And me. I want you to take your life back from your devices, too.
...food swamps had about four unhealthy options for each healthy one. Food swamps were a strong predictor of obesity rates—even stronger than food deserts were. The relationship between food swamps and obesity was especially strong in areas where people lacked both their own cars and access to public transportation.
See primary paper here.
The Dunning-Kruger effect (which applies to docs) is the phenomenon in which difficulty in recognizing one's own incompetence leads to Inflated self-assessment. That is, the worse you are at your job, to some extent, the higher you rate your ability to do that job. Uplifting stuff when we think about management.
In the US, even modest reforms to use taxpayer money to fund research to learn what treatments work best, for which patients, have engendered controversy. Republicans famously charged that the establishment of the Patient-Centered Outcomes Research Institute (PCORI) through the Affordable Care Act, would lead to the creation of “death panels.” The politicians made that argument even though the agency only funds studies and was given no authority to make policy decisions or payment recommendations. PCORI has yet to have a significant impact on clinical practice. It faces a sunset date of 2019, and its future remains unclear.
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 , 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.
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?
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.
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.
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."
'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.”'
Get your kids vaccinated for polio, folks.
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.
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”.
I remember an anthropologist in college making fun of an economist, saying the economists never changed the questions on tests, only the answers. This seems like that. But the guideline includes more organizations than I can shake a stick at:
So it has consensus going for it, I guess. And I like that it makes HTN treatment more like cholesterol treatment: initiation and targets are linked to 10-year vascular disease risk, which can be calculated here.
With a risk >/=10%, you get drugs if your BP is 130/80 mmHg or above. With a risk <10%, and you get lifestyle management alone. Everyone gets drugs at 140/90 mmHg:
I'm on board for recommendations on sleep. If we could get by with less sleep than ~7-8 hours, I figure Mother Nature would have mutated the need out of us long ago. But even though I'm a social media skeptic, I just can't quite bring myself to think that podcasts are bad for me. Maybe I love them too much. But humans are social animals, and in many cases we're put in situations where social interaction just isn't practical. Podcasts fill some of that gap for me. And I agree that the reason podcasts light up people's brains on fMRI is because fMRI is so boring to begin with:
“One of the problems you have in MRI experiments is oftentimes they are very boring,” Gallant said on Freakonomics. “If you put somebody in an MRI scanner, which is a very uncomfortable place to be, and then you flash a word at them every five seconds for an hour, they get bored out of their skull.”
To me, an apt, potentially enlightening, comparison is podcast listening versus phone calls. We know that even hands-free phone calls for drivers radically decrease the quality of driving. Listening to music is associated with no such risk, and neither is talking to a passenger in the car. So is driving while podcasting (DWP) more like hands-free driving, or is it more like driving with music? If you're futzing around with your device trying to find a podcast you like, it's clearly dangerous. That's one reason I absolutely despise Apple's new podcast app, which won't just play podcasts in series like the old app did. I have to pull over to start a new podcast if I'm in the gas-powered wheelchair. But if you don't need to touch your device to play the sound, it seems more like music. On the other hand, podcasts can't shut up when the traffic gets bad or warn you you're about to hit somebody like a passenger can. Sigh. I don't know if I'm talking myself into something or out of something at this point.
I've done a fair amount of telemedicine, all with Vigilias. (I think I was the first doc to ever see a patient on their platform). The practice is closer to in-person medicine than you think. But there are some tricks, as the article points out:
"It sounds strange, but when you're on camera all your actions are magnified," Krupinski says. Sitting six feet away from your doctor, in person, you might not mind or notice her slouching, fidgeting, or gesticulating. But a webcam's intimate vantage point augments these actions in ways that patients can find distracting or off-putting. "You take a sip of coffee and your mug takes up the whole screen, and all they hear is the sound of you slurping," she says. "Or you turn away to make a note, and now all your patient sees is your shoulder. Maybe you disappear from the frame entirely."
And this one is the hardest to get used to:
To appear as though they're making eye contact, clinicians are taught to look not at the patient on their screen, but directly into their device's webcam.
I had other little quirks in my telemedicine days: I had to move my studio to the basement because of complaints about the neighbor's dog barking in the background. And at the beginning I only "dressed" from the waist up, since patients would never see me below the waist. But I found that it made me self-conscious. I needed to have some kind of uniform on to feel like a doctor.
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."
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.
(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).
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.”
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.”'
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."
'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.”'
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.
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.
(it never left) Link posted here because I like the video.
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.
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.
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 is disgusting. But this article is delicious.
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.
SNAP stands for Supplemental Nutrition Assistance Program. It is used by about half of the Medicaid beneficiaries who qualify for it.
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.
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.
Justin Moore, owner of an iPhone, agrees. Don't be a phoneworm.
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.
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.
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?”
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.
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.
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.
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
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.
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.
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)
This will distract from their naked butter churning over spring break.
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."
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.
"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.
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.
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.
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.
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.