There are those who believe that health care lends itself to the usual market forces, meaning that competition will bring about the best products at the lowest prices. For instance, comparative quality ratings and pricing for items such as autos and vacuum cleaners allow us to obtain the best products at the lowest possible costs.

But do these principles apply to health care? Clearly not, for several reasons. For example, if we suddenly become ill and need an ambulance, we summon the nearest local provider with its prevailing charges (which can be substantial), then taken to a nearby medical facility and usually charged exorbitant rates for emergency and/or hospital services.  If you are lucky enough to possess decent insurance, you will be billed according to whatever has—or has not—been agreed to with the ambulance service and hospital as reasonable compensation, and you will usually be required to ante up for any co pays or deductible amounts in your contract. All prices are entirely out of your control and obviously not subject to free market forces. And so it goes through the entire spectrum of medical care that includes drugs and devices, doctors’ fees, and numerous tests and additional services. At the end of this process, you are apt to receive an incomprehensibly large bill that is not coupled with reality or market forces, and even if you aren’t responsible for most of the payment, the money must come from somewhere, for your insurance carrier is not a philanthropical organization.

So, how much are we contributing as a nation to these healthcare expenditures? The bills total approximately $3 trillion annually, or about 17% of our overall economy. Of that total, hospital bills account for 40-50%; tests and ancillary services, 20-30%; doctors, 20%; drugs and devices, 15%: and nursing homes 5%. These amounts generally are twice the total expenditures of other western countries, which generally range from 6-11% of their respective economies. Since our outcomes seem not superior to those of the aforementioned nations, some experts even argue that our illness and mortality rates are even worse than those of other countries. But complicating factors such as obesity, poor lifestyle choices and others, may account for poor outcomes in this nation. Nevertheless, at best, our healthcare system is providing no clear advantage over those of other nations.

So how do we explain all this? We are overpaying for virtually all components of our health care system. We are doing so because there are few if any restraints on the charges. For instance, Obamacare put no controls on the pricing of drugs or clinical care. Pharmaceutical companies’ charges are not only unrestrained, but they can often “game” the system to overcharge for older, generic drugs. The insurance carriers were granted unrestricted leeway in setting premiums and deductibles in exchange for allowing policies that provide maternity and preventive care and that mandate coverage for patients with preexisting conditions.  Hospitals can pad their bills through the use of opaque charges that include all sorts of add-ons and “facility” fees, making them all but impossible to decipher. Fortunately, Medicare serves as a partial restraint on many of these excesses: For instance it applies a so-called Disease Related Grouping (DRG) system to bundle and restrain allowable hospital charges for given diseases/and or treatments. Although this system does restrain charges somewhat, medical purveyors often use other means’ to circumvent these amounts, and hospitals can still bill private insurers at higher rates, depending on prior agreements. Also, coding of procedures and even physician’s services has become a science of gaming to extract the highest possible tariffs. In all cases, those who are uninsured—and are least likely to afford them—receive the highest bills.

In order to understand these large expenditures, we can learn from other countries’ experiences. Although there are several contrasting systems, they all employ governmental price controls coupled with universal participation. In Germany and France, for instance, all individuals must be insured. Most people purchase state sponsored insurance, with premiums based upon one’s income. Private insurance is allowed and may supplant the base insurance for the few who can afford deluxe services. In Canada and Australia, a single payer system is used, analogous to Medicare for all, making private insurance unnecessary. In the United Kingdom and Denmark, an extensive health care structure includes a single payer system with state ownership of hospitals and medical infrastructure. Notably, all these systems couple price controls for services, together with the requirement for participation by the entire population, a factor that spreads the costs widely and is sufficient to cover all those with “pre-existing” conditions.

The U.S. could adopt any of these methods, but a single payer (“public option”, or Medicare for all) would seem to be the most direct and cost-effective. Administrative costs for Medicare average about 2-3%, in comparison to about 20-30% of most private insurers. Even under the mandate by the ACA (“Obamacare”) to limit these costs provided by private insurers to 15% of total outlays (the other 85% devoted the health care), this is still a significant amount. Moreover, private companies can encourage larger medical bills, thus increasing the overall size of their pool but passing on the costs to those who are insured. This means that the 15% could be substantially greater as a portion of the larger pie, allowing CEOs and other directors to receive millions in compensation.

Expanded Medicare would not preclude the addition of supplemental private insurance, as we now have in combination with its basic coverage. An overall plan must be empowered to limit prices for all drugs, procedures, and hospital bills, which would control the entire cost structure of the medical system, allowing us to emulate costs of other western countries. Nationwide pharmaceutical prices must be subjected to negotiated limits as placed by Medicare or related agencies.  A single payer system would also simplify record keeping and unify documents, reducing time required by physicians and office personnel.

Obviously this is but a start, and other issues must be addressed that are too numerous to enumerate here.

In all cases, rational solutions must contain two vital components: 1) Mandatory participation by the entire population. 2) Careful and rational control of all expenditures

Any program lacking these two vital components will be, at best, too costly, or, at worst, socially unacceptable or disastrous.




The Mounting Evidence Against Diet Sodas

Studies suggest possible links between low-calorie beverages and health risks, though more research is needed

Many people think of diet sodas as healthy, low-calorie alternatives to sugary drinks. Yet a small but growing body of evidence suggests that diet sodas may have health downsides and may not even provide the benefits some people turn to them for, such as weight loss. Excess sugar intake is a problem in Western society because it contributes to obesity, diabetes, and other conditions. We know that diet beverages are becoming more popular, but we don’t have a lot of research into the effects of diet beverages on different aspects of health.

According to a 2016 study published in the Journal of the Academy of Nutrition and Dietetics, nearly half of adults and a quarter of children in the U.S. consume artificial sweeteners—and the majority do so on a daily basis. Diet drinks make up the bulk of the intake. So here is what we know so far about diet sodas and their role in health, and what you can you do to make smart beverage choices in the meantime.

               Not So Heart Smart?

The strongest evidence so far links regular diet soda intake with cardiovascular conditions, such as stroke and heart attack, as well as type 2 diabetes and obesity (which are also risk factors for cardiovascular disease). For example, a recent study of about 4,400 people age 45 and older found that those who drank one or more diet sodas every day were three times more likely to have a stroke than those who didn’t. This study, however, had several limitations and didn’t prove that diet sodas themselves caused people to have strokes. Although it could be that people who drink diet sodas are in poorer health than people who don’t, these findings do jibe with previous research, and thus strike a note of caution. For example, three large studies published between 2007 and 2009 found that people who drank diet sodas regularly were more likely to develop type 2 diabetes and had between 30 and 55 percent higher risk of metabolic syndrome (a constellation of health problems that could increase the risk of type 2 diabetes, heart disease, and stroke) than those who didn’t. Two other studies from 2012 further bolstered these results: Researchers linked daily diet soda consumption to about a 45 percent higher risk of heart attack, stroke, and early death in one study of about 2,600 people.

A Cautious Interpretation

The studies linking diet sodas and cardiovascular risk are intriguing, but they still need to be repeated in more rigorous settings. For example, all of these studies relied on participants self-reporting their dietary habits, which can introduce error because people don’t always remember what they ate. Additionally, those who drink diet sodas may already be at increased risk of conditions such as diabetes or obesity because they are unhealthy to begin with. For example, someone who is overweight may have switched from regular soda to diet soda to help control an already burgeoning waistline.

And not every study has shown that diet sodas negatively affect health. For example, in 2012 researchers from the Harvard School of Public Health analyzed the drinking habits of almost 43,000 men and found that those who drank sugary drinks had a higher risk of coronary heart disease, but those who drank diet sodas did not.

Another reason scientists hesitate to say definitively that diet sodas are bad for your health is that they aren’t sure how they increase disease risk. It’s possible that artificial sweeteners may damage blood vessels—possibly explaining their link to diseases such as diabetes and stroke. It’s also possible that the artificial sweeteners commonly used in diet sodas may “trick” the brain into craving rich, high-calorie foods, leading to weight gain. They may also cause changes in hormone levels or gut bacteria, both of which play a role in weight and insulin management. For example, a study published in the journal Nature in 2014 found that artificial sweeteners altered intestinal bacteria in people and mice, increasing their risk of sugar intolerance, a condition often preceding diabetes. However, these various ideas warrant larger, more rigorous studies.

                             What to Do

In general, your best bet is to avoid regular and diet sodas altogether. They offer little nutritional benefit, and in some cases, diet sodas may even cause headaches. For example, shortly after the artificial sweetener aspartame came onto the market in the late 1990s, one of the biggest complaints the Food and Drug Administration received about the sweetener was regarding headaches. No scientific studies have proved that aspartame or diet sodas in general cause headaches, but a review of evidence published in The Clinical Journal of Pain in 2009 suggested that large amounts of the sweetener—such as that in five or more diet soda drinks—could trigger or make headaches worse in people who are already susceptible to migraines.

In the end, an occasional soda—with sugar or artificial sweeteners—is probably fine. But your best bet is to stick with water, plain or sparkling, as much as possible. If you find unflavored water boring, add a splash of bitters with a slice of lemon or lime. Unsweetened tea is also a great choice.



     Most people understand that the health care plans proposed by the Republicans would likely be disastrous to many people, especially to the 22-24 million likely to be shorn of their medical insurance coverage. Less appreciated, however, is the danger posed by the latest budget submitted by Trump that would cut the 2018 National Institutes of Health (NIH) budget by about 18.3%, or $5.8 billion.  This important governmental department currently has an overall budget of $32 billion, with nearly 80% being awarded through competitive grants supporting more than 300,000 researchers at 2,500 scientific institutions throughout the U.S.A. and around the world.

Unfortunately, the president’s proposal has far-reaching negative consequences for public health, technology and drug development. What’s even worse is that if cuts of this magnitude pass, we will likely lose a generation of scientists—especially future young stars, who depend upon grants to support their initial progress, as exemplified by Mary-Claire King, professor of genome sciences at the University of Washington, whose early funding from NIH led to the identification of the BRCA1 gene and its role in inherited breast cancer.  Another example is provided by Feng Zhang of the Massachusetts Institute of Technology (MIT), whose ground-breaking work with colleagues was supported by a 5-year NIH grant that resulted in a technique for editing the genome, CRISPR-Cas9, deemed the 2015 breakthrough of the year by the American Association fro the Advancement of Science. Basic breakthroughs of this type often support the development of new therapies by the applied bio-technical and pharmaceutical industries. Up to 47% of important, trans-formative drugs approved by the FDA between 1988 and 2005 benefited at least in part from public-sector support. Commercial companies often avoid such basic research for fear that the risk involved will not provide sufficient profits. Economists uniformly believe that public-sector funding for scientific research produces high returns, fills an important gap, and disruptions in spending may ultimately undermine the United States’ worldwide advantage in science, technology, engineering, and math.  Experts have estimated that NIH-funded research of each $10 million has produced an average of 2-3 patents of important new products, a result that is unlikely to be matched by for profit commercial companies.

The NIH is at least partially responsible for an increase of life expectancy of the average American by 8 years (a 43% reduction in mortality) between 1970 and 2013 that includes deaths from cardiac disease, diabetes, stroke and cancer.

By forming partnerships between health research institutions in other countries, the NIH influence extends beyond our borders, These are critical for coordinated research and for developing effective responses to global epidemics of diseases such as HIV, Ebola, SARS, and others.

Most experts agree that cuts to the NIH of any magnitude will ultimately hamper long term scientific progress and adversely affect local, national, and global economies, while inhibiting discoveries that are essential for fighting disease worldwide.

The NIH has long enjoyed bipartisan congressional support, as evidenced by the 21st Century Cures Act at the end of 2016. This year marks the beginning of proposed 10 year funding aimed at the conquering of such diseases as cancer (remember Joe Biden’s Cancer Moonshot) and Alzheimer’s disease. These lofty goals are being threatened by funding restrictions proposed by the current administration. The NIH is our crown jewel, providing the foundation for U.S. competitiveness in worldwide discovery and better health for all. Undermining this system will rob us of the best and brightest minds and lead to a global impact with far-reaching consequences.

We should all urge the U.S. congress to continue providing bipartisan support to the NIH in the advancement of science, technology, and medicine in the 21st century.





As you sleep, your body is hard at work digesting yesterday’s dinner. By the time you wake up, your body and brain are demanding fresh fuel. “Breaking the fast” is a key way to power up in the morning. Do it right and the benefits can last all day. If you miss the day’s first meal, you may start off with an energy deficit and have to tap into your energy reserves. I have listed additional advantages provided by a regular breakfast in a previous post.

What’s a good breakfast? It’s one that delivers some healthful protein, some slowly digested carbohydrates, and some fruit or vegetables. A vegetable omelet with a slice of whole-grain toast qualifies, as does a bowl of high-fiber cereal topped with fresh fruit and reduced-fat or soy milk, along with a handful of almonds or walnuts.

Choose whole grains. High-fiber, whole-grain cereals and breads can help keep your blood sugar on an even keel and avoid a midmorning energy crash. With the hundreds of types of cereal on the market, bran cereal, bran flakes, and steel-cut oatmeal are typically the healthiest bets. To choose the healthiest breakfast cereal, read the label and look for:

  • 5 grams or more of fiber per serving
  • less than 300 milligrams of sodium per serving
  • less than 5 grams of sugar per serving.
  • whole grain as the first item on the ingredient list

Include protein. Yogurt is a good choice; Greek yogurt has more protein than regular yogurt. Eggs (up to one a day) are okay for healthy people. Although yolks are high in cholesterol, eggs have proteins, vitamins, and other nutrients and don’t appear to increase the risk for developing heart disease. You might also include foods that have healthful fats such as those in nuts, avacodo, or salmon. Limit processed meats to the occasional treat as these foods are associated with a higher risk of colorectal cancer, heart disease, and type 2 diabetes.

Eat in, not out. You can enjoy a healthful breakfast out if you stick to oatmeal. But much of the traditional fare will start your day with loads of refined carbohydrates and saturated fat. Like most processed food, the breakfast offerings from fast-food chains tend to be high-sodium, low-fiber disasters.

Blend up a breakfast smoothie. Combine fruit, juice, yogurt, wheat germ, tofu, and other ingredients. Toss them in your blender with a bit of ice and you have a refreshing, high energy breakfast

These are but a few ideas to get you started. Obviously there are lots of variations that still allow one to stick to the basic principles. With a little creativity, everyone can reach the same goal, with better health on the line!




     Most of us can’t walk by the popcorn vendor in the Movie Theater or elsewhere without being seduced into a purchase by the great aroma. The great popularity of popcorn is also reflected by a huge increase in demand for bagged popcorn, even sans fragrance. But is such consumption a wise choice? Maybe so, and maybe not, depending upon a few variables, noted below.

First, the possible advantages: To its credit, three cups of popcorn contains slightly fewer calories than one sourdough pretzel. For better or worse, manufacturers of bagged brands have piled on with such claims as “whole grain,” “gluten free,” and “50% less fat,” audaciously making it sound like health food, and in some ways, maybe it is!

So can popcorn be the perfect snack?  The answer is a qualified yes, as long as you’re careful to read the nutritional fine print and not be blinded by packaging claims, or note any added ingredients to the basic product.

Actually, popcorn is a whole grain, which research has shown is healthy. For instance, a 2016 review in the a British medical journal found that eating three servings of whole grains per day was linked to a 22 percent reduction in cardiovascular disease risk and a 15 percent risk of cancer. But, if salt, sugar, and some oils are added, you may be nullifying any benefits. So the labels need to be checked. As a rule of thumb, the values listed in the nutrition facts label are for 1 ounce of popcorn, and that equals about 3 to 4 cups in volume.

In the example of pre-bagged popcorn, the labels are helpful, and as a rule of thumb, for a typical serving of 2 cups, one should try to limit the total calories to a maximum of 100, for added sodium, about 100 mg, and for added fat, about 4 gm. The fats added should be of the unsaturated vegetable variety such as sunflower or safflower oil. Even more healthful alternatives are provided at home by popping it on a stove or in a microwave oven, in which case the best popcorn choices contain little or no sodium, together with no added fats or oils. Under these circumstances, for suitable taste one can add minor amounts of salt and vegetable oil and still preserve sensible levels of everything. But choosing higher caloric alternatives such as added cheeses, sweetened Carmel-corn or Kettle-corn are done at one’s own risk. Also, unless you are sharing with several people, choosing the gargantuan-sized bag at the cinema is unwise.

So, provided that you stay within reasonable bounds, popcorn can indeed be a nearly ideal food and/or snack and virtually guilt free!



Eating more red meat is associated with an increased risk of dying from eight common diseases including cancer, diabetes and heart disease, as well as “all other causes” of death, according to a U.S. study.

Researchers examined data on almost 537,000 adults aged 50 to 71 and found the people who consumed the most red meat had 26 percent higher odds than those who ate the least of dying from a variety of causes.

But people who ate the most white meat, including poultry and fish, were 25 percent less likely to die of all causes during the study period than people who consumed the least, researchers report recently in The BMJ (British Medical Journal).

“Our findings confirm previous reports on the associations between red meat and premature death, and it is also large enough to show similar associations across nine different causes of death,” said lead study author Arash Etemadi of the National Cancer Institute, adding further,”We also found that for the same total meat intake, people who reported a diet with a higher proportion of white meat had lower premature mortality rates”.

For the study, researchers followed the health and eating habits of people from six U.S. states and two metropolitan areas over about 16 years. They analyzed survey data on total meat intake as well as consumption of processed and unprocessed red meat and white meat. Red meat included beef, lamb and pork, while white meat included chicken, turkey and fish.

Then, researchers sorted people into five groups from lowest to highest intake of red and white meat to see how this influenced their odds of death during the study period.

They evaluated deaths from nine conditions, including cancer, heart diseases, stroke and cerebrovascular disease, respiratory diseases, diabetes, infections, Alzheimer’s disease, kidney disease and chronic liver disease, as well as all other causes. Overall, 128,524 people died, with cancer, heart disease, respiratory disease and stroke as the leading causes of death. Only Alzheimer’s disease risk was not linked to red meat consumption.

Certain ingredients in red meat, including nitrates and iron (from blood), may help to explain why it’s linked to higher mortality rates for the other causes of death, the authors argue.

The highest intake of iron was associated with 15 percent higher odds of premature death than the lowest intake, the study found.

The study wasn’t a controlled experiment designed to prove how the amount or type of certain meats might directly influence mortality.

Other limitations include the reliance on survey participants to accurately recall and report on their eating habits and the lack of data on any changes in people’s diets over time, the authors note.

Even so, the findings should reinforce the need for many adults to cut back on meat consumption, said Dr. John Potter of the Center for Public Health Research at Massey University in Wellington, New Zealand.

Potter stated further that “Processed meat can produce cancer–causing chemicals, while saturated fats in meats can increase the risk of cardiovascular disease”. He also added that “Choosing organic meat may not change the risk of premature death, and mortality is higher with higher meat intake for every major cause of death except Alzheimer’s.”

“The really key issue in all this is that the current level of meat consumption, in most of the developed world and increasingly in low– and middle–income countries, is unprecedented in human history,” Potter said. “We need to reduce meat consumption back to about one–tenth of our current level.”

As I have stated in a previous communications, one should try to limit this type of meat consumption to no more than twice weekly. Throw the rest to the sharks!


U.S. Education Secretary heavily invested in questionable “brain training” clinic. I would call it “Snake Oil of the Brain”


The Washington Post has published a detailed report on Neurocore, a “brain performance” company owned by the family of Education Secretary Betsy DeVos. DeVos resigned her Neurocore board seat when she joined the Trump Cabinet, but she and her husband maintain a financial stake between $5 million and $25 million, according to a disclosure statement filed with the Office of Government Ethics. The Neurocore program is claimed to improve brain performance through sessions in which the patient watches television while hooked up to an electroencephalograph (EEG) machine. The report’s author underwent a $250 program evaluation, examined the relevant experimental evidence, interviewed several experts, and concluded:

I’ll admit that before I stepped into Neurocore, I had little intention of signing up for the company’s treatment. I had read too many articles skeptical of brain training to think that I should pay for its services. But it took talking to experts and a visit to Florida to discover that the firm was also hurtful — a Trump University for people with cognitive struggles. By wrapping weak science in sleek packaging, by promising something that it cannot fully deliver, Neurocore offers false hope to people who need honest help. In this regard, what’s most remarkable is that DeVos, the nation’s foremost pedagogue, is behind it all, promoting a form of education that doesn’t actually seem to educate.

After having read this article and coming from a scientific background, I can firmly state that there is nothing to be derived from an EEG that allows for psychological assessment, and therefore, no chance that such “information” could be used for any type of management. I guess one might conclude that this is more “fake news,” this time emanating from the White House!! Does this come as a surprise to any rational person?



Researchers analyzed nutrition studies in a new review published in the Journal of the American College of Cardiology, which intends to cut through the confusion about the best dietary patterns to reduce cardiovascular disease, our greatest killer. The review concludes that current evidence strongly supports eating plenty of fruits, vegetables, whole grains, legumes, and nuts in moderation. Although more controversial, some heart–healthy diets may also include very limited quantities of lean meat, fish, low–fat and nonfat dairy products, and liquid vegetable oils.

The review examined several of these dietary patterns as well as “hypes and controversies” surrounding nutrition to provide the population with information about dietary habits.

Their advice: “There is a growing consensus that a predominantly plant–based diet that emphasizes green, leafy vegetables, whole grains, legumes and fruit is where the best improvements are seen in heart health.”

Other nutrition topics covered in the review include:

  • Eggs and cholesterol. Although a government report issued in 2015 dropped specific recommendations about upper limits for cholesterol consumption, the review concludes, “it remains prudent to significantly limit intake of dietary cholesterol in the form of eggs or any high cholesterol foods.”
  • Vegetable oils. Coconut oil and palm oil should be discouraged due to limited data supporting routine use. The most heart–healthy oil is olive oil, though perhaps in moderation as it is still higher calorie, research suggests.
  • Berries and antioxidant supplementation. Fruits and vegetables are the healthiest and most beneficial source of antioxidants to reduce heart disease risk. There is no evidence to support adding high–dose antioxidant dietary supplements benefits cardiovascular health.
  • Nuts. Nuts can be part of a heart–healthy diet. But beware of consuming too many, because nuts are high in calories.
  • Juicing. While the fruits and vegetables contained in juices are heart–healthy, the process of juicing concentrates calories, which makes it is much easier to ingest too many. Eating whole fruits and vegetables is preferred, with juicing primarily reserved for situations when daily intake of vegetables and fruits is inadequate. If you do juice, minimize calories by avoiding adding extra sugar or honey.
  • Gluten. People who have celiac disease or other gluten sensitivity (about 1% of the population) must avoid gluten—wheat, barley and rye. For patients who don’t have any gluten sensitivities, many of the claims for health benefits of a gluten–free diet are unsubstantiated and are best ignored .
  • The authors also addressed why there can be confusion surrounding nutrition studies. Unfortunately, many of these studies are funded and/or influenced by the food industry and likely have some bias, or are totally inaccurate.

Confounding the issue further, it’s very hard to separate the effects of specific nutrients in a food. For example, an apple contains many components including proteins, vitamins and fiber..

Many people who eat a healthy diet also have other healthy lifestyle behaviors, such as regular physical activity, getting enough sleep, and not smoking, and it can be hard to pinpoint the diet’s effect separate from these other behaviors. Moreover, some nutrition studies tend to be based on surveys that rely on people’s memories of what they ate, which isn’t always reliable.

The founder of modern medicine, Hippocrates, said, “Let food be thy medicine.” If we can get the population to understand the value of nutrition, they could enjoy a greater reduction of cardiovascular and other diseases, and that is certainly more cost–effective than treating diseases before they are causing symptoms or signs.


What the American Health Care Act Would REALLY Mean to Society

I have always agreed with most members of our society, as well as the entire western civilization, that healthcare was a right and not merely a privilege. Now I find that most of my fellow physicians’ groups, as well as others, also share the same opinion in principle, as demonstrated by their near universal rejection of the latest healthcare proposal (AHCA) by the Republican house of representatives.

Primarily due to the access issues raised by the bill, primary care medical societies oppose the AHCA, and it is hard to find any mainstream medical group that supports it.

“This bill would dismantle the Medicaid program,” the American Academy of Pediatrics said in a statement. The bill is “an extreme attack on access and coverage for millions of Americans,” the American College of Physicians stated.

The AHCA is “a highly flawed proposal that will destabilize our health care system, cause significant loss of coverage, and allow for the discrimination against patients based on their gender, age, and health status,” the American Academy of Family Physicians stated.

The American Medical Association also came out against the bill, stating “America should not go backward to the time when our fellow citizens with preexisting health conditions faced high costs for limited coverage, if they were able to obtain coverage at all.”

In a March statement on the original bill, the two major US neurosurgery groups (American Academy of Neurological Surgeons and Congress of Neurological Surgeons) said they had not supported the ACA’s Medicaid expansion but they now questioned the AHCA’s plan to roll it back. “Medicaid is an important safety net program for patients with low incomes, and we do not want to see these individuals lose coverage,” they stated.

In its March statement on the bill, the American College of Surgeons (ACS) praised the expansion of Health Savings Accounts (HSAs) but was concerned about the decline in Medicaid funding and regretted the loss of exchange subsidies. This loss could “affect access to surgical care. As a result of the reduction in subsidies, individuals may only be able to afford insurance with high deductibles or, possibly, may not be able to afford any insurance at all,” the ACS stated.

Even the American Academy of Orthopaedic Surgeons (AAOS), which had endorsed the nomination of Dr Price (one of its members), has not supported the bill. “We’re not really in support [of] or against the bill,” an AAOS leader told Medscape in April. “We’re trying to understand it better at this point.” A check of AAOS press releases shows no statements on the bill since then.


The American Health Care Act represents a totally new direction in US healthcare policy, shifting control from the federal government to the states and to the market. It strips away expansions in coverage under the ACA and replaces billions of dollars in subsidies with modest tax credits. Much of organized medicine actively opposes the AHCA, mainly because of its plans to reduce or eliminate coverage of Americans. Many other groups, such as the AARP, also oppose the bill. Although possible, the AHCA will likely not be enacted in its present form. Furthermore, it is highly doubtful that the Senate will offer anything of real substance, but the jury is still out.


As I have stated previously, (, I believe the only viable system, while in need of modification, is that of a “public option,” i.e. Medicare for all.

Let’s demonstrate how deadly the effects of having little or no insurance plays out in the example of breast cancer: According to a recent study involving more than 52,000 individuals, insurance status and certain demographic variables were linked to breast cancer mortality. Participants studied were those diagnosed with breast cancer in 2007 and 2008. Investigators looked at how insurance status and social factors impacted mortality. Among the results:

  • Women who received Medicaid or were uninsured were more than twice as likely to be diagnosed at a later stage, vs those with commercial insurance.
  • Blacks were 18% more likely than whites to experience such delays.
  • Compared with commercially insured patients, death rates from breast cancer in Medicaid and uninsured women were 40% and 60% higher, respectively.Thus even Medicaid, although better than nothing, provides a sub-optimal form of healthcare, further supporting the Medicare concept.

Sadly, this is but one of many examples that could be cited in a society that paradoxically prides itself in providing equal rights for all!






Possible cause of strokes and dementia

A new study published in the journal Stroke finds that artificially sweetened beverages are associated with dementia and stroke. Researchers analyzed data from nearly 3000 participants and found that those who consumed 1 or more artificially sweetened beverages per day were more likely to suffer from subsequent dementia and stroke. Interestingly, they did not see the same effects for sugar-sweetened beverages; however, this is anything but a ringing endorsement of these latter drinks! Aspartame, commonly known by the brand name NutraSweet, is the dominant sweetener in these products, and, therefore, may ultimately prove to be the responsible cause, but this awaits further confirmation.

Other studies have also found associations between consuming artificially sweetened beverages and poor health outcomes, and as I have previously noted (, there is little or no advantage to consuming such beverages in the attempt to lose weight.

Obviously, finding a statistical relationship in such studies does not definitively establish a causative role of such drinks, but it sure should induce some reservations about the consumption of these products.

The bottom line: There is no way to beat drinking drinking plain water, but if you can’t abide by that dictum, how about carbonated water or unsweetened tea?



Are you a person who loves to be tan? Do you wish for the bronzed look of jet-setting celebrities just back from the tropics?

If so, you’re not alone — let’s face it, we’re a culture that’s obsessed with being tan. It’s attractive, fashionable, and a sign of good health, right? Wrong!

Actually, sun exposure or spending time in tanning booths has many health experts worried: it damages skin and increases the risk of skin cancer. The risk rises if tanning leads to a sunburn — according to the American Academy of Dermatology, a single blistering sunburn can nearly double one’s lifetime risk of melanoma, the most deadly form of skin cancer. So, “looking” healthy carries with it a very high price indeed!

The prevalence of skin cancer (and the costs of its treatment) is rising: nearly five million people in the United States will be treated for skin cancer this year (an increase of 50% from the prior decade) at a cost of more than $8 billion (twice the cost of a decade earlier).

The myth of the base tan

Have you heard of the idea of a base tan? It may seem reasonable enough: before you head off to the beach for vacation, getting a tan ahead of time might help you avoid burning, and there’s the added benefit of not looking pale when you first arrive.

So does a base tan prevent burning? Experts estimate that going out in the sun with a base tan is equivalent to wearing a sunscreen with a sun protection factor (SPF) of 3 to 4. This means the skin can be exposed to up to four times more sun before burning than without the base tan. For example, if you would ordinarily burn after 20 minutes in the sun, a base tan might mean you can be in the sun for up to 80 minutes before burning. While it’s better than nothing, it’s a modest benefit; most recommended sunscreens have SPFs of at least 15 to 30. Since wearing sunscreen is much more effective than relying on a base tan to protect you from burning, the real question is whether having a tan on day one of your vacation is worth the time and expense at the tanning salon before you leave.

Tanning among teens is a particular concern

The earlier one starts tanning, the longer the lifetime skin damage and the higher the skin cancer risk. So there has long been worry about teenagers who spend hours tanning outside or in tanning booths. Because of this concern, a number of states have passed bans or restrictions in recent years requiring parental consent for teenagers to use tanning booths. In 2009, only five states had such restrictions; in 2015, 42 states did.

And it’s working. According to a new study of more than 15,000 U.S. high school students, indoor tanning decreased from nearly 16% in 2009 to just over 7% in 2015. But that’s still a lot of kids — a million or so in the U.S. — putting themselves at unnecessary risk.

What about vitamin D?

There’s been controversy for years regarding safe levels of sun exposure. Some suggest that we should not limit sun exposure too much, because the sun helps increase stores of vitamin D by converting inactive forms of the vitamin in the skin to the active form. This reaction takes far less time than tanning. And vitamin D can be good for your bones, your immune system, and perhaps other parts of the body.

Meanwhile, warnings about the dangers of tanning and sun exposure argue that even brief exposure to intense sun can damage skin and increase cancer risk. And, there are other ways to get vitamin D, such as dairy products and supplements. In my view, it makes little sense to justify sun worship by invoking the health benefits of vitamin D.

So what’s a tan-lover to do?

If your goal is to get a good suntan (or to look like you have one the day you arrive at the beach), think about using “sunless” tanning lotions, gels, or sprays that temporarily stain the skin. You’ll still need sunscreen, though, as these products do not protect against sunburn.

Better yet, rethink whether you really need a tan to look good. After all, today’s swarthy glow is tomorrow’s wrinkled, weathered, leathery hide — or worse, skin cancer.

If your goal is to prevent sunburn, there are better options than getting a base tan:

  • Stay out of the sun when the sun in most intense (from about 10 a.m. to 3 p.m. in most of the United States).
  • Use sunscreen liberally: choose a sunscreen that offers an SPF of at least 15 to 30 and protects against both UVA and UVB radiation. (This is also called “broad spectrum.”) Re-apply at least every two to three hours, more often if you’ve been sweating, swimming, or rubbing your skin with a towel.
  • Wear protective clothing: a long-sleeved shirt, wide-brimmed hat, and long pants offer good protection from sun exposure. Dark fabrics that are tightly woven are best.

These measures are most effective in combination, and are particularly important for children or for anyone with fair skin. Remember that you can burn even on cloudy days. Check your local UV index, which predicts the level of UV radiation and indicates the risk of overexposure on a scale from 0 (low) to 11 or more (extremely high). The National Weather Service calculates the index for most ZIP codes. You can search for the UV index in your ZIP code on the Environmental Protection Agency’s website, or download its mobile app. This advice presupposes that Trump hasn’t trashed this department before you get there!

What’s next?

As with most public health worries, we need more research. For example, how do you know when you’ve had too much sun? It’s not always easy to know when you’ve been out too long and passed the point of no return for a sunburn.

We need more education to correct misconceptions about tanning (such as the myth of the “healthy tan” or the benefits of the base tan), and we need to teach kids, parents, and schools that teens should avoid too much tanning, whether indoors or outside.




Shortly after taking office, Donald Trump misguidedly reinstated an executive order banning U.S. aid to any international organization that supports abortion related activities, including counseling or referrals. This policy is often referred to as the “global gag rule” on women’s reproductive health, supposedly aimed at reducing the number of abortions performed worldwide. First applied by Reagan as an executive action in 1984, the global gag rule as been restored and rescinded repeatedly by administrations for 17 of the past 32 years.

Seemingly well meaning and driven by the religious principles held by some members of our society, what have the results shown? Since the policy defunds—and thus incapacitates—organizations that provide education and contraceptive services, and their functions actually reduce the need for abortions. Thus the resulting evidence indicates that the defunding policy actually increases abortion rates, which in turn increases pregnancy related complications, maternal mortality, increased reliance on unsafe abortions, and higher rates of unsafe sex that include more HIV infections.

An important study published in 2011 compared the changes in the number of abortions in 20 countries in sub-Saharan Africa over a fifteen year period after the restrictive policy was implemented. Unsurprisingly, women living in the countries most affected by this U.S. Gag policy had 2.6 times the odds of having an abortion in comparison with those residing in countries least affected. Similar results had been previously disclosed in a smaller study performed in Ghana in 2006; moreover, this latter study found that the gag policy also resulted in poorer nutritional status in the affected children.

Another similar example is provided by the U.S. President’s Emergency Plan for AIDS Relief (PEPEAR). Since 2004, in an effort to control the global epidemic of AIDS, PEPFAR has provided aid for prevention, treatment, and care of HIV infections in many low-income countries. It increased the access to antiretroviral therapy, which is an evidence-based effective strategy for reducing transmission of HIV and related mortality. That investment has reduced global mortality by an estimated 700,000 adults within the program’s first four years alone, with related economic and employment gains.

By contrast, PEPEAR included a prevention program based upon urging sexual “abstinence and be faithful,” a strategy that has never been demonstrated to be effective in any context. This strategy originally received one-third of the PEPFAR budget. After a decade and a cumulative cost of more than $1.4 billion, a published study showed no measurable impact on disease rates and consequences.

The lesson from these experiences? Scientific data always “trumps” ideology, no matter how seemingly well-intended! Such ineffective and misguided foreign policies, already begun by Trump, ignore scientific analysis and undermine our ability to support global development as well as wasting valuable resources. This will ultimately—directly or indirectly—hurt the American people.

    It seems that Trump’s anti-scientific policies may be disastrous in many other ways as well!