Wednesday, May 28, 2014 - Doctors' War Stories From VA Hospitals - Doctors' War Stories From VA Hospitals


U.S. doctors are well aware of the problems with VA hospitals because many of us trained at them. There are 153 VA hospitals. Most of them are affiliated with the country's 155 medical schools, and they play an integral role in the education of young physicians. These physicians have borne witness to the abuses and mismanagement, and when they attempt to fight against the entrenched bureaucracy on behalf of their patients, they meet fierce resistance.


The veterans who receive their care at VA hospitals are the kindest and most grateful patients that I have had the privilege to care for in my career. Unfortunately, they are getting shortchanged. The time to repair this national embarrassment is long past.


Tuesday, May 6, 2014 - Ignoring an Inequality Culprit: Single-Parent Families

Ignoring an Inequality Culprit: Single-Parent Families

Intellectuals fretting about income disparity are oddly silent regarding the decline of the two-parent family.


Suppose a scientific conference on cancer prevention never addressed smoking, on the grounds that in a free society you can't change private behavior, and anyway, maybe the statistical relationships between smoking and cancer are really caused by some other third variable. Wouldn't some suspect that the scientists who raised these claims were driven by something—ideology, tobacco money—other than science?


Yet in the current discussions about increased inequality, few researchers, fewer reporters, and no one in the executive branch of government directly addresses what seems to be the strongest statistical correlate of inequality in the United States: the rise of single-parent families during the past half century.


Why isn't this matter at the center of policy discussions? There are at least three reasons. First, much of politics is less about what you are for than who you are against….  And intellectual and cultural elites lean to the left. So, quite simply, very few professors or journalists, and fewer still who want foundation grants, want to be seen as siding with social conservatives, even if the evidence leads that way.


Second, family breakup has hit minority communities the hardest. So even bringing up the issue risks being charged with racism, a potential career-killer.


Finally, there is no quick fix. Welfare reform beginning in the mid-1990s offered only modest marriage incentives and has been insufficient to change entrenched cultural practices. The change must come from long-term societal transformation on this subject, led by political, educational and entertainment elites, similar to the decades-long movements against racism, sexism—and smoking.


But the first step is to acknowledge the problem.


Monday, May 5, 2014 - The Questionable Link Between Saturated Fat and Heart Disease

The Questionable Link Between Saturated Fat and Heart Disease

Are butter, cheese and steak really bad for you? The dubious science behind the anti-fat crusade



"Saturated fat does not cause heart disease"—or so concluded a big study published in March in the journal Annals of Internal Medicine. How could this be? The very cornerstone of dietary advice for generations has been that the saturated fats in butter, cheese and red meat should be avoided because they clog our arteries. For many diet-conscious Americans, it is simply second nature to opt for chicken over sirloin, canola oil over butter.


The new study's conclusion shouldn't surprise anyone familiar with modern nutritional science, however. The fact is, there has never been solid evidence for the idea that these fats cause disease. We only believe this to be the case because nutrition policy has been derailed over the past half-century by a mixture of personal ambition, bad science, politics and bias.


One consequence is that in cutting back on fats, we are now eating a lot more carbohydrates—at least 25% more since the early 1970s. Consumption of saturated fat, meanwhile, has dropped by 11%, according to the best available government data. Translation: Instead of meat, eggs and cheese, we're eating more pasta, grains, fruit and starchy vegetables such as potatoes. Even seemingly healthy low-fat foods, such as yogurt, are stealth carb-delivery systems, since removing the fat often requires the addition of fillers to make up for lost texture—and these are usually carbohydrate-based.


The problem is that carbohydrates break down into glucose, which causes the body to release insulin—a hormone that is fantastically efficient at storing fat. Meanwhile, fructose, the main sugar in fruit, causes the liver to generate triglycerides and other lipids in the blood that are altogether bad news. Excessive carbohydrates lead not only to obesity but also, over time, to Type 2 diabetes and, very likely, heart disease.


Sticking to these guidelines has meant ignoring growing evidence that women on diets low in saturated fat actually increase their risk of having a heart attack. The "good" HDL cholesterol drops precipitously for women on this diet (it drops for men too, but less so). The sad irony is that women have been especially rigorous about ramping up on their fruits, vegetables and grains, but they now suffer from higher obesity rates than men, and their death rates from heart disease have reached parity.