OUCH!!!
Who said that???
Health systems exist for two main reasons: To make money. To get re-elected.
That said, it is probably why most things exist.
Category Archives: musings
politicians are like the school debating team
politicians are like the school debating team, generally smart, eloquent, hyper-verbal and capable, but not really central to operations or outcomes
“Eat right. Get physical activity. Don’t smoke. Alcohol in moderation. Spend time with friends.”
http://www.vox.com/health-care/2014/4/22/5640636/dont-read-more-health-books-read-these-14-words
Don’t read more health books. Read these 14 words.
Thomas Frieden has a scary job. As director of the Centers for Disease Control and Prevention, he gets the call when infections begin defeating all known antibiotics, or Ebola resurfaces, or overdoses from prescription opiates begin skyrocketing.
Meanwhile, I’m the kind of person who won’t even go see movies about disease outbreaks. So when I sat down with Frieden recently, I asked him the question hypochondriacs need to know: What has all this data taught him to fear? What does he tell his family to do differently?
His answer was borderline dull:
Very little is different really. It’s basic. Wash your hands regularly. Get regular physical activity. Eat foods you love that are healthy. That’s one of the things that’s so challenging. Take physical activity as an example. You don’t have to have much, 30 minutes a day. Doing that, which can be three 10-minute walks, is going to make a huge difference in your life. You’ll feel better even if you don’t lose an ounce. You will be much less likely to have high blood pressure, high cholesterol, cancer, arthritis, depression. You’ll sleep better. And it doesn’t cost a cent.
There’s a lot a of things that can be done that are not very difficult and can make a really big difference. Of course, get your shots, get vaccination, get a flu shot every year and see the doctor regularly and if you have a problem make sure to get follow up.
The broader point — which came up again and again in our interview — is that the main threats to health aren’t spectacular. People die from heart disease, car accidents, and tobacco a lot more often than they’re killed by Ebola, terrorism, and heroin.
The CDC Director’s reply reminded me of Michael Pollan’s famous, commonsense triplet about diet: “Eat food. Not too much. Mostly plants.” I asked whether Frieden had similarly concise advice. He did.
“Eat right. Get physical activity. Don’t smoke. Alcohol in moderation. Spend time with friends.”
Unlike a lot of health treatments, weird diets, and fancy exercise regimes you’ll read about, this advice is backed up by reams of rock-solid evidence — and following it costs next to nothing.
So there it is: in less than 15 words, the US official who probably knows better than anyone else what might kill you explains how to protect yourself.
Here’s my full interview with Frieden:
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I am an entrepreneur…
Katz on managing severe obesity
good, balanced diatribe..
http://www.linkedin.com/today/post/article/20140408142414-23027997-severe-obesity-let-em-eat-kale
Severe Obesity? Let ‘Em Eat Kale!
The tale of aristocratic indifference on the part of Marie Antoinette, Queen of France at the time of the French Revolution, wife of Louis XVI, is, we now know, likely apocryphal. Still, like many historical distortions, this one reverberates through modern culture just the same, and harbors meaning as archetype, if not as reliably archived fact. You no doubt know the tale:
The peasants were starving and had no bread. Marie allegedly suggested: “let them eat cake!”
We find a modern day analogue in the advice dispensed by foodie elite who suggest that the masses should just eat “real” food. The definition of “real” is generally left open to interpretation- but of course, Marie never said what kind of cake, either.
The connotations of “real” are clear enough: pure, unpackaged foods; those icons of nutritional virtue about which the wholesome truth is so self-evident that ingredient lists and nutrition fact panels are superfluous. Wild salmon comes to mind. And broccoli, presumably organic. And fresh berries.
In other words, since the people have no whole-grain bread: let ‘em eat kale!
Now, frankly, I’m quite partial to kale. And, for that matter, the potentially even more nutritious fiddlehead ferns. But I have a real antipathy for fiddling around, or issuing jejune exhortations, while Rome is burning. And burning, it is.
For those inclined to celebrate the recent and radically distorted ping about childhood obesity rates ‘plummeting,’ came this week’s predictably countervailing pong: they have not plummeted after all. More importantly, the most recent paper on childhood obesity trends shows that severe obesity is rising disproportionately.
That’s worth reiterating: whatever is happening to overall obesity rates, rates of severe obesity are rising briskly in children. Prior research had already indicated that was true in both children and adults, so speaking of cake, this is really just icing on what was already well baked. But we seemed in need of a timely reminder.
Fundamentally, this means that it may no longer help us much to ask and answer: how many Americans are overweight or obese? That number, or percentage, may now be level and rather uninteresting, if only because it is pressed up against the ceiling. To gauge the severity of hyperendemic obesity in our culture, we may now need to ask: how overweight and obese are the many?
The answer, ever more often, is: severely.
That severe obesity rates are rising steadily and perhaps steeply has two flagrant implications. The first is that we are not doing nearly enough at the level of our culture to make eating well, being active, and thereby controlling weight the prevailing norm. These two behaviors and one outcome remain exception rather than rule, costing us dearly- in every currency that matters, human potential above all.
The second implication is that we need good treatments for severe obesity, since it is already well established among us.
I have first hand experience with severe obesity, in adults and kids alike. Unlike garden-variety weight gain, severe obesity generally occurs in the context of diverse hardships. Sometimes, there is the duress of a dysfunctional family dynamic. Sometimes there is an underlying mental health problem. Sometimes the propagating factors are preferentially, if not exclusively, socioeconomic: a rough neighborhood, with lack of access to “real” food and recreational opportunities, and the inevitable clustering of fast food franchises. That latter peril makes me think of wolves surrounding the most vulnerable member of a herd. Almost inevitably, there is ridicule, disparagement, and disadvantage; the literal, daily addition of insult to injury.
Bariatric surgery is effective treatment for severe obesity, and I have long advocated strenuously that it should be available, and reimbursable, for all who truly need it. But meaning no disrespect to the surgeons who provide or patients who receive it, it’s a rather poor option and should be a last resort, not a first, especially for children. The surgery is potentially major, and thus encumbered by all of the customary risks. The long-term effects are far from perfect, and substantially unknown for children. The monetary costs are apt to be unmanageable if this becomes the “go to” solution for an increasingly prevalent problem.
And most importantly: nobody learns anything under general anesthesia. The root causes of severe obesity are not addressed with scalpels. There is no way to share the benefits of a redirected gastrointestinal tract. In contrast, “skillpower” can be shared. A systematic effort to empower those most in need with the skills and resources needed to eat well, be active, lose weight, and find health- physical and mental- would allow for paying it forward, to family and friends, and the next generation. The good of surgery is contained within a body. The good of propagating skills and resources for healthy living reverberates throughout the body politic.
My friend David Freedman, the highly accomplished health journalist, and I have had a spirited and fairly public exchange on the topic of “getting there” from here. When Mr. Freedman suggested that better junk food could be part of the answer, I protested: anything that is genuinely part of the solution is, by definition, no longer junk. When I emphasized the importance of knowing what dietary pattern is best for health, Mr. Freedman parried back that I might be diverting attention from the critical need to pave a way of getting there from here, accessible in particular for those currently most forestalled.
But in the end, our private exchanges indicated that our public argument was mostly smoke and just about no fire. We both agree that we can’t have good diets supporting good health if we don’t acknowledge we know what a good diet is. And we both agree that knowing that “real” food is good does just about nothing to help modify and improve the diets and health of real people.
For that, we need an expansive cultural commitment; a movement; perhaps even a revolution. We need approaches to severe obesity that don’t just fix it after it happens. Big Surgery and Big Pharma may be beneficiaries of this, but the rest of us will be in one helluva fix. The better way is introducing innovative solutions that confront it at its origins and spread of their own accord.
We need to reorient our cultural attitude about obesity so it is not an excuse to argue the respective merits of personal responsibility and public policy. Rather, if we are to fix it at its origins, we need to acknowledge that people who are empowered are most capable, and most inclined, to exercise responsibility. So let’s build it, and see what comes.
We can, and should, empower people to trade up the food choices they are already making.Better chips may not satisfy the purists, but the evidence is in hand that improving food choices- even among the homely fare that comes in bags, boxes, bottles, jars, and cans- adds up to make a truly important difference for populations, and individuals alike. This can be done without spending more money, urban legend to the contrary notwithstanding. Still, we could likely accomplish far more by combining nutrition guidance systems with financial incentives that encourage their use.
Among such approaches, too, are community and New-Age approaches to gardening that might even allow many more of us to grow our own kale- and perhaps fiddlehead ferns.
But “let ‘em eat kale” simply won’t do. It’s fatuous, unrealistic, elitist nonsense. It’s fiddling around. And all the while, Rome burns.
-fin
Is Big Food the new Tobacco?
Finally commented on the Food Politics blog. Excitement.
APR172014
Is Big Food the new Tobacco?
Thanks to Maggie Hennessy at FoodNavigator-USA for her report on a meeting I wish I’d been able to attend—the Perrin Conference on “Challenges Facing the Food and Beverage Industries in Complex Consumer Litigations.”
Hennessey quotes from a speech by Steven Parrish, of the Steve Parrish Consulting Group describing parallels between tobacco and food litigation.
From the first lawsuit filed against [tobacco] industry member in 1953 to mid-1990s, the industry never lost or settled a smoking and health product liability suit. In the mid ‘90s the eggs hit the fan because the industry for all those decades had smugly thought it had a legal problem. But over time, it came to realize it had a society problem. Litigation was a symptom of the disease, not the disease itself.
…When it came time to resolve the litigation, we couldn’t just sit in a room and say, ‘how much money do you want?…A lot had nothing to do with money. It had to do with reining the industry in…We spent so much time early on talking to ourselves about greedy trial lawyers, out-of-touch regulators, media-addicted elected officials and public health people who didn’t know how to run a business. At the end of the day, it didn’t matter. We would have been much better off recognizing these people had legitimate agendas.”
… Maybe there are some parallels, but I urge people not to succumb to the temptation to say, ‘cigarettes kill you, cigarettes are addictive. But mac and cheese, coffee, and Oscar Meyers wieners don’t. That may be true, but there are still risks for the industry.
The article also quotes Michael Reese, plaintiff’s attorney for Reese Richman LLP, talking about the increasingly accusatory tone of media coverage of Big Food:
There’s this idea, which has picked up steam in the media, that large food companies are manipulating ingredients to hook people on food. It hasn’t been manifest in litigation yet, but we’re seeing it with legislative initiatives, like Mayor Bloomberg in New York City saying sugar hooks people and causes diabetes. We’ve seen some with GMOs, though most of that legislation is about consumers’ right to know. But there’s this overarching concept that Big Food is somehow manipulating our food supply and as a result, giving us non-food.
Sounds like the message is getting across loud and clear.
Thoughts?
an idea of earth shattering significance
ok.
been looking for alignment between a significant industry sector and human health. it’s a surprisingly difficult alignment to find… go figure?
but I had lunch with joran laird from nab health today, and something amazing dawned on me, on the back of the AIA Vitality launch.
Life (not health) insurance is the vehicle. The longer you pay premiums, the more money they make.
AMAZING… AN ALIGNMENT!!!
This puts the pressure on prevention advocates to put their money where their mouth is.
If they can extend healthy life by a second, how many billions of dollars does that make for life insurers?
imagine, a health intervention that doesn’t actually involve the blundering health system!!?? PERFECT!!!
And Australia’s the perfect test bed given the opt out status of life insurance and superannuation.
Joran wants to introduce me to the MLC guys.
What could possibly go wrong??????
Machines put half of US work at risk
Great tip from Michael Griffith on the back of last night’s dinner terrific conversation at the Nicholas Gruen organised feast at Hellenic Republic…
http://www.bloomberg.com/news/2014-03-12/your-job-taught-to-machines-puts-half-u-s-work-at-risk.html
Paper (PDF): The_Future_of_Employment
Your Job Taught to Machines Puts Half U.S. Work at Risk
By Aki Ito Mar 12, 2014 3:01 PM ET
Who needs an army of lawyers when you have a computer?
When Minneapolis attorney William Greene faced the task of combing through 1.3 million electronic documents in a recent case, he turned to a so-called smart computer program. Three associates selected relevant documents from a smaller sample, “teaching” their reasoning to the computer. The software’s algorithms then sorted the remaining material by importance.
“We were able to get the information we needed after reviewing only 2.3 percent of the documents,” said Greene, a Minneapolis-based partner at law firm Stinson Leonard Street LLP.
Full Coverage: Technology and the Economy
Artificial intelligence has arrived in the American workplace, spawning tools that replicate human judgments that were too complicated and subtle to distill into instructions for a computer. Algorithms that “learn” from past examples relieve engineers of the need to write out every command.
The advances, coupled with mobile robots wired with this intelligence, make it likely that occupations employing almost half of today’s U.S. workers, ranging from loan officers to cab drivers and real estate agents, become possible to automate in the next decade or two, according to a study done at the University of Oxford in the U.K.
Aethon Inc.’s self-navigating TUG robot transports soiled linens, drugs and meals in…Read More
“These transitions have happened before,” said Carl Benedikt Frey, co-author of the study and a research fellow at the Oxford Martin Programme on the Impacts of Future Technology. “What’s different this time is that technological change is happening even faster, and it may affect a greater variety of jobs.”
Profound Imprint
It’s a transition on the heels of an information-technology revolution that’s already left a profound imprint on employment across the globe. For both physical andmental labor, computers and robots replaced tasks that could be specified in step-by-step instructions — jobs that involved routine responsibilities that were fully understood.
That eliminated work for typists, travel agents and a whole array of middle-class earners over a single generation.
Yet even increasingly powerful computers faced a mammoth obstacle: they could execute only what they’re explicitly told. It was a nightmare for engineers trying to anticipate every command necessary to get software to operate vehicles or accurately recognize speech. That kept many jobs in the exclusive province of human labor — until recently.
Oxford’s Frey is convinced of the broader reach of technology now because of advances in machine learning, a branch of artificial intelligence that has software “learn” how to make decisions by detecting patterns in those humans have made.
Artificial intelligence has arrived in the American workplace, spawning tools that… Read More
702 Occupations
The approach has powered leapfrog improvements in making self-driving cars and voice search a reality in the past few years. To estimate the impact that will have on 702 U.S. occupations, Frey and colleague Michael Osborne applied some of their own machine learning.
They first looked at detailed descriptions for 70 of those jobs and classified them as either possible or impossible to computerize. Frey and Osborne then fed that data to an algorithm that analyzed what kind of jobs make themselves to automation and predicted probabilities for the remaining 632 professions.
The higher that percentage, the sooner computers and robots will be capable of stepping in for human workers. Occupations that employed about 47 percent of Americans in 2010 scored high enough to rank in the risky category, meaning they could be possible to automate “perhaps over the next decade or two,” their analysis, released in September, showed.
Safe Havens
“My initial reaction was, wow, can this really be accurate?” said Frey, who’s a Ph.D. economist. “Some of these occupations that used to be safe havens for human labor are disappearing one by one.”
Loan officers are among the most susceptible professions, at a 98 percent probability, according to Frey’s estimates. Inroads are already being made by Daric Inc., an online peer-to-peer lender partially funded by former Wells Fargo & Co. Chairman Richard Kovacevich. Begun in November, it doesn’t employ a single loan officer. It probably never will.
The startup’s weapon: an algorithm that not only learned what kind of person made for a safe borrower in the past, but is also constantly updating its understanding of who is creditworthy as more customers repay or default on their debt.
It’s this computerized “experience,” not a loan officer or a committee, that calls the shots, dictating which small businesses and individuals get financing and at what interest rate. It doesn’t need teams of analysts devising hypotheses and running calculations because the software does that on massive streams of data on its own.
Lower Rates
The result: An interest rate that’s typically 8.8 percentage points lower than from a credit card, according to Daric. “The algorithm is the loan officer,” said Greg Ryan, the 29-year-old chief executive officer of the Redwood City, California, company that consists of him and five programmers. “We don’t have overhead, and that means we can pass the savings on to our customers.”
Similar technology is transforming what is often the most expensive part of litigation, during which attorneys pore over e-mails, spreadsheets, social media posts and other records to build their arguments.
Each lawsuit was too nuanced for a standard set of sorting rules, and the string of keywords lawyers suggested before every case still missed too many smoking guns. The reading got so costly that many law firms farmed out the initial sorting to lower-paid contractors.
Training Software
The key to automate some of this was the old adage to show not tell — to have trained attorneys illustrate to the software the kind of documents that make for gold. Programs developed by companies such as San Francisco-based Recommind Inc. then run massive statistics to predict which files expensive lawyers shouldn’t waste their time reading. It took Greene’s team of lawyers 600 hours to get through the 1.3 million documents with the help of Recommind’s software. That task, assuming a speed of 100 documents per hour, could take 13,000 hours if humans had to read all of them.
“It doesn’t mean you need zero people, but it’s fewer people than you used to need,” said Daniel Martin Katz, a professor at Michigan State University’s College of Law in East Lansing who teaches legal analytics. “It’s definitely a transformation for getting people that first job while they’re trying to gain additional skills as lawyers.”
Robot Transporters
Smart software is transforming the world of manual labor as well, propelling improvements in autonomous cars that make it likely machines can replace taxi drivers and heavy truck drivers in the next two decades, according to Frey’s study.
One application already here: Aethon Inc.’s self-navigating TUG robots that transport soiled linens, drugs and meals in now more than 140 hospitals predominantly in the U.S. When Pittsburgh-based Aethon first installs its robots in new facilities, humans walk the machines around. It would have been impossible to have engineers pre-program all the necessary steps, according to Chief Executive Officer Aldo Zini.
“Every building we encounter is different,” said Zini. “It’s an infinite number” of potential contingencies and “you could never ahead of time try to program everything in. That would be a massive effort. We had to be able to adapt and learn as we go.”
Human-level Cognition
To be sure, employers won’t necessarily replace their staff with computers just because it becomes technically feasible to do so, Frey said. It could remain cheaper for some time to employ low-wage workers than invest in expensive robots. Consumers may prefer interacting with people than with self-service kiosks, while government regulators could choose to require human supervision of high-stakes decisions.
Even more, recent advances still don’t mean computers are nearing human-level cognition that would enable them to replicate most jobs. That’s at least “many decades” away, according to Andrew Ng, director of the Stanford Artificial Intelligence Laboratory near Palo Alto, California.
Machine-learning programs are best at specific routines with lots of data to train on and whose answers can be gleaned from the past. Try getting a computer to do something that’s unlike anything it’s seen before, and it just can’t improvise. Neither can machines come up with novel and creative solutions or learn from a couple examples the way people can, said Ng.
Employment Impact
“This stuff works best on fairly structured problems,” said Frank Levy, a professor emeritus at the Massachusetts Institute of Technology in Cambridge who has extensively researched technology’s impact on employment. “Where there’s more flexibility needed and you don’t have all the information in advance, it’s a problem.”
That means the positions of Greene and other senior attorneys, whose responsibilities range from synthesizing persuasive narratives to earning the trust of their clients, won’t disappear for some time. Less certain are prospects for those specializing in lower-paid legal work like document reading, or in jobs that involve other relatively repetitive tasks.
As more of the world gets digitized and the cost to store and process that information continues to decline, artificial intelligence will become even more pervasive in everyday life, says Stanford’s Ng.
“There will always be work for people who can synthesize information, think critically, and be flexible in how they act in different situations,” said Ng, also co-founder of online education provider Coursera Inc. Still, he said, “the jobs of yesterday won’t the same as the jobs of tomorrow.”
Workers will likely need to find vocations involving more cognitively complex tasks that machines can’t touch. Those positions also typically require more schooling, said Frey. “It’s a race between technology and education.”
To contact the reporter on this story: Aki Ito in San Francisco at aito16@bloomberg.net
To contact the editors responsible for this story: Chris Wellisz at cwellisz@bloomberg.net Gail DeGeorge, Mark Rohner
The Trouble Is You Think You Have Time – Buddha
The Trouble Is You Think You Have Time – Buddha