Before Holland became the state seismologist in 2010, there wasn’t much for Big Oil and state researchers to argue about. Over the previous 30 years, Oklahoma had averaged fewer than two earthquakes a year of at least 3.0 in magnitude. In 2015 the state is on pace for 875, according to Holland. Oklahoma passed California last year as the most seismically active state in the continental U.S.
Interesting that in last night's PBS's News Hour and NPR's Morning Addition today it was clearly stated these earthquakes were not due to fracking but wastewater disposal. Evidently someone was quite successful in drawing a distinction where there was none.
Takano — a former high school teacher and a community college trustee — was likely referring to the fact that many for-profit colleges are publicly traded and might be more interested in investors than students.
Michael Adorno
At the press conference last week, Takano continued on to lambast the for-profit sector for supposedly leaving students with unsustainable debt, worthless credits, and dismal job prospects. He noted that “72% of for-profit programs produce graduates who earn less on average than high school dropouts."
Michael Adorno, a so-called student debt striker from the Corinthian 100 spoke at the press conference to share his personal story about alleged manipulation at the hands of for-profit Everest College. He said he learned network administration on outdated software and now can't find a job due to recruiters' intimate knowledge of Everest's program.
According to Takano, the Pro Student Act will, among other things:
Require proprietary institutions to derive at least 15% of their revenue from non-federal student aid and ensure that military and veterans’ education benefits are included in that calculation.
Prohibit schools from using revenues derived from federal student aid for recruiting and marketing.
Launch a complaint tracking system for students to report grievances.
Establish a Proprietary Education Oversight Coordination Committee and create a framework for targeting and prioritizing program reviews by the Department of Education.
Strengthen sanctions for violations, establish a Student Relief Fund, and bolster consumer protections for students.
Improve the quality of and access to key information, such as the student default risk index, cohort default rates, loan repayment rates, degree completion rates, and accreditation documents.
Prohibit incentive compensation based on recruitment or academic success.
The legislation follows months, if not years, of complaints against the entire for-profit industry, which has been under fire for its alleged focus on signing up students and depositing their federal financial aid checks rather than providing a quality education.
The for-profit industry gained even more notoriety on Sunday with Corinthian Colleges, a massive for-profit college network, closing its remaining campuses for good after being investigated by state attorneys general and the Department of Education.
For its part, Corinthian has previously told Business Insider in a statement that it believes "career colleges like Corinthian play an important role in the US education system and serve a need that would otherwise be unmet."
I CONFESS I filed this column several weeks late in large part because I had hoped first to figure out a medical bill whose serial iterations have been arriving monthly like clockwork for half a year.
As medical bills go, it’s not very big: $225, from a laboratory. But I don’t really want to pay it until I understand what it’s for. It’s not that the bill contains no information — there is lots of it. Test codes: 105, 127, 164, to name a few. CPT codes: 87481, 87491, 87798 and others. It tells me I’m being billed $29.90 for each of nine things, but there is an “adjustment” to one of $14.20.
At first, I left messages on the lab’s billing office voice mail asking for an explanation. A few months ago, when someone finally called back, she said she could not tell me what the codes were for because that would violate patient privacy. After I pointed out that I was the patient in question, she said, politely: “I’m sorry, this is what I’m told, and I don’t want to lose my job.”
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CreditMike McQuade
I have spent the last two and a half years reporting and writing about medical costs, and during that time I have pored over hundreds of patients’ bills. And while I’ve become pretty adept at medical bill exegesis, I continue to be baffled by how we’ve come to tolerate the Kafkaesque stream of nonexplanations that follow health encounters.
Bills variously use CPT, HCPCS or ICD-9 codes (more about those later). Some have abbreviations and scientific terms that you need a medical dictionary or a graduate degree to comprehend. Some have no information at all. Heather Pearce of Seattle told me how she’d recently received a $45,000 hospital bill with the explanation “miscellaneous.”
Are there no standards or regulations governing medical billing? Even my receipts from the dry cleaner say things like “sweater blue — $7.” The supermarket tells me I’ve paid $2 for 1.3 pounds of gala apples.
“Medical bills and explanation of benefits are undecipherable and incomprehensible even for experts to understand, and the law is very forgiving about that,” said Mark Hall, a professor of health law at Wake Forest University. “We’ve not seen a lot of pressure to standardize medical billing, but there’s certainly a need.”
Hospitals and medical clinics, for their part, often counter by saying that detailed bills are simply too complicated for patients and that they provide the information required by insurers. But with rising copays and deductibles, patients are shouldering an increasing burden. And if providers of Lasik and plastic surgeons can come up with clear prices and payment terms, why can’t others in medicine?
In other industries, lawmakers have swooped in to end unscrupulous practices. The 1968 Truth in Lending Act required clearer terms in writing loans and offering credit. After the housing crisis, the 2009 Mortgage Disclosure Improvement Act demanded that lenders provide clear and consistent information to home buyers. The idea was to protect buyers from being seduced by low-interest teaser rates that would jump dramatically a few years later, for example.
But, Mr. Hall said, such legislation applies only to specific sectors: “There is no general law that says bills must be clear and there are no rules about which can be reported to credit agencies. I think bills are transparent at the grocery not because there’s a law, but because that’s what customers expect.”
Christina LaMontagne, vice president in charge of health atNerdWallet, a consumer financial services company that offers medical bill audits, educational tools and experts to talk patients through their bills, said, “The idea that consumers want user-friendly explanations is exactly the issue.”
“The lack of standardization is a function of history,” she continued, “and relates to how many cooks are in the kitchen: doctors, hospital, insurers, billers. Getting them to agree on how to standardize the bill feels like herding cats.”
I called the American Medical Billing Association, a trade group based in Oklahoma, expecting a defense and instead got a kind of mea culpa, from Cyndee Weston, its executive director: “There are no industry standards with regards to what information a patient should receive regarding their bill,” she said. “The software industry has pretty much decided what information patients should receive, and to my knowledge, they have not had any stakeholder input. That would certainly be a worthwhile project for our industry.”
One recent study found that up to 90 percent of hospital bills contain errors.
Therese Meuel, a business consultant who volunteers as an Affordable Care Act patient navigator in the Bay Area, needed a kidney biopsy earlier this year. She said she “treated it as a kind of experiment to see how difficult it was to be a good consumer.” She discovered that “it was pretty much impossible.”
For a simple needle biopsy that would require 24 hours of observation afterward, she spent hours verifying that the hospital, radiologist, pathologist and anesthesiologist were all in her network, to keep out-of-pocket expenses to a minimum. The hospital bill ended up being around $15,000, for which Ms. Meuel owed $665.46. There were also bills from the radiologist ($1,263) and pathologist ($3,799.25) for which she owed smaller amounts.
The explanation of benefits from Blue Shield listed a few line items that had been paid to the hospital labeled “hospital,” “miscellaneous” or “labs.” All further explanation appeared in CPT codes. Only the explanation of payouts to the pathologist was given in words: “tissue exam special status group 2” ($372.75), “immunofluorescent study” ($1,748.25) and “electron microscopy” ($1,328.25). Not very helpful.
The itemized bill the hospital sent at her request offered minimal elucidation, containing items like: “1. 25030731 HC RT OXYGEN DAILY CHARGE — $2,132.25.”; “2. 0305 30516895 LAB HCT-CHRG ONLY — $104.81”; “3. 35033106 HC CT GUIDED NEEDLE PLCMNT ASP BlOP — $1,828.50.”
(My translation: 1. The supplemental oxygen delivered into the nose after surgery, a routine precaution at many hospitals. 2. A blood test for anemia. 3. The use of a CT scan to guide the biopsy needle into the kidney.)
Ms. LaMontagne of NerdWallet said the pressure to end such confusing billing practices will grow. “The baby boomers have tolerated the current system,” she said. “But 20-somethings and millennials are not used to this and they won’t.”
Until then, you can Google most codes and get a sense of their meaning.
What exactly you owe after that depends on the co-payments and deductibles stipulated by your insurance plan. Many policies have separate deductibles for in-network and out-of-network care and for drugs. There may be different co-payments depending on whether your test is done at a hospital or in an office.
Before you embark on the journey of decoding your bill, you might also want to have a look at a tutorial — Understanding Your Medical Bill — produced by the Khan Academy, an online educator, and the Brookings Institution in Washington. It’s a bit over 12 minutes. That’s about five minutes longer than the Khan Academy’s tutorial explaining Newton’s second law.
For a continuing conversation about health care costs and pricing in the United States, please join our Facebook group, Paying Till It Hurts.
woman walks with her child on a street as schools were closed due to the heavy smog in Jilin, northeast China's Jilin province.
A lawsuit filed by residents of a Chinese town against a chemical plant that they say is responsible for high levels of lead in the blood of local children is shaping up as a test of the central government's resolve to tackle pollution.
Of the more than 50 residents from in and around the rural town of Dapu in central Hunan province who originally agreed to join the lawsuit, only 11 remain, their lawyer, Dai Renhui, told Reuters. Hu Shaobo, another lawyer advising on the case, said some plaintiffs had withdrawn under pressure from local government officials.
The lawsuit, described by lawyers as one of the first of its kind to be accepted by a Chinese court, is scheduled to be heard next month. The plaintiffs are seeking compensation, although Dai declined to say if they had agreed on an amount.
China has declared "war on pollution" in the wake of mounting discontent over a growth-at-all-costs economic model that has spoiled much of the country's water, skies and soil.
A revised environmental protection law that came into effect in January raised penalties for polluters and enabled environmental groups to file public interest lawsuits.
But in less developed regions such as Dapu, factories accused of being polluters are also leading employers and taxpayers, underlining the tensions inherent in China's fight to clean up its environment and improve the rule of law while continuing to grow the economy.
The Dapu lawsuit, filed in the Hengdong county court in March, alleges that pollution from a local chemical plant and smelter called Melody Chemical caused elevated levels of lead in the blood of 11 children named in the suit.
Dapu's lead problem made national headlines last June in an expose by state broadcaster CCTV, in which the head of the township was shown saying children might have raised their own lead levels by chewing on pencils.
After the broadcast, which said more than 300 children had high lead levels, officials opened an investigation and Melody was ordered to shut down.
Attempts by Reuters to reach Melody for comment were unsuccessful.
Plaintiff Yin Wanchun told Reuters by telephone that local officials had urged him to withdraw from the case, saying he had made his point and that participating would cause unspecified problems for him.
"I told them this was a legal matter, what's the government doing interfering," said Yin, who is acting on behalf of his 12-year-old granddaughter.
Tests at a hospital in Changsha, the provincial capital, showed she had high levels of lead in her blood, Yin said.
Liu Huan, a spokesman for Dapu township, said he knew of the lawsuit but added that to his knowledge, local authorities had not urged anyone to withdraw from the suit.
Dai, the lawyer, said the court delayed the first hearing to June from April 28 on the grounds it was a "significant, complex and difficult" case. Attempts to reach the court for comment were unsuccessful.
Town in environmental spotlight
Lead poisoning is one of the serious side effects of China's rapid economic growth and lack of environmental controls.
Exposure to lead is particularly dangerous for children: it inhibits intellectual and physical development and can cause poor concentration, disruptive behavior and even death at high levels.
Dapu, home to about 62,000 people, is dotted with smelters and chemical plants.
A 2014 report by environmental group Greenpeace found that rice samples taken there contained high levels of cadmium and lead, some as much as 22 times the national standard.
Experts said the Hengdong court's acceptance of the lawsuit was progress, noting how Chinese courts had in the past routinely refused to accept such cases.
Nevertheless, plaintiffs in cases like this one would likely struggle to gather sufficient evidence to prove the accused company was responsible for harming the children's health, said Wang Xi, a professor at Shanghai Jiaotong University's School of Law.
"In (less-developed regions), where the government's main job is economic development and poverty alleviation, it's hard for governments to close down all polluting companies at once," added Wang.
Obesity epidemic spreads at alarming rate. This can't be all individual irresponsibility, is the present generation so much more irresponsible than past ones?
Europe’s growing obesity crisis will see almost three-quarters of men and two-thirds of women in the UK being overweight in 15 years, health experts have said.
Projections by the World Health Organisation and UK-based researchers lay bare a problem “of enormous proportions” facing many countries over the next decade and a half.
Ireland leads the trend, with new figures to be presented on Wednesday to theEuropean Congress on Obesity, in Prague suggesting that 89% of men and 85% of women in the country will be overweight or obese by 2030.
In the UK, the comparable figures will be 74% for men and 64% for women, up from 70% and 59% respectively five years ago. The statistics for 57 countries are based on analysis of existing data for 2010 and projections which involved the UK Health Forum, an alliance of public interest and professional groups.
It is reluctant to present the findings as a league table because of the variety and quality of data. However, the figure for Irish men is only matched by Uzbekistan.
Being “overweight” is defined as having a Body Mass Index (BMI) – a measure covering height and weight – of between 25 and 29.9, and “obese” by a BMI of 30 and above.
For the study, the overweight category includes obese people. The proportion of obese Irish men is expected to increase from 26% to 48%, while the figure for those either overweight or obese rises from 74% to 89%.
In terms of obesity, the estimates show a big jump for women in Ireland from 23% to 57%, and the percentage for overweight and obese together from 57% to 85%.
In the UK, 36% of men and 33% of women are predicted to be obese in 2030 compared with 26% of both sexes in 2010.
Other countries facing growing obesity problems include Greece, Spain, Austria and the Czech Republic. Even Sweden, where there has traditionally been a low prevalence of obesity, will see significant rises.
Researchers said most countries show no evidence of reaching even a plateau in adult obesity.
The Netherlands is a rare exception. In 2010, 54% of Dutch men were overweight, including 10% who were obese. These figures are projected to fall to 49% and 8% respectively. For women, the 2030 figures will be 43% and 9%, compared to 44% and 13% in 2010.
João Breda, from the WHO’s regional office in Copenhagen, said: “Although this was a forecasting exercise, and therefore data needs to be taken with extreme caution, it conveys two strong messages – first that the availability and quality of the data in countries needs to be improved and second that these predictions show more needs to be done in terms of preventing and tackling obesity.”
Laura Webber, of the UK Health Forum, warned there was “a worrying picture” of rising obesity across Europe. She said: “Although there is no silver bullet for tackling the epidemic, governments must do more to restrict unhealthy food marketing and make healthy food more affordable.”
Webber said the present “obesegenic environment” encouraged the over-consumption of energy dense foods and discouraged physical activity. Restricting the marketing of unhealthy food to children, making healthier food more affordable, for example through subsidies on fruit and vegetables, and making less healthy food more expensive by using taxes, for example on sugary drinks, were among the measures needed, she told the Guardian.
There should be fewer sugars and fats in processed food and clear nutritional labelling, Webber said.
In another paper to be presented to the conference on Wednesday, Dragos Petrescu, of Cambridge University’s behaviour and health research unit, will say that only a minority of the UK and US populations are likely to support extra taxes on unhealthy foods.
People will allow themselves to be nudged towards healthier eating by being offered smaller portions, changes to packaging and more prominent store displays for less obesity encouraging foods, he will reveal, after his team researched the views of nearly 1,100 people in each country.
The food industry points to changes it says it is making in calorie reducing recipe reformulations, smaller pack and portion sizes and bigger advertising spends to educate the public on healthy eating.
However, analysis of the voluntary public health responsibility deal in England between the Department of Health and industry on food, alcohol and physical exercise – published in the journal Food Policy on Tuesday – raised questions over the effectiveness of the present arrangements.
A team from the London School of Hygiene and Tropical Medicine said it was difficult to establish the quality and extent of such changes because of the lack of progress reports.
It said changes needed to be “evidence-based, well-defined and measurable”, pushing companies to go beyond “business as usual” with clear penalties for those that did not demonstrate progress.
The British company that distributed and sold the drug thalidomide knew almost six months before it was pulled from the market that there were credible claims it caused terrible deformities and the deaths of infants, a new book reveals.
If Distillers had heeded warnings it received in June and July 1961, as many as 1,000 babies would not have been born with severe injuries such as missing limbs, and another 1,000 would not have died shortly after birth, the book says.
Silent Shock by lawyer Michael Magazanik appears to clear up a long-running dispute about when the company knew thalidomide, widely given to women as a cure for morning sickness between 1958 and 1961, was exceptionally dangerous.
Magazanik was a lead lawyer in the Australian case of Lynette Rowe, who was born without arms or legs after her mother took the drug during pregnancy. In preparation for that case in 2012, Magazanik interviewed former workers at Distillers’ headquarters in Australia, including salesman Hubert Woodhouse, known as Woody.
Woodhouse signed an affidavit and agreed to video his evidence that revealed that the company’s most senior management in Australia had known there were strong reports of thalidomide’s danger in June 1961.
In that month, Australian obstetrician William McBride says he had called Distillers to warn them about three babies in his care that had been born with catastrophic injuries after their mothers had taken the drug during pregnancy. Distillers have claimed they never received that call or that he may have spoken to a junior staffer who ignored it. They took no action at the time, later claiming they were unaware of any concerns.
But Woodhouse told Magazanik that senior Distillers staff in Australia – including Bill Poole, who ran the business – were aware of McBride’s warnings through the second half of 1961. Despite this, they continued to aggressively market the drug as safe and effective and to lobby the Australian government to include it on the pharmaceutical benefits scheme, which subsidises drugs.
“I don’t know how Bill Poole found out about McBride’s concerns but he definitely knew about them,” Woodhouse told Magazanik. “Bill Poole was aware around the middle of 1961 of what McBride believed.”
Woodhouse said he often joined senior management for a whisky after work where McBride’s warnings were discussed.
“The conversations were sometimes lengthy and Poole especially expressed great concern at the possibility McBride was right,” Woodhouse said. “Poole believed, and stated, that the future of the business hinged on whether McBride was right or wrong.” He said Poole was aware of how serious the warnings were, telling him he was not to speak about McBride’s report to anyone.
It is not clear whether the Australian arm of the company passed on McBride’s concerns to the UK headquarters at the time, although Woodhouse had assumed they had. Yet Distillers backed Poole’s version of events that it had acted as quickly as possible as soon as warnings were raised. In November, McBride again reported that the drug was connected to deformities, as did German doctors, and it was pulled from sale.
Poole, who is dead, lied on an “industrial scale”, says Magazanik, to cover up Distillers’ knowledge of the drug’s dangers.
Lyn Rowe’s mother Wendy took thalidomide after McBride’s June warnings and would not have been born deformed if those reports had been acted upon more quickly. She received a multi-million dollar settlement in 2012 from Diageo, the UK drinks group which is the legacy owner of Distillers.
Because the trial did not go ahead, Woodhouse’s critical evidence was not made public at the time, but made an “enormous difference” to the claim, Magazanik told Guardian Australia. In 2013, Diageo settled a class action for $AU89m to pay compensation to 100 Australian and New Zealand victims.
“When apologists say that the whole thing was an unavoidable disaster – that’s rubbish. There were repeated opportunities to cut the death and injury toll short,” said Magazanik.
“For the first time we now know just how disgracefully the thalidomide drug companies behaved. Distillers’ top man in Australia sat on McBride’s shocking report for five months, leading to thousands of avoidable deaths and injuries worldwide.”
He said it took could courage and compassion for Woodhouse, who is in his 80s and is very ill, to come forward and tell what he knew.
Although Distillers had acted disgracefully, it was far from alone. “In Germany, Grunenthal and its staff got reports of malformations possibly linked to thalidomide in 1959, 1960 and 1961. It did nothing to investigate _ just kept selling more and more of the drug.”
About 10,000 babies worldwide were born without limbs because of thalidomide. Half of them died shortly after.
And here:
The dark shadow of thalidomide is still with us. The original catastrophe maimed 20,000 babies and killed 80,000: war apart, it remains the greatest manmade global disaster. Now evidence has been uncovered that the pharmaceutical outrage – it is nothing less – was compounded by a judicial scandal that has suppurated all these years.
This move is very welcome and, if anything, overdue.
Trans fats are not just harmful in their own right but vividly illustrate much of what bedevils modern nutrition, or as Michael Pollan has called it, "nutritionism." Before getting back to getting rid of trans fat and what lies ahead, let's look back to see how we got into this mess in the first place.
Trans fat was first introduced into the food supply in an apparently innocent attempt to reduce the adverse effects and mimic the desirable commercial properties – stability and high melting point – of saturated fats. The trans fat era was ushered in by food packages that boldly proclaimed "no tropical oils!" The so-called tropical oils, coconut and palm, had in turn been introduced in the late 1980s to replace highly saturated animal fats. Palm kernel oil and coconut oil are among the very few highly saturated plant oils.
Eventually, and without much help from food labels, the word about "tropical oils" got out. In 1990, the Council on Scientific Affairs of the American Medical Association published a position statement calling for clear disclosure to the public that tropical oils were highly saturated and potentially dangerous.
With the writing on the wall, if not the food package, the creative food industry solution was to invent a new kind of fat.
An industrial process called partial hydrogenation produces trans fat. The trans configuration causes fat molecules to pack closely together, resulting in the desirable commercial properties found in saturated fat. Regrettably, while trans fat reliably extends the shelf life of foods, it clearly shortens the shelf life of people eating those foods – and more so than saturated fat ever did.
The science implicating trans fat in raising the risk of serious chronic disease is essentially ironclad. Numerous research papers and reviews implicate trans fat in raising blood markers of inflammation, adversely affecting blood lipid levels and damaging the lining of blood vessels. Population studies suggest a strong link between trans fat intake and the risk of heart disease, diabetes and cancer. It is, in a word, poison. A slow poison, admittedly, but so are lead, mercury, and arsenic.
As for the misguided tendencies that got us into this mess, here they are in no particular order.
In nutrition, if not more generally, we routinely fail to differentiate baby from bathwater. The introduction of trans fats into the food supply resulted from what increasingly appears to be an excessive fixation on saturated fats in the first place. We recognized harms of diets high in saturated fat and pinned all that harm on the saturated fats rather than the overall dietary pattern.
The evidence was indeed strong that populations eating lots of animal foods and the saturated fats they contained had worse health outcomes than populations eating mostly plants. But the implications of that were that we should all have started eating mostly plants, not that we should have gorged ourselves on Snackwell cookies.
Saturated fat has not been fully exonerated of potential harms by any means, but it is clear both that saturated fats are not all created equal and that we can cut saturated fat and fail to improve our diets.
Similarly, we indicted dietary cholesterol, mistakenly in my opinion, with the apparent result that America now runs on donuts while avoiding eggs – and just look around to tally all the good that's done us!
Diets and foods can offer pros and cons depending on quantity and context. Summary judgments about nutrient classes or food groups that fail to differentiate baby from bathwater have caused years of opportunity to improve public health nutrition to go down the proverbial drain.
The precautionary principle argues that potential harm must be presumed when new exposures are imposed on populations and that the burden of proof resides with demonstrating safety. When trans fat was blithely put into every kind of processed food, we did not have experience with it to know that it would be safe – and had no valid reason for assuming it would be.
The warm welcome trans fat received into our pantries was born of market forces, not public interest. The abundant experience we have with the unintended consequences of food supply trends in the modern era argues strongly against waiving the precautionary principle.We have done so repeatedly, alas, and to our collective detriment every time.
We became preoccupied with saturated fat, replaced it and got fatter and sicker. We became preoccupied with carbs, cut those and got fatter and sicker.
We became so preoccupied with sugar that when it was first introduced, high-fructose corn syrup was thought to be an improvement, even as it has now evolved into something of a scapegoat. There is a basic way of eating well and lots of ways to eat badly – and we keep inventing more of the latter. The trans fat boondoggle replicated, and propagated, the follies of recent nutrition history.
Hearing that your LDL cholesterol value is perfect would be of little comfort if you were on a gurney in the emergency department following a gunshot or car crash. With health, it's the big picture that matters, and no single metric can capture it. The same is true of nutritional quality. Pure trans fat is both cholesterol and fructose free; so what? Fructose is trans fat free for that matter.
We have focused far too excessively on single nutrient properties and missed the dietary forest for the trees again and again. Even health care professionals have propagated this "one nutrient at a time," or ONAAT fallacy, with endocrinologists warning their diabetic patients away from sugar and cardiologists warning about saturated fat and cholesterol.
The truth is, and always was, that wholesome foods making up a healthful diet tend to be good for us all, no matter what does or might ail us, and that foods can avoid any given nutrient and still be junk. Health, and nutrition, are holistic – or devolve into nonsense.
Given where we are now with trans fat, it may stun people to recall that in 2006, when New Jersey state Sen. Ellen Karcher proposed a statewide ban on trans fats, she received death threats that made national news. Sen. Karcher was emulating the actions of Tom Frieden, New York City health commissioner at the time and now director of the U.S. Centers for Disease Control and Prevention.
This reaction to the senator's proposal epitomizes yet another impediment to dietary health: polarized ideology. Some of us are so concerned about the intrusion of nannies into our lives that we turn into abject ninnies.
Consider, for instance, if lead improved the texture of ice cream, arsenic made French fries crispier or a dollop of dioxin gave your salad dressing extra zest. Would it be acceptable to add these known poisons to our food? Should you, as the consumer, need to inquire about them at every restaurant?
Like dioxin, trans fat contributes to cancer risk. Like lead, arsenic and mercury, trans fat is a slow poison. Chefs are not permitted to explore the culinary properties of known poisons in their recipes, and nobody seems to be railing against it. Trans fat, quite simply, should be added to the list.
It seems now it will be, but that doesn't mean there won't be resistance to regulation this time, or next. The trans fat experience invites us all to put epidemiology ahead of ideology, to recognize that we can have too little or too much regulation and to consider coming together on a patch of common ground somewhere between nannyism and ninnyhood.
The removal of trans fat from the food supply — a process underway but not yet completed — has the potential to prevent thousands of heart attacks and deaths each year. So yes, the news is good as far as it goes.
But it doesn't go far enough to get us entirely out of the woods, because food formulations and labeling alike still often serve the interests of sellers rather than eaters.
A multigrain bread may or may not be whole grain. An apricot jam may contain more sugar than apricot yet list apricot as the first ingredient because the sugar is divvied up into four different aliases, each one alone less abundant than apricot but substantially more abundant if all added together and just called "sugar."
Low-fat peanut butter may imply a nutritional virtue while staying silent about the fairly copious additions of sugar and salt that make it far less nutritious overall than regular peanut butter. Not only that, but such "pseudo-nutritious" foods tend to cost more, adding insult to injury and propagating the urban legend that you have to spend more to get better nutrition. You don't; but you do need to be able to identify those more nutritious choices in the first place.
For now, we can welcome the beginning of the end of the trans fat era and bid this misadventure in modern food processing good riddance. But the history of recent decades suggests we will need to remain vigilant if we hope to love food that loves us back. While trans fats are going, it's far from clear that true transparency in food labeling is coming any time soon. Until true food and the whole truth about food both prevail, it isn't quite time for champagne and confetti. We are still in the era of "caveat emptor."
Hungry for more? Write to eatandrun@usnews.com with your questions, concerns, and feedback.
David L. Katz, MD, MPH, FACPM, FACP, is a specialist in internal medicine and preventive medicine, with particular expertise in nutrition, weight management, and chronic-disease prevention. He is the founding director of Yale University's Prevention Research Center, and principal inventor of the NuVal nutrition guidance system. Katz was named editor-in-chief of Childhood Obesity in 2011 and is president-elect of the American College of Lifestyle Medicine. His latest book, "Disease Proof: The Remarkable Truth About What Makes Us Well," was released in September.
A paper published in the journal Neuroscience & Biobehavioral Reviews proposed that “food addiction” is a less accurate description of this condition than “eating addiction”. There is little evidence that people who are driven to overeat become dependent on a single ingredient; instead they tend to seek out a range of highly palatable, energy-dense foods, of the kind with which we are now surrounded.
The activation of reward systems in the brain and the loss of impulse control are similar to those involved in dependency on drugs. But eating addiction appears to be more powerful. As the paper notes, in laboratory experiments most rats “will prefer a sweet reward over a cocaine reward”.
Once you become obese, an article in the Lancet this year explains, biological changes lock you into that condition. Fat cells proliferate. The brain becomes habituated to dopamine signalling (the reward pathway), driving you to compensate by increasing your consumption.
If you try to lose weight, the body perceives that it is being starved, and powerful adaptations (such as an increase in metabolic efficiency) try to bounce you back to your previous state. People who manage, against great odds, to return to a normal weight must consume 300 fewer calories per day than those who have never been obese, if they are not to put the weight back on. “Once obesity is established ... bodyweight seems to become biologically stamped in”. The more weight you lose, the stronger the biological pressure to get back to your former, excessive size.
The researchers find that “these biological adaptations often persist indefinitely”: in other words, if you have once been obese, staying slim means sticking to a strict diet for life. The best you can hope for is not a dietary cure, but “obesity in remission”. The only effective, long-term treatment for obesity currently available, the paper says, is bariatric surgery. This can cause a number of grim complications.
I know this statement will be unwelcome. I too hate the idea that people cannot change their circumstances. But the terrible truth is that, except through surgery, for the great majority of sufferers obesity is an incurable disease. In one respect it resembles cancer: the changes in lifestyle that might have prevented it are unlikely to be of use in curing it.
Fat-shaming is worse than useless. Another paper found that the more weight-conscious people are, the more likely they are to overeat: the stress it induces is a trigger for comfort eating. As the Guardian journalist Sarah Boseley points out in her book The Shape We’re In, “the diet industry ... is one of the biggest frauds of our time”. For the obese, temporary reductions in weight will almost inevitably be reversed.
People who are merely overweight, rather than obese (in other words who have abody mass index of 25 to 30) appear not to suffer from the same biochemical adaptations: their size is not “stamped in”. For them, changes of diet and exercise are likely to be effective. But urging obese people to buck up produces nothing but misery.
The crucial task is to reach children before they succumb to this addiction. As well as help and advice for parents, this surely requires a major change in what scientists call “the obesogenic environment” (high-energy food and drinks and the advertising and packaging that reinforces their attraction). Unless children aresteered away from overeating from the beginning, they are likely to be trapped for life.
You might have expected this knowledge to lead to acceptance, empathy and an end to stigmatisation. Fat chance. A fortnight ago, just after the figures mentioned at the top of this article were published, David Cameron announced a review that could lead to obese people being deprived of social security paymentsif they fail to accept “treatment” for their condition.
This review, conducted by Dame Carol Black, has already pre-empted its conclusions: eight times it describes obesity as “treatable”. Really? How? It will consider the case “for linking benefit entitlements to take up of appropriate treatment”. Are Cameron and Black proposing that benefit claimants will be forced to undergo surgery? Or will they be pressed into a useless and punitive dietary regime? These proposals look to me like a transfer of blame for the disease away from food manufacturers and advertisers, and on to those afflicted.
Why do we have an obesity epidemic? Has the composition of the human species changed? Have we suffered a general collapse in willpower? No. The evidence points to high-fat, high-sugar foods that overwhelm the impulse control of children and young adults, packaged and promoted to create the impression that they are fun, cool and life-enhancing. Many are placed in the shops where children are bound to encounter them: around the tills, at grasping height.
The disease will keep ravaging the population (and slowly overwhelm the health service) until these circumstances change. But the government’s sole contribution has been to tear down mandatory controls, replacing them with a voluntary – and therefore useless – “responsibility deal” with manufacturers and retailers.
It allows them to choose whether or not to use the traffic-light system, which is the most effective way of informing people about the likely impact of what they eat. And many corporations, unsurprisingly, choose not to. As far as nutritional content is concerned, food manufacturing is in effect unregulated.
Industry and government will resist the obvious solutions until they can be resisted no longer. Eventually the change will have to happen, with similar restrictions on advertising, sponsorship, display and accessibility to those imposed on the tobacco pedlars. One day, though not before many thousands have needlessly died, it will become illegal to advertise any food or drink that merits a red traffic-light warning. They will be sold only in plain packaging, with health warnings, on high shelves.
Does this seem draconian to you? If so, remember that obesity afflicts a quarter of the adult population, and is rising rapidly. It causes a range of hideous conditions, just one of which – diabetes – accounts for one sixth of NHS admissions and 10% of its budget. In what looking-glass world is this acceptable? If smoking demands fierce intervention, why not overeating?
This is the choice we face: to recognise that the only humane and effective means of addressing the obesity epidemic is to prevent more people from being hooked, by restricting the pushers – or to continue a programme of fat-shaming, bullying and compulsory treatment, whose only likely outcome is unhappiness.
Now ask yourself again: which of these options is draconian?
The story of Flint, Michigan's children being poisoned by lead-contaminated drinking water has, rightly, shocked and scandalized the nation. But while the situation in Flint is certainly an extreme case, the problem is much more widespread than many realize: Children in essentially every city in America are being exposed to hazardous levels of toxic lead, and very little is being done about it.
At the most severe levels, according to the World Health Organization, "lead attacks the brain and central nervous system to cause coma, convulsions, and even death." Thankfully, very little lead poisoning that severe is happening in the United States. But lead's impact on the brain — particularly the developing brains of children and fetuses — is severe and systematic, "resulting in reduced [IQ], behavioral changes such as shortening of attention span and increased antisocial behavior, and reduced educational attainment."At least mild versions of these impacts are felt at even low levels of exposure "that cause no obvious symptoms and that previously were considered safe."
The CDC recommends follow-up and intervention for kids who have more than 10 micrograms of lead per deciliter of blood. But this is basically just a nice round number that leads to the happy conclusion that most kids' brains aren't being poisoned by lead. The underlying science offers the much less reassuring conclusion that any amount of lead is harmful and tons of kids are ingesting more lead than they should:
Neurological research is demonstrating that lead's effects are even more appalling, more permanent, and appear at far lower levels than we ever thought. For starters, it turns out that childhood lead exposure at nearly any level can seriously and permanently reduce IQ. Blood lead levels are measured in micrograms per deciliter, and levels once believed safe—65 μg/dL, then 25, then 15, then 10—are now known to cause serious damage. The EPA now says flatly that there is "no demonstrated safe concentration of lead in blood," and it turns out that even levels under 10 μg/dL can reduce IQ by as much as seven points. An estimated 2.5 percent of children nationwide have lead levels above 5 μg/dL.
So maybe 5 is the new 10? No such luck.
Braun et al. find that within the range of 2 and 5 micrograms of lead per deciliter, more blood lead is associated with higher levels of ADHD.
Then Nigg et al. studied a population with blood levels "slightly below United States and Western Europe population exposure averages, with a mean of 0.73 and a maximum of 2.2 μg/dL," and found that even at this range, more lead means more ADHD.
Our scientific understanding of this issue is limited by the fact that it's hard to chemically detect very low levels of lead in the blood. But to the extent that scientists have been able to study low levels of lead exposure, they have found that there is no safe point. More lead is always worse, and the level of blood lead enjoyed by the typical American child is at least somewhat hazardous.
Urban soil lead contamination is woefully understudied
The main thing we know about non-catastrophic lead in the United States is that the biggest problem is inner-city soil contaminated by decades-old gasoline. Gas went unleaded in the mid-1970s, but all the old lead burned in the past was dumped into the air and then fell back to earth. The tiny lead particles don't biodegrade. They mix in with the soil, get tracked into houses, and, most of all, end up on the hands and toys of little kids, who have a marked tendency to stick anything and everything into their mouths, leading to the ingestion of lead.
This lead is everywhere, but it's most heavily concentrated in places that were close to a lot of vehicle traffic during the leaded gasoline days — in other words, the centers of big cities.
But there's very little systematic research on the lead situation in most cities. An exception is New Orleans, which happens to benefit from proximity to one of America's leading lead researchers, Tulane's Howard Mielke. Here's what he found:
But most cities are not blessed to have local researchers and comprehensive studies. If you're lucky, what's happened is that someone noticed the recent urban farming trend and decided to look into how much heavy metal contamination there is in the local food supply. Here's a look at DC's community gardens:
Only the Stadium-Armory level of lead contamination is at a truly alarming level. But all the central city locations studied — including Capitol Hill, Dupont Circle, and LeDroit Park — exceed the Norwegian government standard of roughly 100 parts per million of lead in soil.
Brooklyn, it turns out, is basically a gigantic toxic wasteland. And the problem in these cities probably isn't limited to community gardens — there's all kinds of old dirt in parks, backyards, and other places. And though certain kinds of plants grown in metal-contaminated soils can be particularly damaging, lead-contaminated soil really shouldn't be seen as primarily an agricultural concern. The dirt and dust on their own manage to work their way into kids' mouths.
Nobody is really doing much about this
The good news about Flint, such as it is, is that the presence of excessive quantities of lead in municipal drinking water is treated as a genuine scandal and an emergency. The presence of excessive quantities of lead in urban soil, by contrast, is something we are essentially shrugging at as a society.
The District of Columbia's Department of Energy and Environment, for example, offers the official advice to parents of young children that "it’s best to cover any bare soil" in your backyard because children "get lead-contaminated dirt under their fingernails, and dogs can roll around and bring the lead-contaminated dirt into the home."
But this is rather quiet and obscure advice, and there's certainly no citywide program to cover up backyards everywhere with impermeable surfaces. The Department of Parks and Recreation has thoughtfullycovered up the soil in the city's playgrounds so kids don't play in contaminated dirt. But many of the city's parks, like the one in Logan Circle a few blocks from my house, are among the many urban parks in the city operated by the National Park Service, which neither covers its soil nor tests it for lead.
Having urban parks that are unsafe for children to play in seems generally ill-advised, but there's also no publicity or signage to indicate that the seemingly wholesome activity of kids rolling around in the dirt might be harmful.
People who reported eating fast food in the last 24 hours had elevated levels of some industrial chemicals in their bodies, according to a new analysis of data from federal nutrition surveys. The study is the first broad look at how fast food may expose the public to certain chemicals, called phthalates, that are used to make plastics more flexible and durable. The chemicals, which don’t occur in nature, are common in cosmetics, soap, food packaging, flooring, window blinds, and other consumer products. The Centers for Disease Control says "phthalate exposure is widespread in the U.S. population." Though the health consequences of encountering these substances aren’t fully known, scientists have increasingly focused on their effects on health and development, particularly for pregnant women and children. Research in rats has shown that they can disrupt the male reproductive system, and there’s evidence for similar effects in humans.
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