Monthly Archives: February 2014

data saving lives, healthcare, quotes & aphorisms, rapid learning health systems, research methodology

the world’s most potent, booming unnatural resource: data

 

Predictive analytics is “powered by the world’s most potent, booming unnatural resource: data.”

You have been predicted — by companies, governments, law enforcement, hospitals, and universities. Their computers say, “I knew you were going to do that!”

Great quotes from Eric Siegel.

http://bigthink.com/big-think-edge/you-can-predict-the-future

You CAN Predict the Future, and Influence It Too

FEBRUARY 13, 2014, 12:00 AM
Shutterstock_64061473

We are better than ever at making predictions – whether you’re going to click, lie, buy or die, as Eric Siegel puts it.

In a lesson on Big Think Edge, the only forum on YouTube designed to help you get the skills you need to be successful in a rapidly changing world, Siegel, a former professor at Columbia University, shows how predictive analytics is “powered by the world’s most potent, booming unnatural resource: data.”

You have been predicted — by companies, governments, law enforcement, hospitals, and universities. Their computers say, “I knew you were going to do that!”

Advertising

Netflix and Pandora predict the movies and music you will like. Online dating sites select possible matches for you based on your interests. Companies can predict whether you’re going to default on your credit card statements and whether you’re going to commit an act of fraud.

So what do governments and companies do with this gold mine? In the video below, Siegel tells Big Think that these entities not only have the power to predict the future “but also to influence the future.”  And so can you.

Sign up for a free trial subscription on Big Think Edge and watch Siegel’s lesson here:

https://www.youtube.com/watch?v=Kriiamz9KqQ

Reflection Questions 
— Describe how your company is using predictive analytics to influence any operational decisions? Do you analyze who is likely to respond before initiating a marketing campaign? If not, how could this help streamline operations in your department?– How are predictive analytics at work in your life? Do you use Netflix or Pandora to predict movies or music you will like? Have you used an online dating site that selects possible matches for you based on your interests? How has this worked out for you?

— Is the use of predictive analysis exposing people to other people, entertainment, or services that more accurately match their interests or is it pigeonholing people by suggesting things they may like based only on a limited amount of information on previous decisions they’ve made?

For expert video content to inspire, engage and motivate your employees, visit Big Think Edge. 

Watch the video below and sign up for your free trial to Big Think Edge today. 

business, entrepreneurship, management and leadership

Strategic thinking

  • From this HBR article
  • strategic thinking is seen as a universally important skill
  • it about being able to see, predict, and plan ahead
  • “Strategic leaders take a broad, long-range approach to problem-solving and decision-making that involves objective analysis, thinking ahead, and planning. That means being able to think in multiple time frames, identifying what they are trying to accomplish over time and what has to happen now, in six months, in a year, in three years, to get there,” he writes. “It also means thinking systemically. That is, identifying the impact of their decisions on various segments of the organization–including internal departments, personnel, suppliers, and customers.“
  • It’s also important to pass strategic thinking onto employees
  • One of the key prerequisites of strategic leadership is having relevant and broad business information that helps leaders elevate their thinking beyond the day-to-day
  • need to communicate a well-articulated philosophy, a mission statement, and achievable goals throughout your company
  • Whenever possible, try to promote foresight and long-term thinking
  • promote a “future perspective” in your company. If a manager suggests a course of action, you need to him or her ask two questions: First, what underlying strategic goal does this action serve, and why? And second, what kind of impact will this have on internal and external stakeholders? “Consistently asking these two questions whenever action is considered will go a long way towards developing strategic leaders,” he writes.

http://www.inc.com/will-yakowicz/how-to-foster-strategic-thinking-in-employees.html

How to Get Your Employees to Think Strategically BY 

Studies show that strategic thinking is the most important element of leadership. But how do you instill the trait in others at your company?

What leadership skill do your employees, colleagues, and peers view as the most important for you to have? According Robert Kabacoff, the vice president of research at Management Research Group, a company that creates business assessment tools, it’s the ability to plan strategically.

He has research to back it up: In the Harvard Business Review, he cites a 2013 study by his company in which 97 percent of a group of 10,000 senior executives said strategic thinking is the most critical leadership skill for an organization’s success. In another study, he writes, 60,000 managers and executives in more than 140 countries rated a strategic approach to leadership as more effective than other attributes including innovation, persuasion, communication, and results orientation.

But what’s so great about strategic thinking? Kabacoff says that as a skill, it’s all about being able to see, predict, and plan ahead: “Strategic leaders take a broad, long-range approach to problem-solving and decision-making that involves objective analysis, thinking ahead, and planning. That means being able to think in multiple time frames, identifying what they are trying to accomplish over time and what has to happen now, in six months, in a year, in three years, to get there,” he writes. “It also means thinking systemically. That is, identifying the impact of their decisions on various segments of the organization–including internal departments, personnel, suppliers, and customers.”

As a leader, you also need to pass strategic thinking to your employees, Kabacoff says. He suggests instilling the skill in your best managers first, and they will help pass it along to other natural leaders within your company’s ranks. Below, read his five tips for how to carry out this process.

Dish out information.

Kabacoff says that you need to encourage managers to set aside time to thinking strategically until it becomes part of their job. He suggests you provide them with information on your company’s market, industry, customers, competitors, and emerging technologies. “One of the key prerequisites of strategic leadership is having relevant and broad business information that helps leaders elevate their thinking beyond the day-to-day,” he writes.

Create a mentor program.

Every manager in your company should have a mentor. “One of the most effective ways to develop your strategic skills is to be mentored by someone who is highly strategic,” Kabacoff says. “The ideal mentor is someone who is widely known for his/her ability to keep people focused on strategic objectives and the impact of their actions.”

Create a philosophy.

As the leader, you need to communicate a well-articulated philosophy, a mission statement, and achievable goals throughout your company. “Individuals and groups need to understand the broader organizational strategy in order to stay focused and incorporate it into their own plans and strategies,” Kabacoff writes.

Reward thinking, not reaction.

Whenever possible, try to promote foresight and long-term thinking. Kabacoff says you should reward your managers for the “evidence of thinking, not just reacting,” and for “being able to quickly generate several solutions to a given problem and identifying the solution with the greatest long-term benefit for the organization.”

Ask “why” and “when.”

Kabacoff says you need to promote a “future perspective” in your company. If a manager suggests a course of action, you need to him or her ask two questions: First, what underlying strategic goal does this action serve, and why? And second, what kind of impact will this have on internal and external stakeholders? “Consistently asking these two questions whenever action is considered will go a long way towards developing strategic leaders,” he writes.

IMAGE: GALLERY STOCK
LAST UPDATED: FEB 10, 2014
data saving lives, healthcare, healthy habits, policy, quantified self

Health Miranda: You have the right to keep your health information private, anything you disclose about your health can and will be used against you.

  • The Affordable Care Act now lets employers charge employees different health insurance rates, based on whether they exercise, eat healthful foods and other “wellness” choices they make outside of work.
  • As different phases of the law have taken effect and companies have better understood how to implement it, there basically have been three levels of wellness engagement:
  • Level 1 encourages employees to join a wellness program with exercise and nutrition activities and undergo biometric screenings that check weight, body mass, cholesterol and other health indicators.

    Level 2 trades the carrot for the stick. Employees (and insured family members) who don’t submit to the screening and participate in wellness programs face steep penalties; they may have to pay up to 30 per cent more for their share of health insurance costs.

  • Level 3 in the march towards wellness adopts “outcomes” based programs that can require employees to meet specific fitness goals or pay higher insurance costs.
  • WELLOGRAPH.com looks like an interesting prospect at AUD354

http://www.afr.com/p/technology/wearable_tech_privacy_headed_on_1uDsKFvA5cacLwe6vTKIBN

Wearable tech, privacy on collision course

PUBLISHED: 8 HOURS 48 MINUTES AGO | UPDATE: 4 HOURS 28 MINUTES AGO

Wearable tech, privacy on collision courseThe Zepp Labs wearable sensor on a golf glove … this year’s Consumer Electronics Show was dominated by the next generation of fitness devices. With more advanced sensors and improved hardware.

BRIER DUDLEY

Outrage over NSA spying is nothing compared to how people may react to the upcoming collision with wearable computing, medical privacy and new insurance rules.

You don’t need leaked documents to see it coming, though it took me a while to connect the dots after seeing the bewildering array of new health and fitness-tracking gadgets shown at January’s Consumer Electronics Show.

The show was seen as a turning point for “wearables”, including watches, wristbands, headsets and other gadgets. The most popular wearables monitor physical activity and connect wirelessly to phones, which may then upload the data to online services.

Research firms expect the fitness-wearables category to soar over the next few years, outpacing the growth of smartphones and tablets.

Not everyone wants to have a little computer on the wrist or head keeping track of what a wearer does around the clock. But I wonder if they won’t have much choice in the future, under new insurance laws in the US that invite companies to scrutinise and monitor their employees’ health and fitness.

In the past, medical information was generally none of your employer’s business. It’s still technically private. But the health-care overhaul known as Obamacare is chipping away at this wall.

The Affordable Care Act now lets employers charge employees different health insurance rates, based on whether they exercise, eat healthful foods and other “wellness” choices they make outside of work.

A 2013 survey by Aon Hewitt consulting found that motivating employees to change health behaviours is a “significant focus” over the next three to five years at 69 per cent of employers.

It doesn’t seem like a bad thing because it’s wrapped up in warm and fuzzy doublespeak. This isn’t about saving companies money; it’s about your health. Companies aren’t forcing you to participate, they’re offering rewards. We all want to be healthy, right?

As different phases of the law have taken effect and companies have better understood how to implement it, there basically have been three levels of wellness engagement.

TRACKING HEALTH

 

The first encourages employees to join a wellness program with exercise and nutrition activities and undergo biometric screenings that check weight, body mass, cholesterol and other health indicators.

Level 2 trades the carrot for the stick. Employees (and insured family members) who don’t submit to the screening and participate in wellness programs face steep penalties; they may have to pay up to 30 per cent more for their share of health insurance costs.

The law calls this a “reward” for participation. Flip it around and it’s a penalty for not authorising your employer to manage and monitor how you live outside of work.

Better health overall is in everyone’s best interest. But you can’t help but be cynical when it becomes tied to benefit levels, especially in an era of vanishing pensions, flat pay cheques and longer work days.

It’s too early to say whether wellness programs will make a big difference. In the meantime, they can change the workplace dynamic.

By insinuating that individual choices are the driver of health-care costs, they erode the social contract of group plans in which everyone contributes to coverage that takes care of each other and their families in case something happens.

I’m digressing.

Level 3 in the march towards wellness adopts “outcomes” based programs that can require employees to meet specific fitness goals or pay higher insurance costs.

At this point, when body tracking and measurements are used to adjust benefits, it gets harder to maintain the pretence of privacy. Even if individual records are masked, the data will provide enough insight to assess employees’ potential health costs as well as job performance, enabling a new form of discrimination.

Aon Hewitt’s survey said 64 per cent of employers that offer health-care coverage are using data to find cost savings and as they shift towards health-improvement strategies, they’re relying “more on integrated, dynamic data aggregation tools to laser in on the best opportunities for reduction of unnecessary costs”.

TECHNOLOGY ADVANCEMENTS HELP MONITORING

 

Tech companies are ahead of the game. One is Limeade, a hot start-up in Bellevue that last year doubled sales of its software platform, which employers and insurance companies use to encourage and monitor wellness activities. The platform can sync with dozens of fitness-tracking devices and apps.

Last month’s Consumer Electronics Show was dominated by the next generation of fitness devices. With more advanced sensors and improved hardware, they’re building on the success of activity trackers such as the Fitbit and Nike FuelBand that millions of people — including me — already use. Show organisers gave an “innovation award” to the $US320 ($354) Wellograph Watch, which includes a continuous heart-rate monitor, wellness tracker and running watch in a sleek case.

Fitness tracking may become hard to avoid. Intel unveiled sensors at CES that can be embedded into common devices such as earbuds, which then track physical activity. The data can be relayed to a wellness app on a phone and online wellness programs.

Apple also is chasing this opportunity. With the iPhone 5S, it began using a processor with built-in sensors that can be used by fitness apps.

On January 31, word surfaced that Apple had a big meeting with the Food and Drug Administration, apparently to discuss medical apps and perhaps its own version of a health-monitoring watch. This isn’t too surprising. After years of back and forth with tech companies and others, the FDA in September issued guidelines for health-related apps and gadgets, to clarify which will be considered medical devices and require regulatory approval.

I suggest regulators go a step further and issue privacy guidelines for wellness programs, health apps and wearable devices that may share data with insurers and employers. They could be modelled on the Miranda warnings that police use, informing people of their right to avoid self-incrimination under the Fifth Amendment:

“You have the right to keep your health information private, anything you disclose about your health can and will be used against you.”

facts & data points, healthy habits, nutrition

Oz economy outpaces confectionary growth

  • Well this is good news, I suppose, but it is still growing at 2.6%… better not tell Barclay and Brand-Miller!?
  • Chocolate accounts for about half of the value, with sugar confectionery at a quarter.
  • 255,000 tonnes in volume in 2012.
  • Sugar confectionery is the dominant segment in China.
  • Australia’s per capita consumption of chocolate at 6.3kg, higher than New Zealand (4.8kg) but below Switzerland (11.9kg) and the UK (9.4kg).

http://www.foodnavigator-asia.com/Markets/Oz-economy-outpaces-confectionery-growth/

Oz economy outpaces confectionery growth

Post a commentBy Annie-Rose Harrison-Dunn , 10-Feb-2014

Australia's confectionery market fails to keep pace with economy, according to research

Australia’s confectionery market fails to keep pace with economy, according to research

Related tags: Market Line, Australia, Confectionery, Market, China, Japan, Gum, Chocolate,Report, Growth

Related topics: Industry growth, Markets, Confectionery, Australia – New Zealand

The Australian confectionery market is growing slower than the country’s economy, according to a report from Market Line.

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The research firm told ConfectioneryNews that stable growth in the Australian confectionery market over the past five years was forecast to continue to 2017, but said the country’s economy was growing faster.

Behind overall growth

“If we look at GDP between 2008 and follow it through to the end of our forecast period in 2017, we see an average growth rate of just below 6%. In comparison, the confectionery market in Australia is set to have an average growth rate of 2.6% a year, over the same period, meaning that this market is growing at a slower rate than the Australian economy,” Market Line said.

Chocolate dominates the Australian confectionery market and accounted for over half of value sales in the sector in 2012, while sugar confectionery accounted for around a quarter of revenues in the same year.

Market Line said cereal bars, gum and chocolate sales were expected to slowly decelerate up to 2017, meanwhile sugar confectionery sales were expected to grow slowly.

In a separate report released last year, Leatherhead estimated that the Australian confectionery market was worth 255,000 tonnes in volume in 2012, representing a 10% increase from 2008.

Competitive neighbors

Australia is Asia-Pacific’s third largest confectionery market, with Japan and China taking the top spots. “Australia has, however, grown at a faster compound annual growth rate (CAGR) than the Japanese market between 2008 and 2012 at 4.8% as opposed to 0.5%,” Market Line said.

The Chinese market has grown at over double the rate of the Australian market at a CAGR of 4.8%, where sugar confectionery is the dominant segment.

Looking at Australian confectionery on this global stage, the Leatherhead report put Australia’s per capita consumption of chocolate at 6.3kg, higher than New Zealand (4.8kg) but below Switzerland (11.9kg) and the UK (9.4kg).

healthy habits, policy, quantified self, rapid learning health systems

Successful aging – doesn’t matter when, as long as you do start exercising

  • Those respondents who had been and remained physically active aged most successfully, with the lowest incidence of major chronic diseases, memory loss and physical disability. But those people who became active in middle-age after having been sedentary in prior years, about 9 percent of the total, aged almost as successfully. These late-in-life exercisers had about a seven-fold reduction in their risk of becoming ill or infirm after eight years compared with those who became or remained sedentary, even when the researchers took into account smoking, wealth and other factors.
  • Exercise confers a reduction in mortality approximately the same as smoking cessation.
  • successful aging involves minimal debility past the age of 65 with little or no serious chronic disease diagnoses, depression, cognitive decline or physical infirmities that would prevent someone living independently
  • several, unsurprising factors contribute: Not smoking; Moderate alcohol consumption, and; having money.
  • In Australian men aged between 65 and 83, those who engaged in about 30 minutes of exercise five or so times per week were much healthier and less likely to be dead 11 years after the start of the study than those who were sedentary, even when the researchers adjusted for smoking habits, education, body mass index and other variables.

 

PHYS ED 
Exercise to Age Well, Whatever Your Age
By GRETCHEN REYNOLDS
Jon Feingersh/Getty Images

 

Phys Ed
PHYS ED

Gretchen Reynolds on the science of fitness.

Offering hope and encouragement to the many adults who have somehow neglected to exercise for the past few decades, a new study suggests that becoming physically active in middle age, even if someone has been sedentary for years, substantially reduces the likelihood that he or she will become seriously ill or physically disabled in retirement.

The new study joins a growing body of research examining successful aging, a topic of considerable scientific interest, as the populations of the United States and Europe grow older, and so do many scientists. When the term is used in research, successful aging means more than simply remaining alive, although that, obviously, is the baseline requirement. Successful aging involves minimal debility past the age of 65 or so, with little or no serious chronic disease diagnoses, depression, cognitive decline or physical infirmities that would prevent someone from living independently.

Previous epidemiological studies have found that several, unsurprising factors contribute to successful aging. Not smoking is one, as is moderate alcohol consumption, and so, unfairly or not, is having money. People with greater economic resources tend to develop fewer health problems later in life than people who are not well-off.

But being physically active during adulthood is particularly important. In one large-scale study published last fall that looked at more than 12,000 Australian men aged between 65 and 83, those who engaged in about 30 minutes of exercise five or so times per week were much healthier and less likely to be dead 11 years after the start of the study than those who were sedentary, even when the researchers adjusted for smoking habits, education, body mass index and other variables.

Whether exercise habits need to have been established and maintained throughout adulthood, however, in order to affect aging has been less clear. If someone has slacked off on his or her exercise resolutions during young adulthood and early middle-age, in other words, is it too late to start exercising and still have a meaningful impact on health and longevity in later life?

To address that issue, researchers with the Physical Activity Research Group at University College London and other institutions turned recently to the large trove of data contained in the ongoing English Longitudinal Study of Aging, which has tracked the health habits of tens of thousands of British citizens for decades, checking in with participants multiple times and asking them how they currently eat, exercise, feel and generally live.

For the study, appearing in the February issue of the British Journal of Sports Medicine, scientists isolated responses from 3,454 healthy, disease-free British men and women aged between 55 and 73 who, upon joining the original study of aging, had provided clear details about their exercise habits, as well as their health, and who then had repeated that information after an additional eight years.

The researchers stratified the chosen respondents into those who were physically active or not at the study’s start, using the extremely generous definition of one hour per week of moderate or vigorous activity to qualify someone as active. Formal exercise was not required. An hour per week of “gardening, cleaning the car, walking at a moderate pace, or dancing” counted, said Mark Hamer, a researcher at University College London who led the study.

The scientists then re-sorted the respondents after the eight-year follow-up, marking them as having remained active, become active, remained inactive or become inactive as they moved into and through middle-age. They also quantified each respondent’s health throughout those years, based on diagnosed diabetes, heart disease, dementia or other serious conditions. And the scientists directly contacted their respondents, asking each to complete objective tests of memory and thinking, and a few to wear an activity monitor for a week, to determine whether self-reported levels of physical activity matched actual levels of physical activity. (They did.)

In the eight years between the study’s start and end, the data showed, those respondents who had been and remained physically active aged most successfully, with the lowest incidence of major chronic diseases, memory loss and physical disability. But those people who became active in middle-age after having been sedentary in prior years, about 9 percent of the total, aged almost as successfully. These late-in-life exercisers had about a seven-fold reduction in their risk of becoming ill or infirm after eight years compared with those who became or remained sedentary, even when the researchers took into account smoking, wealth and other factors.

Those results reaffirm both other science and common sense. Anoteworthy 2009 study of more than 2,000 middle-aged men, for instance, found that those who started to exercise after the age of 50 were far less likely to die during the next 35 years than those who were and remained sedentary. “The reduction in mortality associated with increased physical activity was similar to that associated with smoking cessation,” the researchers concluded.

But in this study, the volunteers did not merely live longer; they lived better than those who were not active, making the message inarguable for those of us in mid-life. “Build activity into your daily life,” Dr. Hamer said. Or, in concrete terms, if you don’t already, dance, wash your car and, if your talents allow (mine don’t), combine the two.

healthy habits, nutrition, policy

New activity guidelines

  • 60 minutes physical activity per day
  • Add muscle strengthening exercise twice a week

http://theconversation.com/sit-less-move-more-new-physical-activity-guidelines-22948

Sit less, move more: new physical activity guidelines

If you’ve been sitting for an hour, you’ve been sitting for too long. Image from shutterstock.com

Australians should aim for around 60 minutes of physical activity per day, double the previous recommendation, according the new national physical activity guidelines, published today.

And for the first time, the guidelines urge the 12 million Australians who are sedentary or have low levels of physical activity to limit the time they spend sitting.

The recommendations aim to prevent unhealthy weight gain and reduce the risk of some cancers. Physical inactivity is the second-greatest contributor to the nation’s cancer burden, behind smoking.

The guidelines emphasise that doing any physical activity is better than doing none, but ideally adults will get 150 minutes of moderate physical activity each week. This includes brisk walking, recreational swimming, dancing and household tasks such as raking leaves.

This could be swapped for 75 minutes of high-intensity exercise that makes you “huff and puff”, such as jogging, aerobics, fast cycling and many organised sports. Ten minutes of vigorous exercise equals moderate-intensity activity.

The guidelines also recommend including muscle-strengthening activities at least two times a week. This could be achieved by going to the gym and using free weights or resistance exercise machines.

“But it also includes things like going to the store and carrying your shopping bags,” said Jannique van Uffelen, senior research fellow in active living at Victoria University. “It’s anything where you’ve got repeated stimuli with increasing weight or resistance for your muscles so they become stronger.”

Baker IDI’s laboratory head of physical activity David Dunstan said he was heartened to see the recommendations emphasise the health harms of prolonged sitting, for which there has been growing evidence over the past decade.

“For many people, sitting occupies a lot of their time. We need to be encouraging people to avoid long periods of sitting and break up sitting throughout the day,” he said.

“If you’ve been sitting for an hour, you’ve been sitting for too long. We should be aiming to break up sitting times with light-intensity activity one to two times per hour.”

The other major change to the guidelines is the inclusion of muscle strengthening activity, Associate Professor Dunstan said, and the acknowledgement that while brisk walking will improve heart fitness, it will not necessarily improve muscle strength.

“What happens is as we hit the age of 45, we start to lose our muscle mass and that’s accelerated once we get past 65,” he said. “As we lose our muscle mass, we lose our muscle strength, which is an important part of our daily lives.”

Dr van Uffelen said the guidelines were “thorough and comprehensive” and based on the latest international evidence. But with just 43% of Australians meeting the previous target of 30 minutes of moderate-intensity activity on most days of the week, many people found it difficult to work the recommendations into their day-to-day life.

“We live in a society where it’s often easier to jump in a car than to go for a walk or to get to places on your bike,” Dr van Uffelen said.

Governments must “make it easier for people to choose the active option, instead of the passive option – for example, good infrastructure for active transport,” she said.

Kids’ activity

The guidelines recommend children aged five to 12 accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity each day and include activities that strengthen the muscles and bones three days per week.

“We’re not suggesting that young children go out and start lifting weights,” said Alfred Deakin Professor at Deakin University Jo Salmon, who co-authored the scientific review and recommendations for children.

“Strength training activities include running, jumping, skipping, sports like netball or basketball – anything that involves being on your feet and running around. Even hanging from the monkey bars, you’re holding their own body weight,” she said.

“This is based on evidence around strength training for optimising bone health for kids – that’s really going to see them have much less chance of developing osteoporosis in adulthood. Childhood is really a key period for laying down healthy bones.”

The guidelines also emphasise the importance of reducing the time children spend sitting. And it’s not just to promote physical health, Professor Salmon said, emerging evidence shows prolonged sitting affects cognitive development and educational outcomes.

Teachers can play a part by delivering standing lessons, she said, by delivering standing lessons, getting children up during class, giving active homework and encouraging students to complete their homework while standing.

“The other major part of sitting for a lot kids and adolescents is sitting in a car. So if you can promote active transport and even public transport and walking to school, you’re going to reduce the sitting time in transit,” Professor Salmon said.

healthy habits, nutrition

Katz on Sugar :: The dose makes the poison

Another good rant.

http://www.linkedin.com/today/post/article/20140212122027-23027997-sweet-heart-you-suck?trk=eml-ced-b-art-M-0&midToken=AQGaT5hJmHa79A&ut=31wm0nXNnA5m81

Sweet Heart, You Suck

February 12, 2014 

Just in time for Valentine’s Day, epidemiology has given “sweetheart” a whole new meaning with a study demonstrating an association between sugar intake and heart disease. In this case, “sweet” heart is not a term of endearment; it’s a bad prognosis. Sweet heart, suddenly- you suck.

In deference to the holiday, we might repine the dispassion of epidemiologists inclined to replace boxes of chocolates with prescriptions for statins. But epidemiologists, presumably, need love too, even if they have an odd way of showing it. So we’ll let them be, and move on to the study and its implications.

Like much nutritional epidemiology, the study in question was observational. There was no intervention, no randomized assignment to sugar or placebo (historically referred to as “sugar pills,” which clearly won’t do these days). This study, conducted jointly by researchers from the CDC, Emory University, and Harvard, simply used population data about dietary intake to compare variation in percent calories from added sugar, and heart disease mortality.

Let’s digress a moment to emphasize a fine point: the relevant metric was not total sugar, or sugar calories, or sugar grams. It was percent of total calories from sugar. This matters, because we all have only 100% of our calories in play each day. When a higher percentage of calories comes from sugar, a lower percentage comes from everything else. Health is affected both by what we do eat, and what we don’t.

Let’s digress again to note a thing or two about observational studies. My impression is that when people don’t like the results, they are quick to point out the methodologic weaknesses: observational studies can’t prove cause and effect; observational studies just show association; observational studies have often been proven wrong when randomized intervention trials are done; and so on. When people DO like the results, the observational nature of the research is forgiven, and the attendant weaknesses routinely ignored, as wastrue of media coverage in this case.

But what’s good for the goose is good for the gander, and the merits and liabilities of observational studies are the same whether the results support or refute the hypothesis we love best. This new study does not, and cannot, prove cause and effect. It merely showed more cardiovascular mortality among people with a higher percentage of calories coming from added sugar. That may mean that sugar causes heart disease (I suspect it does contribute). It may also mean that diets higher in sugar are just poorer diets- and people with poorer diets are more prone to heart disease. That is somewhat less than astonishing.

In fact, it is tempting to ask about this news headline-generating study: where’s the news? We have long known that excess sugar intake is bad for our health in general. We have long known that excess sugar intake is associated with obesity, insulin resistance, metabolic syndrome, and diabetes. And we have long known that diabetes is among the most potent of risk factors for heart disease. Leaving aside the prior studies that directly address the link between sugar and heart disease, we are left to wonder: how could excess sugar intake NOT be associated with heart disease? That it must be is clear to all who recall the transitive property we learned in 6 grade algebra- if A leads to B and B leads to C, then A leads to C. “A” here is sugar, “B” can be diabetes, and “C” is cardiovascular mortality.

The new study was statistically sophisticated; they don’t publish casual observations inJAMA. But while the researchers controlled for many factors, they did not control for insulin levels, metabolic syndrome, or diabetes- and rightly so. Observational research is subject to the peril of “over adjustment,” where the very factors important to a causal pathway are bullied by the study methods.

I suspect that’s clear as mud for you non-researchers, so let me clarify with an illustration. Imagine an observational study looking at the association between gunshot wounds and health outcomes. Further imagine a researcher thinking you can only assess the harms of the gunshot if you exclude the effects of the bullets. So the group goes on to study the harms of gunshot wounds only in those not actually hit by bullets. I think even the NRA would have to acknowledge the problem here. This is over adjustment.

The new study did not do that, which means that excess sugar could have led to increased heart disease in all the customary ways: inflammation, insulin resistance, and diabetes among them.

Given that, I am surprised at how surprised people seem to be that sugar is linked with heart disease. Social media were buzzing with the news as if it were…news. And the “sugar is poison” cabal, which seemed to be king of the sandbox until quite recently when the “not so fast, grains are the real poison” clan muscled in, has been heralding the news far and wide as if it proves their perspicacity. One colleague in that camp virtually rolled up the new study and smacked me in the head with it to the accompaniment of a hearty: “told you so!”

But I’m not impressed. Diets higher in added sugar and lower in everything else are bad diets. Bad diets are bad for us. In fact, that’s the very thing that makes them bad diets. I’m struggling to find the revelation.

The trouble with this “study generates publication; publication generates headlines; headlines generate blogs; blogs generate tweets, which generate more blogs and tweets…” cycle is that it makes it seem as if every incremental addition to the sum of what we know is a brand new, stand-alone, alternative truth. That’s nonsense. Worse, it’s dangerous nonsense- because there are many more “one nutrient at a time” ways to eat ourselves to sickness and premature death than there are to eat ourselves healthy. As a culture, we seem committed toexploring them all.

Coincidentally, I heard on the car radio today that despite all the twists and turns in the U.S. economy over recent years, bacon sales have ramped up unfailingly. That’s really too bad, because eating more bacon is bad for the environment, bad for the planet, really bad for the pigs- and in my opinion, decisively bad for our health as well. But this is the predictable outcome when we assert or imply that sugar is the one thing wrong with our diets; or wheat is; or grains are. It means everything else is exonerated at worst, exalted at best. So bring on the perfect meal: bacon, potato chips, and diet soda. It must be perfect: there’s no wheat, no grains, and no added sugar.

The importance of sugar intake to health does not obviate the importance of other factors. Some of the same researchers involved in the new study have published other observational studies showing associations between meat and heart disease; meat and diabetes;processed meat and cancer; more fruit intake with less diabetes; more nut intake with less heart disease; and so on. These results don’t disappear when new ones are published. Notably, researchers at Harvard also studied the association between the nutrition guidance system I helped develop and health outcomes, and showed that the higher the overall nutritional quality of foods in general, the lower the rate of chronic disease and premature death from any cause.

Just like ingredients in a recipe, research results must be blended appropriately to avoid half-baked nonsense. Nutrition makes the most sense when viewed holistically.

And so does health. Among the more indelible insights of medical education is that the shinbone is connected to the anklebone. It’s right up there with “all bleeding stops.” I have always taken the shinbone in this case for more than just the tibia- I have taken it for a symbol indicating that everything in the body is connected.

That, of course, includes the heart. Putting the heart in context- namely the thorax, connected to the rest of the body via veins and arteries- argues strongly against any epiphanies about sugar. If excess sugar is bad for health, which seems indisputable, then it is bad for hearts ineluctably configured into that health. Honestly, folks, there are times our reductionism makes the Blind Men from Indostan look omniscient.

If we keep insisting on treating each study as if it is a new truth displacing everything we thought we knew before, we will never make any progress. We are looking at the world through a preselected tunnel, and any light at the end is apt to be the next on-coming train.

Of course excess sugar is associated with heart disease. Of course that doesn’t mean nothing else is. And, of course, this new study didn’t truly prove anything. There was no epiphany here, except for those already shopping for one.

In lieu of sequential epiphanies, I offer up my sound bites of ingestive truth intended to stand the test of time. You can be the judge. Chew on them, and either swallow or spit as the spirit moves you:

1) We can never get to good diets, or good health, one nutrient (or food) at a time.

2) What’s genuinely good for any part of us is just plain good for us.

3) What’s just plain good for us is good for every part of us.

4) What’s genuinely bad for any part of us is just plain bad for us.

5) What’s just plain bad for us is bad for every part of us.

6) Getting a higher percentage of calories from X means getting a lower percentage of calories from Y.

7) Our health is affected for good or bad both by what we don’t eat, and what we do eat in its place.

8) The dose makes the poison.*

9) There are many nutrition details we don’t know, but we know enough to eat well; we are not clueless about the basic care and feeding of Homo sapiens.

10) If you want to get out of the woods, it helps to see the forest through the trees.

 

As for the timing of those prosaic epidemiologists, inveighing against sweet hearts just in time for Valentine’s Day- they’re just doing their jobs, and probably not as heartless as they seem. We can take comfort in the fact that dark chocolate is still good for our hearts, as are strawberries. And to my knowledge, there’s never even been a question about love.

 

-fin

*courtesy of Paracelsus