Monday, May 30, 2011

ISPOR and the JSPH

For more than a decade and a half, our team from the Jefferson School of Population Health (and its predecessor department and office) has been very well represented at the annual meeting of the International Association of Pharmacoeconomics and Outcomes Research or ISPOR!!! ISPOR is the global leader in research on what works and what doesn't and all of the economic implications for pharmaceutical agents world wide. The annual meeting now draws more than 2,300 persons from all over the globe and it spans nearly a week, counting the pre-courses and related activities. Today, I think ISPOR is more important than ever as health reform and Comparative Effectiveness Research have pushed this agenda to the front page. The cost of pharma agents continues to rise, particularly in the oncology arena. We cannot continue to spend money on products without better proof of their comparative effectiveness and possible role in evidence based care moving forward. ISPOR uniquely fills this research void. This year, one of our fellows, Dr. Kellie Dudash, won acclaim for her podium presentation and came away with the prize for best new investigator---a real coup for her, and for our entire research team too. I am particularly proud of Kellie, Dr. Joe Couto and of course, Neil Goldfarb, our long time Associate Dean for Research. This is further confirmation for me that the JSPH is a national leader in interpreting the outcomes of the ACA and leads the way from an academic perspective in doing research in this arena. Our research supports the notion, covered in this blog many times, that the future means -- NO OUTCOME, NO INCOME!! DAVID NASH

Twist Series: The Kitchen Area (Reader's Request)

These are some ways I prevent my nape area from locking while in twists.  Hopefully, they are helpful to you as well:

Rule #1: Re-twist the nape area (and the hairline) weekly.
I rarely go past a week without re-twisting that section.  If I do, I'm headed into loc-ville.

Rule #2: Make big twists in the nape area.
My twists in the back are usually bigger than my twists on the rest of my head.  I make about 3-4 big twists in the nape area.  Any smaller, and ... yes, you've guessed it ... I'm headed into loc-ville.

Rule #3: (Alternative to #2) Make one big horizontal flat twist in the nape area.
This method was developed by a natural haircare buddy named Mooks (some of you may have heard of her).  She and other women use this method to grow and protect the fragile kitchen area.

Rule #4: Patience while untwisting and detangling.
Since the kitchen area is prone to breakage and tangling, exhibit extreme patience while untwisting and detangling this section.  Be sure to lubricate the twists with an oil and/or butter during this process.

Interview with Jimmy Moore, and basics of intima-media thickness and plaque tests

Let me start this post by telling you that my interview with Jimmy Moore is coming up in about a week. Jimmy and I talk about evolution, statistics, and health – the main themes of this blog. We talk also about other things, and probably do not agree on everything. The interview was actually done a while ago, so I don’t remember exactly what we discussed.

From what I remember from mine and other interviews (I listen to Jimmy's podcasts regularly), I think I am the guest who has mentioned the most people during an interview – Gary Taubes, Chris Masterjohn, Carbsane, Petro (a.k.a., Peter “the Hyperlipid”), T. Colin Campbell, Denise Minger, Kurt Harris, Stephan Guyenet, Art De Vany, and a few others. What was I thinking?

In case you listen and wonder, my accent is a mix of Brazilian Portuguese, New Zealand English (where I am called “Need”), American English, and the dialect spoken in the “country” of Texas. The strongest influences are probably American English and Brazilian Portuguese.

Anyway, when medical doctors (MDs) look at someone’s lipid panel, one single number tends to draw their attention: the LDL cholesterol. That is essentially the amount of cholesterol in LDL particles.

One’s LDL cholesterol is a reflection of many factors, including: diet, amount of cholesterol produced by the liver, amount of cholesterol actually used by your body, amount of cholesterol recycled by the liver, and level of systemic inflammation. This number is usually calculated, and often very different from the number you get through a VAP test.

It is not uncommon for a high saturated fat diet to lead to a benign increase in LDL cholesterol. In this case the LDL particles will be large, which will also be reflected in a low “fasting triglycerides number” (lower than 70 mg/dl). While I say "benign" here, which implies a neutral effect on health, an increase in LDL cholesterol in this context may actually be health promoting.

Large LDL particles are less likely to cross the gaps in the endothelium, the thin layer of cells that lines the interior surface of blood vessels, and form atheromatous plaques.

Still, when an MD sees an LDL cholesterol higher than 100 mg/dl, more often than not he or she will tell you that it is bad news. Whether that is bad news or not is really speculation, even for high LDL numbers. A more reliable approach is to check one’s arteries directly. Interestingly, atheromatous plaques only form in arteries, not in veins.

The figure below (from: shows a photomicrograph of carotid arteries from rabbits, which are very similar, qualitatively speaking, to those of humans. The meanings of the letters are: L = lumen; I = intima; M = media; and A = adventitia. The one on the right has significantly lower intima-media (I-M) thickness than the one on the left.

Atherosclerosis in humans tends to lead to an increase in I-M thickness; the I-M area being normally where atheromatous plaques grow. Aging also leads to an increase in I-M thickness. Typically one’s risk of premature death from cardiovascular complications correlates with one’s I-M thickness’ “distance” from that of low-risk individuals in the same sex and age group.

This notion has led to the coining of the term “vascular age”. For example, someone may be 30 years old, but have a vascular age of 80, meaning that his or her I-M thickness is that of an average 80-year-old. Conversely, someone may be 80 and have a vascular age of 30.

Nearly everybody’s I-M thickness goes up with age, even people who live to be 100 or more. Incidentally, this is true for average blood glucose levels as well. In long-living people they both go up slowly.

I-M thickness tests are noninvasive, based on external ultrasound, and often covered by health insurance. They take only a few minutes to conduct. Their reports provide information about one’s I-M thickness and its relative position in the same sex and age group, as well as the amount of deposited plaque. The latter is frequently provided as a bonus, since it can also be inferred with reasonable precision from the computer images generated via ultrasound.

Below is the top part of a typical I-M thickness test report (from: It shows a person’s average (or mean) I-M thickness; the red dot on the graph. The letter notations (A … E) are for reference groups. For the majority of the folks doing this test, the most important on this report are the thick and thin lines indicated as E, which are based on Aminbakhsh and Mancini’s (1999) study.

The reason why the thick and thin lines indicated as E are the most important for the majority of folks taking this test is that they are based on a study that provides one of the best reference ranges for people who are 45 and older, who are usually the ones getting their I-M thickness tested. Roughly speaking, if your red dot is above the thin line, you are at increased risk of cardiovascular disease.

Most people will fall in between the thick and thin lines. Those below the thick line (with the little blue triangles) are at very low risk, especially if they have little to no plaque. The person for whom this test was made is at very low risk. His red dot is below the thick line, when that line is extended to the little triangle indicated as D.

Below is the bottom part of the I-M thickness test report. The max I-M thickness score shown here tends to add little in terms of diagnosis to the mean score shown earlier. Here the most important part is the summary, under “Comments”. It says that the person has no plaque, and is at a lower risk of heart attack. If you do an I-M thickness test, your doctor will probably be able to tell you more about these results.

I like numbers, so I had an I-M thickness test done recently on me. When the doctor saw the results, which we discussed, he told me that he could guarantee two things: (1) I would die; and (2) but not of heart disease. MDs have an interesting sense of humor; just hang out with a group of them during a “happy hour” and you’ll see.

My red dot was below the thick line, and I had a plaque measurement of zero. I am 47 years old, eat about 1 lb of meat per day, and around 20 eggs per week - with the yolk. About half of the meat I eat comes from animal organs (mostly liver) and seafood. I eat organ meats about once a week, and seafood three times a week. This is an enormous amount of dietary cholesterol, by American diet standards. My saturated fat intake is also high by the same standards.

You can check the post on my transformation to see what I have been doing for years now, and some of the results in terms of levels of energy, disease, and body fat levels. Keep in mind that mine are essentially the results of a single-individual experiment; results that clearly contradict the lipid hypothesis. Still, they are also consistent with a lot of fairly reliable empirical research.

Friday, May 27, 2011

Networking, Dementia, Australia and a Breakthrough...

Networking Evening
I just want to say a big thank you to everyone who came along last night and took part in this session. I really enjoyed the very animated conversation and am keen to take some of the ideas we discussed forward. For those of you who didn't attend the ares we really got to grips with were focused on the relationship between artists who work in the broad field of Arts/Health and colleagues in the Arts Therapy field. An outcome of this discussion will be to form a small group who'll pull together a statement that best encapsulates this relationship allowing for synergy and difference, but crucially, offering dialogue and mutuality.

We had some very passionate and interesting discussions around dementia and the arts and I'm sure all who came along last night would want to give a huge thanks to Zoe Keenan who shared her personal experiences around caring for her mum and her creative response to this experience. On the basis of this exciting work and suggestions form the group, we are going to explore some very interesting work in the region. I very much look forward to our next meeting and thanks again for everyone in making this such an enjoyable and inspirational evening.

Australia Calling
I am thrilled to be speaking at this conference. If you want to know more about it, or hear from Arts for Health Australia’s inspirational leader, please come along and meet Margret Meagher at the Head to Head here at MMU on June 30th (full details over the next two weeks). My paper this year at the Canberra conference will explore the relationship between Design, the Arts and Health with a specific focus on how the last days of our lives are often far removed than what we’d hope they might be like.

“The Aboriginal Memorial 1987-88, Ramingining Artists, National Gallery of Australia, Canberra, photographer credit John Gollings
3rd Annual International Arts and Health Conference:
The Art of Good Health and Wellbeing
14 - 18 November 2011
National Gallery of Australia, Canberra, ACT

The Art of Good Health and Wellbeing, 3rd Annual International Arts and Health Conference, will present best practice and innovative arts and health programs, effective health promotion and prevention campaigns, methods of project evaluation and scientific research. The 2011 Conference will continue to have a special focus on mental health and creative ageing, including programs for people with dementia and their carers; as well as workplace wellbeing programs; arts and health programs for Aboriginal communities; the built environment, design and health; medical education and medical humanities. 

Breakthrough: Art in Mental Health
Damian Hebron and Mike Farrer will both be speaking at Breakthrough’s third ARTS in Health Event:
‘Where to Next…?’
Location : NHS North West, 3 Piccadilly Place, Manchester
Date: 10th of June, 2011. 9:30-3pm

Towards a National Forum for Arts and Health Many of you will know that I sit on a group that has been looking at the notion of a National Forum for Arts and Health, following the collapse of the NNAH in 2007. I’ve been working with colleagues around the country to explore ways forward, and the linked report has been made by the external consultants Globe to help inform this direction. I would be grateful for any thoughts on this linked document, which I will feed into the forum at our next meeting.
If you would like me to email a copy of the SUMMARY REPORT, please email me directly.

Wednesday, May 25, 2011

Guest Commentary: Albert Schweitzer Fellowship Celebration of Service

Nicole Cobb Moore, MA
Greater Philadelphia Program Director
Albert Schweitzer Fellowship

The Albert Schweitzer Fellowship (ASF) – Greater Philadelphia Program held its fifth annual Celebration of Service on May 18th at Thomas Jefferson University. The cocktail reception that started the event was warm and buzzing as newly selected Fellows mingled with graduating Fellows, Schweitzer Fellows for Life and a host of academic and community site mentors, local advisory board members, family, friends, and funders.

The ceremony was attended by many distinguished guests and highlighted by keynote speakers, Dr. David B. Nash, Greater Philadelphia Schweitzer Program Chair and Dean of the Jefferson School of Population Health, Sally Harris, Vice Chair of the Schweitzer National Board of Directors, and Sylvia Stevens-Edouard, Executive Director of The Albert Schweitzer Fellowship.

The history of the Greater Philadelphia Program was shared by Dr. Nash, while Sally Harris gave a personal perspective on Albert Schweitzer and the U.S. based Schweitzer Fellowship. Unfazed by major travel challenges to attend this event, Sylvia Steven-Edouard disclosed how she sometimes looks at pictures or reflections of Fellows to rejuvenate her inspiration for the important work that we are doing. Each speaker shared the impact Schweitzer Fellows have on the individuals and communities they serve.

Fellows prepared posters that were presented during the celebration, highlighting their year-long Schweitzer Community Service Projects. Fellows also shared a few words about their Fellowship experience. I would like to share one particular concept that exemplifies the challenges and rewards of the Schweitzer program. When conducting a Schweitzer Project, challenges will inevitably arise, and we label these obstacles “boulders.” Learning to overcome boulders over the course of the Fellowship is one of the most important accomplishments of Schweitzer Fellows. This Schweitzer quote will help explain the symbolism of boulders:

“Anyone who proposes to do good must not expect people to roll stones out of his way, but must accept his lot calmly if they even roll a few more upon it. A strength which becomes clearer and stronger through its experience of such obstacles is the only strength that can conquer them.” -Albert Schweitzer

Throughout the initial Fellowship year, Fellows are reminded of this quote as they conduct their Schweitzer Community service projects, attend graduate level classes and continue to live extraordinary and exceptional lives as our country’s future Leaders in Service.

The celebration this year was enhanced by the first presentation of the Schweitzer-Spirited Award to Neil I. Goldfarb for his humanitarian efforts in the region and for serving as the first program director for the Greater Philadelphia chapter of the ASF.

For more information about the Albert Schweitzer Fellowship – Greater Philadelphia Program, click here.

Monday, May 23, 2011

SHORT REVIEW #9: Egg Blackhead Remover

Purpose: To remove blackheads (and whiteheads).

Ingredients: egg white

Number of trials: 2

How I used it:
• Wash face as usual
• Apply egg white to face liberally
• Place toilet paper pieces on face to make a mask (avoid eyebrows)
• When dry, remove toilet paper, and wash face as usual


This at-home facial did not remove my blackheads instantly; I saw a few skin particles but did not see any blackheads in the tissue as described in the tutorial below.  The day following the facial, however, I did experience slight blackhead reduction in a few areas.  On a scale of 1 to 5, I give this facial a 2.  It's a bit messy and uncomfortable, but it's worth a try.


3in6: Box Braids Trial

{Box braids (with twisted ends)}
See "3in6 Challenge" details here.

Last weekend, I did box braids for the first time since going natural.  My primary reason for doing so was to simply switch things up from my usual twists.  Another reason for doing box braids was to see if I could wear it for 4-5 weeks with considerably less aging and shrinkage than twists.  This natural lady (pookinapp) was my main inspiration for experimenting with box braids.  What has held me off for so long were 1) the fear of my braids locking and 2) the tedious takedown process.  Given that I did my set larger than most people, hopefully the takedown and detangling won't be so bad?  We shall see weeks from now.

How are my challengers doing as we soon stride into Month #4?

The China Study II: Wheat may not be so bad if you eat 221 g or more of animal food daily

In previous posts on this blog covering the China Study II data we’ve looked at the competing effects of various foods, including wheat and animal foods. Unfortunately we have had to stick to the broad group categories available from the specific data subset used; e.g., animal foods, instead of categories of animal foods such as dairy, seafood, and beef. This is still a problem, until I can find the time to get more of the China Study II data in a format that can be reliably used for multivariate analyses.

What we haven’t done yet, however, is to look at moderating effects. And that is something we can do now.  A moderating effect is the effect of a variable on the effect of another variable on a third. Sounds complicated, but WarpPLS makes it very easy to test moderating effects. All you have to do is to make a variable (e.g., animal food intake) point at a direct link (e.g., between wheat flour intake and mortality). The moderating effect is shown on the graph as a dashed arrow going from a variable to a link between two variables.

The graph below shows the results of an analysis where animal food intake (Afoods) is hypothesized to moderate the effects of wheat flour intake (Wheat) on mortality in the 35 to 69 age range (Mor35_69) and mortality in the 70 to 79 age range (Mor70_79). A basic linear algorithm was used, whereby standardized partial regression coefficients, both moderating and direct, are calculated based on the equations of best-fitting lines.

From the graph above we can tell that wheat flour intake increases mortality significantly in both age ranges; in the 35 to 69 age range (beta=0.17, P=0.05), and in the 70 to 79 age range (beta=0.24, P=0.01). This is a finding that we have seen before on previous posts, and that has been one of the main findings of Denise Minger’s analysis of the China Study data. Denise and I used different data subsets and analysis methods, and reached essentially the same results.

But here is what is interesting about the moderating effects analysis results summarized on the graph above. They suggest that animal food intake significantly reduces the negative effect of wheat flour consumption on mortality in the 70 to 79 age range (beta=-0.22, P<0.01). This is a relatively strong moderating effect. The moderating effect of animal food intake is not significant for the 35 to 69 age range (beta=-0.00, P=0.50); the beta here is negative but very low, suggesting a very weak protective effect.

Below are two standardized plots showing the relationships between wheat flour intake and mortality in the 70 to 79 age range when animal food intake is low (left plot) and high (right plot). As you can see, the best-fitting line is flat on the right plot, meaning that wheat flour intake has no effect on mortality in the 70 to 79 age range when animal food intake is high. When animal food intake is low (left plot), the effect of wheat flour intake on mortality in this range is significant; its strength is indicated by the upward slope of the best-fitting line.

What these results seem to be telling us is that wheat flour consumption contributes to early death for several people, perhaps those who are most sensitive or intolerant to wheat. These people are represented in the variable measuring mortality in the 35 to 69 age range, and not in the 70 to 79 age range, since they died before reaching the age of 70.

Those in the 70 to 79 age range may be the least sensitive ones, and for whom animal food intake seems to be protective. But only if animal food intake is above a certain level. This is not a ringing endorsement of wheat, but certainly helps explain wheat consumption in long-living groups around the world, including the French.

How much animal food does it take for the protective effect to be observed? In the China Study II sample, it is about 221 g/day or more. That is approximately the intake level above which the relationship between wheat flour intake and mortality in the 70 to 79 age range becomes statistically indistinguishable from zero. That is a little less than ½ lb, or 7.9 oz, of animal food intake per day.

Thursday, May 19, 2011

Job opportunities, and an Opera

Fables – A Film Opera
VENUE: Zion Arts Centre, Hulme (screening and live theatrical event)
DATE & TIME: 30th June, 7-8pm

Step into a magical world of legend and folklore with Streetwise Opera’s Fables - A Film Opera, a group of four short films interspersed with live performance and theatre, created by some of the UK's leading composers and filmmakers working with 125 Streetwise performers who have experienced homelessness. Composers Mira Calix, Emily Hall, Orlando Gough and Paul Sartin/Andy Mellon, and filmmakers Gaëlle Denis, Tom Marshall, Flat-e and Iain Finlay have created short films based on traditional fables ranging from the classic The Boy Who Cried Wolf to Shinishi Hoshi's contemporary tale, Hey! Come on Out!
This special event at Zion Arts Centre is part of the fringe Not Part of Festival, and involves a screening of the films, around which there will be live performance and theatre created by director Emma Bernard and led by a sizzling folk musicians. They will be joined by Streetwise Opera’s award-winning singers from the Booth Centre in Manchester, the ICC in Nottingham and narrator Neil Allen. The evening will include some rousing opera, folk, hidden performers and uplifting audience participation.

More details HERE.

Arts and Health Practitioners required for exciting dementia project in Merseyside  

Tuesday, May 17, 2011

MORE on Natural Nail Polishes + Future Review

I ordered nail polish, nail polish remover, and a 2-in-1 base coat from Karma Organics.  The package is on the way, and a review will be posted in June.

Why I chose Karma Organics?
A good combination of price and color choice.  They had more colors from which to choose than the other places I checked.  Next on the list would be Zoya.

Meanwhile, ...
The top three supposedly unhealthy chemicals contained in certain nail polishes are toluene, formaldehyde, and dibutyl pthalate (DBP).  (For more details on these ingredients, check the links below.)  Some companies, however, appear to making efforts to eliminate one or more of these chemicals.  After looking at the back of a few polishes I own, I learned the following:
  • Revlon is Toluene, DBP and Formaldehyde free - that's good news
  • OPI is Toluene, DBP, and now Formaldehyde free
  • NYX is DBP free, but contains Formaldehyde and Toluene - argh


Monday, May 16, 2011

Guest Commentary: Humana CEO Charts Course to Better Health Care

Patrick Monaghan
Director of Communications
Jefferson School of Population Health

Mike McCallister didn’t mince any words as he addressed the capacity crowd gathered on May 12 in Connelly Auditorium for the 20th Annual Dr. Raymond C. Grandon Lecture.

“We have an absolute disaster on our hands if we don’t address population health,” the Humana, Inc. chairman of the board and CEO noted. “If we don’t get ahead of this, we’re toast.”

McCallister’s talk, “A Roadmap to Creating a Real Health Care System,” touched on the unintended consequences of health reform; how real problems persist and are getting worse in the wake of reform, and how behavior change – one person at a time – can help fix our broken system. He dispelled a myth or two about what is driving health care costs (hint: it’s not insurance company profit margins), while pointing (poking?) a not-too-indirect finger at America’s collective midsection.

We’re simply not taking care of ourselves and are therefore becoming an obese nation, McCallister said, leading to diabetes and other chronic illnesses.

This came as no surprise to the health care professionals gathered for the lecture. What was surprising, perhaps, were a series of pilot programs put into place by Humana to address the issue within its own ranks. The goal is “to help people achieve lifelong well-being.” Based on some numbers disclosed by McCallister, it seems to be working at Humana.

The “Well-Being Pilots” introduced to Humana associates include:

• Personal Health Score:
- Purpose: Provide objective clinical data coupled with actionable information to drive health improvement
- Results: More than half (55%) of associates improved their individual score

• Personal Well-Being:
- Purpose: Improve participants’ sense of their own overall well-being
- Results: After five months, associates’ “thriving” self-assessment increased from 26%to 41% and “suffering” decreased from 10% to 6%

• The
- Purpose: Deliver a social, mobile and virtual weight loss pilot for associate participants who have a BMI ≥ 28 and a desire to adopt healthy behaviors
- Results: Total pounds lost for all members = 3,474.40 lbs.

• Win, Place, Show Me The Money:
- Purpose: To understand the efficacy of financial incentives in facilitating behavior change and healthy weight maintenance relative to weight loss over time
- Results: Total net weight loss across all participants = 8,657.81 lbs.

McCallister’s talk – and the pilots he outlined – received rave reviews from Thomas Jefferson University Panel Reactors Janice Burke, Rebecca Finley and Mary Schaal. They liked the idea of such programs, designed to “make healthy things fun and fun things healthy.” Such ideas need to take root across the country in order for real change to occur, noted Mary Schaal – a real health care revolution, if you will.

We’d all love to see the plan.

Book review: Biology for Bodybuilders

The photos below show Doug Miller and his wife, Stephanie Miller. Doug is one of the most successful natural bodybuilders in the U.S.A. today. He is also a manager at an economics consulting firm and an entrepreneur. As if these were not enough, now he can add book author to his list of accomplishments. His book, Biology for Bodybuilders, has just been published.


Doug studied biochemistry, molecular biology, and economics at the undergraduate level. His co-authors are Glenn Ellmers and Kevin Fontaine. Glenn is a regular commenter on this blog, a professional writer, and a certified Strength and Conditioning Specialist. Dr. Fontaine is an Associate Professor at the Johns Hopkins University’s School of Medicine and Bloomberg School of Public Health.

Biology for Bodybuilders is written in the first person by Doug, which is one of the appealing aspects of the book. This also allows Doug to say that his co-authors disagree with him sometimes, even as he outlines what works for him. Both Glenn and Kevin are described as following Paleolithic dieting approaches. Doug follows a more old school bodybuilding approach to dieting – e.g., he eats grains, and has multiple balanced meals everyday.

This relaxed approach to team writing neutralizes criticism from those who do not agree with Doug, at least to a certain extent. Maybe it was done on purpose; a smart idea. For example, I do not agree with everything Doug says in the book, but neither do Doug’s co-authors, by his own admission. Still, one thing we all have to agree with – from a competitive sports perspective, no one can question success.

At less than 120 pages, the book is certainly not encyclopedic, but it is quite packed with details about human physiology and metabolism for a book of this size. The scientific details are delivered in a direct and simple manner, through what I would describe as very good writing.

Doug has interesting ideas on how to push his limits as a bodybuilder. For example, he likes to train for muscle hypertrophy at around 20-30 lbs above his contest weight. Also, he likes to exercise at high repetition ranges, which many believe is not optimal for muscle growth. He does that even for mass building exercises, such as the deadlift. In this video he deadlifts 405 lbs for 27 repetitions.

Here it is important to point out that whether one is working out in the anaerobic range, which is where muscle hypertrophy tends to be maximized, is defined not by the number of repetitions but by the number of seconds a muscle group is placed under stress. The anaerobic range goes from around 20 to 120 seconds. If one does many repetitions, but does them fast, he or she will be in the anaerobic range. Incidentally, this is the range of strength training at which glycogen depletion is maximized.

I am not a bodybuilder, nor do I plan on becoming one, but I do admire athletes that excel in narrow sports. Also, I strongly believe in the health-promoting effects of moderate glycogen-depleting exercise, which includes strength training and sprints. Perhaps what top athletes like Doug do is not exactly optimal for long-term health, but it certainly beats sedentary behavior hands down. Or maybe top athletes will live long and healthy lives because the genetic makeup that allows them to be successful athletes is also conducive to great health.

In this respect, however, Doug is one of the people who have gotten the closest to convincing me that genes do not influence so much what one can achieve as a bodybuilder. In the book he shows a photo of himself at age 18, when he apparently weighed not much more than 135 lbs. Now, in his early 30s, he weighs 210-225 lbs during the offseason, at a height of 5'9". He has achieved this without taking steroids. Maybe he is a good example of compensatory adaptation, where obstacles lead to success.

If you are interested in natural bodybuilding, and/or the biology behind it, this book is highly recommended!

Wednesday, May 11, 2011

Remnants of PJ-ism: Glycerin

This will be a short series on my attempt to finish a few remaining products from my 'product junkie' (PJ) days.

product junkie /ˈprädəkt ˈjəNGkē/ Noun
A person with an obsessive habit of purchasing and collecting products, particularly hair products.  

Today's remaining products: Vegetable Glycerin.

I prefer to use honey over glycerin as a humectant.  This bottle from Whole Foods has been in my cabinet for 2 years, more or less, with little usage.  

Finishing strategy: For the past few weeks, in an effort to use it up, I've been mixing it with oils and conditioners for a detangling mix.  I think I'll also use it to mix a new body butter (which I finished weeks ago).

Humana CEO Mike McCallister to visit JSPH on 5/12/11

The Jefferson School of Population Health plays host to a very special guest this Thursday when Humana CEO Mike McCallister visits campus to speak at the 20th Annual Dr. Raymond C. Grandon Lecture.

During Mike’s tenure as CEO, Humana has gained a reputation as the industry’s leading consumer company, leveraging innovative products, processes and technology to better serve more than 10 million health plan members nationwide.

As befits an industry leader, Humana is well positioned to be responsive to the changing demands in this era of health reform as they transform their offerings to focus on prevention and wellness. The company has already begun implementing pilot programs in accountable care; I’m looking forward to hearing some of Mike’s insights on how ACOs will move from the conceptual phase to real-world application.

Moreover, Mike has personally met with President Obama to discuss health reform. It’s an honor to host someone who has the President’s ear on this key topic and we here at JSPH are thrilled and looking forward to Thursday. Hope to see you there!

The 20th Annual Dr. Raymond C. Grandon Lecture, “A Roadmap to Creating a Real Health Care System,” is scheduled for noon to 2 pm Thursday, May 12 in Connelly Auditorium in the Dorrance H. Hamilton Building, 1001 Locust Street, Philadelphia.

m a n i f e s t o update and much, much more...

Head to Head
In my last blog posting, I told you a little about the free event on June 30th that will see a host of international figures from the arts/health world, sharing some of their practice and engaging in conversation. I’ve been overwhelmed by the response and it looks like it will be fully booked well ahead of the event. I have to reiterate that I can’t guarantee anyone a place yet, but thanks for the emails. I will confirm places/agenda/venue/times at the beginning of June.

Towards a National Forum for Arts and Health
Many of you will know that I sit on a group that has been looking at the notion of a National Forum for Arts and Health, following the collapse of the NNAH in 2007. I’ve been working with colleagues around the country to explore ways forward, and the linked report has been made by the external consultants Globe to help inform this direction. I would be grateful for any thoughts on this linked document, which I will feed into the forum at our next meeting.

Networking evening
I’m discussing with a number of network members, the possibility of the next session here at MMU on the evening of 26th May, being an opportunity to share ongoing work, frustration, needs and ideas. The simple idea being that a small number of artists/health practitioners get in touch with me if they’re interested and on the evening, they can share what it is they’d like to discuss…then we can pitch in with constructive criticism and support. This could be really helpful to all of us and I’m pleased to say that the artist Zoe Keenan is happy to share some of her work around dementia and young people who find themselves in the position of being a carer. Zoe has produced some really exciting work around this and would be happy to share it and get feedback.

Anyway, if you’re interested in sharing something, or if you just want to attend, please email me at
(Venue details will be emailed next week)

M A N I F E S T O update
Since the first session last September, just under 400 people around the region have contributed to the emerging m a n i f e s t o and over May and June we’ll be holding the last sessions of the first stage of conversations. In June, I’ll be working with colleagues from all over the North West and others from as far as Durham, Yorkshire, Australia, South Africa, Ireland and the USA, who’ll all be feeding into the discussion. The final event of 2011 will be at MMU in September…then, we go public! Don’t forget, we’ll be getting some high-profile input into the m a n i f e s t o from the art, media, health sectors too, but the core of this work is about our shared vision. On the 9th May I facilitated an event in Cumbria that was over-subscribed. As usual, if you wanted to contribute but weren’t able to attend, please get in touch via email. And for the 3 people who left comments in my ‘composting thoughts bag’ in Cumbria, a particularly big THANK YOU. Your comments will feed into the mix and I really liked the illustrations too.

Tuesday, May 10, 2011

Guest Commentary: Translating Research into Practice for Public Health Preparedness

Tamar Klaiman, PhD, MPH
Assistant Professor
Jefferson School of Population Health

Recently, the movement toward evidence-based practice in both clinical medicine and public health has received increased attention. However, bridging the gap between science and practice remains challenging. In the field of public health emergency preparedness, science is continually evolving, making its translation into practice particularly difficult.

There are potential threats to the public’s health from various types of emergencies including natural disasters, bioterrorism, chemical accidents, and emerging infectious diseases. In just the past few months we have seen tsunamis, nuclear accidents, floods, and tornadoes cause devastation around the world. Given the very real threats to the public’s health, it is imperative that the public health system be prepared to respond to such emergencies.

Traditionally, measuring emergency preparedness has focused on capacities such as checklists and inventories of equipment and supplies; however, this only scratches the surface of creating a public health system that is truly equipped to deal effectively with emergency situations.

Researchers have been working to better define preparedness through the development and testing of rigorous metrics used to evaluate public health system preparedness. While these metrics are grounded in science and have been tested in a variety of situations, translating those metrics into action in local health agencies across the country, and globally, has been a challenge. Similar to clinical medicine, there is great variation in public health performance, and reducing variation continues to be a goal for systems improvement experts across the public health system.

Given the drastic reductions in funding for local public health agencies across the country, public health practitioners will continue to have difficulty securing the resources necessary to conduct, consume, and translate research into practice. The lack of investment in such translation could leave the public vulnerable to numerous public health emergencies, the results of which may be profound.

Monday, May 9, 2011

Looking for a good orthodontist? My recommendation is Dr. Meat

The figure below is one of many in Weston Price’s outstanding book Nutrition and Physical Degeneration showing evidence of teeth crowding among children whose parents moved from a traditional diet of minimally processed foods to a Westernized diet.

Tooth crowding and other forms of malocclusion are widespread and on the rise in populations that have adopted Westernized diets (most of us). Some blame it on dental caries, particularly in early childhood; dental caries are also a hallmark of Westernized diets. Varrela (2007), however, in a study of Finnish skulls from the 15th and 16th centuries found evidence of dental caries, but not of malocclusion, which Varrela reported as fairly high in modern Finns.

Why does malocclusion occur at all in the context of Westernized diets? Lombardi (1982) put forth an evolutionary hypothesis:

“In modern man there is little attrition of the teeth because of a soft, processed diet; this can result in dental crowding and impaction of the third molars. It is postulated that the tooth-jaw size discrepancy apparent in modern man as dental crowding is, in primitive man, a crucial biologic adaptation imposed by the selection pressures of a demanding diet that maintains sufficient chewing surface area for long-term survival. Selection pressures for teeth large enough to withstand a rigorous diet have been relaxed only recently in advanced populations, and the slow pace of evolutionary change has not yet brought the teeth and jaws into harmonious relationship.”

So what is one to do? Apparently getting babies to eat meat is not a bad idea. They may well just chew on it for a while and spit it out. The likelihood of meat inducing dental caries is very low, as most low carbers can attest. (In fact, low carbers who eat mostly meat often see dental caries heal.)

Concerned about the baby choking on meat? At the time of this writing a Google search yielded this: No results found for “baby choked on meat”. Conversely, Google returned 219 hits for “baby choked on milk”.

What if you have a child with crowded teeth as a preteen or teen? Too late? Should you get him or her to use “cute” braces? Our daughter had crowded teeth a few years ago, as a preteen. It overlapped with the period of my transformation, which meant that she started having a lot more natural foods to eat. There were more of those around, some of which require serious chewing, and less industrialized soft foods. Those natural foods included hard-to-chew beef cuts, served multiple times a week.

We noticed improvement right away, and in a few years the crowding disappeared. Now she has the kind of smile that could land her a job as a toothpaste model:

The key seems to be to start early, in developmental years. If you are an adult with crowded teeth, malocclusion may not be solved by either tough foods or braces. With braces, you may even end up with other problems (see this).

Thursday, May 5, 2011

Guest Commentary: Health Literacy and the PPACA

Marlon Satchell, MPH
Project Director
Jefferson School of Population Health

A little over a year after Congress passed the Patient Protection and Affordable Care Act (PPACA), the United States is gradually implementing the key features of this legislation. With a timeline of approximately 5 years to full implementation, it is important to recognize the opportunity that is being given to legislators, insurers, health care providers, community groups and other stakeholders not only to reshape the health care system itself, but also to reshape the way in which health care-based information is transmitted to and understood by consumers.

Some of the milestones in the PPACA related to providing information directly to consumers, and their expected completion dates include:

• Putting information for consumers online (Implemented July 2010)
• Establishing consumer assistance programs in the US (Funding awarded October 2010)
• Free preventive care; Preventing disease and illness (Beginning 2010)
• Free preventive care for seniors (Effective January 2011)
• Improving care for seniors after they leave the hospital (Effective January 2011)
• Understanding and fighting health disparities (2012)

Evidence shows that only 12% of the US population has adequate health literacy. The US Department of Health and Human Services (HHS) defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Health literacy is dependent upon factors including communication by health care professionals, lay and professional knowledge of health topics, and the context in which information is provided. It directly affects individuals’ ability to navigate the health care system, fill out forms and documentation, locate providers and services, share their own health history, manage their medications, engage in self-care and chronic disease management, and understand health-related risks and benefits. HHS has identified the improvement of health literacy as a key goal and released the National Action Plan to Improve Health Literacy in 2010. This plan provides seven steps towards creating information that is “accurate, accessible, and actionable.”

Adequate health literacy is crucial to the success of the aforementioned milestones because these milestones involve a degree of understanding and buy-in from the patients and consumers themselves. Individuals must be able to understand the risks inherent in certain behaviors, they must be aware of the importance of preventive care, and they must know how to manage their own care, particularly after an event such as hospitalization.

Historically, some of the challenges associated with the improvement of health literacy have included a lack of funding for provider training and patient education; the breadth of institutions, services, providers and products available; and a lack of understanding of rapidly changing medical terminology, technology, and treatment.

The implementation of these components of the PPACA provides an ideal opportunity for health care providers, insurers, and others to better inform the public, and to create a foundation upon which the public can gain a better understanding of their health care. While health literacy and the challenges associated with providing information in a manner that is comprehensible for patients and consumers is not a new problem facing the American public, the PPACA provides a prime opportunity for government, health care, insurers, and community groups to develop and disseminate appropriate and consistent health care-related information enabling all patients and consumers to be better informed of their own health and health care-related information.

Wednesday, May 4, 2011

Natural Nail Polishes ... ?

I've never been a big nail polish wearer, but things have changed.  Recently, I've begun painting my nails on the weekends as part of my "pamper myself" time. Despite an investment in a base coat, top coat, and acetone-free nail polish remover, my nails have suffered from the self-manicures. While I don't want to give up my new weekend beauty regimen, I also want my healthy nails back. With that I've decided to look into natural nail polishes. They lack the harmful chemicals that most regular nail polishes contain which damage our nails. Sounds to good to be true?  Well I'll find out soon.  Let me know if you all would like a product review in the near future ...

Here are some polishes I'm currently researching:


3in6: Using My "Out" Pass

See "3in6 Challenge" details here.

So after almost 3 months in twists, I (and my edges) needed a break.  Last weekend I wore a chunky twistout!  

Prior to the style, I washed and hennaed (with a cassia melt for strengthening, not color) for the first time in months.  Then I followed up with a light wash, deep conditioner, and detangling.  After that, it was time to do chunky twists.

As for the healthy intake, it's been going okay.  I've been using a lot of onions and tomatoes in my meals in addition to spinach and the usual.  Daily multivitamin - check.  Water - check.

We're officially halfway there, ladies!!

How do you plan to finish these next 3 months?  Are there any lessons you have learned up to this point?

Tuesday, May 3, 2011

Arts and Health: Head to Head

On Thursday 30th June Arts for Health at MMU in collaboration with the Centre for Medical Humanities; Pioneer Projects and Open Art, will be hosting a once in a lifetime head-to-head, with some key international figures from the Arts and Health field.

These include, amongst others Executive Director of Arts and Health Australia, Margret Meagher; Murdoch University's Dr Peter Wright; Executive Director of DADAADavid Doyle, Durban University of Technolgy's Professor Kate Wells and the Centre for Medical Humanities', Mike White.

This event will offer participants the chance to hear about some global exemplars in arts and community health and research, and take part in a discussion and networking session.

This event is free and places are going to be limited. It is likely that it will take place between 3:00 and 6:00.

Tim Maley Exhibition DADAA
To register your interest (which does not guarantee a place), simply email with your name and subject line reading HEAD TO HEAD. Although priority will be given to North West Arts and Health Network members, this session will have a number of places open to colleagues from further afield.

Confirmation of a place will be provided in early June, as will fine details of the event including agenda, time and venue.

Monday, May 2, 2011

Strength training plus fasting regularly, and becoming diabetic!? No, it is just compensatory adaptation at work

One common outcome of doing glycogen-depleting exercise (e.g., strength training, sprinting) in combination with intermittent fasting is an increase in growth hormone (GH) levels. See this post for a graph showing the acute effect on GH levels of glycogen-depleting exercise. This effect applies to both men and women, and is generally healthy, leading to improvements in mood and many health markers.

It is a bit like GH therapy, with GH being “administered” to you by your own body. Both glycogen-depleting exercise and intermittent fasting increase GH levels; apparently they have an additive effect when done together.

Still, a complaint that one sees a lot from people who have been doing glycogen-depleting exercise and intermittent fasting for a while is that their fasting blood glucose levels go up. This is particularly true for obese folks (after they lose body fat), as obesity tends to be associated with low GH levels, although it is not restricted to the obese. In fact, many people decide to stop what they were doing because they think that they are becoming insulin resistant and on their way to developing type 2 diabetes. And, surely enough, when they stop, their blood glucose levels go down.

Guess what? If your blood glucose levels are going up quite a bit in response to glycogen-depleting exercise and intermittent fasting, maybe you are one of the lucky folks who are very effective at increasing their GH levels. The blood glucose increase effect is temporary, although it can last months, and is indeed caused by insulin resistance. An HbA1c test should also show an increase in hemoglobin glycation.

Over time, however, you will very likely become more insulin sensitive. What is happening is compensatory adaptation, with different short-term and long-term responses. In the short term, your body is trying to become a more efficient fat-burning machine, and GH is involved in this adaptation. But in the short term, GH leads to insulin resistance, probably via actions on muscle and fat cells. This gradually improves in the long term, possibly through a concomitant increase in liver insulin sensitivity and glycogen storage capacity.

This is somewhat similar to the response to GH therapy.

The figure below is from Johannsson et al. (1997). It shows what happened in terms of glucose metabolism when a group of obese men were administered recombinant GH for 9 months. The participants were aged 48–66, and were given in daily doses the equivalent to what would be needed to bring their GH levels to approximately what they were at age 20. For glucose, 5 mmol is about 90 mg, 5.5 is about 99, and 6 is about 108. GDR is glucose disposal rate; a measure of how quickly glucose is cleared from the blood.

As you can see, insulin sensitivity initially goes down for the GH group, and fasting blood glucose goes up quite a lot. But after 9 months the GH group has better insulin sensitivity. Their GDR is the same as in the placebo group, but with lower circulating insulin. The folks in the GH group also have significantly less body fat, and have better health markers, than those who took the placebo.

There is such a thing as sudden-onset type 2-like diabetes, but it is very rare (see Michael’s blog). Usually type 2 diabetes “telegraphs” its arrival through gradually increasing fasting blood glucose and HbA1c. However, those normally come together with other things, notably a decrease in HDL cholesterol and an increase in fasting triglycerides. Folks who do glycogen-depleting exercise and intermittent fasting tend to see the opposite – an increase in HDL cholesterol and a decrease in triglycerides.

So, if you are doing things that have the potential to increase your GH levels, a standard lipid panel can help you try to figure out whether insulin resistance is benign or not, if it happens.

By the way, GH and cortisol levels are correlated, which is often why some associate responses to glycogen-depleting exercise and intermittent fasting with esoteric nonsense that has no basis in scientific research like “adrenal fatigue”. Cortisol levels are meant to go up and down, but they should not go up and stay up while you are sitting down.

Avoid chronic stress, and keep on doing glycogen-depleting exercise and intermittent fasting; there is overwhelming scientific evidence that these things are good for you.