Thursday, September 29, 2011

Cooking Oils - Good or Bad

For information on whether cooking oils are good or bad and which ones to use or avoid, check out this read.

Wednesday, September 28, 2011

An Un-Conference Event...The Scottish Mental Health Arts and Film Festival and a Film from 1939

I am thrilled to be hosting this event alongside Anne Crabtree and the Greater Manchester Arts Health Network and we have four very different and very exciting sessions planned...
An Un-Conference at MMU
20th October
Four seperate sessions focusing on:
8.45 – 11am
Changing Mindsets – the realities of artists engagement for mental health and wellbeing
Dr Langley Brown and Phil Burgess
An interactive ‘how to’ for artists to stimulate enquiry into the underlying skills and knowledge required to work within the health sector and raise awareness of best practice in mental health
For: artists, local authority arts, mental health promotion, charitable mental health or arts organisations, cultural organisations.
For more information or to register for this session only go to:

11.15am – 1.15pm
Understanding and Evidencing Transformative Practice
Professor Lynn Froggett, UCLan, with Alistair Roy and Robert Little
A research based psychosocial approach to understanding how the arts can change individuals and communities followed by interactive workshops to explore how practitioners and organisations can evidence this.
For: individuals and organisations working in arts, health, voluntary sectors, cultural or arts and health organisations with some existing experience of developing or commissioning arts and health.
For more information or to register for this session only go to:

1.45 - 3.45pm
Depression and Imagination
Dorothy Rowe
A talk and discussion exploring the myths surrounding depression , looking at how using your imagination can challenge negative inner beliefs.
For more information about Dorothy Rowe please visit  or
For: strategic leads, politicians, GP’s, managers and staff from public health , mental health, health improvement, local authorities, arts organisations, voluntary sector organisations
For more information or to register for this session only go to:

4.00 - 6pm
Cultural Attendance and Public Mental Health
Mark O’Neill, Glasgow Life
Looking at the evidence for the health impacts of cultural attendance and participation and how it can be promoted as part of a public mental health strategy.
Leisa Gray from Manchester City Galleries will lead a practical example of an object handling session.
For: public health and local authority strategic leads, museums and galleries, LA arts teams, arts organisations, mental health and health promotion leads, arts and health organisations, artists
For more information or to register for this session only go to:

If you have any booking queries please contact Events Northern Ltd on 01772 336639 or

The Scottish Mental Health Arts and Film Festival ( is now one of the largest arts and health events in the world with tens of thousands of attenders expected at almost 300 events taking place between 1-24 October. This year we have 10 provocative and entertaining learning events taking mental health and memory as their starting point.

In venues including The Citizens Theatre, Kelvingrove, CCA and Filmhouse, contributors include activists and community groups such as Oor Mad History and Voices of Experience, celebrities such as Elaine C Smith, former and current Chief Medical Officers Kenneth Calman and Harry Burns - and 10 universities, most are FREE, culminating in our international mental health film awards. The full event and booking details are in the document attached and it would be very helpful if you could promote these to your networks and members.

Monday, September 26, 2011

Guest Commentary: Spending More Resources on Preventive Services is our Common Strategy

Akira Babazono, MS, MD, PhD**
Chair and Professor
Department of Health Care Administration and Management
Graduate School of Medical Sciences, Kyushu University, Japan

Dr. Saito and I visited JSPH to meet most faculty members, with the help of. Dr. Nash, this past August. We thanked them to have given precious information concerning healthcare problems. We are very happy to agree that we need more resources on primary care, including prevention, rather than for specialized care in developed countries where chronic diseases are prevalent.

Lifestyle-related diseases account for about 60% of deaths and we spend majority of health care expenditure on treatment for those diseases in Japan. The Japanese government has mandated insurers to provide health examinations and guidance related to metabolic syndrome since 2010. Insurers have to determine the risk for metabolic syndrome, including level of obesity (abdominal circumference and BMI), blood glucose and lipid levels, blood pressure, and the presence or absence of a smoking habit for every insured person aged 40 and over. Then, insurers are obliged to offer health guidance interventions according to the degree of risk of each insured person.

There are several studies that have reported favorable outcomes. The health examinations and guidance program would be productive because it is the efficient way to motivate patients to continue to maintain a healthy lifestyle in order to prevent chronic diseases.

I hear that the Patient Protection and Affordable Care Act mandates insurers to make co-payments on cancer screening free and to give subsidies to the insured to participate in fitness programs. I believe that we are on the right track because chronic diseases, which cannot always be cured by procedures, are preventable.

** Dr. Babazono and his colleague, Dr. Takao Saito, MD, PhD, attended the Tenth Quality Colloquium at Harvard in August, 2011 and spent the following week at JSPH. This is Dr. Babazono’s 3rd visit with JSPH.

Calling self-experimentation N=1 is incorrect and misleading

This is not a post about semantics. Using “N=1” to refer to self-experimentation is okay, as long as one understands that self-experimentation is one of the most powerful ways to improve one’s health. Typically the term “N=1” is used in a demeaning way, as in: “It is just my N=1 experience, so it’s not worth much, but …” This is the reason behind this post. Using the “N=1” term to refer to self-experimentation in this way is both incorrect and misleading.

Calling self-experimentation N=1 is incorrect

The table below shows a dataset that is discussed in this YouTube video on HealthCorrelator for Excel (HCE). It refers to one single individual. Nearly all health-related datasets will look somewhat like this, with columns referring to health variables and rows referring to multiple measurements for the health variables. (This actually applies to datasets in general, including datasets about non-health-related phenomena.)

Often each individual measurement, or row, will be associated with a particular point in time, such as a date. This will characterize the measurement approach used as longitudinal, as opposed to cross-sectional. One example of the latter would be a dataset where each row referred to a different individual, with the data on all rows collected at the same point in time. Longitudinal health-related measurement is frequently considered superior to cross-sectional measurement in terms of the insights that it can provide.

As you can see, the dataset has 10 rows, with the top row containing the names of the variables. So this dataset contains nine rows of data, which means that in this dataset “N=9”, even though the data is for one single individual. To call this an “N=1” experiment is incorrect.

As a side note, an empty cell, like that on the top row for HDL cholesterol, essentially means that a measurement for that variable was not taken on that date, or that it was left out because of obvious measurement error (e.g., the value received from the lab was “-10”, which would be a mistake since nobody has a negative HDL cholesterol level). The N of the dataset as a whole would still be technically 9 in a situation like this, with only one missing cell on the row in question. But the software would typically calculate associations for that variable (HDL cholesterol) based on a sample of 8.

Calling self-experimentation N=1 is misleading

Calling self-experimentation “N=1”, meaning that the results of self-experimentation are not a good basis for generalization, is very misleading. But there is a twist. Those results may indeed not be a good basis for generalization to other people, but they provide a particularly good basis for generalization for you. It is often much safer to generalize based on self-experimentation, even with small samples (e.g., N=9).

The reason, as I pointed out in this interview with Jimmy Moore, is that data about oneself only tends to be much more uniform than data about a sample of individuals. When multiple individuals are included in an analysis, the number of sources of error (e.g., confounding variables, measurement problems) is much higher than when the analysis is based on one single individual. Thus analyses based on data from one single individual yield results that are more uniform and stable across the sample.

Moreover, analyses of data about a sample of individuals are typically summarized through averages, and those averages tend to be biased by outliers. There are always outliers in any dataset; you might possibly be one of them if you were part of a dataset, which would render the average results at best misleading, and at worst meaningless, to you. This is a point that has also been made by Richard Nikoley, who has been discussing self-experimentation for quite some time, in this very interesting video.

Another person who has been talking about self-experimentation, and showing how it can be useful in personal health management, is Seth Roberts. He and the idea of self-experimentation were prominently portrayed in this article on the New York Times. Check this video where Dr. Roberts talks about how he found out through self-experimentation that, among other things, consuming butter reduced his arterial plaque deposits. Plaque reduction is something that only rarely happens, at least in folks who follow the traditional American diet.

HCE generates coefficients of association and graphs at the click of a button, making it relatively easy for anybody to understand how his or her health variables are associated with one another, and thus what modifiable health factors (e.g., consumption of certain foods) could be causing health effects (e.g., body fact accumulation). It may also help you identify other, more counter-intuitive, links; such as between certain thought and behavior patterns (e.g., wealth accumulation thoughts, looking at the mirror multiple times a day) and undesirable mental states (e.g., depression, panic attacks).

Just keep in mind that you need to have at least some variation in all the variables involved. Without variation there is no correlation, and thus causation may remain hidden from view.

Friday, September 23, 2011

Guest Commentary: Population Health on the World Stage: The UN High Level Conference on Non-Communicable Diseases (NCDs)

Rob Simmons, DrPH, MPH, MCHES, CPH

Director, MPH Program

Jefferson School of Population Health

For only the second time in its 66-year history, the first being in 2001 on HIV/AIDS, the United Nations held a high level (Heads of State and Ministries of Health) meeting of the General Assembly on a population health topic.

Jefferson School of Population Health (JSPH) was one of only eight US university schools to be invited to participate in this historic meeting representing the Civil Society and the NCD Alliance on the health and economic impact of non-communicable diseases (chronic diseases). Along with our colleague, Global Health Specialist Dr. Lucille Pilling, , I was honored to represent JSPH at this event in New York earlier this week.

The five major NCDs are those we are all familiar with in the U.S.: cardiovascular diseases (CVDs), cancers, chronic respiratory diseases (CRDs), diabetes, and mental illness. The major NCD risk factors include poor diet and physical inactivity, tobacco use, and excessive alcohol use.

Currently, more than 60% of all deaths worldwide stem from NCDs. It is estimated that 80% of all NCD deaths occur in low and middle-income nations, up sharply from just under, 40% just twenty years ago.

NCDs have been established as a clear threat not only to human health, but also to development and economic growth. Once considered “diseases of affluence”, NCD’s have now encroached on developing countries, most of whom have limited health, education, and economic infrastructure to address the changing demographics in their countries.

A global analysis of the economic impact of NCDs recently released by the World Economic Forum and the Harvard School of Public Health reported that cumulative economic losses to low and middle-income countries are estimated to surpass US $7 trillion over the fifteen year period of 2011-2025 (an average of $500 billion per year). This yearly loss is equivalent to approximately 4% of these countries’ current annual output. The negative health and economic impact will put a major strain on the budgets of every country around the globe, especially low and middle-income nations.

For these reasons, world leaders came together for this two-day meeting to ratify a series of policies and action steps to address the burden of NCDs. Highlights included presentations from UN Secretary General Ban Ki-moon, Dr. Margaret Chan, Director General of the World Health Organization, 19 “Heads of State,” and leaders from a range of public and private foundations. Throughout the conference, collaboration between the public and private sectors of society was emphasized as the only viable, sustainable platform to reduce the growing and potentially devastating burden of NCDs around the world.

The UN High Level Conference on NCDs was only the first step in a multiple decades-long endeavor to avert a global health and economic crisis. Each nation, multi-national and national public and private organizations, and global business leaders were asked to pledge their political and economic support (to the best of their ability) to this global health initiative. Hopefully, over the next decade and beyond, we will be able to look back at this seminal event and recognize the importance of population health being on the world stage at this place in time.

To learn more about the UN High Level Meeting on NCDs and the global health NCD initiatives, here are some websites regarding the event and actions taken:

Some just released resources on NCDs include:

“The Global Economic Burden of Non-communicable Diseases”, Harvard School of Public Health, World Economic Council, September, 2011

“Scaling Up Action Against Non-communicable Diseases: How Much Will It Cost”, World Health Organization, 2011

“From Burden to “Best Buys”: Reducing the Economic Impact of Non-communicable Disease in Low- and Middle-Income Countries”, World Health Organization, World Economic Forum, 2011

“NCDs: Time for Change”, Global Health, Issue 12, Fall, 2011, Global Health Council

“A Call to Action on Health Promotion Approaches to Non-Communicable Disease Prevention”, International Union for Health Promotion and Education”, September, 2011

Thursday, September 22, 2011

Labour and Conservative Party Conferences; Networking; Dementia and Imagination and Some Thoughts on SOLIDARITY/αλληλεγγύη

Over in the Red Corner; over in the Blue
Over the next few weeks, the North West will be hosting the Labour and Conservative Party conferences: in Liverpool and Manchester respectively.

So, what of it? These are days of knee-jerk politics, photo-opportunities and sound-bites. But, we’re also in the middle of a period of fundamental change which will see the NHS; Education; Culture and the Arts, and of course Public Sector reforms altered beyond recognition. Amidst this bleak landscape, we also see smart u-turns at the sight of public dissent. So when middle-England takes to the streets to demand continued access to forests and woods, they are offered compromise and salve. The NHS and public pensions are an altogether bigger beast, and whilst the looters who took to the streets this summer to stock up on their designer brands are accused of being vermin, those who oversold sub-prime mortgages and played the markets, remain invisible and very much, still in control. And those of us left competing for work and mortgaged up to the hilt with our keenly sold credit-cards and higher purchase lifestyles, are told we’ve been living beyond our means...a mainline drip-feed diet of temporal consumer caffeine.

Whilst we see an incredible expression of frustration and anger at political dominance and abuse across North Africa; neatly coined the Arab Spring, it seems this unrest is acceptable, because its happening under some outmoded dictatorship; somewhere hot and ‘other’. This sort of uprising in England’s Green and Promised Land would never happen, because we live in a democracy...and when we see Monsieurs Sarkosy and Cameron heroically shaking the hands of the free people of Libya; it reassures us, doesn’t it?
Anyway, we have these events; we have simmering civic unrest and we have our agenda for arts, health and well-being. Having some experience of pitching questions to MP’s, I wonder, what are the questions we would ask of the party leaders, if we had the opportunity? I’d very much like to hear your thoughts either online or emailed.

A starter might be around the widening inequalities gap and the potential of the arts bringing communities together: it could be around the broader social impact of the arts, perhaps as a vehicle for giving voice to potential (but apathetic) voters: what about non-pharmacological approaches to mental ill-health or dementia: it could be around social prescribing and social return on investment…or it might simply be about the value of the arts at the heart of 21st century life.

Go on…give it some thought and get back to me.

Networking evening
The next free event will take place here at MMU next Thursday 29th between 6 and 8. I’ll confirm details of the venue once I’ve had an indication if people will be attending or not and I’ll email this out next Tuesday only if you get in touch. I have no agenda for the evening and it will be free-and-easy and led by YOU.

Anyway, if you’re interested in sharing something and want to attend, please email me at
Dementia and Imagination
This is an exciting and growing field, and following ongoing work in Derbyshire, I am working with colleagues across the UK to develop a very exciting research programme around the impact of the arts on the sentience of people living with dementia and the communities they live in. More of that soon.

Time Slips
For now, I’d like to make an unashamed plug for the work of Dr Anne Basting from the University of Wisconsin, who I’d suggest, is delivering some of the finest work around the areas of healthy aging and dementia. Her new website Time Slips, comes on line this weekend and along with the other free resources she has made available, this must be some of the most groundbreaking work out there. The three links below are inspiring and quite unique:

From our own Correspondent
A big thanks to Anne too for her support of Arts for Health intern Claire Ford who has been awarded a Churchill Fellowship to learn more about arts based dementia activity in Milwauke and Washington and to Carrie McGee at MoMA. You can find out about Claire’s ongoing work at her blog:

Word of the Week


Solidarity is the integration, and degree and type of integration, shown by a society or group with people and their neighbors. It refers to the ties in a society - social relations - that bind people to one another. The term is generally employed in sociology and the other social sciences. What forms the basis of solidarity varies between societies. In simple societies it may be mainly based around kinship and shared values.

International solidarity is ''not an act of charity but an act of unity between allies fighting on different terrains toward the same objectives.''
- Samora Machel

''Unlike solidarity, which is horizontal and takes place between equals, charity is top-down, humiliating those who receive it and never challenging the implicit power relations.'' - Eduardo Galeano

''Solidarity is not a matter of altruism. Solidarity comes from the inability to tolerate the affront to our own integrity of passive or active collaboration in the oppression of others, and from the deep recognition of our most expansive self-interest. From the recognition that, like it or not, our liberation is bound up with that of every other being on the planet, and that politically, spiritually, in our heart of hearts we know anything else is unaffordable.''
- Aurora Levins Morales

''Solidarity does not assume that our struggles are the same struggles, or that our pain is the same pain, or that our hope is for the same future. Solidarity involves commitment, and work, as well as the recognition that even if we do not have the same feelings, or the same lives, or the same bodies, we do live on common ground.'' - Sarah Ahmed

Monday, September 19, 2011

Being glucose intolerant may make you live only to be 96, if you would otherwise live to be 100

This comes also from the widely cited Brunner and colleagues study, published in Diabetes Care in 2006. They defined a person as glucose intolerant if he or she had a blood glucose level of 5.3-11 mmol/l after a 2-h post–50-g oral glucose tolerance test. For those using the other measurement system, like us here in the USA, that is a blood glucose level of approximately 95-198 mg/dl.

Quite a range, eh!? This covers the high end of normoglycemia, as well as pre- to full-blown type 2 diabetes.

In this investigation, called the Whitehall Study, 18,403 nonindustrial London-based male civil servants aged 40 to 64 years were examined between September 1967 and January 1970. These folks were then followed for over 30 years, based on the National Health Service Central Registry; essentially to find out whether they had died, and of what. During this period, there were 11,426 deaths from all causes; with 5,497 due to cardiovascular disease (48.1%) and 3,240 due to cancer (28.4%).

The graph below shows the age-adjusted survival rates against time after diagnosis. Presumably the N values refer to the individuals in the glucose intolerant (GI) and type 2 diabetic (T2DM) groups that were alive at the end of the monitoring period. This does not apply to the normoglycemic N value; this value seems to refer to the number of normoglycemic folks alive after the divergence point (5-10 years from diagnosis).

Note by the authors: “Survival by baseline glucose tolerance status diverged after 5-10 years of follow-up. Median survival differed by 4 years between the normoglycemic and glucose intolerant groups and was 10 years less in the diabetic compared with the glucose intolerant group.”

That is, it took between 5 and 10 years of high blood glucose levels for any effect on mortality to be noticed. One would expect at least some of the diagnosed folks to have done something about their blood glucose levels; a confounder that was not properly controlled for in this study, as far as I can tell. The glucose intolerant folks ended up living 4 years less than the normoglycemics, and 10 years more than the diabetics.

One implication of this article is that perhaps you should not worry too much if you experience a temporary increase in blood glucose levels due to compensatory adaptation to healthy changes in diet and lifestyle, such as elevated growth hormone levels. It seems unlikely that such temporary increase in blood glucose levels, even if lasting as much as 1 year, will lead to permanent damage to cells involved in glucose metabolism like the beta cells in the pancreas.

Another implication is that being diagnosed as pre-diabetic or diabetic is not a death sentence, as some people seem to take such diagnoses at first. Many of the folks in this study who decided to do something about their health following an adverse diagnosis probably followed the traditional advice for the treatment of pre-diabetes and diabetes, which likely made their health worse. (See Jeff O’Connell’s book Sugar Nation for a detailed discussion of what that advice entails.) And still, not everyone progressed from pre-diabetes to full-blow diabetes. Probably fewer refined foods available helped, but this does not fully explain the lack of progression to full-blow diabetes.

It is important to note that this study was conducted in the late 1960s. Biosynthetic insulin was developed in the 1970s using recombinant DNA techniques, and was thus largely unavailable to the participants of this study. Other treatment options were also largely unavailable. Arguably the most influential book on low carbohydrate dieting, by Dr. Atkins, was published in the early 1970s. The targeted use of low carbohydrate dieting for blood glucose control in diabetics was not widely promoted until the 1980s, and even today it is not adopted by mainstream diabetes doctors. To this I should add that, at least anecdotally and from living in an area where diabetes is an epidemic (South Texas), those people who carefully control their blood sugars after type 2 diabetes diagnoses, in many cases with the help of drugs, seem to see marked and sustained health improvements.

Finally, an interesting implication of this study is that glucose intolerance, as defined in the article, would probably not do much to change an outside observer’s perception of a long-living population. That is, if you take a population whose individuals are predisposed to live long lives, with many naturally becoming centenarians, they will likely still be living long lives even if glucose intolerance is rampant. Without carefully conducted glucose tolerance tests, an outside observer may conclude that a damaging diet is actually healthy by still finding many long-living individuals in a population consuming that diet.

Sunday, September 18, 2011


As the School of Population Health officially starts its second full academic year I want to take a moment to thank our entire team---the faculty and staff who make it possible for us to bring first-rate "in person and online content" to so many students around the nation. Right now we have more than 310 students taking at least one 3-credit course with us, either in person or online, across our 5 degree programs. It is thrilling for me to report these numbers to you!

On another note, I have been "back on the road again" preaching the gospel, if you would, of health reform through improvement, leadership, waste reduction, and care coordination. Everything that our school stands for and teaches. My message has been very well received...

This past week I was in Colorado Springs for the Fall meeting of the Governance Institute--I have served on their faculty for nearly 20 years and now I generally headline the opening day event. I spoke to almost 300 leaders from hospitals across the nation about the role of good governance in promoting quality and safety. The next day, I led the AHA Center for Governance Meeting in Boston, MA. I reiterated my message to this group and then led 2 workshops where we dug into the details about the structure and function of a good Board Committee on Quality.

Later in the week I attended the National Quality Forum Annual Awards Dinner and meeting in Washington, DC, and was in attendance when Norton Healthcare won the 2011 Annual Award. I am especially proud of Norton as they are partners with Humana in a successful Accountable Care Organization model in Louisville, KY. More on that another time.

I capped off the week with the closing plenary for the South Carolina Hospital Association at their meeting in Hilton Head Island. Here, I emphasized the need for care coordination and the creation of a physician leadership class. I also had the wonderful experience of signing scores of copies of my latest book, Demand Better.

Finally, I am especially proud of my ongoing affiliation with the Main Line Health System in suburban Philadelphia where I chair the Board Committee on Quality. In case you missed it, MLH was named by the Joint Commission as one of the very top systems in the entire country. Kudos should go to the leaders of MLH including Jack Lynch, Don Arthur, and Denise Murphy.

What are you doing to be a part of the solution for health care? DAVID NASH

Friday, September 16, 2011

More on Placebos for Art; the 'Love Arts Festival'; m a n i f e s t o and Enabling: Inclusive Arts Practice, for Public Health and Well-Being

Enabling: Inclusive Arts Practice, for Public Health and Well-Being
11th October, Bolton Central Museum
Bolton Council Arts Development Service invite you to an event to promote inclusive arts practice for public health and wellbeing and to inform your future decision-making and development in this growing area of work.

In the current changing economic climate, with a move to the big society, localism bill, shared services, personalisation and opening up of services for commissioning opportunities, there is a need to equip organisations in the third sector, arts and creative industries with the knowledge needed to ensure they are able to keep up and exploit new opportunities to their fullest. The day will cover inclusive arts practice, how to be tender ready and win contracts in health and social care and how to navigate the emerging health commissioning process. Details and booking:

Placebos for Art...
The Behring Institute for Medical Research has been collecting placebos for Art.

Midway through the course of this project, a special monitoring committee will examine the research for any significant discrepancies. In this type of research, the differences between the control group and the study group become visible only after post-study analysis. All participating patients must give their consent prior to participation; the study will comply with Dutch legislation for academic medical research on human beings and will be carried out according to the applicable international guidelines.

The Behring Institute has published the preliminary results of the Call for Placebos for Art in early 2011. This consists of a first attempt at grouping, categorizing, and defining the pieces, projects, paintings, pills, and installations.

Download the report by clicking on the image above...and make of it, what you will.
“Theatre and other art forms are a fantastic way to explore our complex responses to mental health issues and to encourage people to talk more openly. That’s why I’m supporting the Love Arts festival in Leeds”
Stephen Fry
Love Arts Festival in Leeds
27th September to the 16th November
Bring the arts and mental health together
With Ruby Wax, Phil Hammond, Jon Ronson, Arthur Smith and so much more.

But nearer to home, the  m a n i f e s t o  part one, nears completion...

A lovely piece of music for the weekend

Thursday, September 15, 2011

Guest Commentary: RECs – Help for Ambulatory Care Physicians in Implementing EHRs

Richard Jacoby, MD
Clinical Associate Professor
Jefferson School of Population Health

Over the past year, states across the country have developed Regional Extension Centers (RECs) to support the electronic health record (EHR) initiative passed as part of the American Recovery and Reinvestment Act (ARRA) of 2009. Why is this important? With benefit of a little background information, the answer is pretty clear.

The evidence suggests -- and it is generally believed -- that adoption of EHRs by physicians and other health care providers is a critical first step in enhancing the quality and value of health care delivered in the U. S. However, adoption of electronic health records by physicians has been painfully slow in this country. How many of you still have to fill out a paper form when you visit your doctor?

The Health Information Technology for Economic and Clinical Health (HITECH) Act was included as part of ARRA to provide incentives for physicians and other health care providers to adopt and use EHRs in a meaningful way. By meeting HITECH criteria for “meaningful use”, physicians and other providers can qualify for up to $44,000 from Medicare and/or $63,750 from Medicaid to offset their EHR purchase costs. However, there is a stick to go along with the carrot. Beginning in 2015, CMS will impose financial penalties on providers who do not engage in meaningful use of health information technology.

But adopting and utilizing a new technology can be a daunting task – especially when the technology is implemented in the context of health care provider practices. Recognizing this, the HITECH act established and partially funded RECs to act as consultants – i.e. to support priority primary care providers and certain critical access hospitals in making choices, adopting, and “meaningfully using” EHRs.

RECs assist providers in evaluating the available EHR systems offered by different vendors and selecting one that meets the needs and budget of the practice. Next comes the really hard part – providers must re-engineer the way care is delivered in the practice to coincide with the new technology! It requires a detailed analysis of the practice workflow pre-and post-EHR implementation -- i.e., understanding what each employee currently does, and what that employee will do post-implementation, from the moment a patient enters the office until the time he/she leaves.

Once the practice is up and running with the new technology in place, challenges remain. Providers must understand and comply with specific rules in order for the practice to qualify for incentive payments. If all goes as planned, RECs may play an important role in helping with the transition from paper-based to electronic systems.

The Jefferson School of Population Health is providing services to physicians as part of the REC effort in Pennsylvania. For more information, contact Richard Jacoby, M.D. at

Wednesday, September 14, 2011

Tuesday, September 13, 2011

Heat Training: The "Benefits"

{Stretched texture shot}
heat training /hēt ˈtrāniNG/  Noun
the loosening of one's natural curl pattern through the regular application of high heat.  This process is usually gradual and subtle. (Loo's definition.)

Heat training is essentially a form of heat damage, which is why I have been so against the technique for some years.  However, my thoughts have changed recently since seeing a class of "healthy" heat-trained naturals arise.  Here is one of these naturals sharing her views: Longhairdontcare2011.

"Healthy heat-trained hair" may seem like an oxymoron but I can argue the same with "healthy hair".  Our strands face damage on a regular basis through sun exposure, styling, washing, detangling, and other forms of wear and tear.  So where do we drawn the line between what is healthy hair and what is not?  I think it reasonable to draw it between hair that is strong and supple (healthy) and that which is breaking and brittle (unhealthy). To me, hair that retains a reasonable level of strength and suppleness is hair that is healthy.  That being said, there is such a thing as heat-trained hair that is strong, supple, ... and thus healthy.  However, this is only true for some ladies.  Keep in mind that heat training can work well for some naturals and not so well for others.  For the former group I answer the following question ...


1. Easier Detangling ...
comes with a loosening of the curl pattern. For some naturals, the mass of curls/coils/kinks makes detangling a very tedious task. Generally, I’d say, “suck it up”, but as my hair has gotten longer, I can truly understand how brutal such a task can be for some naturals.  It can be brutal to the point of mechanical damage (e.g., breakage from impatient combing sessions).

2. Fewer SSKs ...
will form if the hair is heat trained.  What is a single-strand knot (SSK)?  It is essentially a knot formed from a strand of hair that has wrapped around itself.  What is a conducive environment for SSKs?  A mass of coils and kinks.  SSKs translate into more trims and sometimes breakage.  Heat training or other hair care steps (read here) can mitigate this issue.

3. Length Retention ...
comes with easier detangling and fewer SSKs.  "Proper" heat training can theoretically help some naturals achieve longer lengths.  Will I ever heat train for length retention?  In all honesty, I do not know yet.

4. Increased Versatility ...
is another benefit of heat training.  It becomes easier to achieve stretched or straight styles when desired.  Additionally, these styles will last longer.

Four Funding Opportunities; Theatre Submissions: Ai Weiwei in Salford and Startling Health Statistics from the USA

Heart Research UK Healthy Heart Grants
Heart Research UK Healthy Heart Grants support innovative projects designed to promote heart health and to prevent or reduce the risks of heart disease in specific groups or communities. Grants of up to £10,000 are available to community groups, voluntary organisations and researchers who are spreading the healthy heart message.

Winston Churchill Memorial Trust
The Trust provides funding for British citizens to travel anywhere in the world for between four and eight weeks, with the aim of gaining knowledge and experience that will enhance effectiveness at work and contribution to the community. Travel Fellowships are to enable men and women from all walks of life to acquire knowledge and experience abroad. In the process, they gain a better understanding of the lives and different cultures of people overseas and, on their return, their effectiveness at work and their contribution to the community is enhanced greatly. For more information visit:

First Light Movies
First Light Movies, which provides grants to projects that enable young people to participate in all aspects of film production, has announced that its Young Film Fund has re-opened for applications. Since launching in 2001, First Light Movies have enabled over 40,000 young filmmakers to write, act, shoot, light, direct and produce over 1000 films and media projects. The funding is available to organisations such as; schools; youth services; community and voluntary groups that work with young people aged between 5 and 18.
The closing date for applications is 2pm on the 12th October2011. For more information visit:

Graphic Thought Facility
The Wellcome Trust Arts Awards
The Wellcome Trust is inviting organisations and individuals to apply for funding through its Arts Awards. The Arts Awards support projects that engage the public with biomedical science through the arts including dance, drama, performance arts, visual arts, music, film, craft, photography, creative writing or digital media. Applications are invited for projects of up to £30,000 through their small & medium-sized grant programme. The aim of the awards is to support arts projects that reach new audiences which may not traditionally be interested in science and provide new ways of thinking about the social, cultural and ethical issues around contemporary science. The next application deadline for small & medium sized projects is the 28th October 2011. For more information visit:

Laced Banana
Laced Banana are accepting submissions for a new regular night dedicated to your NUTS*. Within the theme of mental health you have the chance to have your own writing performed on November 3rd at the Lass O’ Gowrie.
More information including guidelines and topics can be found on our website *New Undiscovered Theatre Shorts

Ai Weiwei in Salford
If you're easily offended, look away now and thanks to CsI for this photo.

Startling Facts from the USA
...and finally thanks to Cheryl G for this link to another creative commons gem

Click on the image to go to the amazing (and disturbing) website...

Monday, September 12, 2011

Guest Commentary: Revisiting Managed Care – 10 Years On

David Woods, PhD, FCPP
CEO, Health Care Media International
Adjunct Faculty, Jefferson College of Graduate Studies

More than decade ago I wrote a book for the Economist Intelligence Unit, The Future of the Managed Care Industry and its International Implications.

What's changed about managed care in 10 years? Well, certainly not public perception. In fact, in a poll at that time a solid majority of respondents believed that the quality of medical care would be harmed rather than improved by the trend toward more managed care.

Yet, despite subsequent studies showing that quality of care has not been demonstrably compromised under managed care, it is hard to find many friends of the system. The media cite horror stories about denial of care; and TV series featured doctors trying to do good despite managed care’s strictures.

Today, more than 80% of Americans insured by their employers are in some sort of managed care plan -- as are the overwhelming majority of doctors.

Alain Enthoven, PhD, a professor at Stanford University and a leading authority on healthcare systems and policy, defines managed care as a strategy used by purchasers of healthcare. Four essential principles of managed care are: selective provider contracting; utilization management; negotiated payment; and quality management.

The principal objection of patients to managed care was the prospect of being thrown out of the hospital within hours of major surgery. They also disliked the necessity of having to go through gatekeepers, typically primary care doctors, before being allowed to see a specialist.

One thing I certainly got wrong in the book was my contention that if managed care has achieved anything, it has slowed the breakneck speed at which US healthcare costs were growing. In fact, those costs have now reached a stratospheric $2.3 trillion a year.

So, according to the premise of my book’s title, I asked the question: What is the future for managed care? I answered it by saying that managed care will not only survive but thrive in the US. I also suggested that managed care would need to get away from the perception that its main function is to restrict care, but rather to supply a service to members that should include such care as is needed.

Managed care plans are seeking to rebuild damaged relationships with providers... and they're looking to shift more responsibility for payment on to users. As they move into less restrictive products they lose their ability to control costs, a fact that is likely to contribute to further premium increases, which in turn could put additional pressure on public programs.

In a recent interview, Dr Alain Enthoven told me that despite deficiencies in managed care that tend to favor fee-for-service delivery, Kaiser Permanente has prospered, he says, mainly because it has rolled out an electronic health record that has led to a cultural change both for patients and for physicians. What has impeded managed care’s progress, he says, is that employers continue to offer fee-for-service care and many have still not even tried managed care. And while managed care companies have made steady progress, employers still don't provide employees with incentives to choose economical healthcare.

Despite changes in managed care over the years, some of the original ambitious goals have not been achieved, including cost containment and universality. Some of the challenges of managed care might be obviated by passage of the Affordable Care Act. Unless the Act is significantly diluted it is perhaps the most significant change in healthcare delivery over the past decade. Gone will be denial of care for pre-existing conditions; and, for any type of insurance to work, the requirement that there be 100% enrollment is central.

Fasting blood glucose of 83 mg/dl and heart disease: Fact and fiction

If you are interested in the connection between blood glucose control and heart disease, you have probably done your homework. This is a scary connection, and sometimes the information on the Internetz make people even more scared. You have probably seen something to this effect mentioned:
Heart disease risk increases in a linear fashion as fasting blood glucose rises beyond 83 mg/dl.
In fact, I have seen this many times, including on some very respectable blogs. I suspect it started with one blogger, and then got repeated over and over again by others; sometimes things become “true” through repetition. Frequently the reference cited is a study by Brunner and colleagues, published in Diabetes Care in 2006. I doubt very much the bloggers in question actually read this article. Sometimes a study by Coutinho and colleagues is also cited, but this latter study is actually a meta-analysis.

So I decided to take a look at the Brunner and colleagues study. It covers, among other things, the relationship between cardiovascular disease (they use the acronym CHD for this), and 2-hour blood glucose levels after a 50-g oral glucose tolerance test (OGTT). They tested thousands of men at one point in time, and then followed them for over 30 years, which is really impressive. The graph below shows the relationship between CHD and blood glucose in mmol/l. Here is a calculator to convert the values to mg/dl.

The authors note in the limitations section that: “Fasting glucose was not measured.” So these results have nothing to do with fasting glucose, as we are led to believe when we see this study cited on the web. Also, on the abstract, the authors say that there is “no evidence of nonlinearity”, but in the results section they say that the data provides “evidence of a nonlinear relationship”. The relationship sure looks nonlinear to me. I tried to approximate it manually below.

Note that CHD mortality really goes up more clearly after a glucose level of 5.5 mmol/l (100 mg/dl). But it also varies significantly more widely after that level; the magnitudes of the error bars reflect that. Also, you can see that at around 6.7 mmol/l (121 mg/dl), CHD mortality is on average about the same as at 5.5 mmol/l (100 mg/dl) and 3.5 mmol/l (63 mg/dl). This last level suggests an abnormally high insulin response, bringing blood glucose levels down too much at the 2-hour mark – i.e., reactive hypoglycemia, which the study completely ignores.

These findings are consistent with the somewhat chaotic nature of blood glucose variations in normoglycemic individuals, and also with evidence suggesting that average blood glucose levels go up with age in a J-curve fashion even in long-lived individuals.

We also know that traits vary along a bell curve for any population of individuals. Research results are often reported as averages, but the average individual does not exist. The average individual is an abstraction, and you are not it. Glucose metabolism is a complex trait, which is influenced by many factors. This is why there is so much variation in mortality for different glucose levels, as indicated by the magnitudes of the error bars.

In any event, these findings are clearly inconsistent with the statement that "heart disease risk increases in a linear fashion as fasting blood glucose rises beyond 83 mg/dl". The authors even state early in the article that another study based on the same dataset, to which theirs was a follow-up, suggested that:
…. [CHD was associated with levels above] a postload glucose of 5.3 mmol/l [95 mg/dl], but below this level the degree of glycemia was not associated with coronary risk.
Now, exaggerating the facts, to the point of creating fictitious results, may have a positive effect. It may scare people enough that they will actually check their blood glucose levels. Perhaps people will remove certain foods like doughnuts and jelly beans from their diets, or at least reduce their consumption dramatically. However, many people may find themselves with higher fasting blood glucose levels, even after removing those foods from their diets, as their bodies try to adapt to lower circulating insulin levels. Some may see higher levels for doing other things that are likely to improve their health in the long term. Others may see higher levels as they get older.

Many of the complications from diabetes, including heart disease, stem from poor glucose control. But it seems increasingly clear that blood glucose control does not have to be perfect to keep those complications at bay. For most people, blood glucose levels can be maintained within a certain range with the proper diet and lifestyle. You may be looking at a long life if you catch the problem early, even if your blood glucose is not always at 83 mg/dl (4.6 mmol/l). More on this on my next post.

Saturday, September 10, 2011

Gain and Retain Length on Afro-Textured Hair

Chicoro is someone I would describe as an afro-textured hair growth guru.  She shares a wealth of FREE information to subscribers of her website:  Check out the site, enter your email address, and get information sent to your inbox weekly.  I did! Enjoy!

Wednesday, September 7, 2011

...a few events on the horizon

Hello again and welcome back to a very damp autumn. Just a few advance notices of events on the horizon.

A one-day conference on
Spirituality and Psychosis
at Liverpool John Moores University on the 10th November 2011

This conference will focus on psychosis and its relationship to spirituality, altered states of consciousness and unusual experiences and how these can be used constructively to facilitate recovery in people given a mental health diagnosis. Contributors are experienced in clinical practice and research, neuroscience and spiritual practices. The day will thereby provide a groundbreaking combination of practical ideas, new psychological understanding, opportunities for experiential work and lively discussion. This conference will appeal to mental health professionals, services users, carers and anyone seeking greater understanding in this rapidly developing area.

Arts 4 Dementia - Best Practice Conference
Royal Albert Hall, 14 November 2011

The Arts 4 Dementia Best Practice Conference will outline the constructive value and discuss the most effective means to bring artistic stimulation to people living with dementia in the community, to enable them to live better and longer in their own homes.

2 interesting dementia-related pieces of work from Collective Encounters

Now and Then (2010)
Now and Then was an innovative project which explored the impact of dementia on carers. The project involved substantial research with people with dementia and their carers in Merseyside and resulted in our Third Age Theatre company producing a 40 minute interactive theatre piece which was performed to health care professionals, health and social care students, at PSS’s Carers Convention and at the National Pensioners Parliament. The piece raised awareness of the challenging situation facing family carers and highlighted significant problems in relation to the health care profession.

Live and Learn (2011 – 2014)
Live and Learn was developed arising from those findings, and through wider research internationally into the impact and value of creative work with people with dementia. This is a three year project funded mostly through Baring Foundation.Live and Learn will bring together third age volunteers with professional artists and dementia specialists to develop new models of creative reminscence to engage people with dementia. Crucially, these models will be ones that can be used by carers in their daily routines. Working both in care homes and in the community we will test new ideas and draw on international best practice; providing creative interventions for people with dementia and on-the-job training for professional and family carers. The project will also involve some performance work, with our Third Age Theatre company producing theatre to highlight the issues and articulate the stories they encounter through the process. We will also have a series of stakeholder events at which we disseminate our findings, share our ideas and facilitated debate with the wider community. The first event will be held on 2nd November and will involve presentations by David Clegg (whose work Ancient Mysteries was recently heard on Radio 4) and Karen Hayes, a poet-in-residence in several care homes and consultant on Live and Learn. The event will also launch Live and Learn and involve discussion around arts and dementia with stakeholders from the health, arts and social care sectors. If you would like further information please email

And last, but not least:

Arts for Health at MMU
Greater Manchester Arts Health Network
An Un-Conference event
four separate sessions on 20th October 2011

Guest Speaker at the Un Conference Event, Dorothy Rowe

Monday, September 5, 2011

Nonlinearity and the industrial seed oils paradox

Most relationships among variables in nature are nonlinear, frequently taking the form of a J curve. The figure below illustrates this type of curve. In this illustration, the horizontal axis measures the amount of time an individual spends consuming a given dose (high) of a substance daily. The vertical axis measures a certain disease marker – e.g., a marker of systemic inflammation, such as levels of circulating tumor necrosis factor (TNF). This is just one of many measurement schemes that may lead to a J curve.

J-curve relationships and variants such as U-curve and inverted J-curve relationships are ubiquitous, and may occur due to many reasons. For example, a J curve like the one above may be due to the substance being consumed having at least one health-promoting attribute, and at least one health-impairing attribute. The latter has a delayed effect, and ends up overcoming the benefits of the former over time. In this sense, there is no “sweet spot”. People are better off not consuming the substance at all. They should look for other sources of the health-promoting factors.

So what does this have to do with industrial seed oils, like safflower and corn oil?

If you take a look at the research literature on the effects of industrial seed oils, you’ll find something interesting and rather paradoxical. Several studies show benefits, whereas several others hint at serious problems. The problems seem to be generally related to long-term consumption, and to be associated with a significant increase in the ratio of dietary omega-6 to omega-3 fats; this increase appears to lead to systemic inflammation. The benefits seem to be generally related to short-term consumption.

But what leads to the left side of the J curve, the health-promoting effects of industrial seed oils, usually seen in short-term studies?

It is very likely vitamin E, which is considered, apparently correctly, to be one of the most powerful antioxidants in nature. Oxidative stress is strongly associated with systemic inflammation. Seed oils are by far the richest sources of vitamin E around, in the form of both γ-Tocopherol and α-Tocopherol. Other good sources, with much less gram-adjusted omega-6 content, are what we generally refer to as “nuts”. And, there are many, many substances other than vitamin E that have powerful antioxidant properties.

Chris Masterjohn has talked about seed oils and vitamin E before, making a similar point (see here, and here). I acknowledged this contribution by Chris before; for example, in my June 2011 interview with Jimmy Moore. In fact, Chris has gone further and also argued that the vitamin E requirement goes up as body fat omega-6 content increases over time (see comments under this post, in addition to the links provided above).

If this is correct, I would speculate that it may create a vicious feedback-loop cycle, as the increased vitamin E requirement may lead to increased hunger for foods rich in vitamin E. For someone already consuming a diet rich in seed oils, this may drive a subconscious compulsion to add more seed oils to dishes. Not good!