Wait... I'm Not the Only One Questioning Wellness Programs?

I think I wrote my first anti-wellness program piece back in 2010, "What's Wong With Wellness? Weawy?"  (do an Elmer Fudd or Baba Wahwah speech impediment; it makes sense - weawy).  Perhaps the most important paragraph was fairly early in the piece, and I stand by it today, almost six years later to the day:

Obviously, "wellness" - however imprecise that word might be - is a Good Thing.  The real question is if these plans actually improve health and cut costs.  The answer appears to be no.  There are just way too many conventional wisdoms that are wrong.  In a nutshell, all of the so-called indicators don't show so much that you are "well", they show that you're "young and healthy".  There is simply not enough hard evidence that taking a random group of adults, all of them products of an almost infinite set of life choices and genetics, and forcing behavioral changes on them will result in different health outcomes.  It's important to add that prevention, in general, drives up costs, it doesn't cut them.  This is pretty well known among those who study statistics 

If you read Karl Denninger at Market Ticker, you know he regularly talks (well, alright, almost preaches) that low carb diets are the answer to most of our current health problems and that the conventional wisdom is flat out wrong.  Example 1. Example 2.  Example 3 (all within 2 days).  Newsflash: Karl's right.  The fact that lots of doctors are coming around to this is more evidence.  I could fill a post with links, but that's not the point. Furthermore, there's simply not good quality science to match our obsession with making everyone in the country look like concentration camp survivors.  How many times do they need to find that higher BMI patients have better outlook and survival than thinner counterparts before they stop calling it paradoxical?  (also)  I recently lost a close friend to complications of liver cancer.  He had lost 80 pounds due to the complications - he wasn't large to start with - and I think he would have had a better chance if he hadn't lost that 80 pounds and was more robust.  It wasn't the cancer that got him. 

According to Jonathon Adler writing in the Volokh Conspiracy, the premises of these corporate wellness programs are being questioned at all levels.  A conference is coming (on tax day) to get some collaboration going on between more folks.

On April 15, the Law-Medicine Center at the Case Western Reserve University School of Law is hosting a full-day conference “Corporate Wellness Programs: Are They Hazardous to Well-Being?”  Speakers include Dr. Soeren Mattke of the Rand Corporation, Dr. Michael Roizen, chief wellness officer of the Cleveland Clinic Foundation, Prof. Dennis Scanlon of Penn State, Prof. Sam Bagenstos of Michigan, Christopher Kucynski of the EEOC, Prof. Jessica Roberts of the University of Houston, Prof. Harald Schmidt of Penn and Elizabeth Click of CWRU.

Adler, in turn, quotes from NY Times piece by Austin Frakt and Aaron E. Carroll in September 2014.

Wellness programs are popular among employers. An analysis by the RAND Corporation found that half of all organizations with 50 or more employees have them. The new survey by the Kaiser Family Foundation found that 36 percent of firms with more than 200 workers, and 18 percent of firms over all, use financial incentives tied to health objectives like weight loss and smoking cessation. Even more large firms — 51 percent of those with 200 workers or more — offer incentives for employees to complete health risk assessments, intended to identify health issues. . . .

The Kaiser survey found that 71 percent of all firms think such programs are “very” or “somewhat” effective, compared with only 47 percent for greater employee cost sharing or 33 percent for tighter networks. . . .

What research exists on wellness programs does not support this optimism. This is, in part, because most studies of wellness programs are of poor quality, using weak methods that suggest that wellness programs are associated with lower savings, but don’t prove causation. Or they consider only short-term effects that aren’t likely to be sustained. Many such studies are written by the wellness industry itself. More rigorous studies tend to find that wellness programs don’t save money and, with few exceptions, do not appreciably improve health. This is often because additional health screenings built into the programs encourage overuse of unnecessary care, pushing spending higher without improving health.

Again, the company I just retired from had a wellness program for years.  It started out gradually: they want you to see a doctor and get tested for various risk factors.  Two years later, goals were set for those risk factors.  The year after that, you got penalized for not meeting their goals.  In the early days, you got a price cut in your insurance costs if you got tested and by the time I left you paid extra if you didn't meet the goals.  Around the annual screenings was a virtually continuous three-ring circus of activities to get employees to participate in group diets, or running clubs (never acknowledging that your cardio may be killing you) or other nonsense.   Treating employees differently by charging them more or less for insurance because of blood test scores or other physical aspects is breaking the Americans with Disabilities Act.  I have no doubt that if companies get actual data that shows they're not getting their sufficient return on their wellness investments, those programs will go away.  Companies are always efficient about maximizing profits, right?  I'm less optimistic that any wellness nonsense encoded into Obamacare will ever go away.   

What's Wrong With Wellness? Weally?...

Wellness Programs in the near future? Cartoon from "In The Bleachers" by Steve Moore

 

 

I work for a major corporation, the best in our industry by most measures.  Long, proud, heritage; that sort of place.  Despite that, we're a pretty ordinary large company, not that different from large American companies in very different fields.  Dear daughter-in-law works for a big pharma company and her corporate stories are more like mine than different.  Like most places, we're getting hammered by medical insurance costs, and again like most, we've signed onto one of those "Corporate Wellness" programs.  This is one of the latest fads to sweep the business community.  Like most fads, it has adherents, true believers, and skeptics.  Like most fads, again, it's overblown and accepted on faith. 

If you're not involved in one of these, beware.  The fed.gov has set itself up to be even more invasively involved in your life through the health care takeover that recently passed.  You can expect to be forced into a plan like this soon, if you haven't already.  If you are deemed overweight, you may be put on a company-monitored diet, or sent to "fat camp" to loose weight.  If you are a smoker, you will probably be forced to take a smoking-cessation class.  You may think it's none of your employer's business if you smoke or eat bacon at home, but the fed.gov thinks it's their business.  You may be financially penalized for not participating in a diet or stop-smoking class.  You may be denied care if you're a smoker or deemed to be overweight; that's routine in the UK, Canada and other countries with nationalized health care. 

Obviously, "wellness" - however imprecise that word might be - is a Good Thing.  The real question is if these plans actually improve health and cut costs.  The answer appears to be no.  There are just way too many conventional wisdoms that are wrong.  In a nutshell, all of the so-called indicators don't show so much that you are "well", they show that you're "young and healthy".  There is simply not enough hard evidence that taking a random group of adults, all of them products of an almost infinite set of life choices and genetics, and forcing behavioral changes on them will result in different health outcomes.  It's important to add that prevention, in general, drives up costs, it doesn't cut them.  This is pretty well known among those who study statistics. 

Take exercise.  Up until the mid 1970s, running and other forms of voluntary, adult exercising were pretty fringe behaviors.  Nowadays, admitting you don't exercise gets you looked at like some sort of Neanderthal.  This will be one of the first things they insist you do.  The reality, though, is that studies show only modest life extension, on the order of a few months, for a lifetime of exercising, easily less time than you spend exercising instead of something else you might prefer.  The other side of that is there is evidence of increased injuries and joint damage in sedentary adults who start exercising.  You could well argue that an arthritic knee or hip is better than a heart problem, but either chronic chest pain or a joint in need of replacement can make your life utterly miserable. 

If I may be a statistics geek, it could be that an adult who exercises regularly is part of a self-selected group that may well be different than the general population.  If these people have a lower rate of some illness, it might not have anything at all to do with the exercise; it could be another attribute of the people who self-select to be regular exercisers, or a large group of these attributes.  Taking the general population and having them start exercising may do nothing for them.  For example, in the early 70s someone did a statistical study that showed no marathon runner had ever had a heart attack.  Their conclusion was that running a marathon made you immune to heart attacks.  But when the running fad started, and people other than the self-selected marathoners of the 1950s and '60s started to do marathons, marathoners started having heart attacks.  Instead of the conclusion they reached, what they should have concluded was that the population of runners was different from the general population, and that some thing or combination of things in this group's lives prevented heart attacks. 

Now don't get me wrong: I have nothing against exercise if it's your choice and not something forced on you.  I started running in the late 1970s and at various times have been a runner, cyclist, and biathlete for over 30 years.  Like many 50-something runners, I had to have a knee cleaned out, and have been discouraged from running, so these days I cycle and lift weights.  I enjoy getting out and moving.  I just don't think that taking a bunch of sedentary people who have never done much exercise in their lives and making them active is going to do much in terms of making them healthier.  

You can hardly turn on the news without hearing that overweight people are less healthy than normal weight people so your Wellness program will probably measure you to make sure you're not overweight.  There are two problems: the first is defining "overweight"; the second is that most studies, and the strongest ones, point to an inverse relationship between weight and mortality (among mature adults), with obesity having a protective role - there's an excellent introduction here and virtually a homegrown encyclopedia here.  Those who grew up in the early to mid-20th century remember being compared to a set of height/weight tables originally developed by the Metropolitan Life Insurance Company.  These tables were eventually discredited for a variety of reasons.  The first was that there aren't really three well-defined frame sizes.  This is not to imply people don't come in different overall sizes, that's pretty obvious, it's just that there is no generally agreed upon standard for "small, medium, and large".  Another problem was that the basis of the charts was measurements of dead people at autopsy, who typically are not as healthy as living people (that was sarcasm, son).  The last 20-25 years have seen the rise of body mass index numbers, or BMI, used in place of those charts.  That's unfortunate.

What? What's wrong with BMI? It's exactly the same concept as the Met Life tables.   It's simply a height/weight table with one difference: there's no real mention of frame sizes so they give you a range you can be in, which many versions of the Met Life tables did, anyway.   There are only two pieces of information that go into BMI, weight and height (the definition is weight divided by height squared); it doesn't make it any more "scientific" if you measure in the metric system and square something.   All you're getting out is wt/ht.  If you pay attention to BMI stories, you know that almost any pro athlete or other fit, strong person, calculates to have dangerously high BMI.  When a cardiac patient can have a better BMI score than a combat-ready Navy SEAL, you need to throw away your scale.  If an underweight cardiac patient really does have a better long term health prognosis than an incredibly fit SEAL, we need to throw out pretty much everything else we think we know about "wellness". 

So if BMI doesn't matter, does that mean weight doesn't matter?  Weight is a pretty crude measurement - it says nothing about the quality of the health of the individual.  To be crude, if you have a prosthetic leg, it might weigh much or much less than your natural leg.  The weight does nothing to predict your long term survival.  Composition undoubtedly matters more than weight.  Does fat matter?  Possibly.  If anything matters, percent body fat probably matters.  The total amount of lean muscle mass probably matters.  That's the difference between the sickly cardiac patient and the SEAL, not their BMI.  It's not what they weigh, it's what they're made of. 

But doesn't this fundamentally say we can't even define what "overweight" is?  This is science; we can't resort to the "art" standard here: "I can't define it, but I know it when I see it".

If the intent is to give you a tool to determine your overall "wellness", BMI or weight are essentially useless.  An electronic body fat scale or other method of measuring percent body fat might be useful, but is there really good enough data to know how a certain value of %bf affects every possible race, nationality or combination?  In my world you would need extensive studies that map long term rates of disease  vs. % bf for all races, ethnicities and nationalities along with all of their diet compositions.  Not gonna happen in this lifetime.  

So let's skip over the weight issue and look deeper.  These are tools that you can't use at home - until that Star Trek tricorder is invented - but represent information you can get with a blood test under doctor's orders.  

The issues are not much less muddy here.  What are you going to measure?  Cholesterol gets measured pretty routinely, but would it make you feel better or worse to know that the reason we measure it is because we can?  Cholesterol was isolated early in the study of cardiovascular disease, and tests to measure it in patients were among the first.  There's a book in my list of recent and favorite reads called, "Good Calories, Bad Calories" by one of the best science writers living today (not my opinion; he has a stack of awards to back that).   He pretty much demolishes the idea that total cholesterol by itself is much of an indicator of anything.   Your ratios of  HDL ("good" cholesterol) to LDL ("bad") are more important indicators.   There are many others: HDL to Triglycerides, VLDL, other blood chemicals and tracers, that are more important than total serum cholesterol.  

Did you know that there is virtually no hard scientific data to back the wide recommendation for a 30% fat calorie diet - especially when opposed to, say, a 25 or 35% calorie from fat diet? Excellent summary here.  It is recommended because they really can't think of any reason to recommend anything different.  The 30% recommendation started before any research into effects of different percent calories was available.  Would it surprise you to know the dietary fat recommendations were political, not scientific?  Driven by democratic committee members, from George McGovern's presidential campaign?  In the intervening years, some of the alternative diets such as the ultra low, 10% fat diets have been studied and proven inappropriate for the general population.  There is woefully little science in any of the dietary recommendations that are common wisdom.  "Good Calories, Bad Calories" will also destroy any belief you might have that a healthy diet is a low fat/high carbohydrate diet.  It is probably the most important health-related book I've ever read. 

My favorite story in the wellness and health screening arena is that soon after I turned 40, I decided to get a physical and it included a cholesterol test.  It came back that my total cholesterol was moderately high, but my HDL was considered way too low.  They recommended that I do some exercise, perhaps walk around the block.  It struck me funny because I had ridden 100 miles on my bike over the weekend between getting tested and getting the results.  Clearly, the cause is not related to exercise.  Years later, my son (in his early 20s) was tested and had similar results.  The lipid profile we share is clearly genetic. 

I always think I'm not unique or special.  If I've experienced something like that, many others must have, also.  I believe that there must be thousands of other people who exercise, watch what they eat and do their best to "be well".  These people will be financially penalized for their genetics. 

So what's the big deal?  How can anybody be anti-wellness?  I'm not anti-wellness, I'm anti-intrusion into my life.  I'm adamantly anti-pseudo-scientific bullcrap, which is what most of the "wellness campaign" stuff is.  Adults should be responsible for themselves.  It is not the government's or your employer's responsibility to see if you do your daily exercises.  This is not Orwell's "1984", where you exercise in front of the cameras so they can verify you're doing it.  It's not even your insurance company's business if you exercise or pursue whatever roads to wellness you choose.  They are selling you a product.  If they told you that you could get a cheaper product if  you weighed less or smoked less, and you chose not to, they should just shut up, sell you the more expensive plan, and obey the contract you signed on to.  I suppose the biggest problem I have with these programs is that they treat you as if you're an idiot.  Like they are the first people you've ever come across in your life that have suggested exercise or weight control.   

Someone once told me the essential difference between liberals and conservatives is that conservatives believe in making their life choices while liberals believe in making your life choices:

If a conservative is a vegetarian, he doesn't eat meat.
If a liberal is a vegetarian, he wants all meat products banned for everyone.

If a conservative doesn't like guns, he doesn't buy one.
If a liberal doesn't like guns, he wants all guns outlawed.

In this situation it would be:

If a conservative thinks eating low fat and exercising is good, he starts eating less fat and exercising.
If a liberal thinks eating low fat and exercising is good, he demands that everyone be required to eat less fat and exercise more.

Genetic Testing In Corporate Wellness Programs?

Fox News in New York issued an interesting report stating that US-based Aetna Insurance and Newtopia, a Canadian company, are working to prove that genetic testing can reduce medical costs to employers, so that they can sell that as part of corporate wellness programs.

Sparking the push to add genetic testing into corporate wellness offerings is a new program from the health insurer Aetna and Newtopia, a small Canadian company that creates personalized health-improvement programs. Their offering uses data from initial wellness program steps like physicals or blood tests to figure out which employees are vulnerable to metabolic syndrome.

That's a group of conditions like high blood sugar, poor cholesterol or a big waistline that, when they occur together, increase a patient's risk for heart disease, stroke and diabetes.

This prompts speculation that companies will genetically screen employees as part of the employment screening process.

In fact, corporations are looking to new genetic testing programs to see if they can predict the probability of disease in future employees. The technology is said to help companies avoid hiring employees who take extra sick time and is supposed to help the companies cut down health expenses altogether.

Wellness programs are sold on the basis that they save employers money.  I've never kept it secret that I'm skeptical of these programs, but to say that at work is to confess to eating babies or something awful.  In reality, employers can push workers harder if the workers can take it.  If they keep having to replace workers who crack under the stress, they don't get the work done.  But there's a really simple solution to reducing the cost impact to corporations:  get them out of the health insurance business.  Make health insurance like car insurance or any other insurance.  Get the government out of health insurance.  That makes it more competitive, and more market based, especially if the byzantine rules that keep you from buying across state lines are gone.  People can buy their own car insurance, is that all that much simpler than health insurance?

Regardless of whether companies are going to start genetic screening, or if that's just wild speculation, it's been my contention for some time that the conventional full time work that we're used to is going away and will likely be gone within the lifetimes of people reading this today, if the trends continue.  The reason is the same: government over-regulation.  The pressure from these rules will help force work relationships to be more independent contractors and far fewer full time employees.  I work for a very large company, so we're not going to be 100% contractors anytime soon, but for new, start-up companies, the barriers being constructed are going to prevent them from growing beyond 50 people (the current number).  The cost of keeping up with new laws and regulations is simply too high.  As Elizabeth MacDonald at Fox Business News put it, "The government, in a sense, does create jobs in the private sector—a massive vegetative, unproductive universe of workers dedicated to dealing with federal rules."

There was a report this week from the Competitive Enterprise Institute showing that the cost of regulations took $1.88 Trillion away from productive uses in our economy.  If U.S. federal regulation was a country, it would be the world’s 10th largest economy, ranked behind Russia and ahead of India. Regulation nation is bigger than Canada.  Their report, with the wonderful title, "Ten Thousand Commandments" lists some memorable facts:

• Economy-wide regulatory costs amount to an average of $14,976 per household – around 29 percent of an average family budget of $51,100. Although not paid directly by individuals, this “cost” of regulation exceeds the amount an average family spends on health care, food and transportation.
   
• The “Unconstitutionality Index” is the ratio of regulations issued by unelected agency officials compared to legislation enacted by Congress in a given year. In 2014, agencies issued 16 new regulations for every law—that’s 3,554 new regulations compared to 224 new laws.
   
• Some 60 federal departments, agencies and commissions have 3,415 regulations in development at various stages in the pipeline. The top six federal rulemaking agencies account for 48 percent of all federal regulations. These are the Departments of the Treasury, Commerce, Interior, Health and Human Services and Transportation and the Environmental Protection Agency.
   
• The 2014 Federal Register contains 77,687 pages, the sixth highest page count in its history. Among the six all-time-high Federal Register total page counts, five occurred under President Obama.
   
• The George W. Bush administra­tion averaged 62 major regulations annually over eight years, while the Obama administration has averaged 81 major regulations annually over six years.

For years, I've been arguing we need to start pruning the Code of Federal Regulations back.  There's a "Regulatory Improvement Act" already in process that would establish a Commission to comb through the Code of Federal Regulations, now 175,268 pages long, and look for harmful, redundant or outdated regulations to get rid of.   That will address the monster we have, adding automatic sunsets or expiration dates for new regulations would help keep the monster from growing as much.  For starters, all new laws would expire after a period time, for example, five years.  Automatic expiration provides a painless way to get rid of obsolete or ineffective rules, and still allows Congress to easily renew successful regulations with a vote.

A Thousand Rants and Diatribes - With New! Improved! Corruption

Blogger informs me that this is my 1000th post since starting this blog, a few weeks short of three years ago.  Obviously, I could have posted this any time since last Friday night when I put up the last post - the reason I didn't is I saw the numbers working up and decided to post this today, because it's my birthday.  A double personal milestone.  I realize that in the real world, those two facts and about $3 would get me a cup of Starbucks plain coffee, but ya gotta find your encouragement where you can.

But let's not talk about me, let's talk about other idiots.

One of the topics I like to write about occasionally is health and fitness.  I think I wrote the first piece mostly on my phone while waiting for Mrs. Graybeard to come out of surgery, getting her second hip replacement.  I especially like to point out the involvement of the fed.gov leviathan in health care, and how you could make a fortune by always betting against whatever recommendation they make - if anyone would take that bet  Wellness programs, coming soon to a government mandated health care program near you, are a prime example.  While there's absolutely nothing wrong with the concept of wellness, nobody truly knows (in the hard science sense of knowing) how to create wellness in an "unwell" population. 

Take the "Capitol Wellness Expo" coming up this week up in DC.  In his column in Townhall (that link) Derek Hunter writes:

The master of ceremonies for the event is a woman named Judy Kosovich, an attorney who, among other things, has written of the need for people to reconnect with the Earth. OK, that’s not so weird, right? Well, maybe not conceptually, but when you read what she’s written it gets weirder.

She opens her article "Time to Go Barefoot Outdoors" on Examiner.com, Ms. Kosovich writes:

Now that the weather is getting warmer, you might want to consider walking on the earth barefoot. Why? Because the earth has an abundance of electrons that will neutralize the excess positive charge you are probably carrying around

In most of the world, this is known as getting shocked, and it's viewed in a negative way.  Think of grabbing the door knob after walking across the rug on these dry, winter days - or sliding across the seat in your car and grabbing the door.   To be fair, not every accumulation of charge is big enough to be felt, but you can be sure that Nature Will Not Allow you to build up too much charge before it's equalized.  And, also to be fair, this is not an idea unique to Ms. Kosovich, and is advocated by some in the Paleo fitness/diet movement.  I bring this up not because I'm opposed to going barefoot (although I do think that electrical charge thing is bunk), but mostly to let you get a picture in your head of what sort of event this is.  I'm picturing granola munching hippies, maybe in a drum circle, making sure they eat organic soy protein (quite possibly the most industrially processed food in the world).  Back to Hunter's piece:

The event is sponsored by the Orwellian-sounding Citizens for Health which is chaired by James S. Turner, a lawyer with the D.C. firm Swankin & Turner. Turner, it turns out, is the “sugar daddy” of Citizens for Health in more ways than one.

Bloomberg Business reported last year that Citizens for Health, “A group that bills itself as the ‘voice of the natural-health consumer’ has received about $300,000 from the sugar industry to help campaign against high- fructose corn syrup as an alternative sweetener.” That $300,000, by the way, constitutes “more than half” of Citizens for Health’s funding last year.

The sugar industry?  Of course, they're opposed to HFCS - it's competition. Citizens for Health, if they really cared about health, should turn the money down and say "a pox on both of you". 

The sugar lobby has an interest in attacking any alternative to the sweetheart deal, so to speak, it has with government. That deal comes in the form of federal government support that artificially keep sugar prices high – 41 percent higher than in the rest of the world, according to the Heritage Foundation.

Why are consumers paying out of their own pockets to support the sugar industry, especially when we are facing an obesity problem in this country? The answer is simple – money.

If you're not from Florida or certain other parts of the south, you're probably not aware that Big Sugar is a political powerhouse.  They keep lower-priced, foreign-made sugar out of the US, and have been implicated in widespread pollution of Lake Okeechobee and the Everglades.  They are known for buying influence at all levels of government: local, state and federal.   Again, Big Sugar was paying Citizens for Health to lobby against their competition, high fructose corn syrup.  Hunter, again:

There’s nothing wrong with lobbying, even though it’s become a dirty word in American politics. A lobbyist, used in the pejorative form, is simply someone who advocates for something with which the person using the word disagrees. We’re guaranteed in the Constitution the right to petition the government for the redress of grievances. The problem is with government itself.

The federal government has gotten so big that they dribble out millions of dollars like a toddler dribbling turds out their Pampers.  They lose track of more money than most of us will see in our lifetimes, so it's only natural that they would attract all sorts of sycophants and parasites, trying to find some of those dribbles.  

Politics makes strange bedfellows because they're all in there scrounging for lost change.

(XKCD 1065)

Wearable Electronics, the Internet of Things and Their Threat to You

A few days ago, Dark Reading, an industry Newsletter targeting IT & Security, had an interesting little piece, A Warning for Wearables: Think Before You Emote.  It's a little speculative, but not very far fetched.  The question: what happens when your Fitbit or other wearable electronics starts spewing information to the Internet that could be used against you?  Author John C. Havens notes a similarity that resonates with me:

Wearable data devices are the modern equivalent of blogs broadcasting directly to the Internet of Things. ... While [users] may not realize their data could be interpreted as inappropriate or breaking corporate confidences, unless they’ve updated their settings accordingly, that choice is not theirs to make.

Instead of blogs, they're more like Facebook or Twitter, or one of those places people post about what they're eating.  The thing is, they're broadcasting very personal biometric data or are capable of doing so.  He presents a possible scenario in which a person's Fitbit gets them fired.

Recently appointed EVP of Social Media for his top-ten PR firm – let’s call him Tom Delancey – assumed he'd been called to see his CEO for a holiday bonus. Having secured a choice article in Fast Company describing the company's forward-thinking approach to wearable devices and innovation, Tom assumed CEO Cheryl would be praising him for positioning the firm as a market leader to their clients. But upon closing the door to her swanky 30th floor corner office, Tom was in for quite a shock:

“You’re fired, Tom. In your Fast Company article you mentioned your innovation meetings with our biggest client happen every week on Thursdays during lunch. One of our competitors went on LinkedIn, identified everyone on your marketing team and their Twitter handles, and followed every tweet generated by their wearable devices. Using a pretty simple algorithm, they were able to correlate what the increase of people's heart rates and other data meant in terms of their mood. Apparently during last week's session something pretty bad happened near the end of the meeting, because everyone's data registered a spike in negative emotion.”

Tom's jaw dropped as his stress-sensing watch registered a massive increase in tension. He gasped as Cheryl turned her laptop on her desk so he could read an Ad Age article headline written in large type: “Delancey Debunked: Our New Client Finds the Off Switch for Quantified Employees.”

“Our new client?” asked Tom. “You mean...”

“Correct,"” Cheryl interrupted. “Our biggest client just fired our agency because you unintentionally broadcast the emotional and quantified data of your team. They didn’t have to say a word. Their data essentially said our client's new product sucks.”

Sound feasible?  It does to me.  Perhaps someone gets a wearable of some kind and neglects to set the privacy options properly.  Perhaps the device isn't secure enough, or not secure at all.  With just a little bit of competitive intelligence, I can imagine this happening. 

It seems to me that an even more likely prospect is the data from your wearables being demanded by the company and used by them against you.  Does your employer have a wellness program?  My last employer had one (I write about wellness more than I thought).  It started out asking for you to visit your doctor once a year and get screened for the things they deemed risk factors.  This was mainly the usual: blood pressure, cholesterol, diabetes, but also included points for seeing your dentist regularly.  Then they introduced numerical goals for all these tests.  Then they started punishing employees for not reaching those goals.  The same company made the facility non-smoking, so that smokers had to go outside, but didn't enforce break time rules as long as the smokers got their work done.  Then they made the entire campus non-smoking, requiring workers to go past the parking lot to the city sidewalks to smoke, and watching time and attendance more carefully.  They specifically said that smoking in your own car violated the company rules, which seemed like an awfully gray area.  Your car is your property. 

How big a step is it to think that a company like this might issue some sort of activity tracker to employees and punish them if they aren't doing the required amount of exercise while not at work?   

Havens notes:

It’s also important to start slow when building employee wellness or other programs utilizing quantified self tools, as Ken Favaro and Ramesh Nair point out in their excellent article, The Quantified Self Goes Corporate. Rather than focus on quick hits or flashy results like my fictional Tom Delancey, the authors provide a great description of what they call, the “quantified core; it is the enterprise equivalent of the ‘quantified self’ movement, the tracking of individuals’ health and daily life patterns for the sake of improving both.” This process demands buy-in from the C-suite with a broad understanding of what it means to improve employee well-being, including physical, emotional, and cultural sensitivities at any program’s core.

I'm aware of the quantified self/biohacking movement and consider myself a biohacker to some degree (I stop short of implanting or injecting things in myself).  To really tell if you're making improvements, you need data, which puts you into the quantified self camp.  Frankly, the idea of an employer monitoring me, deciding I'm not improving my health enough and even just financially fining me (which is what my last employer did), not to mention firing me, is awfully Orwellian.  

 

It's a brave, new world, isn't it.

Scumbag Dakota Access Pipeline Protesters

Today, Townhall ran the headline story that not only did the Dakota Access Pipeline protestors leave an amazing amount of waste behind, they abandoned dogs.

There's a special place in Hell for people who abuse animals - and it's often the first sign of someone who will transition to abusing humans. 

The environmentalists came to North Dakota to protest the construction of the Dakota Access Pipeline and lost. Now, as the cleanup of their protest camp begins, authorities have found it to be a disaster zone. There’s enough garbage and human waste to fill 2,500 pickup trucks. With the ending of the winter months approaching, they fear the spring flooding could wash this waste into the Missouri River, polluting it and other waterways. Yet, efforts to prevent an environmental disaster before the spring have hit another obstacle. Besides leaving heaps of garbage, protesters have left their pets.

After they found the first few dogs, cleanup efforts were halted and a rescue organization came in to search for more abandoned pets. 

Two dogs and six puppies were found and rescued at the main Dakota Access Pipeline Camp by Furry Friends Rockin Rescue.

The rescue has been working hard to catch ALL the animals that were left behind at the camp, but Furry Friends Rockin Rescue isn't giving up on these abandoned pets.

Furry Friends reports that the sound of the heavy construction equipment being used to clean up after the protesters is scaring the dogs and they're hard to find.   There are still protesters in the camp, all subject to arrest, but the majority have left.  The state of North Dakota offered protesters a sweetheart deal including health checkups, hygiene kits, meals, and bus tickets out of state.  One report I heard last week said protesters were being offered a ceremonial arrest if they wanted a picture to post to Facebook or other ego booster.  In my mind, the state bent over backwards to be kinder to the protesters than they deserve. It's only encouraging the bad behavior. 

MORE UPDATED INFO from North Dakota Joint Information Center:

Travel Assistance Center Established for Protesters

Bismarck, N.D. – The North Dakota Department of Human Services, North Dakota Department of Emergency Services and the North Dakota Department of Health have partnered to set up a travel assistance center. This free service will provide protesters with support as they prepare for their return home.

The transportation assistance center will offer personal kits, water and snacks, health/wellness assessments, bus fare for a return trip home, a food voucher, hotel lodging for one night, and a taxi voucher to the bus terminal.

Transportation will be provided from the protest camp to the assistance center.

All camp residents are encouraged to take advantage of these amenities.

Travel Assistance Center Flyer

Greetings,

If you don’t have means to return home, you can receive a ride to the Travel Assistance Center in Bismarck, where you will receive:
· Free health and wellness check-up
· Personal hygiene kit
· Voucher for a one-night stay at a designated hotel in Bismarck
· One $15 meal voucher for Kroll’s Diner in north Bismarck
· Ride voucher from the hotel to the Bismarck Bus Depot the next morning.
· Jefferson Lines bus ticket (Good for non-local destination. Must be in the lower 48 states.)
After you receive your supplies, you will be given a ride from the Travel Assistance Center to the designated hotel.

NOTE: No pets will be allowed.

I don't think that's why those dogs were abandoned.

(Photo from Townhall)

Things I've Been Meaning to Get To

I missed the whole kerfuffle with Tam's blog, and being driven silent by some cretin.  By the time I got back from Israel, on 9/5, she had started posting again, albeit with comments shut down.  I also ran across some comments elsewhere that anyone trying to mess with Tam would score really poorly on the victim selection scale and very likely find themselves in an unanticipated dirt nap.  While that's good for a joke, I wouldn't wish a use of deadly force situation on anyone. 

I'm pretty sure the first thing of Tam's I ever read was her piece on Kathy Jackson's "Cornered Cat", "The Day I Discovered That HCI Wants Me Dead" in which she recounts being in one of those situations.  Not fun.  Not a joking matter.  (As a side note, cops and Emergency Room workers have a notoriously rough sense of humor and make light of the most awful situations imaginable - like fighting to the death).

Anyway, I know you've dropped by on occasion, Tam.  If you see this, sorry you're having cretin troubles.  I appreciate the gun content you're posting and hope life gets back to "normal" ASAP.

----

Long time readers will know that my "Library Thing" bar on the lower right has several books in it from the low-carb viewpoint, and I have a pretty dim view of the current fad of "Wellness Programs".  I really think Gary Taubes' two books ("Why We Get Fat" and "Good Calories, Bad Calories") are two of the most important health and wellness books put together in the last century.  

I think I've found another.  Death by Food Pyramid is a very impressive book by Denise Minger., hostess of the Raw Food SOS blog.  Denise is a young health writer who is known for a very thorough deconstruction of some very famous studies that get lots of press coverage: the China Study and "Forks, Not Knives".   One of the highest compliments I can pay someone is that they're a good, clear, thinker.  Denise is definitely one; she has good thought processes and they're very evident through the book.  She's also an engaging writer with a knack for providing the right amount of levity for this serious subject matter. 

Denise's story starts with being a teenager who gets convinced she needs to be a vegetarian, which progresses to being only raw foods (or some other fad).  At 17, she goes to the dentist and after way too many disconcerting "hmm" sounds, heavy sighs, and pokes with pointy metal objects, finds she needs to have at least 17 teeth worked on - coming from never having had dental problems before she became a vegetarian.  In the space of one year. 

I was seventeen. It’d been a full year since I’d become a strict, low-fat, fruit-noshing raw vegan — led there by a cocktail of food allergies and dewy-eyed trust in people from the internet (bad idea is bad). Perhaps too distracted by my constant brain fog, perpetual shivering, and the clumps of hair making a mass exodus from my scalp, I’d failed to notice the prime victim of my lopsided diet: my teeth.

The book is divided into sections on the shady politics behind dietary recommendations, the slippery science, and concludes with some ideas for going forward.  The final section includes a fair amount of information on the role of ancestral diets and how, one by one, indigenous peoples were made sicker and sicker by switching to the abundant western staples of flour and sugar.  Gary Taubes spent quite a bit of time on this in "Good Calories, Bad Calories".

She asks a very reasonable question:  there are people who claim tremendous improvements in health from eating totally vegetarian and others who claim tremendous improvements in health by being meat-eating omnivores.  How can such opposites provide the same results?  Aside from the should-be-obvious conclusion that "one size never fits all", we have a tendency to focus on what people eat, or what they do, not on what they don't eat or don't do (those are admittedly infinite sets) and rarely on the environment they live in.  Perhaps what vegans and meat-eating "paleo" diet folks have in common is they both avoid heavily processed modern foods?  For another example, in those studies that gave rise to the "Mediterranean Diet" fad (as if there is one diet over the thousands of square miles of the region) they focus on the pasta and little amounts of meat; have they investigated minerals in the water or the soil?  What about the structures of their societies?  What if it has nothing to do with the baguettes, and everything to do with the amount of magnesium or some other mineral in their water?  

It's not too much of a spoiler to say that the FDA food pyramid (currently called "My Plate") has the drawbacks of every other thing the Fed.gov does that's crawling with crony politics.  The famous "eat 30% of your calories from fat", and "limit your intake of red meat" have more to do with the grain and sugar lobbies than they do with hard science.

If you care about this subject, or are forced to care about it, read this. People without the intellectual flexibility to face their favorite ideas being threatened will have a hard time with it (you'll note the vitriol used against Denise in vegetarian forums). 

A little more involved catching up

In which I need to ask for help if you can.  

At top of the "home page" of the blog, right above the blue box that has the blog's name in it, there's a thin gray bar.  There's a little box on the left of that bar just next to an Orange block with a white B in it - the logo for Google's Blogger home page.  If you enter the phrase "cardio is killing you" in the search box it will open four posts.  In the default order they're Cardio May Be Killing You from September 8, 2011, Cardio May Be Killing You - Part 2 from August 1, 2016. Those are the better references, but there's also a third post about corporate wellness programs, Wait... I'm Not the Only One Questioning Wellness Programs? (The last one isn't really related and I have no idea why Blogger returned it in the search).

What I'm calling attention to here is that both of those first two focus on the idea that while the popular idea since the 1970s or earlier was that running or cycling "cardio exercise" in general was the ticket to better health and longer life.  In fact, there was a hidden untruth in there based on the very common attitude that more is better.  Blindly increasing your mileage running or riding or even just walking is not a ticket to long health and better life.  To borrow a passage from myself, ever since Dr. Kenneth Cooper's work on aerobics in the 1960s, cardio has been the standard recommendation.  In the 1970s, when I first started running, there was a highly publicized study that said no marathon runner had ever had a heart attack. They concluded that marathon running made you immune to heart attacks. This was bullcrap - it was pure selection bias.  When this study was done, marathon running was an obscure sport, and only a few really dedicated people ran marathons, so they were a self-selected group of very unusual people.  As the running fad spread, more and more people, with their checkered pasts, started running, and it wasn't too long before marathon runners started having heart attacks, too.  

Where I'm going with this is a major portion of the second post, about atrial fibrillation or Afib.  Like I said, I started running in the late '70s when the fad was soaking in quite well across the country.  I'm not sure exactly when but let's say around '77-'78, so I was 23-24 and not in particularly good shape.  In school I ran when they told me - aside from the sandlot football we'd play - and almost laughed at running deliberately.  Someone likes running?  "Pull the other one, it's got bells on it."  Somewhere around 1994 I saw an orthopedic surgeon about knee pain - it wasn't the first time - that ended with a  fatherly, hand on my shoulder and him saying "you know,  you're not built like a runner."  I had bought a nice bike but we never really rode much.  Suddenly it seemed like a good idea and we started riding.   

I was wholeheartedly “more is better” in cycling for years.  Be able to ride a century (100 miles) any day of the year, “you can ride in one day whatever you ride in a typical week.” My wife and I used to ride together maybe 6 days/week - skipping Friday evenings. Yeah, we'd get rained out or blown out by extreme winds, but the normal thing was to ride every day after work and dinner. This started in the early 90s because I had been the same way about jogging and by the time I was getting close to 40, my knees were giving out. By about 2010 or 12, we just started riding less and eventually dropped it. 

In 2013, the year I turned 59, I had a sudden bunch of awful feelings in my chest - and I was sure I must have talked about it here but it wasn't one big post I couldn't find about it.  After some preliminary things, I was referred to cardiologist and wore one of those 24 hour monitors you'll hear about (a Holter monitor).  Among other things I was told I had Atrial fibrillation - Afib.  I've been through lots of experiences with the cardiologist, who retired a few years ago, and I was assigned to his replacement in that practice group.  Last year, when I turned 70, he told me my chances of having a stroke due to the Afib double when you cross 70, (yeah, from 1% to 2% absolute risk) and started me on a blood thinner

Which leads me to this year.  At my annual check in visit with the cardiologist they told me that during a couple of previous echocardiograms, the results had said my Afib was causing the valve to leak and they set me up for a TEE, - Trans Esophageal Echocardiogram - to get a closer look at my atrial valves.  That was my June 2nd hospital visit.  The TEE is supposed to be able to give a more precise measure of "how leaky is leaky."  So how leaky was it? 

The answer is that it's not a bad leak but it's time to face some harsh realities.  The whole time I was being monitored there (so every time he's seen me since April) I was in Afib constantly.  I don't really notice it, but that doesn't mean anything.

Harsh reality #1: much like my hernia, Afib and these valves don't get better on their own. 

Harsh reality #2: there are pretty much just two ways to fix it. The first is called cardioversion, which uses medication and once you've got the drug in your system, they shock your heart back into a proper rhythm. With the exception of I think that puts me on that medication for life, I think it’s the relatively low pain option. The other fix is more invasive, called ablation. That one shoves an electric probe with an imager and more up your femoral artery into your heart and literally burns away some heart tissue that is causing the Afib. As I understand it, we’re unconscious through that.  There's a cryoablation version of that kills parts of the atrium by freezing instead of burning.  I don't see much difference.  

As it turns out I have two friends that have been down this decision path: one had ablation, and the other had cardioversion.  The doc asked me to do some research and let him know which one I'm more interested in getting done.  The guy with ablation is off his prescriptions and completely over it.  The bad  part is he had to have the ablation done twice and they were six years apart.  I'd really like to not have to do that.  The guy who had cardioversion was "one and done" but he's still on his prescriptions, (in fact the same two drugs I'm on - blood thinner and beta blocker).  

I was hoping to find people who have “Been There, Done That” with either of the Afib fixes. Lacking that, maybe a link to someplace else online where I could go.  At the moment, I'm leaning toward the ablation but that's not as strong as I was leaning before I found my friend had to wait six years to finally get it fixed. 

Thoughts appreciated, stories, results - that sort of thing.  I don't expect doctors to answer, just folks who have BTDT. 

The Fat and Out of Shape Middle-Aged Guy's Guide...

...to being somewhat less "fat and out of shape".

H/T to WSRA today for poking my muse with a sharp stick so that she could poke me.  The unwritten statement in that article is that if you're old or injured, handicapped or disabled, or otherwise not able to put on a ghillie suit and head for the back country, you should give all of your stuff to someone who can do that and then be a good sport and off yourself. To borrow a quote, I don't think so.

There's a reason the armies of the world rarely use guys my age (I'm 57 - some days feel closer to 100, some days closer to 50): with a few exceptions, we simply aren't able to match the fitness, strength, or endurance of the average guy even 20 years younger than us.  Plus, they never created a MilSpec for Depends.  I celebrated my 50th birthday by running a 5 k (3.1 miles) followed by a 55 mile bike ride.  I didn't do that on my 57th.  I could go on and on about "with age comes wisdom", or "old age and treachery will always overcome youth and skill", but I won't. 

Do you move well?  I have arthritis, but am still pretty mobile. The worst of my arthritis affects my hands; mostly thumbs and a couple of fingers.  My right hand is worse than my left, and my thumb and pinky finger are the worst.  It makes many common tasks painful.  Many folks have had hips or knees replaced by the time they get to be my age, and I'm lucky in that regard, although I feel I'm working on needing a hip.  Mrs. Graybeard has had both hips replaced, and has a pound a of stainless in her mid-back from a time we were run down by a light pickup truck while riding our bikes (the day before New Years Eve of Y2K).  I walked out of the ER 3 hours later - she was hospitalized 3 weeks.  I know I'm lucky to get around as well as I do. 

So here you are, a middle-aged guy or gal with somewhat of a paunch, and would like to be a little tougher for the coming problems. Do I need to state the obvious?  If you're listening to some random dude on "teh Interwebz" without checking to see if you have problems that prevent doing any of this stuff, you're out of your freakin' mind. 

The first thing you should do is either buy or check out from your library, "Why We Get Fat and What to Do About It".  Author Gary Taubes is an award-winning science writer who shook up the world when he first started researching this and wrote an article for Science magazine called "The Soft Science of Dietary Fat".  (If you're not familiar with it, Science magazine is the house journal of the American Association for the Advancement of Science, or AAAS, - a very prestigious journal).  He followed that up with a easier version for the NY Times called, "What If It's All Been a Big Fat Lie?" and followed that up with a full-length book, "Good Calories, Bad Calories".  (standard disclaimer about Amazon links - just so you can see the book, I don't get money, yada, yada)  "Good Calories/Bad Calories" is written like a scientific paper and has tons of references; "Why We Get Fat" is more of a how to/what to do book. 

If you want the short version, everything the nanny state tells you to eat is what you should avoid; everything Dr. Atkins tells you to eat is good.  To quote comedian Chris Rock, red meat isn't bad for you; green meat is bad for you.  Fat doesn't make you fat; dietary fat doesn't cause heart disease, "over eating" doesn't cause obesity, and all the dietary wisdom the fed.gov has been pushing since the 1970s is why we're getting fatter and have so much diabetes in our country.  Corporate wellness programs are well-intentioned but wrong; BMI is a meaningless number and overweight is probably a meaningless concept.  Reading all that background will help you understand why the more closely the general population follows the federally recommended diet the less healthy they become.   

This is going to be a big change for most people, and it can be an expensive way to eat.  You're probably going to go through some carb withdrawal.  Depending on how much insulin resistance you have (read those links two paragraphs up!), it might take some time to make a difference.  At one time, I lost about 70 pounds on the Atkins diet.  Stopping it was a stupid thing.  Now I need to lose 40 or 50. 

Now that you've dropped the idea that eating red meat is a problem, let's take on exercise.  The first thing you must do is decouple diet and exercise in your mind.  This has been pushed as the gospel for so long, that even people who don't care about their weight believe fat people wouldn't be fat "if they'd just walk around the block instead of having that second portion".  Yet most of us are familiar with the expression to "work up an appetite".  When did we get the idea that exercise doesn't make us hungry?  I joke that I was drawn to endurance cycling because it's the only sport where you have to eat during the events to compete! 

Exercise is worth doing for a mess of reasons: better ability to handle the tasks of life, muscle helps keep joints from being damaged, better support for all of your skeleton, and weight-bearing exercise helps prevent osteoporosis.  For the target group I'm addressing, I recommend weights and walking for starters.  Chances are everyone in this audience has all the weights we need with ammo boxes and cans; you don't need to go join a gym and work out on Bowflex or Nautilus equipment.  Avoid plyometric exercises - at least for now.  These are the jumping, lunging, high impact movements that you'll see on some TV products.  These are for people who are already in shape, not people trying to get in shape. 

How much weight?  Another point of contention where one group says light weights done many times and others say to increase the weight until you find you can't repeat the exercise more than five times without losing form.  After many years in the first camp, I'm moving toward the second.  There is no such thing as "toning", but you'll see places say to use light weight just to improve "muscle tone" and base that on physical therapy.  If you ever get therapy for an injury, you'll probably be surprised to see they usually work with light weights: a pound or two most of the time.  Yes, you really can protect your joints with that little weight.  But all weight lifting is intended to build muscle.  You either build muscle or you don't. 

Do core strengthening: bent-knee sit-ups or crunches.  If they get too easy, do them against weight.  Carry ammo cans around your house - work up to carrying them around your yard.  If loaded ammo cans are too heavy, bring boxes, or half-full cans.  The nice thing about weight lifting is that everything has weight.  It's just a matter of how convenient it is to work with.  

"Cardio" workouts: running or cycling or walking are pleasant things to do, if you enjoy them, but I suspect that's over-rated, too.  In my case, I know it didn't prevent the usual conditions that set in when you're over-50.  To quote myself:

My favorite story in the wellness and health screening arena is that soon after I turned 40, I decided to get a physical and it included a cholesterol test.  It came back that my total cholesterol was moderately high, but my HDL was considered way too low.  They recommended that I do some exercise, perhaps walk around the block.  It struck me funny because I had ridden 100 miles on my bike over the weekend between getting tested and getting the results.  Clearly, the cause is not related to exercise. 

There you have it: a starting point.  Losing weight might be completely cosmetic, and it may help your health, but it will probably help you if you have to do some moving to keep from being a target.  Fitness and muscle strength will help in manual labor and other things that may be coming.  It will help us be useful - to family, friends and community. 

Don't just be prepared, be prepared to be useful, and a blessing to those in need.  

Techy Tuesday - NSF Funds "Wearable Doctor" Device

EE Times points out an interesting little research story at the University of North Carolina, a wearable health-monitoring device powered by energy scavenged from the person wearing it.

The wearable Health and Environmental Tracker (HET) aims to anticipate, for instance, an oncoming asthma attack and recommend immediate action to thwart the event. Researchers hope that, eventually, most any chronic malady can be similarly addressed by such sensor studded wearables powered by energy harvested from the patients own body. To address this issue, the National Science Foundation (NSF) is funding the Advanced Self-Powered Systems of Integrated Sensors and Technologies (Assist) project with up to $40 million.

Wearable electronics, things like a FitBit are near the peak of the hype cycle, with all the market cheerleaders saying they're the Next Big Thing, so it's an idea at the right time.  FitBits and Smartwatches are powered by batteries, but to be really useful, devices like this HET need to be ultra low power, so that they can be powered by energy harvested from the wearer.  My first thought would be to harvest tiny amounts of the power used in each leg stroke while walking - taking so little that it doesn't perceptibly increase the difficulty of walking.  This one takes a different approach because their target is to warn people of oncoming asthma attacks.

"We are targeting asthma attacks first, in cooperation with partners at the University of North Carolina (UNC, Chappel Hill)," (principal investigator) Bozlurt said. "The Environmental Protection Agency told us the correct wellness and environmental-parameters we needed to monitor in order to anticipate asthma attacks."

Consequently, Bozlurt, (research assistant) Dieffenderfer and associates split the functionality between a wrist worn sensor hub, a chest-adhering patch and a handheld breathalyzer. The wristband focuses largely on environmental factors, monitoring volatile organic compounds and ozone in the air, as well as ambient humidity and temperature (the wristband also includes additional sensors to monitor motion, heart rate, and blood oxygen levels), then transmits collected data wirelessly to medical professionals. The patch includes sensors that track a patient’s movement, heart rate, respiratory rate, the amount of oxygen in the blood, skin impedance and wheezing in the lungs. And the handheld breathalyzer -- called a spirometer -- measures lung function.

It was graduate student James Dieffenderfer who came up with the idea of harvesting energy from the person's breathing to power the HET by using a tiny windmill. 

In fact, the project has already won one award for its energy harvesting spirometer which contains a tiny electricity generator that is driven by the user blowing their breath into it, thus powering the device. Dieffenderfer won a Center for Integration of Medicine & Innovative Technology award for his energy harvesting spirometer. The $150,000 award will be used by Dieffenderfer to develop and market his innovative energy-harvesting health devices to consumers.

Asthma is still a killer, even in developed nations.  Statistics say that in the US, it kills around 3400 people a year, out of 24.6 million people with the disease.  Globally, a quarter million people die from it every year.  The idea that a device can monitor air quality parameters and the way the user breathes and detect a serious asthma attack is an interesting project.  Since no one has ever done tried to monitor continuously in real time like this, no one really knows if they know how to predict such an attack.  (One of my standard sayings to the young engineers, "when you look at something no one has ever looked at before, you see things that no one has ever seen before"!)  That means they'll be running clinical trials to make sure they really have the subject covered. 

(Early prototype of the HET wristband)

Once the conditions for an imminent asthma attack are determined during clinical trials, a specialized cost reduced version can be produced. In the event that different things stimulate asthma attacks in different people, personalized versions will be created.  Initial experiments will be done in controlled environments with industrial partners who want to use the technology in future products.

They expect to be ready to go to production in around four years - in 2020. It's quite a reach to call such a limited use device a "wearable doctor", but it could mark the beginning of a very interesting trend.

Imagine if We Paid for Food like We Do Healthcare

That's the provocative title of an article on Libertarianism.Org and reprinted by FEE (the Foundation for Economic Education).  The article is by Dr. Ryan Neuhofel, DO, MPH, a board-certified family physician in Lawrence, KS. As he puts it:

Imagine if you purchased food like most Americans obtained healthcare.

No, I really want you to try to envision it…

Struggling?

I am a family physician whose father worked in a grocery store and I enjoy eating at Mexican restaurants immensely, so maybe I can help:

I think most of us have some inkling of how screwed up the health care system is in this country, but Dr. Neuhofel puts together a world in which Food is paid for with a system just that screwed up.  Perhaps it's the "after" state for whose who argue that food is a basic human right.  I can't say I was really surprised by anything, but he did a good job of creating a parallel universe populated with a "Green Cross Green Shield (GCGS) Bronze-Select food plan" and an Affordable Sustenance Act (a.k.a. ASA, or “Obamafood”).  Instead of Costco, BJ's Wholesale Club, Amazon, Walmart and dozens of other companies competing to see who can provide a better price per pound or better quality food to get your business, this parallel universe features giant Food Plan providers and (of course) the Fed.gov totally destroying the market incentive to provide better food at lower prices.

I really recommend you read the whole thing, but as I usually do, I'm going to grab a few excerpts to whet your appetite.

Thankfully, your new Green Cross Green Shield (GCGS) Bronze-Select food plan is a benefit provided by your new employer. There is some payroll deduction stuff that you don’t quite understand yet. Most of the plan’s $680 monthly premium is hidden from you and drastically reduces your wages. Still, you are happy that your food plan costs only (as far as you know) $123 per paycheck.
....
Worried that you won’t be able to afford everything on your list, you cross off any special items and opt only for the basics. As you scurry up and down the aisles, you see there are no prices listed on anything, nor labels telling you what is a Bronze-Select item. You suspect the delicatessen with your favorite cheeses is off limits because of the large “included with United Food Platinum-Plus” sign above it but with no mention of Green Cross Green Shield. Remembering that eggs are included as a “free” GCGS wellness benefit you get 3 dozen of those—even though you don’t really need any right now.
...
During check-out, the cashier rings up the items and asks you for a $30 copay. You are given a 6-page receipt with indecipherable codes and then asked to sign a few other forms because some of your items will be billed to you later.

As you drive home, you remember that your monthly food deductible is $250 and you hope that the balance of the bill isn’t overly expensive. (Several months in the future you get a bill for $276 from FoodMart. Although vaguely suspicious that you’ve been taken advantage of somehow, you are happy that you got a big discount on your $18 box of Tasty Flakes cereal and have now reached your deductible.)
...
Upon checkout, you present the waiter your GCGS card, and you are asked to pay a $10 copay. (The billing statement weeks later reveals that the “plan discount” did reduce the initial charge from $64 to $37 and that GCGS paid Burrito King another $27 a few months later which got applied to your deductible.) You question how a simple burrito can cost $37, but nobody, including the majority of food policy experts, knows exactly why.
...
Politicians, regardless of their ideology and grandstanding, are lobbied heavily by a swamp of power players to preserve the status quo. Understandably, most Americans are fed up with all of this, and an increasing number now believe the only solution is a national, federally-administered “single food plan.”

As always, the thing that boggles my mind is those people arguing for a "single payer food plan" are begging the ones who screwed up the existing system to "do it again, only harder".  Whenever there's some sort of corruption found where some industry lobbies the Feds for giveaways, they pounce on the private sector guys and totally ignore the Fed.gov.  If someone bribes a legislator, they've both committed a crime.  

Standing Up To Facebook

I missed this story when it came out in the last week of May, but the corporation behind Crossfit, the extremely popular exercise and nutrition enterprise, withdrew their pages from Facebook after Facebook deplatformed another fitness-related site.  Hat Tip to Reason.com via the Ammo.com weekly newsletter.  According to an official statement published at the time:

Facebook deleted without warning or explanation the Banting7DayMealPlan user group. The group has 1.65 million users who post testimonials and other information regarding the efficacy of a low-carbohydrate, high-fat diet. While the site has subsequently been reinstated (also without warning or explanation), Facebook's action should give any serious person reason to pause, especially those of us engaged in activities contrary to prevailing opinion….

Facebook…serves as a de facto authority over the public square, arbitrating a worldwide exchange of information as well as overseeing the security of the individuals and communities who entrust their ideas, work, and private data to this platform. This mandates a certain responsibility and assurance of good faith, transparency, and due process.

CrossFit, Inc., as a voluntary user of and contributor to this marketplace, can and must remove itself from this particular manifestation of the public square when it becomes clear that such responsibilities are betrayed or reneged upon to the detriment of our community.

In a typical week, we hear of people being deplatformed by Facebook or Google several times.  What we don't hear about is corporations that are paying these companies for their advertising striking back by moving off the platform to other services.  If for no other reason than for the point in the famous Martin Niemöller quote:

First they came for the socialists, and I did not speak out—because I was not a socialist.

Then they came for the trade unionists, and I did not speak out— because I was not a trade unionist.

Then they came for the Jews, and I did not speak out—because I was not a Jew.

Then they came for me—and there was no one left to speak for me.

Crossfit is clearly concerned that being a health and wellness corporation based on contrarian ideas that they might well face the same bans as the Banting7DayMealPlan user group.  They opened the statement quoted above essentially saying so with this "mission statement":

CrossFit is a contrarian physiological and nutrition prescription for improving fitness and health. It is contrarian because prevailing views of fitness, health, and nutrition are wrong and have unleashed a tsunami of chronic disease upon our friends, family, and communities. The voluntary CrossFit community of 15,000 affiliates and millions of individual adherents stands steadfastly and often alone against an unholy alliance of academia, government, and multinational food, beverage, and pharmaceutical companies.

Nick Gillespie writing for Reason says:

Instead of taking it upon themselves to police more than true threats and instead of calling for government regulation of expression, Facebook and other social media services would treat their platforms as free-speech zones and focus instead on providing users with tools to personalize their experiences.

Unfortunately, that's not the world we live in.  Facebook (and Google/YouTube and The Rest) seem to have staked their future on being regulated utilities and using the high cost of entry as a bar to future competitors.  They seem to have decided if they piss off enough conservatives, they'll join the movement to get the Big Gov to regulate them.

Reason calls it a "Bonus Video" to hear CrossFit founder Greg Glassman say he's a "rabid libertarian". 

Poppin' a Cap In the Nanny's Ass

The Nanny State is at it again.  The first Nanny-ism I commented on was the Fed.gov's ill-considered war on salt.  Then, of course, there's the First Lady's attack on children's menus.  Now, I'm sure most of you saw that the San Francisco Board of Supervisors has banned any child's meal that comes with a toy: McDonald's Happy Meal is the archetype that got the headlines. 

"Supporters of the ban claim it will help protect children from obesity, while opponents see it as just the latest example of the nanny state run wild and say it's the parents' right and responsibility -- not the government's -- to choose what's right for their children."

I'll take B.  Allow me a slight detour first. 

Down on the lower right of the top this page is a small, random selection of perhaps 20 books I've entered into the Library Thing web site.  One of the books that will show up from time to time is "Good Calories, Bad Calories" by Gary Taubes, a science writer who has won several prestigious awards in that field: his article "The Soft Science of Dietary Fat" turned the popular perception of this area on its ear.  As someone who has fought the "battle of the bulge" since I was about 15, I've been studying this subject in as much depth as I can for as long as I can recall. "GC/BC" is a very well researched look at much of the common wisdom about diet; about the dangers of eating fat, the role of westernization in the spread of disease, and how the culprit might well be refined carbohydrates rather than fats.  If you have any interest in this field at all, it's really a good read. 

Getting back to the Nanny State, what they won't tell you is that these sorts of efforts have been ongoing for some years now and they are not effective.  If you take the french fries away, kids don't magically get slimmer.  You can really eat anything, anything, and lose weight if you follow some common rules. CNN reports on a professor of nutrition who ate a junk food diet, of " Twinkies. Nutty bars. Powdered donuts.", and lost 27 pounds.

"For 10 weeks, Mark Haub, a professor of human nutrition at Kansas State University, ate one of these sugary cakelets every three hours, instead of meals. To add variety in his steady stream of Hostess and Little Debbie snacks, Haub munched on Doritos chips, sugary cereals and Oreos, too."

Adding interest to the story is that many of the blood tests routinely run to monitor health improved for Professor Haub.  The good Professor is reluctant to say he's healthier, but your blood doesn't lie.  If the numbers mean anything to begin with, if you improve the numbers, you've improved your health. 

"Haub's 'bad' cholesterol, or LDL, dropped 20 percent and his 'good' cholesterol, or HDL, increased by 20 percent. He reduced the level of triglycerides, which are a form of fat, by 39 percent."

A simple explanation is that losing weight probably made these blood profiles better.  As I pointed out in my long piece on corporate wellness programs, these indicators don't show that you're "well" so much as they point out that you're young and healthy. 

It doesn't matter that the Nannies behind the Happy Meal ban are well-intentioned.  Banning toys is not going to have the desired effect and personal liberty continues the long slide down the drain. Obesity is a big, complicated topic, and simply removing options is not going to fix everything.  I always get the feeling that these nannies would walk into a village in the third world with people lying around starving to death and think, "my, look how nice and lean they look!"

Perhaps the best introduction to the topic of obesity for the intelligent lay-person is Adiposity 101, a continuously updated paper online since the early 1990s.  It might just turn some notions of yours upside down.

Odds and Ends

Borepatch has a great summary of why we shouldn't fund NPR - they're violating their whole reason for existence. 

The argument for funding NPR is that they can focus in greater depth than commercial news sources, giving listeners more background and context around important stories.  This leads directly to a better informed electorate (so goes the argument) which is a public good.

and then goes on to show that this isn't true.

When Discovery ended her mission yesterday, I went outside to hear and feel the double sonic boom all returning shuttles give - and I realized I'm going to miss this.  From about 1986 until 1997, Mrs. Graybeard worked up there; starting on expendable vehicles and then over to work on the shuttle solid rocket boosters.  After Challenger (she was outside watching - I was working through lunch and watching on TV) they had an open house at the KSC for family; Discovery was on the pad for the return to flight operation, and we got a good look at her.  On two separate other open houses years later, I stood underneath Discovery.  I almost could have reached out and touched her, but I didn't.  Still, I got up close and personal with Discovery like no other member of the STS "fleet".  Yeah, she was getting to look like a used space ship Han Solo might fly, but I'm going to miss her.

As I mentioned in my riff on corporate wellness programs, I work for a major aerospace corporation.  Like many, we have a big "diversity" program.  I can't help but feel like they're going about it all wrong;  they emphasize what we look like, or what we eat, not who we are.  For example, we have a very Indian guy in our group, with a very Indian name, heavy accent, did his undergrad work in India and MSEE in the states.  I have more in common with him than 99% of the people outside the building.  Last week, I was on TDY in the factory.  I was the only "old white guy" in the place, but I had more in common with those technicians and younger engineers, like the young Latina, than with the vast majority of administrative workers, marketing people, HR folks and other non-technical workers - as well as the 99% of the public outside our buildings.  Diversity isn't white guys and Indian guys or "smart Latinas": it's engineers and art majors.