blood clots in the brain by 21 percent.

But when drinking less than 4 cups seem to have no beneficial effect. Stroke has been noted that kills about 200 people every day in the UK. About 85 percent of victims of ischemic stroke, which occurs freezing in traveling to the brain and shut down the blood supply. The rest suffered a hemorrhagic stroke, in which the blood vessel in the brain bursts, causing fatal bleeding.

British consumers expected to consume 165 million cups of tea every day, mostly black. This tea is packed with components called flavonoids, which are considered good for the heart and brain.

Hand massage 6 Hours, Ocha Tea Secrets Qualified

TEA Ocha was becoming known in Indonesia by Japanese restaurants are mushrooming. Not just tea, Ocha also contain elements of Japanese culture, ranging from planting procedure, process, up to the tea ceremony.

At the launch of Mirai Ocha at Four Season Hotel, Jakarta, some time ago, Okezone got knowledge about tea processing this packaging. Interestingly, there is a stage where Ocha tea should be massaged for six hours.

Massage leaf tea is one of the important final processing to produce Ocha. The purpose of the massage to give color, luster, flavor, and aroma best owned by Ocha.

For pemijatannya process, first of all necessary jontan table. special tables that are used to massage the tea leaves, the base consists of a thick layer of Japanese paper and placed in a wooden frame. Under heavy paper so that there is coal to be rather hot surface, and is used to dry the tea leaves when massaged.

In a single massage process, many tea leaves are 3 pounds or two handfuls of big fists. First, the tea leaves that have been steamed, put on jontan, then gently massaged and regular direction and given a bit of pressure.

Then, roll the tea leaves are divided into two separate parts. Each section rotated 180 degrees. This process is repeated continuously until you get the best Ocha tea.

Secrets Behind a Cup of Coffee and Tea

@ IRNewscom I Jakarta: Do NOT underestimate the tradition of drinking tea or coffee, in-Shelah Shelah your busy life, because a lot of benefits that are good for your health to consume two types of drinks.

What are the benefits, the following information is summarized from various cracked Irnews:

Tea also contains ingredients that can fight the cause of the infection.
Tea contains L-theanine, an amino acid that adds immunity against bacteria, including the bacteria that cause food poisoning them.

Meanwhile, the coffee is not many containing L-theanine, did not indicate the presence of anti-bacterial substances in it.

Black tea, green or oolong tea, each of which has potent anti bacteria levels are quite large.

In addition, it also has other health benefits, which helps the heart and reduces the risk of cancer.

Well, why did not immediately prepare a cup of tea right now?

August 26, 2013

More Thoughts on Cold Training: Biology Chimes In

Now that the concept of cold training for cold adaptation and fat loss has received scientific support, I've been thinking more about how to apply it.  A number of people have been practicing cold training for a long time, using various methods, most of which haven't been scientifically validated.  That doesn't mean the methods don't work (some of them probably do), but I don't know how far we can generalize individual results prior to seeing controlled studies.

The studies that were published two weeks ago used prolonged, mild cold exposure (60-63 F air) to achieve cold adaptation and fat loss (12).  We still don't know whether or not we would see the same outcome from short, intense cold exposure such as a cold shower or brief cold water plunge.  Also, the fat loss that occurred was modest (5%), and the subjects started off lean rather than overweight.  Normally, overweight people lose more fat than lean people given the same fat loss intervention, but this possibility remains untested.  So the current research leaves a lot of stones unturned, some of which are directly relevant to popular cold training concepts.

In my last post on brown fat, I mentioned that we already know a lot about how brown fat activity is regulated, and I touched briefly on a few key points.  As is often the case, understanding the underlying biology provides clues that may help us train more effectively.  Let's see what the biology has to say.

Biology of Temperature Regulation

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Meaningful Use Stage 2 Beta - A Suggestion

It’s that time of year again when Meaningful Use conversations heat up because all sorts of deadlines are approaching, and as expected, nobody is ready. Meaningful Use was originally intended to have 3 stages, each lasting two years. At the end of 2011, Meaningful Use Stage 2, which should have started in 2013, was postponed by one year and reduced to 90 days to allow vendors and providers enough time to build, deploy and implement new functionality required for Stage 2. As 2013 is drawing to a close and Stage 2 is practically upon us, a flurry of organizations is petitioning the Secretary of Health and Human Services (HHS) to delay Stage 2 just a little bit longer.

The College of Healthcare Information Management Executives (CHIME) fired the first shot back in May, asking for one more 12 months extension. Later in July, the American Medical Association (AMA) and the American Hospital Association (AHA), combined forces and jointly requested additional flexibility to be built into Stage 2 and that providers that are still at Stage 1 should not be forced to upgrade their software in 2014 (more on that below). The American Academy of Family Physicians (AAFP) followed with its own sophisticated proposal on how to better stagger the transition to Stage 2. Next, the Medical Group Management Association (MGMA) petitioned the Secretary to place a moratorium on all penalties for providers that achieved Stage 1, and to allow Stage 1 meaningful users to continue attesting for Stage 1 if they cannot obtain a Stage 2 certified product. HIMSS, the EHR vendors association, sent their letter in support of maintaining the current Stage 2 Meaningful Use launch schedule, but extend its first year to be 18 months long. Confused yet? Let’s detangle the mystery.

First and foremost, whether you began your Meaningful Use journey in 2011 or are about to jump in next year, this conundrum affects you directly, because beginning January 1st 2014 all meaningful users must implement and utilize 2014 certified EHR technology (CEHRT). Even if you plan on just attesting to Stage 1 next year, you cannot use just any old 2011 certified EHR. So all 300,000 or so eligible professionals who have previously attested to Meaningful Use Stage 1, plus all late adopters planning to enter the fray in 2014, will be out there trying to wrestle a good place in line for upgrades, training and installations. Most will do so only after January 1st, and all will have to be ready to start clicking the boxes no later than October 1st. That’s over 1,000 clinicians per day, not counting new entrants. Any way you want to look at it, it’s not a very likely scenario.

Much has been said in the various letters to HHS regarding the small number of EHRs that managed to get certified for 2014, compared to the seventeen hundred complete EHRs certified for Stage 1. This is true, and this may pose a completely different type of problem down the road when doctors realize that most of these fly by night products will soon disappear. However, as late as October 2010, we had less than three dozen certified complete EHRs for Stage 1, a number that grew exponentially in the following couple of years. My guess would be that by the end of the year all major, midsize and viable minor players will be 2014 certified. The problem this time around is that Meaningful Use Stage 1 has been rather successful and there are now about 6 times as many providers needing a new EHR as there were in 2011, and unlike 2011, those who fail to get their upgrades in time will not only lose an incentive, but will be financially penalized by CMS. It just doesn’t seem fair.

Delaying Meaningful Use Stage 2 by yet another year will obviously address the time crunch problem, but if we really want to be fair, we have to admit that another delay will look really bad for the program. Putting in place a complicated scheme of who should buy what and when, and who should attest to which Stage at which time, in an attempt to control the flow of upgrades, is bound to create much confusion in an already over specified and (needlessly) complex EHR certification scheme. So what should HHS do? Take another hit to its credibility and further delay Stage 2? Push forward full steam and deal with the consequences at a later date? Perhaps Meaningful Use is more like a Chinese finger trap at this point, and the best strategy would be to relax a little bit, and understand that 5 year plans rarely go as planned and that’s OK. Below is a humble suggestion to that effect. (Note: Here we are discussing the Eligible Professional measures. The Hospital equivalent should be straightforward.)

Meaningful Use Stage 2 Beta

There are three factors affecting the Meaningful Use program trajectory: time frame, requirements definition, software readiness. Unfortunately, we started by defining the time frame and then discovered that requirements definition and software certification did not fit in our predefined schedule and not even in our expanded schedule. Also unfortunately, we cannot control software readiness, since it depends on thousands of independent players that we can motivate, cajole or threaten, but that’s about it. What is left then? The requirements. The definition of Stage 2, or any other Stage, is not immutable even at this late junction. Those who made the rules can change them ever so slightly to allow a hybrid Stage 2 Beta (see figure below) to be inserted between good enough and perfection.

Proposed Meaningful Use Stage 2 Beta vs. Current Meaningful Use Stage 2 (click image to enlarge)


When compared to Stage 1, Meaningful Use Stage 2 introduced 4 types of changes:
  1. Higher thresholds for existing measures
  2. Transition of optional (Menu) measures to required (Core)
  3. New measures (Menu and Core) for existing EHR functionality
  4. New measures that require new software to be built (Menu and Core)
The changes in #1 and #2 can be all satisfied with 2011 CEHRT. #3 can be satisfied by most 2011 CEHRT, and even some of the #4 measures are already deployed in the better 2011 CEHRT. Splitting and transitioning portions of a handful of #3 and #4 measures from Core to Menu, will allow the 300,000 providers that already attested to Stage 1, to seamlessly move on to Stage 2 Beta without much turmoil. All in all we are talking about 5 such changes from Core to Menu, plus allowing for the increased number of clinical quality measures to continue to be submitted through attestation if necessary.
  1. CPOE for labs and radiology capabilities were present in all good EHRs long before ONC certification came into play.
  2. Patients access to health information is, by definition, what patient portals are for, and many 2011 CEHRT used portals to become certified. True, ability to download and transmit information is rarely there if at all, but although this is a 2014 certification requirement, it is not a Meaningful Use actual requirement.
  3. Having the EHR suggest education materials based on patient health status has been around for a decade, and the better 2011 CEHRT already have that built in.
  4. Secure messaging through a patient portal is part and parcel of any patient portal. More exotic forms of messaging which are required for 2014 certification are optional for users (same as #2).
  5. Electronic health information exchange is only available for a minority of users, for reasons other than EHR capabilities, which should have been present in all 2011 CEHRT.
  6. Electronic submission of clinical quality measures is possible from 2011 CEHRT that have a CMS approved registry. There aren’t that many and insisting on the methodology here seems a bit petty.
The proposed Meaningful Use Stage 2 Beta is achievable with 2011 CEHRT, and allowing it to be used along with the 2014 CEHRT for an interim Stage 2 Beta, should provide immediate resolution to the problem at hand. Since most 2011 CEHRT contain functionality to meet the problematic measures anyway, my guess would be that these newly designated Menu measures will be very popular with Stage 2 Beta attestations, particularly because many of the current Stage 2 Menu measures are heavily dependent on non-existing third party infrastructure. And just so CMS doesn’t feel that it is giving away too much by allowing 2011 CEHRT to be used for a slightly less stringent Core set, let's up the ante on the Menu measures and require that 5 are satisfied instead of the current three. If I was working on Meaningful Use 2 Beta, I would pick the first 4 items above, plus visit notes or family history from the current Menu items (no decent EHR comes without notes and histories).

The difficulty with this Meaningful Use Stage 2 Beta proposal is that all downgraded measures have something to do with the much debated subject of interoperability, thus Stage 2 Beta could be erroneously construed as a retreat from interoperability in general, and so called patient engagement in particular. It may be so, but to a very small degree, since there is no way to pick 5 Menu items without having at least 3 of them relate to interoperability/engagement. Besides, it is usually better to continue moving ahead at a slightly slower pace than it is to come to a dead stop, or alternatively keep going fast and furious over the impeding cliff. Personally, I would use the Beta period to evaluate the program to a greater degree than just how much money was paid out in incentives, and I would take a hard look at the incredible complexity introduced in the EHR certification program, because this too frequent and too invasive granularity is not sustainable, and is the root cause for the difficulties we are experiencing right now.

August 20, 2013

Reflections on the 2013 Ancestral Health Symposium

I just returned from the 2013 Ancestral Health Symposium in Atlanta.  Despite a few challenges with the audio/visual setup, I think it went well.

I arrived on Thursday evening, and so I missed a few talks that would have been interesting to attend, by Mel Konner, Nassim Taleb, Gad Saad, and Hamilton Stapell.  Dr. Konner is one of the progenitors of the modern Paleo movement.  Dr. Saad does interesting work on consummatory behavior, reward, and its possible evolutionary basis.  Dr. Stapell is a historian with an interest in the modern Paleo movement.  He got some heat for suggesting that the movement is unlikely to go truly mainstream, which I agree with.  I had the opportunity to spend quite a bit of time with him and found him to be an interesting person.

On Friday, Chris Kresser gave a nice talk about the potential hidden costs of eradicating our intestinal parasites and inadvertently altering our gut flora.  Unfortunately it was concurrent with Chris Masterjohn so I'll have to watch his talk on fat-soluble vitamins when it's posted.  I spent most of the rest of the day practicing my talk.

On Saturday morning, I gave my talk "Insulin and Obesity: Reconciling Conflicting Evidence".  I think it went well, and the feedback overall was very positive, both on the content and the delivery.  The conference is fairly low-carb-centric and I know some people disagree with my perspective on insulin, and that's OK.   The-question-and-answer session after the talk was also productive, with some comments/questions from Andreas Eenfeldt and others.  With the completion of this talk, I've addressed the topic to my satisfaction and I don't expect to spend much more time on it unless important new data emerge.  The talk will be freely available online at some point, and I expect it to become a valuable resource for people who want to learn more about the relationship between insulin and obesity.  It should be accessible to anyone with a little bit of background in the subject, but it will also be informative to most researchers.

After my talk, I attended several other good presentations.  Dan Pardi gave a nice talk on the importance of sleep and the circadian rhythm, how it works, how the modern world disrupts it, and how to fix it.  The relationship between sleep and health is a very hot area of research right now, it fits seamlessly with the evolutionary perspective, and Pardi showed off his high level of expertise in the subject.  He included the results of an interesting sleep study he conducted as part of his doctoral work at Stanford, showing that sleep restriction makes us more likely to choose foods we perceive as unhealthy.

Sleep and the circadian rhythm was a recurrent theme at AHS13.  A lot of interesting research is emerging on sleep, body weight, and health, and the ancestral community has been quick to embrace this research and integrate it into the ancestral health template.  I think it's a big piece of the puzzle.

Jeff Rothschild gave a nice summary of the research on time-restricted feeding, body weight and health in animal models and humans.  Research in this area is expanding and the results are pretty interesting, suggesting that when you restrict a rodent's feeding window to the time of day when it would naturally consume food (rather than giving constant access during both day and night), it becomes more resistant to obesity even when exposed to a fattening diet.  Rothschild tied this concept together with circadian regulation in a compelling way.  Since food is one of the stimuli that sets the circadian clock, Rothschild proposes to eat when the sun is up, and not when it's down, synchronizing eating behavior with the natural seasonal light rhythm.  I think it's a great idea, although it wouldn't be practical for me to implement it currently.  Maybe someday if I have a more flexible schedule.  Rothschild is about to publish a review paper on this topic as part of his master's degree training, so keep your eyes peeled.

Kevin Boyd gave a very compelling talk about malocclusion (underdeveloped jaws and crowded teeth) and breathing problems, particularly those occurring during sleep.  Malocclusion is a modern epidemic with major health implications, as Dr. Boyd showed by his analysis of ancient vs. modern skulls.  The differences in palate development between our recent ancestors (less than 200 years ago) and modern humans are consistent and striking, as Weston Price also noted a century ago.  Dr. Boyd believes that changing infant feeding practices (primarily the replacement of breast feeding with bottle feeding) is the main responsible factor, due to the different mechanical stimulation it provides, and he's proposing to test that hypothesis using the tools of modern research.  He's presented his research at prestigious organizations and in high-impact scientific journals, so I think this idea may really be gaining traction.  Very exciting.

I was honored when Dr. Boyd told me that my 9-part series on malocclusion is what got him interested in this problem (1, 2, 3, 4, 5, 6, 7, 8, 9).  His research has of course taken it further than I did, and as a dentist his understanding of malocclusion is deeper than mine.  He's a middle-aged man who is going back to school to do this research, and his enthusiasm is palpable.  Robert Corruccini, a quality anthropology researcher and notable proponent of the idea that malocclusion is a "disease of civilization" and not purely inherited, is one of his advisers.

There were a number of excellent talks, and others that didn't meet my standards for information quality.  Overall, an interesting conference with seemingly less drama than in previous years.

August 19, 2013

How to Hang Out Your Electronic Shingle

(Source: forgotten-ny.com)
When a doctor, a lawyer, an accountant or any other professional graduated from University, or moved to a new town, he or she would most often locate a nice little office, prepare it for the big day and hang out a shingle to let the world know that new services are available. The world back then consisted of the immediate neighborhood in the big city or an entire small town out in the country.  While waiting for the new shingle to do its thing, the new doctor would most likely join the country club, attend the pee-wee league games of his/her children, patronize local eating establishments and slowly the word of mouth would help build a new practice that would become a fixture in the community for years to come.

Fast forward to 2013 when nobody strolls leisurely where shingles are not hanging any more, and doctors rarely live and raise families within walking distance of their medical practice. Word of mouth has been largely replaced by text of iPhone and the enameled dangling shingles are now flashing electronic signs in the clouds. Heck even doctor services are increasingly delivered electronically from somewhere in the clouds. So when you push open the door to the coffee shop in the morning, chances are that nobody is going to ask you about their gout and nobody is going to say “morning Doc”, and neither you nor they will give a damn anyway. So if you are, or aim to be, practicing independently, you will need to upgrade your shingle for the electronic times.  

Shingle = Website

First and foremost you need to hang your shingle where it can be seen by prospective clients. If you have an established practice with a waiting list from here to Armageddon, you can safely close your browser now, and go take care of your patients, at least for the next couple of years. If you are not exactly in this enviable position, read on. You need a shingle on the web, a.k.a. a website. A Google Maps generic listing doesn’t count. A canned webpage with your name, address and hours of operations won’t do either, because the rules have changed. For the skeptical, harried and alienated modern person, your website should provide the same reassurance that a simple white rectangle with the word Doctor on it provided 50 years ago. You need a nice website with a minimum of four or five pages to keep people looking at your shingle a bit longer. As to content, look around for other doctors’ websites, see which ones you like better, and model yours in a similar fashion. A good place to look for structure is hotel websites. Yes, hotels. Hoteliers are trying to convey to customers that they are each very important and special, that they will be safe and comfortable, that the premises are clean and upscale, that staff is dedicated and highly professional, that booking is easy and extra amenities are abundant. If you have a sudden urge to throw up just about now, hire a kid to do this for you. A professional “medical websites” firm is not necessarily better and it will cost you ten times as much.

Location = Search Engine Optimization (SEO)

It is pointless to hang your shingle on highway H between endless fields of corn and soybeans (although I know at least one such practice that is thriving). Equally useless would be to hang a shingle from a 5th floor window, or by the back door, next to the big trash containers. Unlike physical shingles, electronic websites can be made to appear just where they are most visible to people most likely to need your services. Today, the equivalent of strolling down Main Street is searching for stuff on the Internet. Having your nice and readable shingle appear in just the right place, at the right time, for the right people, is called search engine optimization (SEO) in the Internet age. Frankly, it is a boring subject, even more so than designing your website, but if you want to read about it, here is a beginner’s guide, and then of course, there is the authoritative book written by Dr. Kevin Pho, which covers much of what we are discussing here. You should peruse these references even if you let one of your kids build the website (kids know all about these things), and even more so if you plan to shell out a few thousand dollars for a professional. Your goal, in a nutshell, is that when someone in your service area is searching for a doctor of your specialty, or a condition that you treat (much more tricky), your website will be the first entry on the first page of Google results. It will take time to get there, but you will never get there if you don’t start. And, yes, this is about marketing, and yes, doctors today are supposed to actively market their practice, just like everybody else. Feel free to pour yourself a drink before reading on.

Word of Mouth = Rating Sites

The means by which messages get from one individual to another have obviously changed. Actual “word of mouth” is still a useful communication channel for finding professional services, but most people looking for a doctor will ask Google first, and then proceed to review unsolicited recommendations from perfect strangers. The entire notion of new information being diffused through social networks has been turned on its head, unless you count planet Earth as one social network. You could argue that your practice is local and planet Earth is irrelevant. You could argue that your patients are older, sicker and that they don’t use computers. You could argue that only dumb people would trust anonymous advice on some random website. However, your small universe is now indistinguishable from the whole, and perhaps the patients you have now don’t use computers, but those who influence their decisions most certainly do, and besides we are talking about attracting new patients. As to rating sites, think about your most recent important purchase, and honestly try to remember how much weight you placed on the little yellow stars at Amazon, or their low tech predecessor at Consumer Reports. Not how accurate these turned out to be, but how much they influenced your purchase. Since you are not selling gadgets to the entire world, how can you make those little yellow stars (all 5 of them) appear next to your name? If you search randomly for physicians, you will see that the ones with star ratings have between one and a handful of reviews. This in itself is reason to discard the information as statistically insignificant, but yellow stars are a very powerful visual cue. Let’s get the ball rolling then.

Do you have at least one friend/employee that is/was your patient at least once or twice? Is one of your patients a physician also looking for stars? Did you call in a script for Uncle Joe last Christmas? Find your comfort zone and get yourself one 5 star rating. Since there are many places people can rate doctors, pick the one where you have some ratings and link it to your website (e.g. “Dr. Jones on Health Grades”), so people can easily find your ratings and continue to grow them. Some would go as far as suggesting that you should personally solicit that patients recommend you on the Internet. Meh…. What you should do though, is have social media buttons on your website (e.g. like us on Facebook, recommend us on G+). All people have to do is click a button, which most of us are willing to do, and there is no option to “hate us on Facebook”, so risk is minimal. Yes, it sounds humiliating, rather shallow in nature and a mega waste of your time. It is all of the above, except it shouldn’t take any of your time to get with the times (so to speak).

For completeness sake, we should mention another type of rating site that may be crucial to building a practice and obtaining referrals. Health plans are increasingly publishing “preferred provider” lists, or add some special designation to the preferred ones on their network listings. These preferences are based on much more complicated and time consuming activities (e.g. MU, P4P, PCMH), and we will address them in a future post. For now be aware that payers “recommendations” are coming and that this is not your grandfather’s word of mouth.

Community = Social Media

We cannot complete the electronic shingle discussion without addressing the new community concept, whether community at large such as Twitter, Facebook and blogging, or specific communities and forums for folks with a particular health concern. If you are reading this, then you are pretty familiar with social media, so we will dispense with preaching to the choir. Besides, if your practice is in trouble, there are better ways to spend your time and energy in the short term. Go back to the top and start with that electronic shingle, which is a prerequisite to anything you will ever do in cyberspace. If you are sitting idle waiting for patients to show up, you may want to consider adding a blog section to your website, but don’t even think about venting your frustrations there. If there’s anything left in the bottle, pour yourself another drink, or maybe switch to coffee, and write a short essay with the customary cliché advice on how to eat right and exercise. Your cyberpatients will love you for it. Cheers....

August 15, 2013

New Medicine – First, Show Me the Money

This is a warning shot across the bow of the mighty health care ship which seems to be changing course in search of calmer waters to carry the riches stowed deep in its rusty hull. I have no arsenal to fire anything more than sporadic warning shots through the descending darkness, but this ship is now on a collision course with the American people, the 47% that Gov. Romney scoffed at and an equal number that is yet to be awakened by the ringing disaster bells. The navigation chart used by the captains of this ship, mapping an America full of dumb and gullible people, too fat and too lazy to make any sudden movements as the corroding ship sails through their bodies, is woefully incorrect. Americans may be slower than most, more forgiving than others, but sooner or later, the health care ship will have to battle the people, and it will be sank, or emerge victorious at the conclusion of the American experiment.

A couple of weeks ago I wrote about Dr. Ezekiel Emanuel’s thinly veiled fury at the medical profession which seems reluctant to accept promotion to the rank of Puppet Captain of the health care ship. That is beginning to change, and this week’s issue of JAMA carries a brief manifesto from three physicians accepting the Captain bars and calling on all colleagues to do the same. The piece, titled “First, Do No (Financial) Harm”, is a succinct summary of health care’s new prime directive: First, Show Me the Money. Before recommending a course of treatment, doctors should first assess the patient’s financial capability. To deflect any remnants of ethical questioning, the authors suggest that assessment of financial status should be undertaken for all patients, not just the obviously poor. This in their learned opinion eliminates the appearance of discriminatory practice, and appearances are the major concern here, because this navigation strategy will have to be packaged by some Mad Men for consumption by the presumed stupid masses. [Note to EMR vendors: Perhaps financial prowess should be another vital sign that the nurse can collect during intake (e.g. how much can you afford to shell out of pocket? Nothing; Up to $100; Up to $1,000; Up to $10,000; Up to $100,000; No Limits), and decision support would be objectively provided by the EMR during Assessment & Plan. This should probably be added to Meaningful Use Stage 4.]

The example provided in the article is of course treatment of mild back pain, which requires no treatment. This, and MRI for headaches, or antibiotics for a cold, are the preferred examples to illustrate the benefits of cost consciousness by both providers and consumers. Nobody dares venture into the conversation that will have to take place with a cancer patient, other than Oregon, of course, which is mandating that this “conversation” takes place before the state will pay for anything. If the “conversation” did not result in the impoverished, sick, depressed and frightened patient asserting his or her “cultural values and preferences” to forgo expensive treatment (as all poor people should), the State will pull the plug anyway, thus empowering those who fail to be empowered on their own.

Let’s go back to MRIs and physical therapy for back pain which is a subject better suited for polite conversation. The authors provide us with a very thoughtful script on how a doctor would go about the difficult conversation of gently avoiding overtreatment of back pain. First you find out if the patient has any money in their wallet, then you proceed with the unrelated task of explaining that an MRI is clinically inappropriate. The latter can probably be skipped if the empowered patient doesn’t know enough to ask for an MRI. The next step is to tell the (poor) patient that beneficial treatment, like physical therapy is too expensive for him/her, and suggest self-care at home (an illustrated sheet of exercises should help). To round it up for those with no money and no real insurance, you could amicably suggest the patient’s “local yoga class”. This is how you “[o]ptimize care plans for individual patients”.  The optimal care plan for someone living on the 10th floor of a housing project is most definitely a “local yoga class”. Marie Antoinette must be smiling in her headless grave.
A couple of years ago, my son’s friend, Kenny, got injured during a football game in his high-school senior year, and needed surgery on his knee. Since Kenny did not have a car, and even if he did he was in no condition to drive after surgery, my son drove him to the downtown clinic for post-op follow-up. Kenny came out of the exam room limping cheerfully since the nurse said that he is all good to go and does not need to come back. My son, having had his own surgical encounter with football’s unintended consequences earlier that year, was a bit surprised and asked where Kenny should go for his physical therapy.  According to the friendly nurse, Kenny didn’t need any fancy PT. The boys walked out, one furious and the other limping and smiling sheepishly. I haven’t seen Kenny since that year and I don’t know if he is still limping, but this formerly bubbly and faster-than-the-wind running back has not shown up at the traditional, and immensely popular, Thanksgiving high-school reunion football games ever since.
From the dawn of civilization to the current day and most likely well into the future, the rich and powerful in all social orders enjoyed better access to better medicine than members of the human species who are poor and powerless.  Similar to disparities in other life-sustaining goods and services, enlightened governance systems have attempted to minimize (not eradicate) these differences in medical service provision due to an emerging sense of social justice and also because prosperity seemed to accrue to better nourished, better educated and healthier societies. A nation founded on the premise that individuals have an inalienable right to pursue happiness cannot weave social injustice into the very fabric of its existence, and expect to thrive. We know this, because we tried similar schemes before, and failed in what were arguably the darkest and most perilous moments in U.S. history. 

Utilizing inherently trusted individuals to prevail upon the unfortunate that what seems like injustice is actually good for them in the long run, is not a novel idea. Substituting betrayal by physical healers in clinics, for indoctrination by spiritual leaders in churches, is a minor innovation. Internalizing and institutionalizing pure evil wrapped in misleadingly kind and gentle rhetoric, while inflicting much pain and suffering on countless human beings, is also a sure recipe for the ultimate destruction of the perpetrators no matter how righteous they believe they are. Doctors, who are tempted to accept compliance with the newly created Captain positions on the misguided health care ship, without questioning its opiate laden navigation route, are simultaneously terminating the medical profession’s days of glory.  There will be no joy. There will be no trust. There will be no prestige. There will be no respect. And there will be no financial privilege. Captains of this doomed ship are a dime a dozen and they all reside below deck.

In order to protect privacy, names and locations mentioned in this post have been changed, as have certain physical characteristics, quotations and other descriptive details.

August 13, 2013

AHS Talk This Saturday

For those who are attending the Ancestral Health Symposium this year, my talk will be at 9:00 AM on Saturday.  The title is "Insulin and Obesity: Reconciling Conflicting Evidence", and it will focus on the following two questions:
  1. Does elevated insulin cause obesity; does obesity cause elevated insulin; or both?
  2. Is there a unifying hypothesis that's able to explain all of the seemingly conflicting evidence cited by each side of the debate?
I'll approach the matter in true scientific fashion: stating hypotheses, making rational predictions based on those hypotheses, and seeing how well the evidence matches the predictions.  I'll explore the evidence in a way that has never been done before (to my knowledge), even on this blog.

Why am I giving this talk?  Two reasons.  First, it's an important question that has implications for the prevention and treatment of obesity, and it has received a lot of interest in the ancestral health community and to some extent among obesity researchers.  Second, I study the mechanisms of obesity professionally, I'm wrapping up a postdoc in a lab that has focused on the role of insulin in body fatness (lab of Dr. Michael W. Schwartz), and I've thought about this question a lot over the years-- so I'm in a good position to speak about it.

The talk will be accessible and informative to almost all knowledge levels, including researchers, physicians, and anyone who knows a little bit about insulin.  I'll cover most of the basics as we go.  I guarantee you'll learn something, whatever your knowledge level.

Cost Effectiveness of Health Information Exchange

At some point it was decided that the exchange of clinical information between facilities of care is lacking in both quantity and quality, and it was further decided that a drastic increase in frequency of such exchange will improve the health of people and the quality of care they received, while reducing costs of health care. The idea, which is almost as old as medicine itself, has been perfected by physicians over centuries of evolving documentation standards and sharing of knowledge in general. As medicine became a service provided by a bewildering array of entities in parallel and/or in sequence over one lifetime, the need for clinical information exchange increased exponentially, making this particular activity a perfect candidate for computerization in the Internet age. Since all computerized functions are better and cheaper than their manual predecessors, it was decided that the Nation must engage in sophisticated exchange of health information to the point where one’s medical records are omnipresent wherever one may need or want to perform, or have performed, a health related function. That’s nice, a bit creepy perhaps, but nice nevertheless, possibly useful, and certainly very convenient.

The Department of Health and Human Services (HHS) is the government agency in charge of making Health Information Exchange (HIE) a reality in this country. A recent HHS pamphlet published in Health Affairs provides an update on the state of HIE for the first term of the current administration (2008 to 2012), spanning the first four years of legislation, rulemaking and financial incentives in support of computerizing medical records and their exchange across facilities of care. The results are based on a survey of hospitals that were asked if they “electronically exchange/share” any one of four types of clinical information (clinical summaries, medication lists, lab results, radiology reports) with other hospitals or ambulatory providers inside or outside their own system. The study shows (see below) that the rates of hospital exchange/sharing of information with any other entity, which stood at 41% in 2008, jumped to 58% by 2012. That’s a whopping 17% over 4 years or slightly over 4% per year on average, although there is a clear acceleration after 2010 when financial incentives became a reality.
(source Health Affairs)
According to CMS reported numbers, the government paid out roughly $14.5 Billion in incentives to hospitals and health professionals by the end of 2012, or approximately $850 Million for each 1% increase in self-reported electronic exchange/sharing of health information by hospitals.  The survey did not inquire about the levels of such exchange, so there is no way to ascertain if hospitals with affirmative responses are exchanging all clinical information of the types listed, most of it, some of it, or occasionally some things here and there. A quick back of the napkin calculation indicates that upwards of $27 Billion will be needed to sustain the current growth rate for the next 8 years or so, in order to achieve universal exchange, and that’s without counting the startup costs of State HIE organizations, Regional Extension Centers and other grant making activities for this purpose, not to mention privately funded infrastructure and operational expenses. And here I have to make a confession: these dollar amounts are in a realm of finance where I cannot tell if these are reasonable expenditures, an incredible bang for the buck, or outrageous waste.

It makes perfect sense that making pertinent information electronically available at the point of care is helpful, and test results, clinical summaries and medication lists are obviously pertinent in most cases. But then, it also makes perfect sense that propping a clogged artery open with a stent should be very helpful in most cases. What is not obvious without additional research is whether there are cheaper and less invasive methods to achieve the same results. Does the most cost effective method of making clinical data available at the point of care consist of a nationwide network of big-iron servers and Federal protocols, continuously fed by hundreds of thousands of clinicians furiously typing and clicking away at hostile terminals? Maybe. Maybe not.

Unencumbered by any doubts, HHS is proposing to forge ahead with “Principles and Strategy for Accelerating Health Information Exchange (HIE)”, because “real-time interoperable HIE” is critical to the success of the Affordable Care Act and its various programs. Note that HIE just got a couple of extra qualifiers prepended to it. Interoperable exchange implies that the exchange is taking place between machines (not people), and that those machines can both exchange information, and understand it well enough to put it to some use. Interoperability is all about the exchange of computable data elements and their analysis. So having a piece of paper (or a PDF) containing all pertinent information, magically appear in the hands of a hospitalist or other care provider, on-demand, does not qualify as interoperability. It doesn’t qualify as real-time either, because real-time in computer language means just as it happens, with no delays and no waiting, so when the doctor updates something in his computer, the hospital computer knows right away, and vice versa.

And how does HHS propose to reach this ubiquitous HIE state? There are lots of steps to accelerate, strengthen, advance, enable, align, support, educate and other operative actions, involving standards, stakeholders, committees, agencies, States, ecosystems, policies, guidance, regulations, incentives, rewards and such, all meshed together in a “multi-year approach that is consistent, incremental, yet comprehensive”, culminating with HIE becoming “standard business practice for providers”. If you are tempted to discard this as fluff, think again because “HHS’ approach to accelerating HIE among health care providers is expected generally to follow a natural lifecycle of incentives followed by payment adjustments and finally through conditions of participation in Medicare and Medicaid programs”. A natural lifecycle indeed...

August 10, 2013

Healthy And Beautiful With Kombucha Mushroom Tea

Healthy And Beautiful With Kombucha Mushroom Teaby Ahmed Tsar Blenzinky

Before bed, take a capsule beauty Fitr. The next morning in the can instead of pretty, but grow pimples on his face. Panicking, he immediately consult a Beauty Advisor who gave the capsule yesterday. He complains why the effects are spotty. The adviser who got angry instead of replying, even smiling. He said, "Ma'am please do not get angry for now. Look, how the capsule had to be spotty in advance. Well, tomorrow morning the pimple will certainly be lost. Ya definitely have not read the manual that I include today huh? "Mubarak smiled shyly and nodded. Mubarak was finally home.
The next morning was also acne has disappeared from the face of Mubarak, but changed to tiny mushrooms growing black. Mubarak did not panic this time. Soon he was to the bathroom. According to the guidebook was reading, her face should be washed with warm water to mushroom with former acne fall instantly. True enough, the mushrooms disappear changed pretty face glowing. More beautiful and radiant than face-Fitr before taking the capsule beauty. Inquired have inquired, it turns out there is a secret on Mushroom. The fungus called Kombucha.
The above illustration only complains fiction that might happen in the future to get a beautiful face quickly. However, contrary to Kombucha Mushroom. This plant really nutritious for health and beauty. In fact, so many benefits contained, the famous Mushroom earned the nickname "1001 benefit". Presupposes 1001 on a collection of tales from Baghdad, amounting to one thousand plus this one. Well as well as Kombucha, a variety of benefits we can get from this fungus.
Origins Kombucha Mushroom Tea
Remember, Fungi "1001 benefit" called Kombucha is not Cambodia. Although the two names that are nearly identical, Kombucha mushroom is not from the country Cambodia. Kombucha own name if followed in his footsteps comes from two words, namely 'kombu' and 'cha'. 'Kombu' is the name of a doctor from Korea who lived in the 5th century AD. Meanwhile, the word 'cha' is derived from the Chinese means 'tea'. According to the story, in about 414 BC, a Japanese emperor who named Inkyo. One time the emperor had a chronic digestive disease. The cause is prolonged constipation. Then on the advice of the physician of ginseng country, the emperor herb tea consumed by the fungus fermented concoction physician. After taking it, the emperor's illness could be cured. On the physician services, the member name of the herb Emperor 'kombucha', which means herb tea from a physician named Kombu.
According to Wikipedia, mushroom tea originating from East Asia and spread to Germany via Russia around the turn of the 20th century. Healing of various diseases is increasingly being used in households in various countries in Asia. Therefore, this fermented mushroom has various names. Call it cajnyj kvas, heldenpilz, mandarin tea mashroom, fungus japonicum, tea kwass, olinka, Mogu, kargasok tea, zauberpilze, olga spring, super mushroom, or others. In Indonesia alone, more commonly referred to kombucha "mushroom depot" which means mushroom castle.
Overview How Making Kombucha Mushroom Tea
However, I get the benefit of this fungus should be processed first. Way of processing, this fungus is used as a medium for fermentation of the tea. Yes like a husband and wife pair of candidates, it should be paired with Kombucha tea drink in order to produce health (probiotics) or beauty potion. Familiar with Yogurt? Processing process very similar to making yogurt. Yoghurt clear if he made from the fermentation of milk that gets seeds Mushroom Yogurt, Kombucha tea while getting seed yeast fermentation of Kombucha. If it be the result of fermentation, the taste is similar to yogurt or fresh acids like carbonated apple juice.
Step-by-step creation of a health drink Kombucha mushroom tea is; (1). The first step must gather materials and equipment. For less material there are three kinds. Kombucha mushroom is used as a medium for yeast so fermentation tea (Kombucha Mushroom seeds are used as a source of yeast has been sold everywhere through the Internet. Costs less than Rp 60,000 to Rp 80,000 per piece or per jar). The second and third ingredients are 70 or 100 grams of granulated sugar with 1 liter of water. The last ingredient is black or green tea (or herbal tea also bsa) as much as two teaspoons. As for the device, to provide a place cooking pot with a jar of water. Do not forget to also provide a tool in the form of fabric jar covers, (2). Having prepared all the materials and tools, make drinks tea as usual. Miunuman green tea to green tea, as well as black tea.
Purpose of making tea as usual, yes as you make tea. Mix two teaspoons of tea as much as one liter of water into the already boiling. But this time without the sugar mixed in advance; (3). After settling for 15 minutes, strain the tea dregs or separate them with airn seduhannya and enter into the steeping water sugar as much as 10 percent of the steeping water. Then stirred; (4). Because the water is still warm steeping tea let it cool first, adjust the water temperature of the room where the tea is made. Do not let the temperature exceeds 25 degrees Celsius due to yeast Kombucha colony will die when put in hot water.
When the cooling process, of course, avoid steeping water from intruding animals Flies, Mosquitoes, and Ants or also do not let dust enter into it; (5). Now enter the new colony of yeast fungus Kombucha (also known by the acronym scoby / bacteries and symbiotic colony of yeasts) when steeping water was cold. The size is as much as 10% of the steeping water, the same as the size of sugar earlier. But before putting the yeast colonies, first steeping pour water into the jar made of glass. Close the jar tightly that already contains a mixture of yeast colonies and steeping water, cover with a cloth. Just like before, this handy cover to avoid any small animals or other dust particles into the jar; (6). Save steeping jar containing water mixed with the yeast, between eight to ten days. In this step, the process of fermentation occurs. Keep the jar in a cool, should not exceed a temperature of 30 degrees Celsius and storage temperature should not be less than 20 degrees Celsius.
Jars should not be exposed to sunlight, the jar should not be moved move (rocking) or always transferred during storage; And, (7). Reached after 10 days in storage, separate yeast colonies back to the Kombucha Mushroom Tea Kombucha water. Grab trick with clean hands and do not remove the colony. Yeast can be used again as a re-fermentation medium, but must be washed first with tap water or warm water. Well Kombucha tea is finished, pour into a bottle and seal tightly. To make it more palatable drink tea first let for approximately 5 days.
Meanwhile, to make Kombucha Mushroom yeast colonies steps procedure is the same as the process of making kombucha tea, but the jar can be used smaller. The newly formed layers of cellulose and steeping tea that has been used as a starter for the manufacture of fermented Kombucha tea drinks later.

August 09, 2013

Food Reward Friday

This week's lucky "winner"... cola!

Thirsty yet?  Visual cues such as these are used to drive food/beverage seeking and consumption behavior, which are used to drive profits.  How does this work?  Once you've consumed a rewarding beverage enough times, particularly as a malleable child, your brain comes to associate everything about that beverage with the primary reward you obtained from it (calories, sugar, and caffeine).  This is simply Pavlovian/classical conditioning*.  Everything associated with that beverage becomes a cue that triggers motivation to obtain it (craving), including the sight of it, the smell of it, the sound of a can popping, and even the physical and social environment it was consumed in-- just like Pavlov's dogs learned to drool at the sound of a bell that was repeatedly paired with food.

Read more »

August 05, 2013

Green tea dangers for pregnant women


Many mothers also gave birth after an instant path to re-trim as slimming pills or slimming tea (green tea) that contain laxative (laxative), but remember, that whatever we eat or drink, will affect breast milk is drunk baby. Perhaps we should start to believe yourself that there is nothing in the instant weight loss, should be accompanied by regular exercise or exercise and eating a healthy diet.

Drinking tea or green tea is beneficial for the body, but there is a time when drinking tea needs to be reduced. Similar to those recommended by parents to reduce or eliminate coffee, mothers who are pregnant should be careful in consuming green tea because the caffeine content is very large. While mothers who are breastfeeding, are also advised not to consume coffee and green tea because it can cause restlessness (difficult silent), difficulty sleeping, anemia and other adverse effects in children who are breastfeeding.

By doing light exercise but ongoing routine every day for at least 15 to 20 minutes, like walking, and even perform routine chores such as gardening and scrub the floor for 30 minutes a day can help you lose weight.

Reduce your intake of carbohydrates like little rice, bread, potatoes and noodles at least a third or a quarter of the usual. Of course this must be balanced diet with vegetables, fruits, and low cholesterol protein like chicken. Do not forget to reduce your intake of sugar and snack. All of this is more efficacious than drinking slimming tea, green tea extract, or slimming pills. Green vegetables and beans even better to improve the quality of breast milk.

August 02, 2013

ABOUT "OU TEA" (MAGIC BLACK TEA)

OU TEA is black tea tampa magic remarkable chemicals (100% Natural)OU TEA very useful as an alternative treatment of various diseases.Want to be healthy consumption, "OU TEA"

What is Ou tea?


Ou tea is "black tea", which is a tea made from the leaves of Camelia chinensis choice, with the best fermentation process. Although there are lots of 'tea' made from various plants (later called herbal tea), but tea from tea leaves of Camellia chinensis is the first, original and totally tea.In addition, the fermentation process outea (Camelia chinensis), not just the tea leaves are crushed, but the chain of antioxidant molecules and various active substances in it are also cut and become more effective.That is why Ou tea can help the healing process almost all diseases if taken appropriately in the way proper tea consumption ou., While enjoying tea Ou tea, while improving the health (and healing for the sick).

What's the difference Ou tea with other teas?


Ou tea superior in terms of fermentation process than other tea types, namely: green tea (almost without fermentation), red tea (with a little fermented) and oolong tea (fermented normally allowed to happen by itself)., Ou tea also result not only destroyed the tea leaves , but the chain of antioxidant molecules and various active substances in it are also cut and become more effective. That is why Ou tea can help the healing process almost all diseases if taken properly.

Is Outea contain drugs or other additives?


No, Ou tea is pure black tea. 100% natural, without the addition of chemicals.

What diseases can be helped by drinking Ou tea?


Useful Ou tea almost all cases, such as uric acid, diabetes, heart disease, kidney disease, stroke, cancer, high blood pressure, high cholesterol, impotence, cysts, pain during menstruation, asthma, rheumatism, etc.. In terms of viral diseases and pathogenic microorganisms, antiviral and antibacterial Ou tea character will help the healing process. Ou tea also has anti-inflammatory properties, so it can help repair gingivitis, inflammation of the gastrointestinal tract, etc..

What secret is so powerful Outea?


In addition to containing a variety of vitamins, minerals, and other nutrients, Ou tea also have a lot of active substances that are useful for health as an antioxidant. All varieties of tea actually has similar content. So many say that green tea can cure cancer, but many have failed. A Japanese doctor, Prof. Dr.. Yukie Niwa make study why some patients can be cured with herbs while other patients with similar conditions do not recover (Free Radical Inviting Death, by Yukie Niwa MD, Ph.D case 122-127). The difference lies in the digestive system of the patient. In the case of patients whose digestive systems strong enough enzymes, herbal concoctions perfectly digested consumed, destroyed the active substances and active in the body so that the result is effective, he will recover. Other patients who are not cured because pencernaanya unfavorable.

So he tries to find a way to destroy the active ingredients in herbs outside the body, so that any consumption, although the patient weak digestion, these active substances can work with effectively. One method he used was fermented. That is why Ou tea so powerful. The most advanced fermentation process produces tea that active substances, especially antioxidants, destroyed in so short molecular chains more effectively in the body.


Why should Ou tea hangat2 ​​drink while still hot?


Ou tea is a tremendous source of antioxidants good to overcome damaging free radicals. In the body of free radicals cause chain reactions that damage like rust on metal. Antioxidants are the only way to overcome the "rust" caused by free radicals in the body. When Ou tea cools, more gases (including oxygen) are entered, partly as a result of anti-oxidants Ou tea it reacts with oxygen, so that the levels of antioxidantsdecreased. Heating it again will not help, because when reheated, the oxygen out of the liquid by bringing an antioxidant that has been reacted with