Hi there stranger! Links for Wednesday, December 27, 2017: end of days food, upcycled stretchers, and therapeutic cold

 What do you eat when the world ends?

I'm a Cold War Kid myself, but it's hard to wrap my head around how all-encompassing the nuclear arms race was to people in my parents' generation. Huge resources were spent preparing for a worldwide nuclear war that never came, including in planning how to feed survivors:

In 1955, Eisenhower’s Federal Civil Defense Administration launched a propaganda campaign they called “Grandma’s Pantry,” calling for each household to have ready a seven-day supply of food and water for an attack.

The purpose of the food was completely, utterly utilitarian, ironically parroting the very Soviet philosophy we were fighting against:

The requirements were stark: America’s Armageddon ration needed to be nutritious, cheap, easy to eat, shelf-stable, and reproducible at mass scale. Taste, visual appeal, quality, packaging, and all the other attributes that normally come with designing a successful, mass-produced consumer good would be discarded in favor of the simplest food the government could design.

The USDA eventually landed on crackers as the best medium for bulgur-wheat rations in a bunker scenario; after 52 months of storage it reported merely a “discernible but inconsequential decrease” in flavor. 

States like my own put their own spin on preparations:

...in Kansas, officials calculated they could probably provide two million pounds of food after an attack, and that if survivors reduced consumption to an “austerity diet” of 2,000 calories, the state’s food stocks could last nearly two months. Besides the official stocks, Kansas’s wildlife could help too: Its forests, plains, and waters contained, officials believed, 11 million “man-days” of food — the amount of food needed to feed an adult for one day — in rabbit meat, 10 million man-days of wild birds, five million man-days of edible fish, and nearly 20 million man-days of meat in residential pets. After an attack, officials also planned to confiscate household vitamins for the good of the general population and ration carefully the state’s 28-day supply of coffee. Everything would be fine.

2,000 calories a day was "austerity." Huh. That residential pet diet sounds delicious, though. 

Alas, the stored crackers didn't stand the test of time:

Later that year [1974], the U.S. exhumed 20 tons of crackers — hidden in an old streetcar tunnel under Dupont Circle in Washington, D.C. that had been used since the Cuban Missile Crisis to store civil defense supplies — and shipped them to Bangladesh to feed survivors of a monsoon there. Other cracker caches were dispatched to Guatemala to aid victims of a devastating 1976 earthquake. The recipients of the disaster food reported developing what one newspaper described as “severe gastric disturbances” after ingesting the biscuits. As those reports trickled back to the U.S., officials across the country wondered just what they’d stocked away for a nuclear apocalypse. In mid-1976, E. Erie Jones, the Illinois state emergency coordinator, convened a group in his shag-carpeted office in Springfield for a taste test; it didn’t even start well. The mere smell from the newly opened tin caused coughing fits. He took a single bite, grimaced, then canceled the rest of the experiment. In reporting the taste test gone wrong, the Chicago Tribune declared that the “Survival biscuits [would be] better as weapons” than food if a war did unfold.

And that's how it seems to end. Instead of trying to feed survivors, the current thinking (doomsday preppers aside) is that a nuclear war would simply kill so many of us that planning on feeding anyone is presumptuous.

Old stretchers are used as fencing in London, but they're falling apart

Is being cold good for us?

Cronise, Bremer, and Sinclair propose what they call the “Metabolic Winter” hypothesis: that obesity is only in small part due to lack of exercise, and mostly due to a combination of chronic overnutrition and chronic warmth. Seven million years of human evolution were dominated by two challenges: food scarcity and cold. “In the last 0.9 inches of our evolutionary mile,” they write, pointing to the fundamental lifestyle changes brought about by refrigeration and modern transportation, “we solved them both.” Other species don’t exhibit nearly as much obesity and chronic disease as we warm, overfed humans and our pets do. “Maybe our problem,” they continue, “is that winter never comes.”

See also: Is keeping offices cold sexist?

Vaccines are awesome

From kottke.org, who doesn't always post medical stuff, but when he does, it's good. 

Thanksgiving extravaganza! Links for Wednesday, November 22, 2017

17th century food was fibrous, bland, and surprisingly good for you (if you could get enough of it)

This is not to say that their food tasted bad, necessarily. But it was clearly very simple, and very starch-heavy. From China to Europe to sub-Saharan Africa, gruels and stews made out of staple grains or legumes were the daily fare. Italian farmers weren't eating eggplant parmesan or spaghetti with meatballs. They were typically eating either boiled beans or grains, day after day after day.

First mind-blowing passage from this post:

One example: I didn't realize until recently that broccoli, Brussels sprouts, cauliflower, kale, cabbage, and collard greens are all technically the same species, Brassica oleracea. The substantial differences between these sub-species are all due to patient intervention by human farmers over millennia. Many of these changes are surprisingly recent. Early versions of cauliflower may have been mentioned by Pliny and medieval Muslim botanists, but as late as 1600, a French author was writing that cauli-fiori "as the Italians call it" was "still rather rare in France." Likewise, Brussels sprouts don't appear to have become widely cultivated until the Renaissance.

Selective breeding and pollination (the original GMOs) have radically altered what our food looks like. See this picture of fruit from the link. Look closely at the watermelons in the right lower corner. They look nothing like the pink, juicy, almost seedless beasts we see in the grocery store circa 2017:

"as time went by, a dish tended to become sweeter, spicer, and more complicated."

We paid for that sweeter, spicier food, and not just in our waistbands. The Columbian Exchange brought diseases to immunologically naive people and turned people in to chattel. The English didn't have bad teeth til sugar came along. 

Eat up.

You'll only gain 0.8 pounds this holiday season. But if you do that every year you get fat

We overestimate our own weight gain a lot over the holidays:

When Jack Yanovski and his colleagues began their study of 200 National Institutes of Health employees, they were responding to a media environment that frequently cited holiday weight gain averages of 5 to 10 pounds. But they found their subjects gained an average of only 0.8 pounds between mid-November and early January, and that those same subjects overestimated their own weight gain by a factor of 4.

But then we don't lose the modest weight that we do gain, and after a couple decades we're in trouble:

 A 2014 review of six different studies found an average holiday weight gain of 1 pound. A 2017 summary of the research found similar results. Just 1 pound — but a significant pound because research also suggests that it could account for most (if not all) of our average annual weight gain. “Yup, it’s small,” said Dale Schoeller, professor emeritus of nutritional sciences at University of Wisconsin-Madison and author of the 2014 review paper. “But because it’s a large percentage, it’s not unimportant.” Schoeller calculates total annual weight gain by comparing the average weight of a 20-year-old in 1960 to the average weight of a 60-year-old in 2000. By his calculation, Americans gain about 0.8 pounds a year. Over the course of 20 years’ worth of Thanksgivings, he pointed out, it can start to add up.

Links for Tuesday, November 21, 2017: more on the new HTN guideline, Gymnastics coaches throwing robot shade, the last iron lungs, Germany bans smartwatches, and Raymond Chandler hated US healthcare

Thoughtful post on the new HTN guideline by Dr. Allen Brett

Representative quote: "Consider, for example, a healthy white 65-year-old male nonsmoker with a BP of 130/80 mm Hg, total cholesterol level of 160 mg/dL, HDL cholesterol of 60 mg/dL, LDL cholesterol of 80 mg/dL, and fasting blood glucose of 80 mg/dL — all favorable numbers. The calculator estimates his 10-year CV risk to be 10.1%, making him eligible for BP-lowering medication under the new guideline. To my knowledge, no compelling evidence exists to support drug therapy for this person."

A gymnastics coach says the Boston Dynamics robot flip was a 3.5/5.0

'In a back salto, says Mazloum, “you want to be able to go as high as you can, and you want to be able to land as close to where you take off as possible.” To do that, the gymnast has to squat, throw her arms up by her ears so her body is a straight line (in gymnast-speak, opening the shoulder angle and the hip), then contract into a “closed” position again. By these standards, Atlas’ trick is “not the cleanest flip,” explains Mazloum.

Here’s Mazloum’s critique: Atlas didn’t quite get to that open position, “so it didn’t really get the full vertical that we look for. That’s why it went backwards a little bit.”'

The last of the iron lungs

Get your kids vaccinated for polio, folks.

Germany has banned smartwatches for kids

If I understand this correctly, it is not because smartwatches cause kids to be distracted monsters (although I don't doubt that that statement is at least a little bit true). The decision stems from the capability of bad guys to hack in and monitor the location of little Dick and Jane:

You have to wonder who thought attaching a low-cost, internet-enabled microphone and a GPS tracker to a kid would be a good idea in the first place. Almost none of the companies offering these “toys” implement reasonable security standards, nor do they typically promise that the data they collect—from your children—won’t be used be used for marketing purposes. If there ever was a time to actually sit down and read the terms and conditions, this was it.

Get your shit together, parents.

Asking parents to destroy them might be a bit of an overreaction, though.

Raymond Chandler paints a dark picture of American healthcare in a newly-discovered story

The title, "It’s All Right – He Only Died," sounds like the title of a video residencies would show interns to convince them that quality improvement and patient safety are part of their job.

The doctor who turned away the patient, Chandler writes, had “disgrace[d] himself as a person, as a healer, as a saviour of life, as a man required by his profession never to turn aside from anyone his long-acquired skill might help or save”.

Links for Tuesday, November 7, 2017: hacking the genome, ammonia in the NFL, and community health workers for hypertension

Body hacker Josiah Zayner wants us all to use CRISPR to modify our bodies

And give ourselves cancer. I think he forgot the cancer part. From author Rowan Jacobsen:

"Let’s be clear: don’t try this at home! Although hundreds of gene-therapy trials are under way, and many experts believe they will eventually transform almost every aspect of human health, few have been proven safe. When you start scrambling your DNA, very bad things can happen. You can get cancer. Your immune system can attack the unfamiliar DNA, as happened when an 18-year-old with a rare metabolic disorder died during a University of Pennsylvania gene-therapy trial in 1999."

You may recall a link I posted to this guy giving himself a DIY fecal transplant. I'll give him an A+ for marketing. You can't beat the name Gut Hack:

NFL players have decided (not recently, it seems) that inhaling ammonia is performance-enhancing

Instead of something sinister, though, what the widespread use of smelling salts really reveals is the increasingly bizarre culture created by the NFL's (win-at-all-costs pressure cooker. Extreme parity, the minuscule margin of error, the constant threat of injury and million-dollar stakes all push players to exploit any shortcut, no matter how weird, gross or pitiful. More than a century ago in major league baseball, players like Hall of Fame pitcher Pud Galvin thought consuming ground-up monkey testicles was the answer (seriously). A decade ago, football found deer antler spray. Now it's smelling salts.

Not coke, but smelling salts in a cup. I think I would actually prefer ground-up monkey testicles.

More evidence that community health workers improve the care of certain patient populations

(paywall, but the abstract is free)

The proportion of patients with controlled hypertension increased from 17.0% at baseline to 72.9% at 18 months in the intervention group and from 17.6% to 52.2% in the usual care group; the difference in the increase was 20.6% (95% CI, 15.4%-25.9%; P < .001).

Links for Thursday, November 2, 2017: Why Amsterdam works for bikes, dirty mustaches, dockless bike sharing, weird fertility quotes, and menstrual synchrony

Norman Garrick, author of one of my favorite papers on the built environment's effect on health, on why Amsterdam is so good for bikes:

1. All streets are bike streets

2. Separated cycle tracks, not bike lanes

3. When possible, go completely car free

4. Two speeds, both slow

5. Stress-free intersections

That favorite paper? Right here: Community design, street networks, and public health

“A French scientist caused a sensation in 1907 when he recounted an experiment showing that the lips of a woman kissed by a mustached man were polluted with tuberculosis and diphtheria bacteria as well as food particles and a hair from a spider’s leg.”

Is dockless bike sharing the next Uber?

FWIW, I hate the "Uber for ...." thing. But I'm told that it's interesting shorthand for investors. The part of this article I'm fascinated by is the "dockless" part. To my reading, dockless bike stations eliminate so many of the traditional obstacles of traditional bike shares. Less permitting, less infrastructure, less up front expense. I even wonder if they're the way that small- to medium-sized towns get into the bike share game. But you can't just ignore the city governments:

'Technically the dockless companies can enter a market without asking permission. They only need to leave some bikes around the city, and anyone with the app can start riding. But since bikes are portable and can be left anywhere, they’re vulnerable. An unhappy city regulator could round them up and haul them away at any time. “[This is] ask permission, not forgiveness,” Jordan says, reversing a popular Silicon Valley mantra. “It’s not like Lyft, where the cars are moving around, or Airbnb, where you don’t publish the address.”'

The fertility business is booming, especially on the sperm donor side

Up front: I'm totally, 100% on board with whatever fertility treatments people need to receive in order to reproduce. But there are soooo many weird quotes in this:

"Want your sperm donor to have a B.A. in political science? Want your egg donor to love animals? Want the genes of a Division I athlete? All of these are possible. Prospective parents overwhelmed by all the choices can leave it to the heavens and pick a donor by astrological sign."

and:

'The Seattle Sperm Bank categorizes its donors into three popular categories: “top athletes,” “physicians, dentists and medical residents,” and “musicians.”'

But some of the quotes from donors are heartbreakingly sweet:

'The donor said she was a “homebody” who loves taking pictures and being with family on the beach. Her personal goals, she wrote, include being “the best possible mom I can be for my children. I want to be ‘present’ when I am with them and invest into their lives. . . . I want my life to matter.”'

Here is the original Nature paper describing the synchronization of women's menstrual cycles

 

Links for Thursday, October 26, 2017: walkability and city growth, eating alone is bad for you, BMX is back, and diet avocados

Is wichita's poor walkability holding it back economically?

From the Chung Report: 

Our respondents believed Wichita is fairly inaccessible on foot, with 77.4 percent saying they either disagreed or strongly disagreed to the idea that Wichita is walkable. This means this aspect of Wichita likely won't attract millennials over other cities that are more progressive when it comes to transportation. And our peers do seem to be more progressive.

WalkScore.com, a website that determines walkability and bikeability for U.S. cities, calls Wichita a "car-dependent city," which means most errands require a car. Cities with scores of 70 to 89 are considered very walkable while scores of 90 to 100 are a "walker's paradise." Wichita scored a 35 on walkability and a 44 on bike infrastructure, meaning the city has minimal bike infrastructure. This same site gave Des Moines and Omaha walk scores of 45 and Cleveland a walk score of 60.

These trends aren't going unnoticed. Advocacy groups like Bike Walk Wichita (disclosure: I'm on the board) have made tremendous progress in getting more attention paid to walkability and bikeability over the last decade (including a bike share and dozens of miles of new bike lanes and paths). But clearly there is work to be done. 

Eating alone may increase your risk of metabolic syndrome

Metabolic syndrome, FYI, is a catch-all term for people at risk of developing diabetes and heart disease. It's a constellation of extra weight around your waist, higher-than-normal blood sugars, abnormal triglyceride levels in the blood, and higher-than-normal blood pressures. A few observations about this study: we've known for a while that being alone in general is bad for you. Like, 30% increased risk of dying on any given day bad. So it's not a surprise that eating alone is associated with risk. But is it any different than being alone in general? I don't think the authors make that case. 

Individuals who ate alone 2 or more times per day in their dataset were more likely to live alone, were more likely to be unmarried, and were more likely to skip meals. Interestingly, alone eaters ate out less, which is generally considered a good behavior. Women who ate alone ≥2 times per day were 29% more likely to have metabolic syndrome than women who didn't eat alone. But once they accounted for other factors, like XXXXX, the assocation went away, statistically-speaking. Eating alone two or more times a day was associated with a 45% increased risk for abdominal obesity and a 64% increase for metabolic syndrome in men. This was especially true in men without spouse. The men without a spouse were 300% more likely to have metabolic syndrome, while married men were only 48% more likely to have metabolic syndrome.

BMX is "back"

(it never left) Link posted here because I like the video. 

Someone created "diet" avocados and I just want to die

My disgust with this isn't related to the specter of GMOs or hybrid crops. I'm actually generally in favor of both (see the Hawaiian papaya story to understand why). I just find the idea of taking a food that is perfectly good for you in its native state and monkeying with it to make it "diet" depressing. Avocados aren't a wonder food, and their trendiness will eventually fade. But they're fine the way they are. Their high fat content has never hurt anyone, and it might even make you feel full longer. So for heaven's sake. Eat a normal avocado. Don't fall for this. 

Links for Wednesday, October 25, 2017: Leonardo and the aortic valve, e-bike smackdown in NYC, candy corn is disgusting but interesting, and McDonalds takes phones away

Leonardo da Vinci understood the anatomy and physiology of the heart better than the physicians of his day

He made wax molds of the aortic valve.

Based on zero deaths reported from e-bicycles, NYC mayor Bill DeBlasio is outlawing them. Super. 

He says not to worry, deliveries by car (responsible for 70 deaths in NYC so far in 2017) will still be available. I'm as skeptical of e-bikes as any long-time cyclist (mopeds and golf carts on the local bike paths cause me to mumble horrible things under my breath), but this is bananas. They should stay on the streets. They're smaller, slower, and infinitely safer to their surroundings than cars.

Candy corn, aka clown droppings, explained

Candy corn is disgusting. But this article is delicious. 

McDonald's is experimenting with locking up phoneworms' devices

My grouchy side says "Your pocket is just as good a place as the Fun Zone locker." My realistic side says that most of us lack the self-control to ignore a device that's in our pocket:

According to a survey of 302 parents conducted by McDonald's in Singapore, most (98%) say they use their mobile device whenever they're with family and more than two-thirds of them admitted using smartphones during meals. Most parents also said their kids use their phone during family time.

Links for Monday, October 16, 2017: SNAP to keep seniors home, every-other-day iron, high school football's decline

SNAP is a good way to keep senior citizens out of the hospital. 

SNAP stands for Supplemental Nutrition Assistance Program. It is used by about half of the Medicaid beneficiaries who qualify for it. 

In certain iron-deficient women, it might be better to take iron every other day. 

Previous warnings about small trials apply here, but in a study in The Lancet, investigators assigned women with mild reductions in iron storage (serum ferritin levels of ~25 ug/L or less) but not moderate or severe anemia to receive 60 mg ferrous sulfate every day for two weeks or every other day for 4 weeks. Then the investigators checked their fractional iron absorption and total iron absorption. 

Two weeks following treatment, the alternate-day group had higher fractional iron absorption (22% vs. 16% ) AND total iron absorption (175 vs. 131 mg).

To make sure that this was an effect of timing and not just splitting the dose, a smaller group of women was then assigned randomly either 120 mg FeSO4 daily or 60 mg twice daily and the testing process was repeated. In this case, there was no difference between the two groups. 

So what's the take-home? First, there is no benefit (*ahem*, small study) in dividing iron doses into twice daily. Second, it might be beneficial, at least in this specific patient population, to give the iron less often, but for a greater length of time. Mechanism unknown, at least to me. I have some concerns about every-other-day dosing. It seems like a good way to drive down adherence to therapy. But the effect is promising. In an astonishingly British-sounding editorial (the authors are straight from Downton Abbey casting), one states that the results "are likely to lead to a more felicitous means of administering this widely used therapy." Felicitous, in case you were born west of eight degrees longitude, means "well chosen or suited to the circumstances." Or "pleasing and fortunate." But the latter definition will seem strange to anyone who's ever tried to pass a ferrous sulfate-laced stool.

Kansas is among states where high school football participation is down more than 10 percent. 

Speculation is that this is related to fear of traumatic encephalopathy and concussion. Speculation on my part is that this is the beginning of a slow decline in football in the non-deep-south.

Congrats to Allen County, Kansas on its 2017 RWJF Culture of Health Prize. 

Jony Ive, designer of the iPhone, says we use our iPhones too much.

Justin Moore, owner of an iPhone, agrees. Don't be a phoneworm. 

Links for Friday, October 13, 2017: Ford's soy-plastic car and US-themed UK chicken shacks

Henry Ford and George Washington Carver (!) once collaborated to build a plastic car made from soy.

Those are soy fibers. Images from the Henry Ford Museum.

Ok, only the body panels were soy plastic, but still. The everyday mechanical-chemical innovation of that part of history has been almost entirely replaced in our national mythos by software innovation. Kids don't seem to tinker as much as they used to.

Story from The First.

A UK writer catalogued chicken restaurants in the UK named after US states: "And after excluding Kentucky (for obvious reasons), I found 13 Tennessees, 6 Kansas, 4 Californias, 2 Floridas, and 1 each of a few others."

Story from The Gist.

Links for Tuesday, October 10, 2017: anabolic steroids are terrible for you, spoon for health, and tabletop devices in restaurants

Anabolic steroids are terrible for your heart.

Just an FYI. By the way, the image above is an ad for WrestleMania VI, a place I think we can all agree had its share of anabolic steroid use. Over 1/3 of the competitors are now dead, all of them prematurely. 

Spooning, on the other hand, is the good stuff.

There is no cheatin' spoon. There's only the big spoon and the little spoon, and your size ain't nothin' but a number:

1. “I love being big spoon but he’s so big I feel like a sloth just hanging onto a branch.”

2. “I’m always the big spoon! Because of the height difference, it makes me feel like I’m a rocket pack!”

3. “I feel like a koala when big spooning my boyfriend because he’s way taller.”

4. “I say if you think you’re going to sleep facing away from me you best be prepared for a koala on your back through the night.”

5. “My boyfriend is almost always the big spoon, although sometimes in the middle of the night I roll over to him and am his ‘jetpack.’ I love being the little spoon but it makes me anxious because sometimes I fart on him when I fall asleep.”

Bonus: “I prefer to lie face down and have my partner lie flat directly on top of me. The weight is so calming and eases my anxiety. Not spooning per se…maybe spatula-ing?”

Tabletop devices in casual dining restaurants aren't going anywhere soon.

How long until they have these in fast food places, too? Even Sonic has started modifying their kiosks to be more interactive. Big potential public health downside: More desserts ordered. Like 30% more.

Links for Friday, October 6, 2017: no thyroid testing in obese kids, where "blade runner" came from, Uber and drunk driving, and blazing fast Citi bikes

Don't test the thyroids of generic obese children, says Choosing Wisely

The endocrine section American Academy of Pediatrics has listed its five "Choosing Wisely" tests to avoid. TSH levels in obese kids is one of them. I completely, completely agree. But telling a mom or dad that is equivalent to malpractice in their eyes. It really illustrates one of the central problems with the way we practice medicine: order the test, make mom happy, keep the family as patients, but cost the system some extra money that could be better spent on something else. Refuse the test and you make mom unhappy (sometimes very unhappy), you lose the family as patients, and the family simply goes somewhere else with a provider that will comply with their wishes. Sure, you can have a prolonged conversation with the family about why you're not doing it, but the cost of physician time exceeds the cost of the lab test pretty quickly. Whew. OK. Rant concluded. 

The title of "Blade Runner" comes from an obscure physician-penned novel about a future dystopian society that has eugenics as the core of its national healthcare strategy.

It follows the adventures of a young man known as Billy Gimp and his partner in crime, Doc, as they navigate a health-care dystopia. It’s the near future, and eugenics has become a guiding American philosophy. Universal health care has been enacted, but in order to cull the herd of the weak, the “Health Control laws”—enforced by the office of a draconian “Secretary of Health Control”—dictate that anyone who wants medical care must undergo sterilization first. As a result, a system of black-market health care has emerged in which suppliers obtain medical equipment, doctors use it to illegally heal those who don’t want to be sterilized, and there are people who covertly transport the equipment to the doctors. Since that equipment often includes scalpels and other instruments of incision, the transporters are known as “bladerunners.” Et voilà, the origin of a term that went on to change sci-fi.

The name Blade Runner actually came not from the story itself, but from the title of a nearly incomprehensible adaptation by William S. Burroughs, The Blade Runner: a Movie.

Uber's effect on drunk driving is disappointingly inconsistent

The team delved into whether ride-hailing affected crash rates in four cities: Las Vegas, Portland, Ore., Reno, Nev., and San Antonio, Texas — American cities in which Uber, the nation's largest ride-sharing company, launched, ceased, then resumed operations. And the results were mixed. Crashes involving alcohol decreased as Uber resumed services in Portland and San Antonio, but not Reno. And in no case did Uber's resumption of service result in fewer total injury crashes or serious crashes overall.

It's easy to look at this kind of story and be really, really disappointed. But I think it's just further proof that changing human behavior is complex. It is not a matter of greater knowledge = better decisions. If it were, the smoking rate and the rate of texting while driving would both be nearly zero. I'm optimistic for ride sharing and autonomous vehicles' role in reducing drunk driving deaths. 

Citi bikes have so penetrated New York City that over 50% of peak-hour taxi trips would be faster if taken by Citi bike. 

See graphic above. No word on how the bikes compare to ride sharing, though. This statistic kills me. But then again, I'm from the least congested city in America.

Links for Wednesday, September 27, 2017: Pennywise as a McDonald's shill, healthcare as a right, vitamin D and falls

Unsatisfied with limiting itself to its whopperCoin cryptocurrency, Burger king Russia is complaining that Pennywise the dancing clown gives McDonald's an unfair advantage.

What? There's no way any kid ever has confused Pennywise with the modern-day Ronald McDonald. The Willard Scott version, maybe:

But Willard's been out of the burger bidness for a while now. 

See also: Whoppercoin

Healthcare isn't a right, but access to it is vital to a functioning democracy. 

That's my take. Atul Gawande (disclosure: I'm a big fan) takes his surgical mind to the problem and, as usual, illuminates the complexity of the issue. What if we had a system that allowed trash to back up into the streets if people didn't buy exorbitantly expensive "garbage insurance?" I suspect we'd move toward a system like what we have now: mostly affordable, in many cases government-subsidized trash collection. Healthcare could follow a similar model.

USPSTF is putting the kibosh on vitamin D for fall prevention.

When I was a resident in the early oughts, vitamin D was the hottest thing going. We thought we were going to fix or prevent sooooo many problems by optimizing people's levels. Unfortunately, almost no intervention with vitamin D has proven successful. Vitamin D levels instead serve as kind of a generic marker of unwellness. Repleting those levels does not in and of itself fix the unwellness, though.

Links for Monday, September 25, 2017: how to read a chocolate bar label, nothing's stopping you from deleting Facebook, and Amish smartphones

How to read a chocolate bar label.

Phrases to Avoid:

Chocolaty...Made with chocolate...Chocolate liquor...Vegetable oil...Butter oil...Artificial sweeteners...Milk substitutes...PGPR...Vanillin...Distributed by...Product of. 

(link from marginal revolution)

Report: nothing's stopping you from deleting Facebook right now.

Sigh. Even the Amish have smartphones now.

This will distract from their naked butter churning over spring break.

Links for September 18, 2017: American sperm, movement is life, neighborhoods and vascular disease risk, and Taiwanese fruit ghosts

Canada needs our sperm. America!

Background: It is illegal to pay for sperm donations in America's hat. 

"What Canada should do is legalize compensation for renewable bodily fluids in our own country. It would be the morally right thing to do. It would help make and save more lives, without harming anybody.

Until we realize our mistake, we need you Americans to keep rolling up your sleeves and unzipping your pants not just for the sake of lucre, but also for the sake of the thousands of current and future Canadians whose lives depend on you."

The more you move, the longer you live.

Bottom line up front (BLUF): Over 4.0 years of accelerometer use, total sedentary time was associated with an increased risk of dying. Not only that, but the longer the usual sedentary bout, the higher the risk of dying (roughly double for the highest quartile). This study is encouraging, in a way: you don't have to move that much to really affect your risk, you just have to move often. But this doesn't apply to you, dear reader, since you ride your bike to the grocery store and forsake social media. Don't you?

If you live in a disadvantaged neighborhood, the usual risk factors for heart disease probably underestimate your risk.

BLUF: In a group of patients from the Cleveland Clinic, the Pooled Cohort Equations Risk Model, or PCERM of the American College of Cardiology and American Heart Association underpredicted vascular disease risk in patients from disadvantaged communities (those with a high "Neighborhood Disadvantage Index," or NDI). For a patient from a disadvantaged community, the model only achieved a "concordance index," a measure of how well it predicts vascular disease, of 0.70. In Affluent communities, on the other hand, the concordance index was 0.80. That doesn't sound like a huge difference, but the NDI was much more powerful at predicting variation between census tracts than was the PCERM tool itself.

Fruit names do not invite ghosts, says Taiwanese government

"The seventh month of the lunar calendar is called Ghost Month, when the gate of the underworld is said to open and people prepare offerings for the dead.

People have refrained from offering bananas, plums, pears and pineapples, because the fruits’ names sound like they are inviting ghosts in Hoklo (also known as Taiwanese), the market’s Fu-te Temple (福德宮) chairman Lin Lai-fa (林來發) said.

In Hoklo pronunciation, banana sounds like “inviting” (tsio), plum like “you” (li), pear like “come” (lai) and pineapple like “prosperity” or “more” (ong), the combination of which sounds like an invitation for ghosts to stay in someone’s home."

Whatever, Taiwanese Agricultural and Food Agency. I've seen a Dragon Fruit. That thing's bound to attract demons.

Links for September 15, 2017: male infertility "crisis," adrenal fatigue, the horror of goop, and water>artificial sweeteners

The male infertility "crisis" is in the eye of the beholder

Anyone who wants a baby should be able to have one, and I'm glad we have thoughtful, careful reproductive endocrinologists and urologists working on the problem. But I think as we rocket toward 10 billion people on planet Earth, calling it a crisis is probably premature. 

FWIW: adrenal fatigue isn't a real thing, no matter what GOOP says

Speaking of GOOP, Olga Khazan takes on its mysterious enduring popularity

What would possess a person to think that inserting jade eggs (those are actual egg-shaped pieces of stone, mind you) into her vagina would make her feel better? I have two theories: first, stories are more powerful than data. Local Wichita public health dynamo Becky Tuttle says that stories are "data with soul," but that's only part of the story. People like the illusion of certainty where there is only doubt. I think that's what quacks have always offered. 

See also: Nuts! the film about the Kansas doctor who implanted goat testicles, and No, women should not insert jade eggs into their vaginas

Until we have definitive evidence on artificial sweeteners, we should all drink water

Confession: medical school turned me into an heroic Diet Coke drinker in the late '90s. /at first it was just because I needed a reliable source of caffeine to keep me awake, but later it became more of a habit. It may even have had some religious undertones. Short story author Amy Parker once called it "the national beverage," and it was true for me. Every drink felt like a sip of America herself. But in February, after a bout of severe insomnia, I decided to give up caffeine altogether (it helped). It was only by coincidence that 1) data had started to accumulate that diet drinks were certainly not a panacea, and might even be bad for us, and 2) most other artificially sweetened beverages taste the way I imagine ground Smurf would taste. So I mostly gave them up, too. I've probably had 5-10 caffeine-free diet drinks since, and unless someone can produce evidence that they're not bad for me, I'm done forever. Mostly.

See also: Why one cardiologist has drunk his last diet soda

"The greatest favor you can do is...put away your phone."

Sherry Turkle from the MIT Media Lab talks about the frequency she hears people say they'd "rather text than talk." People say they feel less vulnerable when they text than they feel in a face-to-face conversation. I agree. I feel less vulnerable texting, too. 

So don't be a phone worm. When I was in medical school in the late '90s, I remember classmates making fun of a woman in our class who was pathologically attached to her cell phone. We'd all just learned the word "pathologic," and our family members were already asking us for medical advice, so we all felt comfortable making the diagnosis. Anyway, hers was the phone that would ring its Nokia ringtone multiple times a day to interrupt class back when this was still a novel occurrence:

In the year 2017, I'm not sure she'd even hit the average cell phone use. Recently, at my kids' gymnastics lesson, I was flanked by two women on cell phones. The first one sat to my right, bouncing off my shoulder as she sat. I forgave her for this, because she couldn't see me past the smartphone glued to her left ear. Then she proceeded to scream intermittently at two kids who were not in the gymnastics class, all while never removing the phone from her ear. I didn't blame the kids for being wound up; it was after school, and they were stuck in a building watching a sister when they would've undoubtedly preferred to be outside on the playground. But she couldn't be bothered to interrupt what seemed like a very non-urgent conversation.

I moved to a quieter place, sacrificing my chair for the floor. Then, three feet away, a second person started talking at full voice on her cell phone, telling the unfortunate listener on the other end repeatedly how pissed she'd been earlier in the day. Keep in mind, it was sunny and 66 degrees outside. Either person stepping outside to take her call would have been healthful and humane. But both women, insofar as my amateur observational skills could tell, sat in the middle of a crowded room and talked on their phones for the duration of the one-hour practice, save for the intermittent screaming at their kids. One child actually begged lady number two not to talk on the phone anymore, and was told to "zip it." A third man, who I assume was also a parent, broke his phone conversation only to tell a toddler to "stop fucking around." The toddler did not heed his instruction, and the man was soon sufficiently lost in his talking and texting to allow, shall we say, ample f'ing around, toddler-style. 

Sherry Turkle doesn't get into this directly in the brief video above, but this is all consistent with her observations that technology is killing social skills. We collectively show decreased empathy and a decreased ability for self-reflection. A big part of my job is handling sometimes delicate negotiations within clinics or within medical systems or between payers and doctors. In those situations, vulnerability is key. If the interested parties can't look one another in the eye and feel insecure and feel like their decisions impact the other people around the table, we get nowhere. 

Don't get me wrong. I've taken my share of calls and texts in crowds. But I've felt like an asshole almost every time. So to keep from being a hypocrite, I've set my phone to no alerts for messages or emails, and I frequently put it on sleep mode, meaning it won't ring unless an immediate family member or neighbor calls (I figure the neighbors have the best view of my house burning down). And though I've occasionally feared that this would kill my productivity, I'm fairly certain now that it does the opposite. I'm more productive the more time I spend apart from my device. People think email is urgent, for example. According to psychologist Dan Ariely, it's not. Yuval Noah Harari, author of some incredible work including Sapiens, meditates for two hours a day. And the astonishingly productive computer scientist and self-help writer Cal Newport is "indifferent" to his smartphone, still subscribes to paper newspapers, and only upgraded from a flip phone because his wife guilted him into it when they had their first baby. 

So here's a challenge for this week: Go outside your phone (comfort) zone. The next time you're standing in line waiting for something to happen, or watching your kids jump on the trampoline, or between innings at a softball game, or waiting for a movie to start, leave your phone in your pocket. Better yet, take it to whatever vehicle brought you to the game (except your skateboard; skateboards are a bad place to store a phone). It'll be hard to do, but you have the strength. Concentrate on your breathing. Once you've safely stowed the phone away, look at the others around you. You might have to work for some eye contact, because they probably aren't following the same rules you are. While you're gyrating around trying to get them to look at you, think about their stories. It'll give you something to ask them about. If they won't talk to you, make like Yuval Harari and make this time your meditation. If you're not the meditative sort, think about what you want to accomplish with the rest of the day. Make a mental plan. For a few minutes, don't be a phone drone.

See also: CRANK UP THE BASS, HOW ELSE CAN YOU CRANK UP THE BASS?, SOCIAL MEDIA IS A SET OF COMMON PLATFORMS TO DRAW OUT OUR WORST TENDENCIES, HAVE SMARTPHONES DESTROYED A GENERATION? 

Links for September 12, 2017: Little Library Locator, Kerry to Cannondale's rescue, bike manners in China, and ICT flash dine

Ever wonder where to find a little library near your house? My 10-year old did. She found the answer at Little Locator.

Did John Kerry help save Cannondale-Drapac?

If so, bravo, Mr. Secretary. With Rigoberto Uran's podium at the 2017 Tour de France, things are looking up for one of only two American-sponsored teams in the UCI peleton.

Are stationless bike shares brining out people's bad manners in China?

I've never traveled to China, but my hunch is that the bikes being scattered all over Beijing have a lot more to do with 1) a lot of people in a small space, and 2) the Wild West unregulated atmosphere of bike shares there:

In many cities, the supply of bicycles far exceeds demand, bringing chaos to sidewalks, bus stops and intersections and prompting grumbles that excessive competitiveness — seen as a national trait — is spoiling a good thing. In Shanghai, where officials have struggled to maintain order, there is now one shared bike for every 16 people, according to government statistics.

In some places, the authorities have confiscated tens of thousands of bicycles and imposed parking restrictions. News outlets have documented the waste with astounding images of mountains of candy-colored bicycles, each hue representing a different bike-share company.

I'm signed up for the ICT Flash Dine. You should sign up, too:

Links for Sept 5, 2017: books by the foot, Chilis, McDonalds as community center, and radiology job security

Where do decorative books in restaurants and bars come from?

Answer: Books by the Foot, mostly.

Inside the Church of Chilis

I grew up about twenty miles outside of a small town. So small that the addition of something like a Chili's would really set the place on fire. I still remember when we got a Wal-Mart and when we got a McDonald's. I can't say that either of those were great for the town on balance. I suppose they offered some low- to mid-range jobs, salary-wise. My mom had one of them at Wal-Mart for years. But no one that I know of ever felt the kind of devotion to either place that's described in the hard-core Chili's trainers in this article:

For the right kind of new person, though, Chili's is the righest kind of place. Her story echoes Sara's, which echoes everyone else's at their level: She was pursuing a different path (grad school for criminal justice), but kept being drawn back to Chili's, where she realized she was happiest. She was searching for something and found it there. For Nikki, now, it has grown into pure purpose. "I live and breathe for this company," she says. "This is totally what I was supposed to do. This is what makes me tick everyday. Everything I do is with Chili's. This is not a job for me—this is my life."

McDonald's is a surprisingly important meeting place

Speaking of McDonalds, the burger place occupies a special place in the communities in which it's found (I'd say serves, but I'm not there yet): 

In Sulfur Springs, Texas, in the late morning, Lew Mannon, 76, and Gerald Pinkham, 78, were sitting alone at a table, the last of the morning regulars to leave. She was needling him about politics. (“I like to tease the men who come, get them all riled up, tell them they just don’t want a female as president.”) Both are retired, Gerald from working for an airfreight company, and Lew after 28 years as a bank teller.

When I asked Lew about her life, she started to tear up, stopped for a second, and composed herself. “Life is hard. Very hard. Seven years ago I lost my husband to leukemia. Then three years ago I lost one of my sons. Health complications from diabetes. When my son died, I had nobody to help me, emotionally, except this community here. Gerald lost his wife three years ago, and we have helped support each other through that.”

She stopped again, unable to speak from tears. After a moment of silence: “I look composed on the outside. Many of us do. But I struggle a lot on the inside. This community here gives me the support to get by.”

When I was in second grade, I got to have my birthday in McDonald's. It was noteworthy for a couple reasons: first, birthday parties were always a little touch-and-go with me, since my birthday so often fell dead-center in corn harvest; and second, because I was the first person in my class to have his party at the new McDonald's in town. I remember it all: the faux-wood bent booths, the paper hats, the Happy Meal toys.

None of these kids are me, but they might as well be. (http://bit.ly/2x7DyOo)

I was so excited to leave school to take my friends there that my mom tried to slow my down and I fell on the cement and tore my jeans. I didn't even care.

Radiologists are (rightly) concerned about how artificial intelligence may affect their careers

"Radiology has become commoditized over the years," Kelley says. "People don't want interaction with a radiologist, they just want a piece of paper that says what the CT shows."

See also: Let's kill radiology and pathology and combine them into "Information Specialists." (paywall)

Links for September 1, 2017: building a better block, football broadcaster crisis of conscience, kibbutzing for happiness, meldonium, stem cell clinics, FSH, and whoppercoin

Ed Cunningham quit college football over concussion concerns.

That little click you just heard was another tiny domino falling in the decline of football. I've said before that the NFL was one thing, but it's such a small, relatively well-paid population that it doesn't mean much. Once concern starts spreading upstream into college, high school, and beyond, football is in trouble.

Can a Kibbutz make us happier?

In my neighborhood we've experimented with our version of Kibbutzing: we used to have a monthly (or so) breakfast where everyone in the neighborhood was invited to a single house for pancakes, breakfast burritos, etc. Like so much in life, though, it was overtaken by other Saturday morning chores. It's hard for even a breakfast burrito to compete with kids' soccer, the Home Depot, and volunteer duties. It's time to resurrect our Kibbutz. 

Caitlin Thompson doped like Maria Sharapova and liked it.

Caitlin brings up the possibility of this having been a placebo effect. I agree. It's hard to find clinical trial data on meldonium in English; almost all the trials are published in Russian:

And there are no systematic reviews. Wolfgang Schobersberger, Tobias Dünnwald, Günther Gmeiner, and Cornelia Blank wrote a nice narrative review (paywalled) on meldonium's transition to a performance-enhancing drug, though. The take-home from their article is right in the abstract:

The benefit of taking meldonium in view of performance enhancement in athletes is quite speculative, and is discussed without sound scientific evidence.

The FDA is (finally) taking on stem cell clinics.

A few years ago, a stem cell clinic opened here in Kansas, with surprising fanfare. IIRC, they convinced the Governor and even Kansas State Head Football Coach Bill Snyder to attend a grand opening. Coach Snyder is even in a video on their website. Not long after, I reached out to the docs in the clinic through their website to ask to talk about the evidence they were using to justify their treatment regimens. I never got a response. That clinic is not on the list, as far as I can see, of clinics that have been contacted by the FDA.

Is follicle stimulating hormone responsible for post-menopausal weight gain?

I'm skeptical. And I suspect the downstream effects of blocking FSH, which aren't completely known yet, might be worse than an extra 15 pounds.

Burger King is launching its own cryptocurrency that can only be used to buy whoppers. For real. 

I hope I'm not being burned by fake news here.