May 2010

Ahhhh! One of my favorite subjects: bottled water.

There was a new study out this week on bottled water and although it was conducted by a Canadian lab, on products found in Canadian stores, it raises fresh questions about whether there’s any real advantage for consumers who shun the tap for the “healthier” plasticized versions of H2O.

It was presented at a meeting of the American Society for Microbiology in San Diego by a Montreal company called Ccrest Laboratories, which specializes in pharmaceutical product testing.

They don’t normally test the quality of consumer products. But when a couple of their employees got sick, and blamed it on the bottled water they drank at work, the company decided to do some testing for bacteria in a variety of brands.

They found that 70 percent of the products contained high levels of heterotrophic bacteria. Government standards haven’t been set for this contaminant. But an non-governmental agency called United States Pharmacopeia (USP) recommends no more than 500 colony forming units (CFU) per milliliter.

The highest level found in a bottled water product in Canada was 80,000 CFU/ ML. Tap water, on the other hand, came in at about 170 CFU/ ML.

Researcher Sonish Azam commented: “Despite having the cleanest tap water a large number of urban Canadians are switching over to bottled water for their daily hydration requirements. Unsurprisingly, the consumer assumes that since bottled water carries a price tag, it is purer and safer than most tap water.”

He added: “Heterotrophic bacteria counts in some of the bottles were found to be in revolting figures of one hundred times more than the permitted limit.”

In the U.S., the Environmental Working Group (EWG), a private advocacy association, has been looking at bottled water for years. A spokeswoman told The Globe and Mail in Toronto that heterotrophic bacteria is not a threat to most people with healthy immune systems.

But she added: “What it tells us is that the system is not very good, that there may be leaks, that there may be some old bacteria in the walls. That’s something that we as public-health professionals need to worry about.”

The Canadian Bottled Water Association insists that bacteria is found naturally in many different products, including fresh fruit and vegetables. So, no reason for alarm, they say.

Consumers, apparently, tend to agree. The International Bottled Water Association reports that consumption of bottled water has held steady throughout the recession. The product commanded 29.2 percent of the “liquid refreshment” market in 2009, actually slightly up from the prior year.

An interesting related note: The recent report by the President’s Cancer Panel addressed water consumption.

It concluded: “Filtering home tap or well water can decrease exposure to numerous known or suspected carcinogens and endocrine-disrupting chemicals. Unless the home water source is known to be contaminated, it is preferable to use filtered tap water instead of commercially bottled water.”

Some refreshing advice.


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We keep hearing that health care dollars will be saved by expanding insurance coverage, so that uninsured who get sick aren’t overcrowding our hospital emergency rooms. But a new study by the Centers for Disease Control shows that the uninsured aren’t the main culprits when it comes to overuse of the ER.

In addition, use of emergency rooms by patients seeking treatment for scrapes and sniffles is a myth, according to the report, Emergency Department Visitors and Visits: Who Used the Emergency Room in 2007?

Groups most likely to have had at least one emergency room visit in a year include adults over 75; the poor; African Americans; and people covered under Medicaid.

“Uninsured persons are not more likely than others to access the [emergency room] for non-urgent visits,” the CDC said.

As Reuters reports: “The survey contradicts a common perception that emergency rooms are packed with uninsured people and illegal immigrants. It also rejects some claims that people are using the emergency department for routine care – just 10 percent of visits were for non-urgent causes.”

Even Tne New York Times has reflected these images of emergency room use. A December 2008 correctly stated that ER volume is steadily increasing. But it added: “Helping push up that volume have been the growing ranks of the uninsured, because emergency rooms are legally obliged to see all patients who enter their doors, regardless of their ability to pay.”

But the Times echoed the CDC when it added that ER use was rising rapidly even among insured patients who have no regular physician. Older Americans, it said, represent the fastest-growing segment of the ER population.

The 2009 National Report Card on the State of Emergency Medicine – prepared by a task force of academic physicians – gave overall emergency care a grade of D- in the U.S.

The report noted: “…factors leading to an increased demand for emergency services include the rising numbers of individuals who cannot afford medical care or have nowhere else to go.

“While it is commonly thought that this primarily applies to the underinsured and uninsured, the emergency department has also become a health care safety net for individuals who have insurance, but are unable to obtain appointments with primary care physicians or medical specialists in a timely manner. This includes individuals who have health care coverage through Medicaid or Medicare, but cannot find physicians willing to accept their coverage.”

The heart of the ER problem, then, is not lack of coverage but lack of access. And with an aging population and an ongoing shortage of primary care physicians – things won’t improve any time soon. It’s hard to see how the new health care reform law will correct the problem.

The reasonable answer is to expand access to primary care. Although there has been a recent uptick in physicians entering primary care practice, we need to go a step beyond that and create more opportunities for masters-level practitioners. That means allowing physicians assistants and advanced nurse practitioners to have basic, primary care private practices – with MD oversight.

Encourage supply to meet the demand.


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The pill turns 50, and Raquel Welch comes out of the Tinseltown woodwork to give it a Bronx cheer.

Well, fair enough. There’s little doubt that the birth control pill was a culture changer and a trigger for the sexual revolution. It’s almost hard to fathom what sexual attitudes were a mere half-century ago compared to the way people view sex today.

Topics that would have only been whispered about in 1960 – in the corner at a cocktail party, after the third round of martinis – are now fodder for prime time TV shows. Imagine the plot lines of the popular Two and A Half Men unfolding as the family gathered around their black and white Zenith during the days when Kennedy was campaigning for president.

Sure, the subject of birth control is still sensitive, even controversial in some ways. But to the Western culture at large, and the media that caters to its entertainment whims, the arguments of opponents and skeptics seem quaint.

So now along comes Ms. Welch, 69, who did her part to stir the sexual revolution and had three failed marriages. You may not think of her as a likely candidate to come out swinging against what she called in an interview “a sea change in moral values.”

Naturally, she’s entitled to her opinion but what she forgets is that almost every invention, or social innovation, has had both good and bad consequences.

Some medical breakthroughs are viewed as purely positive. Antibiotics, for example, or the polio vaccine. But even vaccinations are controversial in some quarters.

Nothing changed society more than the automobile. Yet you could argue that the new mobility led to the kind of sterile suburban sprawl that now soddens the American landscape. Tens of thousands are killed every year in auto accidents. And don’t forget that the car played a part in the sexual revolution, too.

Nuclear weapons ended the biggest and deadliest war of the century, but since then we’ve been obsessed with the idea of them falling into the hands of terrorists or rogue regimes.

Cell phones, computers, the Internet, online social networking – all of them big pluses with their power to interconnect humanity. And still in many ways, people are more isolated than ever.

However, none of these genies will ever be put back into the lamp. It may be helpful to Raquel Welch to stroll down memory lane and remember the good old days but unfortunately her insight won’t bring back the simpler times of the 1950s.

No. It’s straight ahead, mates, and keep your eyes peeled for what happens next.


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Assessing food choices at the supermarket by reading labels is difficult and time consuming. So methods are springing up to alert people with simple checkmarks or numbers.

One of them, the Smart Choices program, has already been scrapped. It was suspended last fall when the FDA said it was in the process of developing uniform labeling on food products. The Smart Choices stamp of approval had been given to such items as Froot Loops and the frozen treat, Fudgsicles.

Smart Choices was sponsored by 14 different companies, including Kraft and Kellogg’s, so it was a bit like the fox guarding the chicken coop.

Other efforts have sprouted up around the country. A color-coded rating system called Nutrition iQ was lauched at Chicago-area Jewel-Osco stores last fall.

Now gaining currency is a system called NuVal, which rates food items on a scale of 1 to 100 – 1 being the most unhealthy and 100 being the most nutrient-packed. The rating, unlike Smart Choices, is not on the package but on the shelf.

It was developed by Dr. David Katz, director of the Yale Prevention Research Center. The apparent advantage to NuVal is that it is the creation of independent researchers who are not funded by corporate America.

However, NuVal does license its system to a growing number of supermarkets and it’s unclear exactly how the financial arrangements work. Still, NuVal seems to be taking hold.

One reason is that the system can be used in marketing. Kroger began testing NuVal in 23 Kentucky stores this month, according to the Lexington Herald-Leader. That’s just one prong of the Kroger initiative; another is bringing in registered dieticians to answer consumer questions during scheduled “tours” of the markets.

As a capper, Kroger is offering the “LC600 Health Station,” which allows customers to measure their weight, blood pressure, blood oxygen levels and other vitals. They can create an online account that allows them to track their progress.

If you’re having trouble knocking your body into shape, Kroger is there to lend a helping hand.

Eventually, the company intends to expand the concept to all 2,400 stores. Why are company officials doing this?

Yes I know. Corporations like to be good citizens, too, but there is another angle. BNET Food, which reports on food industry trends for managers and execs, says: “In today’s hyper competitive grocery market, Kroger’s move boils down to one word — Walmart (WMT).

“By adopting NuVal as part of its new Health Matters program … Kroger is hoping to distinguish itself from Walmart, which has been gobbling up grocery market share in recent years.”

Another plus is that NuVal is not opposed to processed foods per se. Sure, fresh blueberries earn a rating of 100 and Salerno Original Butter Flavored Cookies get a 1.

But some ice creams score in the 90s. In a Q&A section, NuVal explains: “Non-fat or low-fat ice creams that score highly tend to be made with skim milk and have added fiber. The fiber is added to replace texture that is lost when fat is removed. It’s important to remember that since ice cream is made from milk, it has nutrients you get from milk, which boosts its nutrition.”

When NuVal was introduced two years ago, an upset blogger at The UK Guardian wrote: “What’s wrong with NuVal? It gives its highest meat score, 48, to turkey breast while leg of lamb gets only 28. This rating is doubtless based on the current orthodoxy that fat and cholesterol are dietary antichrists. But there is little evidence to support this and much to challenge it.

“The Women’s Health Initiative trial, for instance, found that after eight years of low-fat eating, women were no better off in terms of cardiovascular disease or cancer risk, and not significantly lighter than their higher fat-eating counterparts.”

My view has always been: Prepare most of your meals from scratch. A good rule of thumb I’ve heard and liked: Would your grandmother have cooked and served this food?

It looks like nutritional ratings systems are here to stay and that’s fine. But I hope consumers will only add them to the mix when considering a purchase, along with a big helping of common sense.

Photo: Turkey breast earns a high rating – for meat – under the NuVal system. Via

On assignment in South Florida, I interviewed a teacher who said some of her students were fascinated by “negative figures” of the past.

“Like Hitler?” I asked.

Yes, sometimes Hitler, but more often serial killers, she said. The ever-popular Charles Manson, for example.

But kids aren’t the only ones intrigued by evil. Washington, DC is a city of museums and monuments, including one called The National Museum of Crime & Punishment. Its slogan is: “So much fun – it’s a crime!”

The museum recently made headlines when Ted Bundy’s VW bug went on display. It was unveiled at a ceremony in February. A tarp as removed with a flourish to reveal a tan beetle with some rust spots, but otherwise in decent shape. Wyndell Watkins Sr., a retired D.C. police deputy chief who was on hand for the event, said: “This was kind of like a death wagon.”

There is an exhibit featuring John Wayne Gacy’s artist tool box – the executed child killer was a clown and painter – along with other “murderabilia.”

There’s a gift shop, of course, called The Cop Shop. One of the items, which you can also purchase online, is a $12 T-shirt for infants that says: “I just spent nine months in solitary!”

To the south, the FBI has been assembling another museum strictly dedicated to serial killers, although it is not open to the public. It’s for research purposes and has been labeled, “The Evil Minds Research Museum.”

Among other things, it contains Gacy’s actual collection of paintings. Behavioral scientists working for the FBI are studying them to find out what made the guy tick, perhaps giving them insights on how to track down future killers – and prevent more deaths.

At the FBI’s Behavioral Science Unit in Quantico (think: Special Agent Starling in Silence of the Lambs), unit chief and supervisory special agent Greg Vecchi was interviewed for a webcast.

Speaking of Gacy, he said: “He would draw pictures or paint pictures of clowns, and he had clown paintings in the room where he dismembered the bodies. And he had clown paintings that he did after he got arrested and when he was basically on death row.

“And so we got those paintings and we are studying those paintings. We want to look at the brush strokes. We want to look at what drives him, what changes, because the pictures are completely different. Before he was arrested, for instance, the clowns were Flippo the Clown, very happy clowns, very colorful; afterwards his paintings were very dark. It was basically a skeleton or a skull dressed up or painted up to be a clown.”

The stated goal of the Crime & Punishment Museum is not research, but to remind visitors that there are some pretty dangerous people out there and you’d better watch your P’s and Q’s. When you see Bundy’s car, for example, you should understand what a terrible idea hitchhiking can be.

But kids, teenagers and adults aren’t drawn to these kinds of exhibits because they want to learn, although they might be useful for that purpose. They come to be creeped out. It’s the same reason people go to see a horror movie. A chill up the spine, hairs raised on the back of your neck.

It’s somehow psychologically satisfying to view danger – as long as it’s from a safe distance.

Photo: Bundy’s VW bug:

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Everybody knows about the war on cancer. Last week, we had a glimpse of the war within the war.

On one side are those who believe environmental risks have been underestimated; on the other are those who insist the focus should be on lifestyle factors. The former position was detailed last week in a 240-page report by “The President’s Cancer Panel,” a document that was two years in the making and was authored by appointees from both presidents Bush and Obama.

The conclusions were taken to task by the American Cancer Society, which issued a statement the next day, saying that the presidential report was not backed up by facts and jumped to unwarranted conclusions.

The presidential panel argued that a number of environmental carcinogenic concerns have not been adequately addressed over the years. They include toxic substances in tap water, plastic containers, agricultural produce exposed to pesticides and chemical fertilizers, animals raised on antibiotics and hormones, and air pollution.

The American Cancer Society responded: “There is no doubt that environmental pollution is critically important to the health of humans and the planet. However, it would be unfortunate if the effect of this report were to trivialize the importance of other modifiable risk factors that, at present, offer the greatest opportunity in preventing cancer.”

It also said that “the perspective of the report is unbalanced by its implication that pollution is the major cause of cancer, and by its dismissal of cancer prevention efforts aimed at the major known causes of cancer (tobacco, obesity, alcohol, infections, hormones, sunlight) ….”

But the panel stood by the report, its chairman, LaSalle Leffall Jr., told The New York Times. “This is an evenhanded approach, and an evenhanded report,” said Leffall, of Howard University. “We didn’t make statements that should not be made.”

I suggest reading the panel’s summary and conclusions, then judging for yourself whether it dismisses lifestyle contributions to cancer development.

In my view, the panel builds a strong case – albeit circumstantial – that chemicals in our food, water and air probably do contribute to cancer more than 6 percent (34,000 cases per year), which is the position of the American Cancer Society. What the panel seems to be doing is calling for more research to sort it out.

There’s no doubt that if we could wipe out tobacco use cancer rates would plummet. The American Cancer Society says that would eliminate 30 percent of cancer cases. It also blames obesity and lack of exercise.

But Americans who smoke understand this, and smoke anyway. The reasons for pursuing destructive behavior are more psychological – there’s no lack of education on this issue. The same goes for obesity and diet. The media has been on-message for decades when it comes to tobacco. The risks of being overweight, in terms of both cancer and heart disease, are detailed in the press daily.

On the other hand, environmental hazards do seem to have been downplayed. The risks of using certain kinds of plastics in food storage, for example, have been publicized but not nearly enough. When is the last time you saw an analysis of the chemicals involved in food production?

Keep the pressure up on lifestyle factors, to be sure. But leave open the possibility that environmental issues may be responsible for many more cases of cancer than we previously believed. There must be plenty of researchers out there eager to tackle the question. Hopefully this report will free up some grant money so they can contribute the hard data we need.

Graphic: President’s Cancer Panel report cover (U.S. Department of Health and Human Services/ National Institutes of Health)

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It’s a sure bet that the Gulf oil spill will raise a lot of long-term health issues. New reports out this week warn of headaches, sinus trouble and asthma attacks. Seafood will be at risk if contaminants get into the food chain.

People in southern Louisiana have already complained about a stench coming off the shoreline, causing burning eyes and nausea. The Environmental Protection Agency is worried about water contamination, too.

So – who’s to blame? Of course mistakes were made by British Petroleum. There were building flaws. The pieces didn’t do what they were supposed to do after the explosion.

But it’s people like us who buy oil products day after day, week after week, month after month, year in and year out who are at the root of responsibility for the fiasco. We are, in essence, poisoning our own food, killing the wildlife and corrupting natural resources.

We’ve given lip service to changing our energy habits, but we haven’t made much progress. We have the Smart Car, but we also have the Hummer, which gets about 10 city miles per gallon. And that, according to what popular media tells us, is the coolest thing on wheels these days.

In the current movie The Losers, the protagonists end the flick with a ride in the vehicle of their dreams: a canary yellow hummer limousine. Wow. Heads turn when that baby pulls up.

Not everyone can afford a Hummer, but a fleet of other four-wheel drive sport utility vehicles don’t fare much better when it comes to fuel efficiency. The GMC Sierra, Nissan Armada, Nissan Titan and Land Rover get 12 city mpg.

President Obama has managed to get auto manufacturers to accept new fuel economy measures – by 2016. That’s when SUVs will have to start getting 35.5 mpg (average city and highway). But the U.S. experienced its first oil jolt in the 1970s, and you’d think we would have accomplished more in 40 years.

Oil is used to make plastic, too, and we live in an era when almost everything is plastic. When you go to the supermarket, you carry your food home in a plastic bag – a petroleum-based product. Oil is even used in fertilizers to grow the food before it gets delivered to the store – by gas guzzling truck.

In a typical 44-gallon barrel of oil, 37 gallons are used for fuels (gas, heating oil, jet fuels, etc.) and seven are converted into solvents, fertilizers, pesticides, and plastics according to

We’ve missed a lot of opportunities to wean ourselves off of fossil fuels. The Gulf “Deepwater Horizon spill” is a reminder that it’s never too late to change course.


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How much health care can be delivered for a billion dollars? That’s a lot of preschool checkups for kids, prevention services for young adults, and medical procedures for adults and seniors.

But it’s also close to the amount spent by health care interests during the fierce debate on health care reform, according to a new report in the Capitol Hill newspaper, Roll Call.

Hospitals, physicians and companies that manufacture medical products were responsible for about 20 percent of the whopping $879 million spent on lobbying during a 15-month period leading up to the bill’s final passage. Pharmaceutical companies spent the largest chunk, $253 million.

Ralph Neas, president of the National Coalition on Health Care told the publication: “That is an astounding amount of money. I can’t think of anything that remotely comes close to that amount of lobbying.”

That’s the latest take on it, but not the only one. In March, The Center for Public Integrity estimated that $1.2 billion was spent in 2009 on lobbying firms working to influence health care reform, along with “other issues” – lobbyists aren’t required to break issues down.

In March, the CPI called health care reform “a bonanza for K Street,” referring to the lobbying firms based in Washington. In total, it said, 1,750 companies and organizations hired professionals to promote their interests.

The CPI report details the top seven lobbyists, how much each received to work on health care reform, and who owns the firms.

Last August, Bloomberg reported that there were six health care lobbyists for each member of congress – a total of 3,300 of them scurrying strolling through the halls of Congress to make sure their clients’ point of view was heard.

What always amazes me is the amount spent on health care that is actually not spent on health care. In other words, expenditures on everything from paper shuffling to advertising to pharmaceutical propaganda on prime time – everything but delivering services.

Forget about the health care lobby. The U.S. already spends 31 percent of its health care dollar on administrative expenses, compared to 16.7 percent in Canada, according to the New England Journal of Medicine.

Just what we need – more ways to spent money on health care that have nothing to do with health care.


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