Working off an interactive inforgraphic, Cliff Kuang points out some interesting differences between the food budgets of Americans people in other nations, and what it might mean for health:

Your average American eats more calories per day than people in any other country in the world. No surprise there! But once you start delving in the data, the picture does indeed get a little weird: We don’t eat that much more than Europeans. But their obesity rates stand at 15%, while ours are double that, at 34%. What the hell?

(…)

For starters, Americans only spend 6.9% of their income on food. Compare that to a country such as Italy, which has a far lower rate of obesity. Italians eat only 100 fewer calories per day than we do–but they spend more than twice their income on food

That trend holds up all across Europe: The British, Germans, and French all eat almost as much as us, but spend between 50-100% more on food.

Granted, Americans don’t walk as much as Europeans do. But the obvious thing you have to conclude is that we simply eat cheaper food that’s worse for us. Again, that’s no surprise given the amount of fast food and processed food that Americans eat. The real question is why we eat like that. I’d place the blame squarely on the 1950s, and our wholesale embrace of mechanized food after World War II. In those days, fast food, canned vegetables, and cheap chicken became a sign of America’s progressiveness: Cheap food, in the days after World War II, were a marker of the roaring economic progress we were making. Cheap food, in other words, was a source of national pride before it became a national habit. Europe, by contrast, had no such industrial miracle. Instead, they simply held onto the food traditions that they always had–of home cooking, for example.

To flip it forward a bit, I would argue that Europeans are willing to pay more for better food because what they eat is so wrapped up with national pride and cultural identity. Why wouldn’t you spend the time to buy great ingredients for something homemade if that’s how your beloved great-grandmother did it? Americans, by contrast, have far less of a cultural attachment to the food we eat. We don’t have national dishes and food traditions that bind us together in the way of Italy or Greece. Sure, we have hamburgers, but can anyone argue that those matter as much as sardines and pasta to Souther Italians? Or fish and dolmas to Greeks? It’s no surprise that we’re so susceptible to cheap food: In some ways, it’s because food simply means less to us.

Assuming for the sake of argument the validity of the underlying data, it’s an intriguing phenomenon. Daily caloric intake doesn’t vary all that much between the United States and most of Europe, and yet obesity, diabeties, and heart disease, all of which are related to diet, are far bigger problems in the United States than they are across the pond. It’s also generally true that healthier food tends to end up being more expensive than the processed, frozen, and fried stuff that fills up American grocery carts on a weekly basis, especially for the average family of four.

I’m not entirely sure about Kuang’s explanation for this difference between American and European food buying habits, though. On the American side at least, I’d suggest that it’s not really the idea of cheap food that has become part of our culture as the idea of fast, easy to make, convenient food, whether it comes from McDonalds or a grocery store. It was the 1950s, after all, that saw the advent of the TV Dinner, the quick and easy substitute to the family dinner. As time has gone on and American life has become seemingly more busy, the appeal of convenience has come to dominate our food choices. Watch commercials for grocery products today and you’ll see that the focus is on easy and convenience of preparation, not so much on price. The fact that the convenient food ends up being cheaper, I’d argue, isn’t nearly as important as the fact that its easier to prepare. In a nation where two working parents and kids busy with school activities, it’s easy to see why that’s a major selling point.

I’ll take Kuang’s description of the European cultural attachment to food as true, but it’s also true that Europeans tend not to live the same kind of on-the-go lifestyle that Americans have taken upon themselves. Taking two hours out of the day to prepare a meal isn’t quite as big a deal under such circumstances, and the attraction of popping a frozen pizza in the oven not nearly as apparent. That, combined with the fact that Europeans don’t seem to be nearly as sedentary as Americans, is likely one of the main explanations for why they are able to equal our caloric intake yet not suffer as many health consequences.

Notwithstanding all the comments about how sedentary Americans are, though, it would be ironic indeed if one of the main contributors to America’s obesity epidemic is the fact that we’re just too busy to eat healthy.

H/T: Andrew Sullivan

The Daily (“Paula’s big fat secret“):

Paula Deen — the queen of high-calorie, Southern cooking — is about to come clean and confess that she can’t eat her own dishes anymore because she has diabetes.

The Georgia-born chef — a Food Network star who has written five best-selling cookbooks — has been trying to keep her condition a secret, even after the National Enquirer reported in April that she has Type 2 diabetes, which is often associated with fatty foods and obesity.

Sources say Deen, 64, who never addressed the diabetes question, has worked out a multimillion-dollar deal to be the spokeswoman for a pharmaceutical company and endorse the drug she is taking.

Novartis, the drug company she is said to be working for, declined to respond to Flash’s questions, as did Deen’s agent and Deen herself.

“Paula Deen is going to have to reposition herself now that she has diabetes,” said one source. “She’s going to have to start cooking healthier recipes. She can’t keep pushing mac and cheese and deep-fried Twinkies when she is hawking a diabetes drug.”

Deen has faced withering criticism for the high amounts of fat, salt and sugar in her dishes. When Deen’s cookbook for kids, “Lunch-Box Set,” was published in 2009, Barbara Walters asked her, “You tell kids to have cheesecake for breakfast. You tell them to have chocolate cake and meatloaf for lunch. And french fries. Doesn’t it bother you that you’re adding to this?”

Last August, “No Reservations” host Anthony Bourdain called Deen “the worst, most dangerous person to America” and said she should “think twice before telling an already obese nation that it’s OK to eat food that is killing us.”

That’s a bit harsh. But, yeah, it’s one thing to indulge in the occasional treat and quite another to eat nothing but garbage. It’s a pretty sweet deal, though, to go from making millions helping contribute to the diabetes epidemic to making millions from hawking a treatment.

Canadian researchers received approval Tuesday from the U.S. Food and Drug Administration to begin testing an experimental and potentially breakthrough HIV vaccine on human subjects with the first phase of clinical trials scheduled for January, the National Post has reported.

The vaccine could be a milestone achievement in HIV prevention because it works similarly to existing vaccines for polio and the flu: by using whole samples of dead viruses to stimulate an immune response in recipients without causing them to contract the disease. The National Post has also reported that the vaccine has gone through preliminary toxicology tests without raising safety concerns.

“None of the researchers in the past have used this approach,” lead researcher Dr. Chil-Yong Kang, a virologist at the University of Western Ontario who has been working on the vaccine since 1987, said in an announcement.

These trials are likely to take years. They could end in failure, but hopefully they won’t. Nonetheless, along with the fact that men like Magic Johnson have shown us that HIV/AIDS can, if properly treated, be more of a chronic condition than a fatal disease, it is really fantastic news.

via Kasia Cieplak-Mayr von Baldegg

Overturning a regulation based on a decades old law that makes compensation for such activities a crime, a Federal Court has ruled that nearly all bone marrow donors can be compensated for their donation:

SAN FRANCISCO — A federal appeals court ruled Thursday that most bone marrow donors can be paid, overturning the government’s interpretation of a decades-old law making such compensation a crime punishable by up to five years in prison.

In its ruling, the 9th U.S. Circuit Court of Appeals said a technological breakthrough makes donating bone marrow a process nearly identical to giving blood plasma.

It’s legal — and common — to pay plasma donors. Therefore, the court ruled, bone marrow donors undergoing the new procedure can be paid as well and are exempt from a law making it a felony to sell human organs for transplants.

The unanimous, three-judge panel of the court did say it remains a felony to compensate donors for undergoing an older transplant method, which extracts the marrow from the donors’ bones.

But the court said the new technology isn’t covered by the law because actual bone marrow isn’t taken from the donor. Instead, specialized cells that grow into marrow are taken from a donor’s bloodstream, and it’s basically a blood donation, not an organ transplant, the court said. It noted that two-thirds of bone marrow transplants employ the newer process.

Tens of thousands of people with leukemia, lymphoma and other blood diseases are saved each year by such procedures. An estimated three thousand others die waiting for donations, which unlike simple blood donations need to be genetically compatible, making matches especially difficult for African Americans.

Advocates for paying donors said compensation will spur even more donations. Detractors argue that donor compensation will exploit the poor to undergo risky medical procedures to benefit the wealthy.

The National Marrow Donor Program, the nonprofit that provides transplants from volunteers, opposes payments.

“We were surprised and puzzled by the appellate court’s decision regarding allowing compensation,” said Michael Boo, the program’s chief strategy officer. “The National Marrow Donor Program is studying the decision and assessing the impact. We do not anticipate the ruling will change the NMDP’s current policies and practices.”

The ruling overturns a lower court decision barring compensation for all bone marrow donations.

The ruling comes in a lawsuit that was filed by the libertarian public policy law from The Institute For Justice, which represented cancer patients, the families of children with cancer, doctors, and other organization in a lawsuit challenging the law. At that time IJ released this video featuring many of the Plaintiffs in the case:

The Cato Institute’s Ilya Shapiro sees signs that this case could lead to a reexamination of the manner in which Congress regulates organ donation to begin with:

The good news is that, with the bone marrow market effectively deregulated, Congress may now be motivated to reexamine its misguided ban on compensating organ donors. One of the greatest obstacles to reforming the prohibition on organ sales is the fortunate fact that relatively few Americans require organ transplants in any given election cycle. According to government statistics, 112,546 Americans are currently on some kind of organ transplant waiting list. That means only around 1 in 3,000 Americans (and their families and friends) would be seriously motivated to demand organ transplant reform from Congress. Congress will now be forced to grapple with its policies regarding bone marrow transplants, which may be an opportune time for advocates to push for wider organ transplant reform.

The Ninth Circuit’s opinion also clears the way for Supreme Court review of NOTA. If this case reaches the high court, IJ can press its constitutional arguments more forcefully. And even if the Supreme Court merely affirms the Ninth Circuit’s opinion on statutory grounds, we will inevitably learn much about the justices’ views on the constitutionality of NOTA more broadly.

For the moment, Flynn v. Holder means that, for the first time in over 25 years, a spotlight has been shined on NOTA and its disastrous effects on Americans’ medical liberty. And that is why the Ninth Circuit’s narrow bone marrow opinion may actually be a significant step toward the rational regulation of organ markets.

Leaving aside the much more controversial issue of compensation for organ donation for the moment, the ruling in this case seems to have been so self-evident that one wonders why the Federal Government fought so hard against it. As noted, the new procedure for extracting bone marrow is the functional equivalent of collecting a blood donation and, since the law allows people who donate blood to be compensated, there’s no logical reason why the law should be applied in a manner that prohibits compensation for a functionally identical way of donating another bodily fluid, and in this case one that could be of great aid to people suffering from many different forms of cancer.

It was this essential similarity between blood donation and the new method of bone marrow extraction, called apheresis, that was the central fact that the Court hunt its hat on in ruling on the regulation:

Congress could not have had an intent to address the apheresis method when it passed the statute, because the method did not exist at that time. We must construe the words of the statute to see what they imply about extraction of hematopoietic stem cells by this method. This issue has not been addressed by any of our sister circuits.

Since payment for blood donations has long been common, the silence in the National Organ Transplant Act on compensating blood donors is loud. “Blood” is omitted from the list of examples of “human organs” in the statute and the regulation. The statute says “human organ” is defined as a human “kidney, liver, heart, lung, pancreas, bone marrow, cornea, eye, bone, and skin or any subpart thereof and any other human organ . . . specified by the Secretary of Health and Human Services by regulation.”42 The regulation adds intestines and the rest of the gastrointestinal tract to the list: “kidney, liver, heart, lung, pancreas, bone marrow, cornea, eye, bone, skin, and intestine, including the esophagus, stomach, small and/or large intestine, or any portion of the gastrointestinal tract.”43 Neither the statute nor the regulation defines “human organ” to include “blood.” The government concedes that the common practice of compensating blood donors is not prohibited b y the statute.

The government argues that hematopoietic stem cells in the veins should be treated as “bone marrow” because “bone marrow” is a statutory organ, and the statute prohibits compensation not only for donation of an organ, but also “any subpart thereof.”44 Hematopoietic stem cells are formed in the bone marrow, and most are found there because they generally mature into blood cells and platelets in the marrow. Therefore, the government argues, they should be viewed as “subparts” of the bone marrow, even when these stem cells are obtained through apheresis, which is to say, from blood flowing through veins.

We reject this argument, because it proves too much, and  because it construes words to mean something different from ordinary usage. If the government’s argument that what comes from the marrow is a subpart of the marrow were correct,  then the statute would prohibit compensating blood donors. The red and white blood cells that flow through the veins come from the bone marrow, just like hematopoietic stem cells. But the government implicitly concedes that these red and white blood cells are not “subparts” of bone marrow under the statute, because it explicitly concedes that the statutedoes not prohibit compensation for blood donations.

(…)

It may be that “bone marrow transplant” is an anachronism that will soon fade away, as peripheral blood stem cell apheresis replaces aspiration as the transplant technique, much as “dial the phone” is fading away now that telephones do not have dials. Or it may live on, as “brief” does, even though “briefs” are now lengthy arguments rather than, as they used to be, brief summaries of authorities. Either way, when the “peripheral blood stem cell apheresis” method of “bone marrow transplantation” is used, it is not a transfer of a “human organ” or a “subpart thereof” as defined by the statute and regulation, so the statute does not criminalize compensating  the donor.

On it’s face the Court’s analysis seems to be on the money. As noted, if apheresis is “organ donation” for which compensation is barred, then so is regular blood donation. The problem with barring compensation, of course, is that it tends to reduce the available supply of the product in question. Yes, many people will be compelled to donate voluntarily, especially in extraordinary circumstances as the surge in blood donations after 9/11 showed us. However, it’s also fairly obvious that blood donation works largely because compensation is offered, and it seems equally clear that allowing compensation for bone marrow will increase the available supply of the same, which can only stand to benefit the cancer patients who desperately need it. There are obvious ethical concerns about compensating for organ donation, but the idea that the Federal Government’s hypertechnical reading of the statute was acting to the detriment of sick people is really quite shocking.

Virginia Postrel, who herself donated a kidney to a friend many years ago, addressed the more controversial issue of compensation for organ donation several years ago:

Such proposals, of course, attract vehement opposition from people who fear that financial incentives would squeeze out unpaid donors, entice the poor into bad medical choices, or “cheapen the gift.” Some volunteers would undoubtedly drop out, relieved to let someone else provide their loved one’s new kidney. But real incentives, rather than token rewards, would produce a net increase in the number of transplants. Giving a kidney to a relative or friend could still speed up the process, providing an incentive to do so but relieving such donors of any sense of emotional blackmail.

A well-designed system could address the concerns about donor welfare by including educational programs, waiting periods, and follow-up care for donors, and possibly by allocating the payments over time rather than offering immediate cash. As for “cheapening” donation, Matas notes the importance of attitude. “We need to create a culture of dignity. There are many people who want to do this, and the incentive would push them over the edge,” he says. “The message should be, ‘We can compensate you but never repay you.’”

Outlawing payments to donors is ostensibly a way to keep the system fair, giving rich and poor an equally lousy chance of getting a kidney. But wealthier people can already more easily register at distant centers with short lists. They’re also more likely to have friends and relatives who can afford the nonmedical expenses that living donation often entails, including time off from work, child care, hotel rooms, or cross-country travel. (It is legal for recipients or third parties to pay such expenses, but, unlike medical costs, they are not covered by insurance.)

Patients with enough money and the right networks have yet another option. They can go abroad, to countries where the authorities sanction or ignore payments to living donors.

(…)

It is also a completely predictable byproduct of the current system, willed into being by policy makers who ignore the plight of kidney patients and by doctors who see above-board payments—and the protections of contract and malpractice law that would go with them—as pollution. Living donation is a low-risk procedure for the donor that offers life-changing rewards for the recipient. Yet the donor is the only person involved in the process who receives no compensation. “There’s no reason that someone who does this should not get something substantial that will make a difference in their lives,” says David. To people who like to celebrate living donors as heroes, payment seems terribly crass. But the vicarious thrill of someone else’s altruism comes at a terrible cost.

There’s another point as well, and that is that everyone involved in a transplant procedure gets compensated for their role, except for the person who donated the organ, or their estate in the case of posthomous donations. That would be like a music industry where the record companies, producers, sound engineers, and concert promoters got paid, but the artists were forced to work for free. That certainly doesn’t sound fair on some level. It’s not an easy issue, and I haven’t entirely made up my mind myself on this, but I also don’t see why its the province of the state to say what someone can and cannot do with their own body.

You can read the full opinion in Flynn et al v. Holder et al here.

If you sell bottled water in the European Union, you’ll no longer be able to make the seemingly self-evident claim that drinking your product will prevent dehydration, and it’s a decision that is earning no small degree of ridicule from the British press:

EU officials concluded that, following a three-year investigation, there was no evidence to prove the previously undisputed fact.

Producers of bottled water are now forbidden by law from making the claim and will face a two-year jail sentence if they defy the edict, which comes into force in the UK next month.

Last night, critics claimed the EU was at odds with both science and common sense. Conservative MEP Roger Helmer said: “This is stupidity writ large.

“The euro is burning, the EU is falling apart and yet here they are: highly-paid, highly-pensioned officials worrying about the obvious qualities of water and trying to deny us the right to say what is patently true.

“If ever there were an episode which demonstrates the folly of the great European project then this is it.”

The ruling came about in response to a proposal by two German scientists who are critical of many of the EU’s food safety regulations:

German professors Dr Andreas Hahn and Dr Moritz Hagenmeyer, who advise food manufacturers on how to advertise their products, asked the European Commission if the claim could be made on labels.

They compiled what they assumed was an uncontroversial statement in order to test new laws which allow products to claim they can reduce the risk of disease, subject to EU approval.

They applied for the right to state that “regular consumption of significant amounts of water can reduce the risk of development of dehydration” as well as preventing a decrease in performance.

However, last February, the European Food Standards Authority (EFSA) refused to approve the statement.

A meeting of 21 scientists in Parma, Italy, concluded that reduced water content in the body was a symptom of dehydration and not something that drinking water could subsequently control.

Now the EFSA verdict has been turned into an EU directive which was issued on Wednesday.

The Guardian’s Martin Robbins calls some of the reaction to the decision “daft hysteria”:

Firstly, “regular consumption” of water doesn’t reduce the risk of dehydration any more than eating a pork pie a day reduces the risk of starvation. If I drink half a pint of bottled water while running through a desert in the blistering sun, I’ll still end up dehydrated, and if I drink several bottles today, that won’t prevent me from dehydrating tomorrow. The key is to drink enough water when you need it, and you’re not going to get that from any bottled water product unless it’s mounted on a drip.

Secondly, dehydration doesn’t just mean a lack of water, or ‘being thirsty’; electrolytes like sodium are important too. If salt levels fall too far, the body struggles to regulate fluid levels in the first place. That’s why hospitals use saline drips to prevent dehydration in patients who can’t take fluids orally, and why people with diarhhoea are treated with salt-containing oral rehydration fluids. Presumably the next big investigation at the Express will expose the shocking waste of NHS money on needless quantities of saline solution, when jolly old tap water would work just as well.

So the ruling seems pretty sensible to me, or at least as sensible as a ruling can be when the claim being tested is vexatious in the first place. It’s accurate advice, and it prevents companies selling bottled water from making exaggerated claims for their products, which is a good thing.

Exaggerated? Seriously?

Like regulators on this side of the Atlantic, the EU regulators and people like Robbins apparently believe that consumers are too stupid to think for themselves and that they blindly accept whatever claims are made by manufacturers. They also believe that they know better than the average person what’s good for them, and that the government exists to protect them, not so much from those venal, evil corporations, but from their own stupidity. Does Robbins truly believe that the average European is too dumb to realize that you need to do more than just drink water to stay healthy? Sadly, based on my own observations of people like him here on this side of the pond, I think he does.

What, exactly, would be wrong with permitting bottled water manufacturers from mentioning dehydration in their ads? Personally, I don’t see it, and I see far more evil in empowering a centralized state with the right to regulate the information that businesses are permitted to provide to consumers to such an absurd, paternalistic degree. People are smart enough to evaluate claims like this own their own, I say let them do it.

The most amusing thing about all of this, of course, is that, while the EU’s financial system continues to descend into chaos, the EU’s bureaucrats are wasting their time on nonsense like this. If Europe does survive as a united entity through all of this, it won’t be because of people like Martin Robbins who apparently find regulating the advertisement claims for bottled water more important than, well, fixing the broken system that they see all around them.

Megan McArdle has been suffering with a severe autoimmune disease that affects the thyroid with some debilitating and generally unpleasant side effects. Treatment has reduced the symptoms greatly, thankfully, but they have her wondering about medical protocols in general:

Thyroid deficiency is measured by checking the levels of something called Thyroid Stimulating Hormone (TSH). When your thyroid levels are too low, your body releases TSH to get things moving again. Only if your thyroid is conking out, the TSH doesn’t do much, so your body releases more. Most labs consider the “normal” range to be somewhere between 0.5 and 5.

The American Association of Clinical Endocrinologists now considers this to be too conservative; they’ve revised their guidelines to between 0.3 and 3. My TSH levels were right at the edge of the new, narrower range.

There are real risks to taking too much thyroid hormone–it can cause heart palpitations and increase your risk of fractures. Unfortunately, too little thyroid hormone can leave you fat, bald, constipated, and depressed.

Doctors used to treat mostly based on symptoms; they kept giving you thyroid supplement until you lost weight, regained your hair, and perked the hell up. If you developed heart palpitations, sweating, insomnia, or anxiety, they cut back your dose.

But then it became easier to test for TSH. Guidelines were developed–conservative guidelines that erred on the side of hypothyroidism, since being hyperthyroid can kill you, while being hypothyroid just, well, makes you fat, bald, constipated, and depressed.

As a result, as thyroid patients have now been complaining for years, doctors stopped paying attention to the symptoms. They treated the number instead of the disease. As long as your levels were under 5, they told you that you were fine and there was nothing more they could do.

[...]

The more we rely on a central board to make decisions for huge numbers of people, the more tempted we are going to be to rely on metrics which can be collected, aggregated, and mined for data. Where does that leave the thyroid patient with “normal” blood levels . . . and a collection of vague, frustrating–but nonetheless very real–symptoms?

Megan found a doctor willing to be aggressive and the treatment has greatly improved her quality of life. Presumably, many if not most patients lack the means or fortitude to do that and simply suffer on the basis that the doctor is the expert.

My gut instinct is to err on the side of quality of life while monitoring for signs of over-treatment. The metrics don’t mean much if the patient is miserable, after all.

Alas, an “evidence-based” approach is easier to sustain institutionally. Doctors are at the mercy of insurance companies and being able to point to specific chemical thresholds as a basis for ordering additional tests and doling out treatments is useful in defense against charges that they’re exceeding normal rates of prescription. Similarly, numbers are helpful in justifying actions before professional boards and juries when bad outcomes occur.

Kevin Drum figures that, in the unlikely case that the Supreme Court strikes down the ObamaCare* health insurance mandate,  we’ll eventually wind up with something like it through the back door.

Answer: insurance companies go ballistic. If they’re required to insure all comers at the same price but healthy people aren’t required to buy insurance, then prices spiral as sick people sign up for coverage and healthy people drop out. Eventually this death spiral will lead — as the name implies — to death for insurance companies, and at that point it becomes a staredown. Something has to be done, and either Democrats or Republicans will blink first. It may seem like a no-brainer that Democrats will be the ones to cave if this happens, but that’s not clear. All it takes is 41 holdouts to filibuster the GOP, and as the insurance industry gets ever more desperate they’ll start pushing hard on their Republican pals.

Obviously the outcome is unclear. But depending on where public opinion falls — and requiring insurance companies to insure everyone is pretty popular — Congress might end up reinstating the mandate in some form or another. It’s genuinely a crapshoot.

I actually think the more likely outcome is the institution of a single payer system with private insurance as and add-on for the well-heeled.

Even absent ObamaCare, our insurance-based system was likely to collapse in the medium term. It’s just unsustainably expensive. But ObamaCare exacerbates the problems, both by forcing insurance companies to raise rates to pay for allowing those with pre-existing conditions into the pool on the same basis as healthy people and by creating subsidized exchanges (starting in 2014) and thus giving businesses an ability to opt out of being the insurer of first resort.

Given how obvious the “unintended” consequences of its cumulative provisions are, I’ve always assumed that killing private insurance through stealth was the intent.**

___________

*I use this as–as does Drum–a non-pejorative shorthand for the bill. The bill’s given name, Patient Protection and Affordable Care Act, suffers from both being unwieldy and absurdly propagandistic. And PPACA doesn’t exactly roll off the tongue as either an acronym or initialism.

**Perhaps because I grew up with Army medical care, I’ve always diverged from the conservative mainstream on this issue. Healthcare just doesn’t work as a market given the inelasticity of demand on the part of consumers and the fact that providers have long existed as a cartel. My objections to ObamaCare were based on the fact that it did little to fix the flaws of the existing system and, indeed, exacerbates some of them. 

Twitter is abuzz with news that Congress has declared pizza to be a vegetable. It’s actually not news at all.

AP (“Pizza is a vegetable? Congress says yes“)

Congress wants to keep pizza and french fries on school lunch lines, fighting back against an Obama administration proposal to make school lunches healthier.

The final version of a spending bill released late Monday would unravel school lunch standards the Agriculture Department proposed earlier this year, which included limiting the use of potatoes on the lunch line and delaying limits on sodium and delaying a requirement to boost whole grains.

The bill also would allow tomato paste on pizzas to be counted as a vegetable, as it is now. USDA had wanted to prevent that. [emphasis added]

I have no strong views on the merits here. While making school lunches “healthier” would seem an unassailable good, it has to be balanced against other considerations, including costs and the propensity of the kids to actually eat the food. I’d rather my kids eat chicken breasts and broccoli than hot dogs and fries; I’d rather my kids eat a hot dog than throw their lunch in the trash. And, hey, ketchup is a vegetable.

But it’s worth noting that, while most people won’t bother to read past the headlines, the fact of the matter is that treating pizza–or, actually, the tomato sauce on said pizza–as a vegetable is the existing policy.

A Federal Judge has ruled that the new, graphic, cigarette warning labels mandated by the Federal Government are unconstitutional because they compel manufacturers to engage in advocacy speech mandated by the Federal Government:

A federal judge blocked the federal government Monday from requiring tobacco companies to begin putting graphic new warning labels on cigarette packages, cartons and advertisements beginning next year.

In a 29-page decision, U.S. District Judge Richard J. Leon granted a request from five tobacco companies to issue a preliminary injunction barring implementation of the Food and Drug Administration’s new mandate.

“The Court concludes that plaintiffs have demonstrated a substantial likelihood that they will prevail on the merits of their position that these mandatory graphic images unconstitutionally compel speech, and that they will suffer irreparable harm absent injunctive relief pending a judicial review of the constitutionality of the FDA’s rule,” Leon wrote.

The tobacco companies hailed the decision.

“We are pleased with the judge’s ruling and look forward to the court’s final resolution of this case,” said Bryan D. Hatchell, a spokesman for R.J. Reynolds Tobacco.

The judge’s decision puts on hold a plan unveiled in June by the FDA designed to shock customers with nine graphic images of tobacco’s impact, including smokers exhaling through a tracheotomy hole, struggling for breath in an oxygen mask and lying dead on a table with a long chest scar.Cigarette cartons, packs and advertising would have been required to feature these and six other graphic warnings, replacing the discreet admonitions that cigarette manufacturers have been required to offer since 1966. The startling images would have dominated half of the front and back of each carton and pack and 20 percent of each large ad.

(…)

The color images also would include a diseased lung, a mouth with mottled teeth and a disfigured lip, a weeping woman and a cartoon of a crying baby in an incubator along with messages such as “Warning: Cigarettes are addictive,” “Warning: Cigarettes cause cancer” and “Warning: Smoking can kill you.”

Each brand would have rotated all the images randomly throughout the year. Every warning would also have to include “1-800-QUIT-NOW,” a hotline smokers could call for help kicking the habit.

This strikes me as a sensible decision, and I say that as someone who’s never smoked a cigarette in my life. The idea that a business should be forced to host graphic government propaganda on its packaging strikes me as completely nonsensical, and really points out the continued government hypocrisy when it comes to issues like this. The government has been telling us that smoking is bad for you for nearly 50 years now, while at the same time providing financial assistance to tobacco farmers and profiting off the taxes charged on cigarettes and cigars. At the same time they want to put these warnings on cigarette packaging, it’s fairly obvious that neither the Federal Government nor the states have any intention of  acting to ban tobacco because they make far too much money off those taxes (not to mention that we already know that prohibition never works). You can’t really have it both ways, and when you get right down to it, it really isn’t the government’s business to be telling people how to live their lives.

If you aren’t smoking now, don’t start. If you are smoking, stop. That’s my advice. But if people want to continue buying and using a lawful product, that’s their right, and they don’t need to be subjected to endless government propaganda in the process of doing so. We are, I think, at the point in our society where people know that cigarette smoking is an unhealthy habit, but it is their right to continue taking that risk, isn’t it?

Here’s the court’s decision:

R.J. Reynolds et al v. US FDA et al

NYT (“Obama to Scrap a Portion of Health Care Law“):

The Obama administration announced Friday that it was scrapping a long-term care insurance program created by the new health care law because it was too costly and would not work.

Kathleen Sebelius, the secretary of health and human services, said she had concluded that premiums would be so high that few healthy people would sign up. The program, which was intended for people with chronic illnesses or severe disabilities, was known as Community Living Assistance Services and Supports, or Class.

“We have not identified a way to make Class work at this time,” Ms. Sebelius said. She said the program, which had been championed by Senator Edward M. Kennedy, Democrat of Massachusetts, was financially unsustainable.

Kathy J. Greenlee, the assistant secretary of health and human services in charge of the program, said: “We do not have a viable path forward. We will not be working further to implement the Class Act.”

[...]

Two early critics of the Class program — Senator John Thune of South Dakota and Representative Charles Boustany Jr. of Louisiana, both Republicans — said they had been vindicated.

“The Obama administration ignored repeated warnings about the financial solvency of this massive new entitlement and suppressed information on the viability of the program,” Mr. Thune said.

In an interview, Mr. Boustany said that “in their haste to get the bill passed,” President Obama and Congressional Democrats ignored warnings about the program’s financial risks.

When Congress was developing the program in late 2009, Senator Kent Conrad, Democrat of North Dakota and chairman of the Budget Committee, described it as “a Ponzi scheme of the first order” because it required an ever-increasing stream of premiums to cover the cost of benefits. Connie Garner, who helped devise the long-term care program as an aide to Mr. Kennedy, said she was “very, very disappointed” by the decision. “The program could have been made to work” if the administration had tried harder, Ms. Garner said.

I haven’t followed this particular aspect of the law closely enough to have an opinion and, consequently, don’t have one. Certainly, catastrophic care of this sort would seem to be a starting point, rather than a luxury component, of a centralized health plan. But I haven’t the foggiest how you’d make it work as a pay-as-you-go standalone plan.

Anesthesiologist Eugene Lipov thinks he has found a cheap, effective treatment for post-traumatic stress disorder. The Army won’t fund it.

Megan McCloskey, Stars and Stripes (“Doctor: PTSD injection can work miracles, but DOD won’t fund it“):

In 2007, the Chicago-based Lipov discovered that injecting a local anesthetic into a bundle of nerves in the neck of war veterans relieved PTSD symptoms. One, or sometimes two injections, and the veterans were suddenly better.

Lipov has tried three times in the last four years to get the Department of Defense to fund a study on the treatment, but even with an endorsement of then-Sen. Barack Obama, he hasn’t been able to wrench open the government pocketbook. The best he’s been able to do is convince two Navy doctors in San Diego to do a small study of their own.

“You would think the government would look at the results I’ve had and say, ‘This is a great idea. How can I help you?’” Lipov said. “But I’m still waiting.”

[...]

Lipov says his 12 patients have shown the shot to work, and in 2009, an Army doctor replicated those results with two soldiers at Walter Reed Army Medical Center. Lt. Col. Sean Mulvaney’s results were published in the Pain Practice journal, where he wrote that both of his patients with chronic PTSD “experienced immediate, significant and durable relief.” Mulvaney has now treated 15 patients with the shot.

The testimonials of many of the veterans and servicemembers are powerful. The nightmares, flashbacks, anger and other PTSD-related issues were gone, they said, replaced with a calm they hadn’t felt in years.

Still, with those who hold the purse strings in the military research community, it’s been a hard sell for an outsider like Lipov. The 10-minute procedure has been used since 1925 to treat pain, so it isn’t a new concept. But no one before has proposed that it could treat PTSD, which despite its physical manifestations in the brain, is still largely thought of as an emotional problem.

Lipov and his supporters say this is bureaucracy at its worst, rejecting a novel treatment from an outsider. But the Army’s explanation seems perfectly reasonable:

The U.S. Army Medical Research and Materiel Command at Fort Detrick isn’t buying it. Last month, they rejected Lipov’s latest proposal, a $1.6 million clinical trial.

Reviewers of the proposal acknowledged that should a randomized controlled trial prove successful, it “could lead to important innovations in the medical treatment of PTSD.”

But they wrote in their scientific review that they were concerned Lipov’s study was overly ambitious and expensive for a relatively untested concept — and one they think lacks a convincing neurobiological explanation for why it works.

Even a psychologist who has signed on to help advise Lipov as he moves forward with his work, agrees with the reviewers on that note.

“You have to start with a theory that makes sense to folks,” said Stevan Hobfoll, who heads the Department of Behavioral Sciences at the Rush University Medical Center in Chicago.

Col. Carl Castro, director of Ditric’s Operational Medicine Research Program, said Lipov skipped an important step: a study with control groups. Without that, the scientific community looks at results as little more than fallible anecdotes.

The Army, which spends about $30 million a year on PTSD research, would like to explore Lipov’s approach, but he “needs to do a scientifically rigorous study, and that way if he gets promising results, we can be confident in doing a much larger clinical trial,” Castro said. “We don’t want to fund a study that has the possibility of failure, or has findings that will be so ambiguous we won’t know what to make of the findings. It’s a novel concept and really we have just got to ensure that what we’re doing is safe and actually does what the treatment is supposed to do.”

There’s an old joke about a doctor who has come up with a miracle treatment and is presenting his success story. A questioner asks him if he’s using a control group and the doctor huffs, “No! I’m not going to kill half my patients!” The questioner retorts, “Ah, but which half?”

One hopes Lipov’s treatment works. PTSD is rampant in those who have suffered the stress of multiple deployments over the past decade. But there’s a reason medical research protocols exist. That a handful of patients who have been desperate enough to try Lipov’s treatment are feeling better doesn’t really tell us much. Maybe they’re experiencing a Placebo effect. Maybe the injection itself provides temporary relief but has yet-unknown side effects. There needs to be a sound basis for moving forward and then careful, controlled research to figure out these things.

A Canadian-born scientist was awarded the Nobel Prize in medicine on Monday for his discoveries about the immune system but hours later his university said that he had been dead for three days.

The Nobel committee had been unaware of Ralph Steinman’s death and it was unclear whether the prize would be rescinded because Nobel statutes don’t allow posthumous awards.

Steinman, 68, who shared the prize with American Bruce Beutler and French scientist Jules Hoffmann, died on Sept. 30 of pancreatic cancer, acccording to Rockefeller University, which said he had been treated with immunotherapy based on his discovery of dendritic cells two decades earlier.

The cells help regulate adaptive immunity, an immune system response that purges invading microorganisms from the body.

Nobel committee member Goran Hansson said the Nobel committee didn’t know Steinman was dead when it chose him as a winner and was looking through its regulations.

(…)

An earlier statement from the award panel at Sweden’s Karolinska Institute said, “this year’s Nobel laureates have revolutionized our understanding of the immune system by discovering key principles for its activation,” the award panel at said in a statement in Stockholm.

The trio’s discoveries have enabled the development of improved vaccines against infectious diseases. In the long term they could also yield better treatments of cancer, rheumatoid arthritis, type 1 diabetes, multiple sclerosis, and chronic inflammatory diseases, hansson said.

Beutler and Hoffmann were cited for their discoveries in the 1990s of receptor proteins that can recognize bacteria and other microorganisms as they enter the body, and activate the first line of defense in the immune system, known as innate immunity.

The work of the three scientists has been pivotal to the development of improved types of vaccines against infectious diseases and novel approaches to fighting cancer. The research has helped lay the foundations for a new wave of “therapeutic vaccines” that stimulate the immune system to attack tumors.

“They have made possible the development of new methods for preventing and treating disease, for instance with improved vaccines against infections and in attempts to stimulate the immune system to attack tumors,” the committee said.

Sad news, indeed, and there’ s no word on what happens to Steinman’s Nobel considering that the was dead when it was awarded. Typically, Nobel Prizes are not awarded posthumously.

Update: The committee that awards the Nobel Prize in Medicine has announced that Steinman will be given the award posthumously:

Canadian scientist Ralph Steinman will keep his Nobel prize for medicine, the Nobel Foundation has said, after his death on Friday threw it into doubt.

The rules state “work by a person since deceased shall not be considered”.

But the foundation said it was unaware of Prof Steinman’s death from pancreatic cancer and that the award had been made “in good faith”.

It would seem I was slightly ahead of the curve with my post yesterday asking whether Chris Christie was “too fat” to be President, because it’s become quite the topic of discussion among the pundits today. Over at The Washington Post for example, Eugene Robinson was out this morning with a column that essentially said that Christie needs to put down the doughnut and go for a walk:

Whether or not he lets himself be persuaded to run for president, Chris Christie needs to find some way to lose weight. Like everyone else, elected officials perform best when they are in optimal health. Christie obviously is not.

You could argue that this is none of my business, but I disagree. Christie’s problem with weight ceased being a private matter when he stepped into the public arena — and it’s not something you can fail to notice. Obesity is a national epidemic whose costs are measured not just in dollars and cents but also in lives. Christie’s weight is as legitimate an issue as the smoking habit hat President Obama says he has finally kicked.

Robinson was joined by Michael Kinsley, who if anything was even less civil in the manner in which he wrote about the issue:

Look, I’m sorry, but New Jersey Governor Chris Christie cannot be president: He is just too fat. Maybe, if he runs for president and we get to know him, we will overlook this awkward issue because we are so impressed with the way he stands up to teachers’ unions. But we shouldn’t overlook it — unless he goes on a diet and shows he can stick to it.

(…)

A presidential candidate should be judged on behavior and character, not just on policies — especially because the chance these days of any actual policies being enacted is slim. (Most of us, fortunately, aren’t judged this way — at least not in this life. But presidents are.)

Controlling what you eat and how much is not easy, and it’s harder for some people than for others. But it’s not as difficult as curing a chemical addiction. With a determined, disciplined effort, Christie could thin down, and he should — because the obesity epidemic is real and dangerous. And the president inevitably sets an example.

As with most people, Robinson and Kinsley are under the assumption that obesity is purely caused by irresponsible behavior — over-eating, lack of exercise, etc — and that someone who is obese is guilty of some kind of moral failing. As Ezra Klein points out, though, the medical evidence for that just isn’t there:

For decades now, we’ve known that obesity is linked to genetics. In one famous study attempting to separate behavior from biology, Danish researchers looked at a registry of adopted children to see whether their weight correlated with that of their biological parents or that of their adopted parents. Biology won out. “The two major findings of this study were that there was a clear relation between the body-mass index of biologic parents and the weight class of adoptees, suggesting that genetic influences are important determinants of body fatness; and that there was no relation between the body-mass index of adoptive parents and the weight class of adoptees, suggesting that childhood family environment alone has little or no effect.”

To suggest that you can draw a straight line from obesity to discipline is, in light of this sort of evidence, absurd.

Moreover, as Megan McArdle notes, the idea that weight is somehow a proxy for self-discipline seems to be rebutted by the likes of Mike Huckabee, Oprah Winfrey, and even Christie himself. For that matter, I’d simply note that our 42nd President wasn’t exactly a prime exponent of a healthy eating lifestyle for most of his eight years in office, and the American people seems just fine with it. (Of course, they also learned that Mr. Clinton had other appetite issues, but that’s an issue for another day) By and large, I think it’s fairly clear that Bill Clinton’s weight really didn’t impact his Presidency.

There’s also little evidence, so far at least, that Christie’s weight has been a serious health issue for him. In the 20 months he’s been Governor, he’s only been hospitalized once, for asthma. While it’s arguably the case that the asthma may have been aggravated by his weight, it’s hardly evidence of the kind of chronic health problems that Robinson suggests would be an issue should Christie run for, and potentially become President of the United States. As one doctor quoted in Klein’s piece put it, the fact that Christie is fat is not, by itself, evidence of anything medically:

I called Zeke Emanuel, an oncologist and bioethicist at the National Institutes of Health. “I think the fact of the matter is that the guy is going to have to release his health records, and that will give us a much better picture,” Emanuel says. “You need to know if he has high cholesterol, if he’s had myocardial infarction. But just knowing if he’s obese? That’s worthless.”

Ken Thorpe, a professor at the Rollins School of Publish Health at Emory University, was similarly unimpressed. “Excess weight probably shaves between zero years and a year-and-a-half from life expectancy,” he says. Compare that to smoking, which rips 13 to 14 years off a person’s life expectancy. “The problem with obesity is morbidity, not mortality. You have a higher rate of diabetes, bad cholesterol, back pain, that kind of thing. But if you’re taking your blood sugar medications and the right statins and so on, you can control a lot of that.”

As I noted yesterday, the one unknown question that a Christie candidacy would raise is whether personal appearance is really as relevant in politics as we tend to think it is. Since the dawn of the television era, we’ve tended to elect Presidents who either look like, or literally are, movie stars, the suggestion that Americans might be put-off by another William Howard Taft really isn’t that far fetched. But, maybe we should let them decide that for themselves. As Jazz Shaw put it today maybe Americans are ready for a “Big Presidency.”

I still don’t think Christie will run, I also don’t think he should run. Not because he’s fat, though. The question is why people like Kinsley and Robinson seem to think it’s such a big deal. Jonathan Chait, who I doubt can be considered an ideological ally of Christie’s, has a theory:

Why does his weight matter at all? The only real reasoning I see here is that American elites view obesity with disgust, and they’re repulsed at the notion that a very fat guy could rise to a position of symbolic leadership. It’s not a very attractive sentiment.

Is that what this is really all about?

As the political media continues to push ahead with speculation about Chris Christie’s Presidential intention, ABC News wonders if the New Jersey Governor’s weight would keep him out of the office:

For Chris Christie, there was no way around it. “In case you haven’t noticed, I’m slightly overweight,” he said during a debate in his successful campaign for governor.

Two years later, Christie is the man of the moment in presidential politics, with many powerful Republicans clamoring for him to run. But it has been 100 years since Americans sent a true heavyweight to the White House, when William Howard Taft tipped the scales at well over 300 pounds.

Nor is Christie just “slightly overweight.” So there is no delicate way to ask this: Is Chris Christie too fat to win?

Politics, after all, is a business of image and first-impressions — and study after study shows that people judge the hefty more harshly than they judge those who are thin.

“Overweight people have much less of a chance of getting a job, they have much less of a chance of keeping a job … they are paid less than those who are thin,” said David Birdsell, dean of the School of Public Affairs at Baruch College in New York.

“In this era of exercise, we impute moral failings to people who don’t rein in their weight,” he said. “Those prejudices are just intensified for people who seek elected office.”

Indeed, John McLaughlin, a New York-based Republican political consultant, said he routinely advises his clients to watch what they eat.

“You don’t want them to gain weight, to look poorly on television,” he said.

(…)

Political scientists and strategists said they could not recall a truly heavy American politician finding great national success in the television age.

“Our candidates tend to be tall, they tend to have great hair,” said Russell Riley, a presidential scholar at the University of Virginia’s Center of Public Affairs. “This doesn’t seem to be a business that, at the presidential level, willingly accepts people who are demonstrably overweight.

Well, at least not since the days of William Howard Taft, who was so legendarily large that he once got stuck in the White House bathtub and ordered it be replaced with one that was big enough for four average sized men. Of course, Taft was also the last President with facial hair, and we haven’t had a major party Presidential candidate with facial hair since the Republicans nominated Thomas Dewey in 1948. And, starting in 1960, we have seen television and the moving image influence political elections in fundamental ways.

Put simply, a candidate who does not look good on television, or who doesn’t know how to use the medium, is going to be at a distinct disadvantage when going up against someone who does. The classic example of this is the legendary, and perhaps apocryphal tale of the 1960 Nixon-Kennedy debates. According to the accepted history, people who watched the debate on television believed Kennedy won, while those who listened on radio believed Nixon had won. The actual history of the debates is somewhat more complicated. Nixon had been ill before that first debate and choose to utilize a form of makeup that made his face seem even more pallor than usual over the television sets of the time. He had also injured his knee the weekend before and was apparently in pain due to standing for so long. Also, there were actually four Nixon-Kennedy debates and it’s generally accepted that Nixon’s performances were much stronger in the final three debates than in that first one. The problem for Nixon is that far more people watched the first debate than the final three, so it’s probable that a lot of people didn’t get to see those debates. Despite this twist on the legend, though, the lesson that the Nixon-Kennedy debates set in many peoples minds was that television was “dumbing down” politics, and that we had entered an era where appearance and image would matter more than substance.

It’s been generally true that television has irreversibly changed the political process, and the manner in which we pick Presidents. One need only look at the campaigns and Presidencies of our two most media savvy Presidents to see that effect. Both Ronald Reagan and Bill Clinton used television, and their ability to use it to their advantage, to advance their agendas on numerous occasions. Reagan made many Oval Office or East Room addresses designed to push a piece of legislation through a House of Representatives controlled by the opposition party, for example. Bill Clinton arguably both resurrected and relaunched his 1992 campaign thanks to appearances on 60 Minutes where he addressed the Gennifer Flowers allegations, and The Arsenio Hall Show. In both cases, image mattered significantly to their ability to connect with the public.

So what does this say about Christie? Are we forever in an era where only tall, thin, people with good hair will be elected President, or is the door still open for the next William Howard Taft? Some argue that Christie’s weight might actually be an advantage in the current political climate:

At a time when many Americans are angry with Washington and fed up with politicians, Christie’s weight allows him to stand apart from the political crowd, they said. It is an image Christie played to when he warned New Jerseyans to “get the hell off the beach” as Hurricane Irene approached in late August.

“People want something different, something out of the ordinary … someone who is willing to stand up and confront problems,” McLaughlin said “Being a picture-perfect candidate I don’t think is as important anymore.”

Doug Muzzio, a political scientist at Baruch College, said Christie’s weight could help him subliminally with voters, too.

“Maybe this is a time when you need someone to be a bull in a china shop,” Muzzio said. “Well, bulls are big.”

Maybe, or maybe in a nation where obesity is seemingly a national pastime, how someone looks on television isn’t as big a deal as it used to be.