Saturday, March 24, 2012

Social Network Medicine is a Bad Idea


I like social networking as much as the next person and as an "early
adopter" medical blogger no one can accuse me of not being dialed
into "The World Wide Web" or "The Facebook". But my embracing of mobile
health stops when I read about a new start up that was mentioned in the
New York Times this week. HealthTap is a concept that I hope doesn't
make it. HealthTap is a start-up based in

ICD-10 To Be Delayed Indefinitely--Never Mind!


After years of telling us they are serious this time and everyone in the health care system had better be ready on time to implement the new disease coding system, CMS said today the whole project is going to be delayed indefinitely.The new ICD-10 system requires payers and providers to convert from the old system of 13,000 codes to the new system of 68,000 codes.All payers and providers were

First Aid for Car Crashes


A big crash happened right in front of me today while I was at a stop
light. The sound of crunching metal and screeching brakes is truly
frightening and it was clear help would be needed. I crossed the
intersection and parked my car and ran across the street to see if I
could help. Surprisingly, the man driving the car that was hit was not
hurt. The young woman in the car that struck him

Dark Spots in Eye and Skin


I must admit, being a physician, I notice unusual skin changes where
ever I go and I'm fascinated with the variety of conditions I see.
Thanks to the Captain of our snorkeling trip in Hawaii for allowing
these photos of his congenital condition called Nevus of Ota.
(Originally described by Ota and Tanino in 1939). As you can see, there
is a gray or blueish patch on the skin around the eye

Qnexa, the Latest FDA Approved Obesity Drug


There are very few obesity drugs currently approved for use in the US-- not because effective drugs don't exist, but because the FDA has judged that the side effects of existing drugs are unacceptable. 

Although ultimately I believe the most satisfying resolution to the obesity epidemic will not come from drugs, drugs offer us a window into the biological processes that underlie obesity and fat loss.  Along those lines, here's a quote from a review paper on obesity drugs that I think is particularly enlightening (1):
Read more »

Speaking at AHS12


I'll be giving a 40 minute presentation at the Ancestral Health Symposium this summer titled "Digestive Health, Inflammation and the Metabolic Syndrome".  Here's the abstract:
The “metabolic syndrome” is a cluster of health problemsincluding abdominal obesity, insulin resistance, low-grade inflammation, highblood pressure and blood lipid abnormalities that currently affects one thirdof American adults.  It is thequintessential modern metabolic disorder and a major risk factor for diabetes,heart disease and certain cancers.  Thistalk will explore emerging links between diet, gut flora, digestive health andthe development of the metabolic syndrome. The audience will learn about factors that may help maintain digestiveand metabolic health for themselves and the next generation.
Excessive fat mass is an important contributor to the metabolic syndrome, but at the same level of body fatness, some people are metabolically normal while others are extremely impaired.  Even among obese people, most of whom have the metabolic syndrome, about 20 percent are metabolically normal, with normal fasting insulin and insulin sensitivity, normal blood pressure, normal circulating inflammatory markers, and normal blood lipids.

What determines this?  Emerging research suggests that one factor is digestive health, including the bacterial ecosystem inside each person's digestive tract, and the integrity of the gut barrier.  I'll review some of this research in my talk, and leave the audience with actionable information for maintaining gastrointestinal and metabolic health.  Most of this information will not have been covered on this blog.

The Ancestral Health Symposium will be from August 9-12 at Harvard Law School in Boston, presented in conjunction with the Harvard Food Law society.  Tickets are currently available-- get them before they sell out!  Last year, they went fast.

See you there!

Food Reward: Approaching a Scientific Consensus


Review papers provide a bird's-eye view of a field from the perspective of experts.  Recent review papers show that many obesity researchers are converging on a model for the development of obesity that includes excessive food reward*, in addition to other factors such as physical inactivity, behavioral traits, and alterations in the function of the hypothalamus (a key brain region for the regulation of body fatness).  Take for example the four new review papers I posted recently by obesity and reward researchers:
Read more »

Pseudo-Evidence Based Medicine Should be a Global Health Concern


We have frequently advocated for evidence-based medicine (EBM) , that is, medicine based on judicious use of the best available evidence from clinical research, critically reviewed and derived from systematic search, combined with biomedical knowledge and understanding of patients' values and preferences.  However, EBM risks being turned into pseudo-evidence based medicine due to systematic manipulation and distortion of the clinical research evidence base.  Dr Wally Smith wrote about pseudo-evidence based medicine, which he defined as "the practice of medicine based on falsehoods that are disseminated as truth," in the British journal Clinical Governance (Smith WR. Pseudoevidence-based meidicne: what it is, and what to do about it. Clinical Governance 2007; 12: 42-52. Also see this post).  

Now it appears that this issue is causing concern in the Cochrane Collaboration, the main voluntary international group promoting EBM.  An article from December, 2011 in the Indian Journal of Medical Ethics outlined why we need to question the trustworthiness of the global clinical evidence base.  (See Tharyan P. Evidence-based medicine: can the evidence be trusted.  Ind J Med Ethics 2011; 8: 201-207.  Link here.)  It merits further review.

The Role of Vested Interests

Dr Tharyan, its author, emphasized that a major threat to the integrity of the clinical research data base is the influence on clinical research of those with vested interests in marketing particular products, e.g., drugs, devices, etc.
The motives for conducting research are often determined by considerations other than the advancement of science or the promotion of better health outcomes. Many research studies are driven by the pressure to obtain post-graduate qualifications, earn promotions, obtain tenured positions, or additional research funding; many others are conducted for financial motives that benefit shareholders, or lead to lucrative patents.

The Importance of Pervasive Conflicts of Interest

Early on, the author discussed how the distortion of the clinical research data base arises from the pervasive web of conflicts of interest in medicine and health care:
This hijacked research agenda perpetuates further research of a similar nature that draws more researchers into its lucrative embrace, entrenching the academic direction and position statements of scientific societies and academic associations. Funders and researchers are also deterred from pursuing more relevant research, since the enmeshed relationship between academic institutions and industry determines what research is funded (mostly drugs at the expense of other interventions), and even how research is reported; thus hijacking the research agenda even further away from the interests of science and society.


The article then goes on to show how the influence of vested interests may distort the design, implementation, analysis, and dissemination of research.

Distortion of Research Design and Implementation

The Research Question

Dr Tharyan noted
The majority of clinical trials conducted world-wide are done to obtain regulatory approval and a marketing licence for new drugs. These regulations often require only the demonstration of the superiority of a new drug over placebo and not over other active interventions in use. It is easier and cheaper to conduct these trials in countries with lower wages, lax regulatory requirements, and less than optimal capacity for ethical oversight. It is therefore not surprising that the focus of research does not reflect the actual burden of disease borne by people in the countries that contribute research participants, nor address the leading causes of the global burden of disease. Some 'seeding' trials, conducted purportedly for the purpose of surveillance for adverse effects, are often only a ploy to ensure brand loyalty among participating clinician-researchers.

Insufficient Sample Size

The article stated,
Many trials do not report calculations on which the sample size was estimated, often leading to sample sizes insufficient to detect even important differences between interventions (for primary, let alone secondary outcomes)

I would add that such small trials are particularly bad at detecting important adverse effects of the interventions being promoted.

Excessively Stringent Enrollment Criteria

As Dr Tharyan wrote,
Most RCTs funded by industry and academia are designed to demonstrate if a new drug works, for licensing and marketing purposes. In order to maximise the potential to demonstrate a 'true' drug effect, homogenous patient populations; placebo controls; very tight control over experimental variables such as monitoring, drug doses, and compliance; outcomes addressing short term efficacy and safety; and methods to minimise bias required by regulatory agencies are used to demonstrate if, and how, the drug works under ideal conditions.

The problem is that very few patients in clinical practice resemble those enrolled in such trials, so the generalizability of the trials' results is actually dubious. Ideally, clinicians practicing evidence-based medicine could refer to trials that include patients similar to those for whom they care.
Practical or pragmatic clinical trials are designed to provide evidence for clinicians to treat patients seen in day-to day clinical practice, and evaluate their effectiveness under 'real-world' conditions. These trials use few exclusion criteria and include people with co-morbid conditions, and all grades of severity. They compare active interventions that are standard practice, and in the flexible doses and levels of compliance seen in usual practice. They utilise outcomes that clinicians, patients, and their families consider important, such as satisfaction, adverse events, return to work, and quality of life). Recommendations exist on their design and reporting , but such trials are rare.

Comparisons to Placebo, not the Other Interventions Clinicians Might Realistically Consider

Per the article,
Industry sponsored trials rarely involve head-to head comparisons of active interventions, particularly those from other drug companies, thus limiting our ability to understand the relative merits of different interventions for the same condition.

The result may thus be a number of studies showing particular interventions appear to be better than nothing, but few if any studies that would help clinicians decide which intervention would be best for a particular patient.

Inappropriate Comparators

However,when studies are done comparing the intervention of interest to other active interventions, the details of the choice of comparators are often managed so that the comparators are likely to appear to be worse.
Even if active interventions are compared in industry-sponsored trials, the research agenda has devised ways in which the design of such trials is manipulated to ensure superiority of the sponsor’s drug. If one wants to prove better efficacy, then the comparator drug is a drug that is known to be less effective, or used in doses that are too low, or used in non-standard schedules or duration of treatment. If one wants to show greater safety, then the comparator is a drug with more adverse effects, or one that is used in toxic doses. Follow up, also, is typically too short to judge effectiveness over longer periods of time.

Meaningless Outcomes

A favorite tactic used in the design of trials influenced by vested interests is to choose outcomes that are likely to show results favorable to the product being promoted, but have no meaning for patients or clinicians. There are three ways this is commonly done.

The first is to use rating scales that are very sensitive to small perturbations, but not meaningful in terms of how patients feel or function:
The choice of outcome measures used often ensures statistically significant results in advance, at the expense of clinically relevant or clinically important results. Outcomes likely to yield clinically meaningless results include the use of rating scales (depression, pain, etc.). These scales yield continuous measures usually summarised by means and standard deviations, rather than the dichotomous measures clinicians use such as: clinically improved versus not improved. These rating scales, however extensively validated, are hardly ever used in routine clinical practice. A difference of a few points on these scales results in statistically significant differences (low p values), that have little clinical significance to patients.

Another is to use surrogate outcomes,

Thursday, March 22, 2012

Image Challenge

What is the diagnosis? You be the doctor. This 32 year old man wonders
about the raised spots on his testicles. They are non-tender and non
itchy. (click on the image for a close-up view) 1. Beta-galactosidase
deficiency 2. Fordyce's angiokeratomas 3. Radiation dermatitis 4.
Scabes 5. Varicocele The answer will be posted tomorrow so be sure to
check back. Make your guess in the

Wednesday, March 21, 2012

Goal Play Leadership Lessons

My blog friend, Paul Levy, former CEO at Beth Israel Deaconess Medical
Center in Boston, was the first hospital CEO to create a blog ("Running
a Hospital") that became famous for it's honesty and look into a
hospital's inner workings. He is now embarking on the next chapter of
his life with the publication of his new book," Goal Play - Leadership
Lessons from the Soccer Field." Who knew

Sunday, March 18, 2012

How Doctors Get Paid

Medical economics is more confusing than "advanced derivatives" and the
entire banking industry collapse. Have you ever wondered how doctors
get paid? I will try to give a brief tutorial. Consider it "Doctor
Reimbursement 101". First of all, all payments made by Medicare or
Insurance companies are based on a weird rating called the Relative
Value Scale. A group of mainly specialty

Friday, March 9, 2012

Boing!

I just had a featured article published on Boing Boing, "Seduced by Food: Obesity and the Human Brain".  Boing Boing is the most popular blog on the Internet, with over 5 million unique visitors per month, and it's also one of my favorite haunts, so it was really exciting for me to be invited to submit an article.  For comparison, Whole Health Source had about 72,000 unique visitors last month (200,000+ hits).

The article is a concise review of the food reward concept, and how it relates to the current obesity epidemic.  Concise compared to all the writing I've done on this blog, anyway.  I put a lot of work into making the article cohesive and understandable for a somewhat general audience, and I think it's much more effective at explaining the concept than the scattered blog posts I've published here.  I hope it will clear up some of the confusion about food reward.  I don't know what's up with the image they decided to use at the top. 

Many thanks to Mark Frauenfelder, Maggie Koerth-Baker, and Rob Beschizza for the opportunity to publish on Boing Boing, as well as their comments on the draft versions!

For those who have arrived at Whole Health Source for the first time via Boing Boing, welcome!   Have a look around.  The "labels" menu on the sidebar is a good place to start-- you can browse by topic.

Thursday, March 8, 2012

Will the Pace of Innovative Change Overtake the Financial Imperative to Slash Spending?

I thought it was worth passing along the comments by Jim Tallon, president of New York's United Hospital Fund, in a recent post.Tallon reflected on an international meeting he attended with health care leaders from a number of industrial nations--"nations whose health care systems, indeed underlying philosophies, ranged from market orientation through hybrids to government authority:" "Across

Tuesday, March 6, 2012

Electronic Health Records Don't Cut Costs

A new study was published in the Journal Health Affairs that reports
computerized patient records are unlikely to cut health care costs and
might encourage doctors to order more expensive tests. Save your
research dollars, Health Affairs...I could have told you that! The
electronic health record gives doctors information about the patient
instantly and helps coordinate care between

Sunday, March 4, 2012

Saturday, March 3, 2012

Spam Comments on EverythingHealth

Dear Readers, I am seeing more and more comments on EverythingHealth
that are not real but are simply there to drive readers to commercial
webpages, advertisers or porn. All bloggers love comments and the
dialog that goes with social media. That is why we blog and I never
delete controversial comments or criticisms. Most commenters are
respectful and very thoughtful and I learn a lot from

Tweet

I've decided, on the sage advice of a WHS reader, to join the world of Twitter.  I'll be using it to announce new posts, as well as communicating papers that I find interesting, but either don't have time to blog about or think are too technical for a general audience.  My tag is "whsource".  Head on over to Twitter if you want to follow my tweets.

Thursday, March 1, 2012

Embezzlement in Doctors Offices

I just read an article that talked about more medical practices being
victims of embezzlement. In a 2009 survey of members of the Medical
Group Management Association (MGMA), 83% of 945 respondents said they
had been the victim of employee theft. I guess this means I can come
out of the closet now. I have always been ashamed that my practice of 5
Internal Medicine doctors was embezzeled by

Tuesday, February 28, 2012

Palatability, Satiety and Calorie Intake

WHS reader Paul Hagerty recently sent me a very interesting paper titled "A Satiety Index of Common Foods", by Dr. SHA Holt and colleagues (1).  This paper quantified how full we feel after eating specific foods.  I've been aware of it for a while, but hadn't read it until recently.  They fed volunteers a variety of commonly eaten foods, each in a 240 calorie portion, and measured how full each food made them feel, and how much they ate at a subsequent meal.  Using the results, they calculated a "satiety index", which represents the fullness per calorie of each food, normalized to white bread (white bread arbitrarily set to SI = 100).  So for example, popcorn has a satiety index of 154, meaning it's more filling than white bread per calorie. 

One of the most interesting aspects of the paper is that the investigators measured a variety of food properties (energy density, fat, starch, sugar, fiber, water content, palatability), and then determined which of them explained the SI values most completely.

Read more »

Monday, February 27, 2012

Soda-Free Sunday

Last Thursday, I received a message from a gentleman named Dorsol Plants about a public health campaign here in King County called Soda Free Sunday.  They're asking people to visit www.sodafreesundays.com and make a pledge to go soda-free for one day per week. 

Drinking sugar-sweetened beverages (SSBs), including soda, is one of the worst things you can do for your health.  SSB consumption is probably one of the major contributors to the modern epidemics of obesity and metabolic dysfunction.

I imagine that most WHS readers don't drink SSBs very often if at all, but I'm sure some do.  Whether you want to try drinking fewer SSBs, or just re-affirm an ongoing commitment to avoid them, I encourage you to visit www.sodafreesundays.com and make the pledge.  You can do so even if you're not a resident of King county.

Sunday, February 26, 2012

"Five Myths About Medicare"

I recommend you read John Rother's recent op-ed in the Washington Post, "Five Myths About Medicare."John argues that each of these statements is a myth:Medicare is inefficient and fails to control costs--the CBO has projected that per capita spending will grow only 1% more than inflation over the next decade.The well-off don't pay enough for their Medicare benefits--working age premiums as well

Overuse of Cardiac Stents

One of my patients is in the hospital in another city (where he lives
part of the year) after suffering a GI bleed. He had a black stool, had
lost blood, was quite anemic and experienced weakness and chest
tightening before he came to the ER. In the emergency room his
Cardiologist was called and admitted him under the cardiology service.
When I called the Cardiologist to identify myself as

Wednesday, February 22, 2012

Is Sugar Fattening?

Buckle your seat belts, ladies and gentlemen-- we're going on a long ride through the scientific literature on sugar and body fatness.  Some of the evidence will be surprising and challenging for many of you, as it was for me, but ultimately it paints a coherent and actionable picture.

Read more »

Saturday, February 18, 2012

By 2606, the US Diet will be 100 Percent Sugar

The US diet has changed dramatically in the last 200 years.  Many of these changes stem from a single factor: the industrialization and commercialization of the American food system.  We've outsourced most of our food preparation, placing it into the hands of professionals whose interests aren't always well aligned with ours.

It's hard to appreciate just how much things have changed, because none of us were alive 200 years ago.  To help illustrate some of these changes, I've been collecting statistics on US diet trends.  Since sugar is the most refined food we eat in quantity, and it's a good marker of processed food consumption, naturally I wanted to get my hands on sugar intake statistics-- but solid numbers going back to the early 19th century are hard to come by!  Of all the diet-related books I've read, I've never seen a graph of year-by-year sugar intake going back more than 100 years.

A gentleman by the name of Jeremy Landen and I eventually tracked down some outstanding statistics from old US Department of Commerce reports and the USDA: continuous yearly sweetener sales from 1822 to 2005, which have appeared in two of my talks but I have never seen graphed anywhere else*.  These numbers represent added sweeteners such as cane sugar, high-fructose corn syrup and maple syrup, but not naturally occurring sugars in fruit and vegetables.  Behold:

Read more »

Tuesday, February 14, 2012

Blogger Break

EverythingHealth will be taking our own advice and renewing the spirit
and soul for the next week. Check out the links on the right side for
great blog reading and be sure to check back for more exciting health
news in a week. Aloha!

Sunday, February 12, 2012

Avoid Obesity and Let Babies Eat With Their Hands

Babies who feed themselves with their fingers chose less sugar and were
less likely to become obese than spoon fed babies, according to a study
in the British Medical Journal Open. It was a small study based on
recollection, but the findings were still interesting and give us clues
about how children self regulate food. When babies start eating solid
food, parents often offer sweetened baby

Saturday, February 11, 2012

Cigarette Smoking-- Another Factor in the Obesity Epidemic

Obesity rates in the US have more than doubled in the last 30 years, and rates of childhood obesity and extreme adult obesity have tripled.  One third of US adults are considered obese, and another third overweight.  This is the "obesity epidemic".

The obesity epidemic has coincided with significant changes in the US diet, which are clearly involved.  However, there's another probable contributor that's often overlooked: declining smoking rates.  

Here's a graph of cigarette consumption over the last century in the US (1):
Read more »

Friday, February 10, 2012

There is No Free Lunch and There is No Free Contraception

The otherworldy Obama Administration solution to the contraception firestorm might work politically but it makes no sense in the real world.The President, hoping to quell a growing political firestorm, today announced a new policy that no longer requires religiously affiliated organizations to provide employees with contraception coverage in health-insurance plans.Under the new policy, insurance

Wednesday, February 8, 2012

Alternatives to Komen Foundation

Sometimes my fellow health bloggers get it so right...the best thing I
can do for my readers is steer them to another blog. And that is what I
am doing. The Blog That Ate Manhattan is written by Dr. P. and she did
a great job of pointing out that we can still donate to the fight
against breast cancer, now that the Komen Foundation has shown their
true political leanings. That debacle will

Dismantling the Affordable Care Act: The Obama Supreme Court Argument + 51 Republican Senators

I have no idea which way the Supreme Court will rule this year on the Affordable Care Act. Let me go out on a limb and predict a 5-4 vote on the question of whether the individual mandate is Constitutional. Just don’t ask me which way the vote goes.I found the recent Obama administration brief submitted to the Court on the mandate question somewhat ironic. Not surprisingly, the Obama Justice

Monday, February 6, 2012

My TEDx Talk, "The American Diet: a Historical Perspective"

On October 21st, I spoke at the Harvard Food Law Society's TEDx conference, Forum on Food Policy.  The conference kicked off with three talks on nutrition, by Drs. Walter Willett, David Ludwig and myself.  My talk is only 17 minutes long as per TED format, but it's packed with research on both quantitative and qualitative changes in the US diet over the last two centuries.  It contains surprises for almost anyone, and I can guarantee you've never learned this much about the history of the US diet in 17 minutes.  The talk was titled "The American Diet: a Historical Perspective"; you can access it by following that link.

Read more »

Medicare Advantage Premiums Drop an Average of 7% and Enrollment up 10%—That Must Make Republicans Just Want to Cry

Medicare Advantage would appear to be a fantastic success—senior premiums are dropping and enrollment is increasing.Listening to Health and Human Services Secretary Sebelius last week, you would think private Medicare plans were a Democratic idea and this is their success. Many industry observers, including me, have worried that Medicare Advantage benefits would shrink and premiums would rise

Saturday, February 4, 2012

An Interview with Dr. C. Vicky Beer, Paleo-friendly MD

As I was preparing my recent article on the Paleo diet (1), I interviewed a local Paleo-friendly MD named C. Vicky Beer.  I was only able to include a snippet of the interview in the article, but I thought WHS readers would be interested to read the rest of the interview with Dr. Beer:

Read more »

Polio Survivors

Poliomyelitis is a contagious viral disease that affects nerves and can
lead to paralysis. Most people under the age of 50 don't know that
polio was once an epidemic that killed and paralyzed millions of people
between 1840 and the 1950's. It was one of the most feared infections
world wide. Modern polio vaccination has almost wiped out the disease.
It is rare for physicians in the

Wednesday, February 1, 2012

Concussion Management

It's football, soccer and ice-hockey season and that means concussions.
Concussion is a mild traumatic brain injury that is the result of a
blow to the head. It is so common that over 1 million visits annually
to emergency rooms are for concussions. And most people don't even go
to the emergency room so it is estimated that 3 times as many occur as
are reported. Sports related activities

Animal Theory, Going Feral in 2012

Since the late 1970s, scholarship in the field of human and nonhuman animal relations--a development of animal, environmental, and social liberation movements--has significantly developed, testing the limits of the humanism and liberalism that gave birth to it. In the 1980s and 90s, philosophers, historians, sociologists, anthropologists, feminists, socialists, and literary theorists have contributed to this academic and cultural project. Research in human and non-human animal relations has particularly come into vogue in the last decade. This new literature developed out of increasing interdisciplinary as well a younger generation with more radical political ambitions, those who were dissatisfied with the presuppositions and/or simplicity of earlier theory.

Below are a few lists of books published between 2010 and 2012 that I would love to read by the end of the year; books such as Zoopolis which re-conceptualizes interspecies ethics as interspecies justice, Critical Theory and Animal Liberation which organizes the most sophisticated collection of critical animal studies theory to date, Creaturely Poetics which articulates a movement in animal ethics away from reason and power toward vulnerability, and Social Lives with Other Animals which investigates the social formation of species identity within the particular intersections of oppression. Animalkind, Beyond Animal Rights, and Animal Ethics in Context further challenge the traditional and universal morality espoused by animal advocates for more nuanced considerations that are far from self-certain. And if these books aren't tricky enough, the first philosophy book entirely dedicated to the moral considerability of plants, Plants as Persons, is bound to give the zoocentrist a run for her money.

Tim Tyler's book CIFERAE and Dominic Pittman's Human Error, and Boddice's Anthropocentrism add further complexity to our understanding of our humanity and the hegemony of anthropocentrism while Pat Shippman and Hal Herzog explore the myths of human-animal relationships with the latest empirical research in anthropology and psychology. Then there is Meat, Animals and Public Health, and Animals as Biotechnology which offer meditations on the relationship between our treatment of animals and the intersections of human, animal, and ecological health. Last but not least, I'm majorly anticipating Kari Weil's Thinking Animals, which seems like it will provide the greatest synthesis of human-animal studies yet published.



If you are interested in contributing a book summary and review to be posted on this blog, please send me an email or comment below.

NEW DIRECTIONS IN ANIMAL ETHICS / JUSTICE:
Zoopolis: A Political Theory of Animal Rights (Sue Donaldson, Will Kymlicka, 2012)
Zoopolis offers a new agenda for the theory and practice of animal rights. Most animal rights theory focuses on the intrinsic capacities or interests of animals, and the moral status and moral rights that these intrinsic characteristics give rise to. Zoopolis shifts the debate from the realm of moral theory and applied ethics to the realm of political theory, focusing on the relational obligations that arise from the varied ways that animals relate to human societies and institutions. Building on recent developments in the political theory of group-differentiated citizenship, Zoopolis introduces us to the genuine "political animal". It argues that different types of animals stand in different relationships to human political communities. Domesticated animals should be seen as full members of human-animal mixed communities, participating in the cooperative project of shared citizenship. Wilderness animals, by contrast, form their own sovereign communities entitled to protection against colonization, invasion, domination and other threats to self-determination. `Liminal' animals who are wild but live in the midst of human settlement (such as crows or raccoons) should be seen as "denizens", resident of our societies, but not fully included in rights and responsibilities of citizenship. To all of these animals we owe respect for their basic inviolable rights. But we inevitably and appropriately have very different relations with them, with different types of obligations. Humans and animals are inextricably bound in a complex web of relationships, and Zoopolis offers an original and profoundly affirmative vision of how to ground this complex web of relations on principles of justice and compassion.



Critical Theory and Animal Liberation (John Sabonmatsu, 2011)
Critical Theory and Animal Liberation is the first collection to approach our relationship with other animals from the critical or 'left' tradition in political and social thought. Breaking with past treatments that have framed the problem as one of 'animal rights,' the authors instead depict the exploitation and killing of other animals as a political question of the first order. The contributions highlight connections between our everyday treatment of animals and other forms of social power, mass violence, and domination, from capitalism and patriarchy to genocide, fascism, and ecocide. Contributors include well-known writers in the field as well as scholars in other areas writing on animals for the first time. Among other things, the authors apply Freud's theory of repression to our relationship to the animal, debunk the 'Locavore' movement, expose the sexism of the animal defense movement, and point the way toward a new transformative politics that would encompass the human and animal alike.


Creaturely Poetics: Animality and Vulnerability in Literature and Film (Anat Pick, 2011)
Simone Weil once wrote that “the vulnerability of precious things is beautiful because vulnerability is a mark of existence,” establishing a relationship between vulnerability, beauty, and existence transcending the separation of species. Her conception of a radical ethics and aesthetics could be characterized as a new poetics of species, forcing a rethinking of the body’s significance, both human and animal. Exploring the “logic of flesh” and the use of the body to mark species identity, Anat Pick reimagines a poetics that begins with the vulnerability of bodies, not the omnipotence of thought. Pick proposes a “creaturely” approach based on the shared embodiedness of humans and animals and a postsecular perspective on human-animal relations. She turns to literature, film, and other cultural texts, challenging the familiar inventory of the human: consciousness, language, morality, and dignity. Reintroducing Weil’s elaboration of such themes as witnessing, commemoration, and collective memory, Pick identifies the animal within all humans, emphasizing the corporeal and its issues of power and freedom. In her poetics of the creaturely, powerlessness is the point at which aesthetic and ethical thinking must begin.


Social Lives with Animals: Tales of Sex, Death and Love (Erika Cudworth 2011)
The conventional trilogy of social domination, of class, 'race' and gender has been challenged by new concerns around other distinctions – of place and location, age and generation, sexuality and forms of embodied difference. Despite these important developments, sociology has mostly stopped short at the difference of species. Erika Cudworth draws on various traditions of critical theorizing in sociology and animal studies in arguing that the social is not exclusively human and that species should be understood as a complex system of social domination which is co-constituted with intra-human social dominations. This understanding of species as a social system of relations is exemplified through three case studies: the eating of animals as food, the rearing of animals in industrial agriculture and the keeping of animals as companions. These sites reveal ways in which relations of species domination shape the lives both of humans, and of domesticated animals. Social Lives with Other Animals is a critical sociology of species which takes us beyond theories of speciesism or anthropocentricity and presents a necessary challenge to the power relations in the social formations of species.


Animalkind: What We Owe to Animals (Jean Kazez, 2010)
By exploring the ethical differences between humans and animals, Animalkind establishes a middle ground between egalitarianism and outright dismissal of animal rights. A thought-provoking foray into our complex and contradictory relationship with animals. Advocates that we owe each animal due respect. Offers readers a sensible alternative to extremism by speaking of respect and compassion for animals, not rights. Balances philosophical analysis with intriguing facts and engaging tales


Beyond Animal Rights: Food, Pets, and Ethics (Tony Milligan, 2010)
Issues to do with animal ethics remain at the heart of public debate. In "Beyond Animal Rights," Tony Milligan goes beyond standard discussions of animal ethics to explore the ways in which we personally relate to other creatures through our diet, as pet owners and as beneficiaries of experimentation. The book connects with our duty to act and considers why previous discussions have failed to result in a change in the way that we live our lives. The author asks a crucial question: what sort of people do we have to become if we are to sufficiently improve the ways in which we relate to the non-human? Appealing to both consequences and character, he argues that no improvement will be sufficient if it fails to set humans on a path towards a tolerable and sustainable future. Focusing on our direct relations to the animals we connect with the book offers guidance on all the relevant issues, including veganism and vegetarianism, the organic movement, pet ownership, and animal experimentation


Animal Ethics in Context (Clare Palmer, 2011)
It is widely agreed that because animals feel pain we should not make them suffer gratuitously. Some ethical theories go even further: because of the capacities that they possess, animals have the right not to be harmed or killed. These views concern what not to do to animals, but we also face questions about when we should, and should not, assist animals that are hungry or distressed. Should we feed a starving stray kitten? And if so, does this commit us, if we are to be consistent, to feeding wild animals during a hard winter? In this controversial book, Clare Palmer advances a theory that claims, with respect to assisting animals, that what is owed to one is not necessarily owed to all, even if animals share similar psychological capacities. Context, history, and relation can be critical ethical factors. If animals live independently in the wild, their fate is not any of our moral business. Yet if humans create dependent animals, or destroy their habitats, we may have a responsibility to assist them. Such arguments are familiar in human casesùwe think that parents have special obligations to their children, for example, or that some groups owe reparations to others. Palmer develops such relational concerns in- the context of wild animals, domesticated animals, and urban scavengers, arguing that different contexts can create different moral relationships.


WHAT IT MEANS TO BE HUMAN:
CIFERAE: A Bestiary in Five Fingers (Tim Tyler, 2012)
In this bold and creative new investigation into the philosophical and intellectual parameters of the question of the animal, Tom Tyler explores a curious fact: in arguing or assuming that knowledge is characteristically human, thinkers have time and again employed animals as examples, metaphors, and fables. From Heidegger’s lizard and Popper’s bees to Saussure’s ox and Freud’s wolves, Tyler points out, “we find a multitude of brutes and beasts crowding into the texts to which they are supposedly unwelcome.” Inspired by the medieval bestiaries, Tyler’s book features an assortment of “wild animals” (ferae)—both real and imaginary—who appear in the works of philosophy as mere ciferae, or ciphers; each is there deployed as a placeholder, of no importance or worth in their own right. Examining the work of such figures as Bataille, Moore, Nietzsche, Kant, Whorf, Darwin, and Derrida, among others, Tyler identifies four ways in which these animals have been used and abused: as interchangeable ciphers; as instances of generalized animality; as anthropomorphic caricatures; and as repetitive stereotypes. Looking closer, however, he finds that these unruly beasts persistently and mischievously question the humanist assumptions of their would-be employers. Tyler ultimately challenges claims of human distinctiveness and superiority, which are so often represented by the supposedly unique and perfect human hand. Contrary to these claims, he contends that the hand is, in fact, a primitive organ, and one shared by many different creatures, thereby undercutting one of the foundations of anthropocentricism and opening up the possibility of nonhuman, or more-than-human, knowledge.


Thinking Animals: Why Animal Studies Now? (Kari Weil, 2012)
Animal studies has emerged as a major field within the humanities, despite its challenge to the very notion of the “human” that shapes humanities scholarship. Kari Weil investigates the rise of animal studies and its singular reading of literature and philosophy through the lens of human-animal relations and difference, providing not only a critical introduction to the field but also an appreciation of its thrilling acts of destabilization. Weil explores the mechanisms we use to build knowledge of other animals, to understand ourselves in relation to other animals, and to represent animals in literature, philosophy, theory, art, and cultural practice. Examining real and imagined confrontations between human and nonhuman animals, she charts the presumed lines of difference between human beings and other species and the personal, ethical, and political implications of those boundaries. Her considerations recast the work of such authors as Kafka, Mann, Woolf, and Coetzee, and such philosophers as Nietzsche, Heidegger, Derrida, Deleuze, Agamben, Cixous, and Hearne, while incorporating the aesthetic perspectives of such visual artists as Bill Viola, Frank Noelker, and Sam Taylor-Wood and the “visual thinking” of the autistic animal scientist Temple Grandin. Weil addresses theories of pet keeping and domestication; the importance of animal agency; the intersection of animal studies, disability studies, and ethics; and the role of gender, shame, love, and grief in shaping our attitudes toward animals. Exposing humanism’s conception of the human as a biased illusion, and embracing posthumanism’s acceptance of human and animal entanglement, Weil unseats the comfortable assumptions of humanist thought and its species-specific distinctions.


Some We Love, Some We Hate, Some We Eat: Why it's so Hard to Think Straight about Animals (Hal Herzog, 2010)
Drawing on more than two decades of research in the emerging field of anthrozoology, the science of human–animal relations, Hal Herzog offers surprising answers to these and other questions related to the moral conundrums we face day in and day out regarding the creatures with whom we share our world... Some We Love, Some We Hate, Some We Eat is a highly entertaining and illuminating journey through the full spectrum of human–animal relations, based on Dr. Herzog’s groundbreaking research on animal rights activists, cockfighters, professional dog-show handlers, veterinary students, and biomedical researchers. Blending anthropology, behavioral economics, evolutionary psychology, and philosophy, Herzog carefully crafts a seamless narrative enriched with real-life anecdotes, scientific research, and his own sense of moral ambivalence... Alternately poignant, challenging, and laugh-out-loud funny, this enlightening and provocative book will forever change the way we look at our relationships with other creatures and, ultimately, how we see ourselves.


Human Error: Species-Being and Media Machines (Dominic Pettman, 2011)
What exactly is the human element separating humans from animals and machines? The common answers that immediately come to mind—like art, empathy, or technology—fall apart under close inspection. Dominic Pettman argues that it is a mistake to define such rigid distinctions in the first place, and the most decisive “human error” may be the ingrained impulse to understand ourselves primarily in contrast to our other worldly companions. In Human Error, Pettman describes the three sides of the cybernetic triangle—human, animal, and machine—as a rubric for understanding key figures, texts, and sites where our species-being is either reinforced or challenged by our relationship to our own narcissistic technologies. Consequently, species-being has become a matter of specious-being, in which the idea of humanity is not only a case of mistaken identity but indeed the mistake of identity. Human Error boldly insists on the necessity of relinquishing our anthropomorphism but also on the extreme difficulty of doing so, given how deeply this attitude is bound with all our other most cherished beliefs about forms of life.


The Animal Connection: A New Perspective on What Makes Us Human (Pat Shipman, 2011)
Why do humans all over the world take in and nurture other animals? This behavior might seem maladaptive--after all, every mouthful given to another species is one that you cannot eat--but in this heartening new study, acclaimed anthropologist Pat Shipman reveals that our propensity to domesticate and care for other animals is in fact among our species' greatest strengths. For the last 2.6 million years, Shipman explains, humans who coexisted with animals enjoyed definite adaptive and cultural advantages. To illustrate this point, Shipman gives us a tour of the milestones in human civilization--from agriculture to art and even language--and describes how we reached each stage through our unique relationship with other animals. The Animal Connection reaffirms our love of animals as something both innate and distinctly human, revealing that the process of domestication not only changed animals but had a resounding impact on us as well.--From publisher description.


What it Means to be Human: Historical Reflections from the 1800s to the Present (Joanna Bourke, 2011)
In this fascinating account, Joanna Bourke addresses the profound question of what it means to be “human” rather than “animal.” How are people excluded from political personhood? How does one become entitled to rights? The distinction between the two concepts is a blurred line, permanently under construction. If the Earnest Englishwoman had been capable of looking 100 years into the future, she might have wondered about the human status of chimeras, or the ethics of stem cell research. Political disclosures and scientific advances have been re-locating the human-animal border at an alarming speed. In this meticulously researched, illuminating book, Bourke explores the legacy of more than two centuries, and looks forward into what the future might hold for humans, women, and animals.


Anthropocentrism: Humans, Animals, Environments (Rob Boddice, 2011)
Anthropocentrism is a charge of human chauvinism and an acknowledgement of human ontological boundaries. Anthropocentrism has provided order and structure to humans' understanding of the world, while unavoidably expressing the limits of that understanding. This collection explores the assumptions behind the label ‘anthropocentrism', critically enquiring into the meaning of ‘human'. It addresses the epistemological and ontological problems of charges of anthropocentrism, questioning whether all human views are inherently anthropocentric. In addition, it examines the potential scope for objective, empathetic, relational, or ‘other' views that trump anthropocentrism. With a principal focus on ethical questions concerning animals, the environment and the social, the essays ultimately cohere around the question of the non-human, be it animal, ecosystem, god, or machine.

AGRO-ECOLOGY:
Plants as Persons: A Philosophical Botany (Matthew Hall, 2011)
Matthew Hall challenges readers to reconsider the moral standing of plants, arguing that they are other-than-human persons. Plants constitute the bulk of our visible biomass, underpin all natural ecosystems, and make life on Earth possible. Yet plants are considered passive and insensitive beings rightly placed outside moral consideration. As the human assault on nature continues, more ethical behavior toward plants is needed. Hall surveys Western, Eastern, Pagan, and Indigenous thought, as well as modern science and botanical history, for attitudes toward plants, noting the particular resources for plant personhood and those modes of thought which most exclude plants. The most hierarchical systems typically put plants at the bottom, but Hall finds much to support a more positive view of plants. Indeed, some Indigenous animisms actually recognize plants as relational, intelligent beings who are the appropriate recipients of care and respect. New scientific findings encourage this perspective, revealing that plants possess many of the capacities of sentience and mentality traditionally denied them.
 

Meat: A Benign Extravagance (Simon Fairlie, 2010)
Meat is a groundbreaking exploration of the difficult environmental, ethical and health issues surrounding the human consumption of animals. Garnering huge praise in the UK, this is a book that answers the question: should we be farming animals, or not? Not a simple answer, but one that takes all views on meat eating into account. It lays out in detail the reasons why we must indeed decrease the amount of meat we eat, both for the planet and for ourselves, and yet explores how different forms of agriculture--including livestock--shape our landscape and culture.At the heart of this book, Simon Fairlie argues that society needs to re-orient itself back to the land, both physically and spiritually, and explains why an agriculture that can most readily achieve this is one that includes a measure of livestock farming. It is a well-researched look at agricultural and environmental theory from a fabulous writer and a farmer, and is sure to take off where other books on vegetarianism and veganism have fallen short in their global scope.


Animals and Public Health: Why Treating Animals Better is Critical to Human Welfare (Aysha Akhtar, 2012)
It is often assumed, particularly by those in the health fields, that the welfare of animals is in opposition to that of humans. Aysha Akhtar, M.D., M.P.H., dispels that notion by presenting scientific evidence that demonstrates just how intricately related human and animal health and welfare are. In a lively and engaging manner, this highly accessible text takes the reader through a diverse array of health topics and explores the link between the way we treat animals and how it affects human health. Dr. Akhtar explores the lives of animals in violent homes, factory farms, experimental laboratories, the entertainment industry and the wildlife trade. She reveals how their poor treatment is both directly and indirectly related to some of the most significant and urgent health issues we face today. This ground-breaking and timely book draws from examples as diverse as domestic violence, Michael Vick's dog-fighting ring, the world's most ominous infectious diseases, animal attacks, high-profile drug failures and global warming. The result is a powerful and compelling argument on the critical need to improve our treatment of animals not only to alleviate their suffering but also to alleviate our own.

Animals as Biotechnology: Ethics, Sustainability, and Critical Animal Studies (Richard Twine, 2010)
In Animals as Biotechnology: Ethics, Sustainability and Critical Animal Studies sociologist Richard Twine places the questioning of human/animal relations at the heart of sustainability and climate change debates. This book is shaped by the incongruous parallel emergence of two approaches to nonhuman animals. The animal sciences concerned with the efficient and profitable production of animals into meat and dairy products now embrace molecular knowledge as a means to extract new sources of biocapital from farmed animal bodies. However the emergence of animal studies and critical animal studies ”mostly in the humanities and social sciences ”work to question the dominant instrumental character of our relations with other animals. Twine considers the emergence of these approaches to bring into relief the paradox of a novel biotechnological power to breed new forms of animals at the very time when critical animal studies and threats such as climate change pose serious questions of anthropocentrism and hubris... This book concludes by considering whether growing counter calls to reduce our consumption of meat/dairy products in the face of climate change threats are in fact complicit with an anthropocentric discourse that would marginalize from its understanding of sustainability a more thorough ethical questioning of normative human/animal relations.

The Wyden-Ryan Plan Will Be the Foundation for Serious Medicare Reform—and Maybe More

In two companion articles in January’s New England Journal of Medicine, Henry Aaron with Austin Frakt, and Joe Antos critique the Wyden-Ryan Medicare reform proposal.Senator Ron Wyden (D-OR) and Representative Paul Ryan (R-WI) are proposing a hybrid Medicare reform proposal combing both Republican defined contribution free market principles—a premium support scheme—with Democratic defined

Tuesday, January 31, 2012

EverythingHealth Anniversary

Thank you to loyal blog follower, KM, for this cute pic.
EverythingHealth is now getting over 4,000 page views a day from all
over the globe. That is just amazing to me and I have met so many
wonderful bloggers over the past 5 years. I am fascinated by the power
of the internet and how readily information can be found. My goal of
providing credible, up to date information without commercial

Monday, January 30, 2012

Paleo Diet Article in Sound Consumer

I recently wrote an article for my local natural foods grocery store, PCC, about the "Paleolithic" diet.  You can read it online here.  I explain the basic rationale for Paleo diets, some of the scientific support behind it, and how it can be helpful for people with certain health problems.  I focused in particular on the research of Dr. Staffan Lindeberg at the University of Lund, who has studied non-industrial populations using modern medical techniques and also conducted clinical diet trials using the Paleo diet.
Read more »

The New Health Law Needs to Be Repealed, Expanded, and Replaced—So Long As It Doesn’t Have a Mandate

Last week’s State of the Union speech was notable because the President hardly mentioned the new health care reform law.Avoiding what is supposed to be the centerpiece domestic accomplishment of President Obama’s first term stuck out like a sore thumb.He said almost nothing because the Obama team simply doesn’t know what to say.The fact is the Affordable Care Act (ACA) is generally unpopular, and

Sunday, January 29, 2012

Romney Should be Proud of Massachusetts Health Care

I don't understand why Mitt Romney is running away from the
Massachusetts health reform that was enacted in 2006 under his reign as
Governor. They are in their 6th year and by any standards it can be
considered a success. The plan included Medicaid expansion, subsidized
private health insurance, a health insurance exchange, insurance market
reforms and requirements for individuals and

Friday, January 27, 2012

Insulin and Obesity: Another Nail in the Coffin

There are several versions of the insulin hypothesis of obesity, but the versions that are most visible to the public generally state that elevated circulating insulin (whether acute or chronic) increases body fatness.  Some versions invoke insulin's effects on fat tissue, others its effects in the brain.  This idea has been used to explain why low-carbohydrate and low-glycemic-index diets can lead to weight loss (although frankly, glycemic index per se doesn't seem to have much if any impact on body weight in controlled trials). 

I have explained in various posts why this idea does not appear to be correct (1, 2, 3), and why, after extensive research, the insulin hypothesis of obesity lost steam by the late 1980s.  However, I recently came across two experiments that tested the hypothesis as directly as it can be tested-- by chronically increasing circulating insulin in animals and measuring food intake and body weight and/or body fatness.  If the hypothesis is correct, these animals should gain fat, and perhaps eat more as well. 

Read more »

Wednesday, January 25, 2012

Heavy Menstrual Bleeding

Heavy menstrual bleeding is common and 10% of all women experience it
in their reproductive years. Women who are NOT in menopause and who
have heavy bleeding that occurs during their regular cycle usually have
a benign reason for the bleeding. Fibroids and endometrial polyps are
common causes of heavy bleeding periods. Menorrhagia is the medical
term for abnormally heavy periods. This

Tuesday, January 24, 2012

Migraine Headaches and Oral Contraceptives

Women who are taking oral contraceptives (Birth Control Pill) and
develop new migraine headaches or increased severity of headaches after
starting the Pill should be told to discontinue the Pill. Women with
migraine who use oral contraceptives are at a 2-4 fold increased risk
of ischemic stroke compared to women who have migraines and are not on
the pill. The risk of a young woman having a

Monday, January 23, 2012

A Novel Approach: Ask the Primary Care Doctor

The government, academics and policywonks are always in the process
of "redesigning" health care. Patients with increased health care needs
are considered "complex" and these patients consume the major health
resources (translate: "money"). In fact 65% of total health care
expenditures are directed toward the 25% of patients with multiple
chronic conditions. Eighty percent of Medicare

What Causes Insulin Resistance? Part VII

In previous posts, I outlined the factors I'm aware of that can contribute to insulin resistance.  In this post, first I'll list the factors, then I'll provide my opinion of effective strategies for preventing and potentially reversing insulin resistance.

The factors

These are the factors I'm aware of that can contribute to insulin resistance, listed in approximate order of importance.  I could be quite wrong about the order-- this is just my best guess. Many of these factors are intertwined with one another. 
Read more »

Sunday, January 22, 2012

Three Announcements

Chris Highcock of the blog Conditioning Research just published a book called Hillfit, which is a conditioning book targeted at hikers/backpackers.  He uses his knowledge and experience in hiking and conditioning to argue that strength training is an important part of conditioning for hiking.  I'm also a hiker/backpacker myself here in the rugged and beautiful Pacific Northwest, and I also find that strength training helps with climbing big hills, and walking farther and more easily with a lower risk of injury.

Richard Nikoley of the blog Free the Animal has also published a book called Free the Animal: Beyond the Blog, where he shares his strategies for losing fat and improving health and fitness.  I haven't had a chance to read it yet, but Richard has a reasonable perspective on diet/health and a sharp wit. 

Also, my friend Pedro Bastos has asked me to announce a one-day seminar at the University of Lisbon (Portugal) by Dr. Frits Muskiet titled "Vitamins and Minerals: A Scientific, Modern, Evolutionary and Global View".  It will be on Sunday, Feb 5-- you can find more details about the seminar here.  Dr. Muskiet is a researcher at the Groningen University Medical Center in the Netherlands.  He studies the impact of nutrients, particularly fatty acids, on health, from an evolutionary perspective.  Wish I could attend. 

Friday, January 20, 2012

The Many Faces of Psoriasis

This 26 year old female noticed that her nails had been changing over a
6 month period. Note the small pits and separation of the nail plate
from the nail bed. This lifting is called onycholysis. There is only
one disease where both of these findings are seen together and that is
psoriasis. Most people think of psoriasis as a skin disorder with
patchy silvery plaques that form on the

Bone Mineral Density Tests

The recommendations for when and how often women should be tested for
osteoporosis with bone density testing (DXA Scan) has been vague. Many
women are tested in their early 50s when they go through menopause with
follow up tests as frequently as every year. Others break a hip without
ever being tested. A new study published in The New England Journal of
Medicine states that bone loss

Thursday, January 19, 2012

Important Research From Medicare Demonstration Projects: Almost Nothing Works

I will suggest that most of us believe the way to control health care costs, and at the same time maintain or improve quality, is to both use the managed care tools we have developed over the years, and perhaps more importantly, change the payment incentives so that both cost control and quality are upper most in the minds of providers and payers.The Congressional Budget Office (CBO) has just

Wednesday, January 18, 2012

What Causes Insulin Resistance? Part VI

In this post, I'll explore a few miscellaneous factors that can contribute to insulin resistance: smoking, glucocorticoids/stress, cooking temperature, age, genetics and low birth weight.

Smoking

Smoking tobacco acutely and chronically reduces insulin sensitivity (1, 2, 3), possibly via:
  1. Increased inflammation
  2. Increased circulating free fatty acids (4)
Paradoxically, since smoking also protects against fat gain, in the very long term it may not produce as much insulin resistance as one would otherwise expect.  Diabetes risk is greatly elevated in the three years following smoking cessation (5), and this is likely due to the fat gain that occurs.  This is not a good excuse to keep smoking, because smoking tobacco is one of the most unhealthy things you can possibly do.  But it is a good reason to tighten up your diet and lifestyle after quitting.

Read more »

Will the Feds Be Ready With the Fallback Insurance Exchanges by October 2013?

Insurance exchanges have to be up and running in all of the states by October 2013 in order to be able to cover people by January 1, 2014.If the states don't do it, the feds have to be ready with a fallback exchange. States have to tell HHS if they intend to be ready by January 1, 2013.The White House just released a report saying that good progress is being made in 28 states. That begs the

Sunday, January 15, 2012

What Causes Insulin Resistance? Part V

Previously in this series, we've discussed the role of cellular energy excess, inflammation, brain insulin resistance, and micronutrient status in insulin resistance.  In this post, I'll explore the role of macronutrients and sugar in insulin sensitivity.

Carbohydrate and Fat

There are a number of studies on the effect of carbohydrate:fat ratios on insulin sensitivity, but many of them are confounded by fat loss (e.g., low-carbohydrate and low-fat weight loss studies), which almost invariably improves insulin sensitivity.  What interests me the most is to understand what effect different carbohydrate:fat ratios have on insulin sensitivity in healthy, weight stable people.  This will get at what causes insulin resistance in someone who does not already have it.

Read more »

Saturday, January 14, 2012

Skin Conditions With Aging

Patients often have growths or skin changes that they wonder about.
After examining them, in many cases I say "happy birthday"...it's a
manifestation of getting older. Aging leads to a number of skin and
hair changes and when you add the effects of sun, smoking and the
environment, the changes can be profound. Over time the epidermis thins
and by age 60 the dermis is 20% thinner than before.

Thursday, January 12, 2012

Haiti Remembered

This is the 2nd anniversary of the terrible Haiti Earthquake that
measured 7.0 on the scale. The disaster killed 316,000 people and
displaced 1.5 million more. Even now more than 500,000 people are still
in makeshift shelters and only half of the aid pledged for
reconstruction has been spent. My organization sent medical teams and
supplies to the disaster zone and our doctors and nurses

New Obesity Review Paper by Yours Truly

The Journal of Clinical Endocrinology and Metabolism just published a clinical review paper written by myself and my mentor Dr. Mike Schwartz, titled "Regulation of Food Intake, Energy Balance, and Body Fat Mass: Implications for the Pathogenesis and Treatment of Obesity" (1).  JCEM is one of the most cited peer-reviewed journals in the fields of endocrinology, obesity and diabetes, and I'm very pleased that it spans the gap between scientists and physicians.  Our paper takes a fresh and up-to-date look at the mechanisms by which food intake and body fat mass are regulated by the body, and how these mechanisms are altered in obesity.  We explain the obesity epidemic in terms of the mismatch between our genes and our current environment, a theme that is frequently invoked in ancestral health circles.

Read more »

I Hope Trustmark Tells HHS to Go Pound Sand

Today, the Department of Health and Human Services announced that, "Trustmark Life Insurance Company has proposed unreasonable health insurance premium increases in five states—Alabama, Arizona, Pennsylvania, Virginia, and Wyoming. The excessive rate hikes would affect nearly 10,000 residents across these five states."The HHS statement continued, "In these five states, Trustmark has raised

Tuesday, January 10, 2012

2012: A Year of Huge Uncertainty in Health Care Policy

2013 may be the most significant year in health care policy ever.But we have to get through 2012 first.Once the 2012 election results are in there will be the very real opportunity to address a long list of health care issues.If Republicans win, the top of the list will include “repealing and replacing” the Affordable Care Act. If Obama is reelected, but Republicans capture both houses of

Monday, January 9, 2012

What Causes Insulin Resistance? Part IV

So far, we've explored three interlinked causes of insulin resistance: cellular energy excess, inflammation, and insulin resistance in the brain.  In this post, I'll explore the effects on micronutrient status on insulin sensitivity.

Micronutrient Status

There is a large body of literature on the effects of nutrient intake/status on insulin action, and it's not my field, so I don't intend this to be a comprehensive post.  My intention is simply to demonstrate that it's important, and highlight a few major factors I'm aware of.

Read more »

Sunday, January 8, 2012

What Causes Insulin Resistance? Part III

As discussed in previous posts, cellular energy excess and inflammation are two important and interlinked causes of insulin resistance.  Continuing our exploration of insulin resistance, let's turn our attention to the brain.

The brain influences every tissue in the body, in many instances managing tissue processes to react to changing environmental or internal conditions.  It is intimately involved in insulin signaling in various tissues, for example by:
  • regulating insulin secretion by the pancreas (1)
  • regulating glucose absorption by tissues in response to insulin (2)
  • regulating the suppression of glucose production by the liver in response to insulin (3)
  • regulating the trafficking of fatty acids in and out of fat cells in response to insulin (4, 5)
Because of its important role in insulin signaling, the brain is a candidate mechanism of insulin resistance.

Read more »

Saturday, January 7, 2012

What Causes Insulin Resistance? Part II

In the last post, I described how cellular energy excess causes insulin resistance, and how this is triggered by whole-body energy imbalance.  In this post, I'll describe another major cause of insulin resistance: inflammation. 

Inflammation

In 1876, a German physician named W Ebstein reported that high doses of sodium salicylate could totally eliminate the signs and symptoms of diabetes in certain patients (Berliner Klinische Wochenschrift. 13:337. 1876). Following up on this work in 1901, the British physician RT Williamson reported that treating diabetic patients with sodium salicylate caused a striking decrease in the amount of glucose contained in the patients' urine, also indicating an apparent improvement in diabetes (2).  This effect was essentially forgotten until 1957, when it was rediscovered.

Read more »

Friday, January 6, 2012

What Causes Insulin Resistance? Part I

Insulin is an ancient hormone that influences many processes in the body.  Its main role is to manage circulating concentrations of nutrients (principally glucose and fatty acids, the body's two main fuels), keeping them within a fairly narrow range*.  It does this by encouraging the transport of nutrients into cells from the circulation, and discouraging the export of nutrients out of storage sites, in response to an increase in circulating nutrients (glucose or fatty acids). It therefore operates a negative feedback loop that constrains circulating nutrient concentrations.  It also has many other functions that are tissue-specific.

Insulin resistance is a state in which cells lose sensitivity to the effects of insulin, eventually leading to a diminished ability to control circulating nutrients (glucose and fatty acids).  It is a major contributor to diabetes risk, and probably a contributor to the risk of cardiovascular disease, certain cancers and a number of other disorders. 

Why is it important to manage the concentration of circulating nutrients to keep them within a narrow range?  The answer to that question is the crux of this post. 

Read more »

Wednesday, January 4, 2012

New York Times Magazine Article on Obesity

For those of you who haven't seen it, Tara Parker-Pope write a nice article on obesity in the latest issue of NY Times Magazine (1).  She discusses  research showing  that the body "resists" fat loss attempts, making it difficult to lose fat and maintain fat loss once obesity is established.
Read more »

Monday, January 2, 2012

High-Fat Diets, Obesity and Brain Damage

Many of you have probably heard the news this week:

High-fat diet may damage the brain
Eating a high-fat diet may rapidly injure brain cells
High fat diet injures the brain
Brain injury from high-fat foods

Your brain cells are exploding with every bite of butter!  Just kidding.  The study in question is titled "Obesity is Associated with Hypothalamic Injury in Rodents and Humans", by Dr. Josh Thaler and colleagues, with my mentor Dr. Mike Schwartz as senior author (1).  We collaborated with the labs of Drs. Tamas Horvath and Matthias Tschop.  I'm fourth author on the paper, so let me explain what we found and why it's important.  

The Questions

Among the many questions that interest obesity researchers, two stand out:
  1. What causes obesity?
  2. Once obesity is established, why is it so difficult to treat?
Our study expands on the efforts of many other labs to answer the first question, and takes a stab at the second one as well.  Dr. Licio Velloso and collaborators were the first to show in 2005 that inflammation in a part of the brain called the hypothalamus contributes to the development of obesity in rodents (2), and this has been independently confirmed several times since then.  The hypothalamus is an important brain region for the regulation of body fatness, and inflammation keeps it from doing its job correctly.

The Findings

Read more »

Sunday, January 1, 2012

Junk Free January

Last year, Matt Lentzner organized a project called Gluten Free January, in which 546 people from around the world gave up gluten for one month.  The results were striking: a surprisingly large proportion of participants lost weight, experienced improved energy, better digestion and other benefits (1, 2).  This January, Lentzner organized a similar project called Junk Free January.  Participants can choose between four different diet styles:
  1. Gluten free
  2. Seed oil free (soybean, sunflower, corn oil, etc.)
  3. Sugar free
  4. Gluten, seed oil and sugar free
Wheat, seed oils and added sugar are three factors that, in my opinion, are probably linked to the modern "diseases of affluence" such as obesity, diabetes and coronary heart disease.  This is particularly true if the wheat is eaten in the form of white flour products, and the seed oils are industrially refined and used in high-heat cooking applications.

If you've been waiting for an excuse to improve your diet, why not join Junk Free January?