Your boss will weigh you now

According to Blue Cross Blue Shield of North Carolina’s Annual Report, claims in 2008 reached $10.7 Billion — half the entire budget for the state of North Carolina. Claims increased nearly three times the growth in health plan members. Claims also cost the State Health Plan more than $200 million over that budgeted. Politicians had believed that preventive wellness and managed care in the State Health Plan, administered by BCBSNC, would save the state money.

Participants in the State’s Health Plan pay more out-of-pocket expenses for medical care than those in any other major health plan in the state, and that’s about to go up even more for some of them. They believed that wellness care and healthy lifestyle benefits were free.

Employers will now perform random tests of employees for evidence that they’ve smoked outside of work and will weigh employees in the workplace and report their BMIs to the state. Employees deemed noncompliant with the State Health Plan’s employer wellness initiative, will pay one-third-more for health insurance. Employers believed that eliminating smokers and fat people would lower health costs.

Employers, politicians and participants believed the marketing. The results were easily predictable. When decisions work from false beliefs, rather than sound evidence, the end results aren’t likely to be very good.

Under the State

North Carolina State University employees, state employees, teachers, retirees and other members of the North Carolina State Health Plan received a mailing last week about changes to their benefits, effective July 1, 2009. The changes would affect their out-of-pocket expenses, deductibles and co-payments. As part of the state’s “Comprehensive Wellness Initiative” signed into law (Senate Bill 287) in April by Governor Beverly E. Perdue, everyone covered by the state plan must now complete an Attestation Form, stating that they, and their covered dependents, do not use tobacco products and that they have a BMI less than 40 or are participating in approved weight management and/or tobacco cessation programs. They must also agree to submit to random testing for the presence of nicotine and to be weighed and measured at their workplace. By July 2012, the BMI requirement will be lowered to less than 35.

The mailing included “the requirements for compliance and the consequences of noncompliance” to its weight management and smoking cessation policies. The consequences of noncompliance mean paying one-third higher insurance premiums, higher deductibles and out-of-pocket expenses, for themselves and all covered family members. Noncompliants will no longer be eligible for the 80/20 plan and will be automatically moved to a costlier 70/30 plan. Plus, “members will forfeit any coinsurance and deductibles already paid under the 80/20 Standard Plan.”

“But wait!”, a reader wrote. “This is a government health insurance, the state’s health plan. And, we were told that the State Health Plan’s Healthy Living Initiative is voluntary and free.”

It is… at a price.

This is what happens when people want something for free and to let someone else manage their health, rather than take care of themselves for regular upkeep and purchase insurance to protect themselves from unforeseen major medical expenses. Anymore, insurance is no longer actual insurance; it’s health management, because that’s where the money and politics are.

Skyrocketing claims

Years ago, the state had signed with BCBSNC for managed health care focused on wellness and prevention and “quality” measures (providers mandated to provide care that adhered to pay-for-performance measures). Like company benefit managers, politicians believed that it would not only save, but make them money. The recent audit of the State Health Plan revealed, however, that it lost $79.7 million in 2008 and that the higher number of claims and administrative expenses cost the state $200.1 million more than planned.

Why did claims rise so much? The reasons are not surprising, but admitting them goes against today’s political correctness.

The popular belief is that when people get low cost insurance benefits, they over-utilize medical services which raises costs. But, that doesn’t fully explain the growing numbers of claims filed under the State’s Health Plan and why these managed care plans actually cost employers and consumers more.

● Newly insured? No. These teachers and state employees have had health insurance, so they aren’t making up for years without medical care.

● New members? No. The surge in claims isn’t explained by more members, as claims increased three times over the increase in members, according to the 2008 BCBSNC Annual Report. In just 2008, the company processed 46 million claims, more than 10% over the previous year; while membership increased by only 130,000 members, 3.5% of the 3.7 million members.

● Cheap? No. The theory that low health insurance premiums are encouraging overuse doesn’t hold up. Premiums for an employee and family (non-Medicare) under the NC State Plan are $533 a month for the 80/20 plan and $450 for the 70/30 plan — this is well over the national average. According to the Kaiser Family Foundation and Health Research and Educational Trust study on Employer Health Benefits, the average worker paid $293 for family coverage each month.

● Suddenly sick? There is no evidence that, over the past three years, teachers and state employees are suddenly becoming ill in greater numbers than ever.

Preventive wellness initiatives and disease management, as holistic and intuitively helpful as they may sound, have been shown to raise healthcare costs, and not just because of the additional tests, treatments, diets and lifestyle interventions. Health risk assessments, the key element in employer wellness programs, and screening tests are the gateway to identifying more people for prescription drugs (and other diets, products and interventions offered through health partnerships). These make money for insurers managing healthcare for government- and employer-offered health plans, under the guise of managing health indices (risk factors).

Opportunities for insurers to generate revenue with employer wellness programs go beyond pharmacy benefit management. The personal lifestyle information members reveal are marketing gold mines. Yet, for instance, nowhere among the member information is there a cautionary note telling participants in the State Health Plan that its commercial workplace wellness program and online health risk assessment are not covered under federal Health Insurance Portability and Accountability Act (HIPAA) privacy protection. That means participants have no protections in how their personal health information is used or sold. Nor are members likely aware of advertising content that appears to be health information. And few members likely stopped to read the more than 5,700-word privacy and terms disclaimer* on the North Carolina Workplace Wellness site.

Wellness isn’t medical care

The State Health Plan’s wellness initiative mandated by the legislature and largely enacted through employers, is “wellness care” and healthy lifestyle interventions, rather than caring for sick people. It was sold to politicians and company benefit managers as saving costs and preventing aging-related diseases. These alternative beliefs, born of the new field of “lifestyle medicine,” are increasingly finding their way into popular culture, even though few are supported by the scientific and medical literature.

BCBSNC tells prospective group plan managers that the key to controlling healthcare costs is prevention. Calling obesity the public health crisis of the 21^st century, it blames “sedentary jobs, high-calorie diets and leisure time spend in front of the TV or on a computer” and claims that fat people in North Carolina are responsible for $83 million in medical costs that could be reduced by healthier lifestyles. It claims that expensive diseases - from heart disease, diabetes to cancers - can be prevented by regular check-ups, cancer and cholesterol screenings, cholesterol medications, diet and exercise counseling, blood pressure checks and treatment. It also blames fat people for raising everyone else’s health care premiums.

How many politicians and employer benefit managers do you know who go to the medical literature, let alone understand the research, to realize these claims are far from slam dunks and are not supported with good science? Employers and politicians also don’t weigh the health risks and safety concerns associated with wellness initiatives. Examinations of the scientific evidence behind employee wellness program recommendations; screenings; and diet, exercise and lifestyle behavioral interventions, find poor evidence for effectiveness, as well as numerous inconsistencies with U.S. Preventive Services Task Force recommendations, that they claim to be following.

In fact, there’s not even a link between degenerative diseases of aging or premature death and any of the health indices in preventive wellness programs.

Health discrimination

Ideal health risk indices — from BMI, blood pressure, blood sugars to cholesterol — are mostly euphemisms for thin and young. Those who believe that their own good health is because they eat “right,” exercise and have perfect numbers are often young and upper-income and not old enough to experience age-related changes. Their genetic good fortune is not evidence of good behavior, either. Evidence-based research to date has shown these health indices are primarily measures of aging, genetics and social stresses, and not significantly malleable with “healthful” diets and lifestyles. With aging, the “ideal” numbers of healthy 20-year olds cannot be achieved for most workers without taking controversial and risky prescription drugs or temporarily lowered by undergoing mostly ineffective weight loss measures.

Today’s healthism stigmatizes those who don’t follow culturally acceptable lifestyles, or look like they do. It is also accompanied by blaming victims of diseases, such as cancers, diabetes and heart disease, for having brought on their diseases themselves through bad behavior; and by growing age and class discrimination. Discrimination claims filed with the Equal Employment Opportunity Commission have jumped to the highest level since the agency opened in 1965, spokesperson David Grinberg told the media earlier this year. Just from 2007 to 2008, age discrimination claims grew nearly three times those of race and twice as fast as those of gender or religion.

Fat people and smokers are especially stigmatized and actively denormalized in our culture. Citing efforts to contain healthcare costs, it’s a short step from raising premiums on them to removing them from surgery waiting lists, denying them medical treatment, and refusing to hire them at all — all discriminatory practices that have been increasing over recent years. As Brian House, from the Dept of Sociology at the University of Washington in Seattle, and co-author Dr. Michael Siegel, M.D., Social and Behavioral Sciences Department, Boston University School of Public Health, cautioned in the January issue of Tobacco Control: “In recent years, a new trend in worksite smoking policies has emerged: a shift from ‘smoke-free’ workplace policies to what have been termed ‘smoker-free’ workplace policies.” House and Siegel found a lack of published evidence for the effectiveness of such policies, nor any evaluations of their far-reaching deleterious consequences that are putting people at increased risks.

Moreover, they wrote, “norms of other unhealthy behavior could also start to shift and socially justify barring employment to other groups.” They exampled Clarian Health in Indianapolis, which planned to begin “fining employees for smoking, having a body mass index greater than 30 and if their blood pressure, cholesterol and glucose levels are too high.” The war on obesity has become a war against the ‘obese’ and is far different than caring for them.

The State Health Plan’s healthy living initiative

The summary of the new benefit modifications that were mailed to members last week states: “NC HealthSmart, the State Health Plan’s healthy living initiative… is voluntary. Eligible members can use the program at no charge… The tools and services available through NC Health Smart include tobacco cessation and weight management programs.” The State’s healthy living initiative includes tobacco cessation support through a telephone quitline, health coaches, and smoking cessation medications; weight management in the form of nutrition counseling, weight loss medications and bariatric surgery as covered benefits, a web and telephone support line, health coaches, workplace diet and wellness initiatives, case management and personal health risk assessments.

It says its employer wellness program, called the “Eat Smart, Move More, Weigh Less,” encourages lifestyle management and “health-friendly policies” at workplaces.

The new benefits also include a Pharmacy Benefits section that’s been rewritten from last year’s plan, with new pharmacy drug exclusions for drugs not covered by the plan, prior approval requirements and quantity limits for some drugs, and a preferred drug list of drugs available through the plan with others subject to higher co-payments. Medications for chronic diseases, such as rheumatoid arthritis, multiple sclerosis, hepatitis C, and anemia, must be purchased through its contracted vendor or members will pay the total amount.

Participants in the NC State Health Plan noted that none of their wellness benefits were being reduced, even as the plan threatened to cripple employers and the state, and will cost taxpayers more than $300 million this year to keep solvent. BCBSNC saw profits of $186 million last year. In fact, in order to receive affordable health coverage, participation in preventive wellness is increasingly becoming mandatory, but not because it’s been proven to save medical costs or to be effective. According to the database on health plans kept by AthenaHealth, which manages electronic medical records and billing for more than 19,500 medical providers nationwide, BCBSNC sent out 250,000 reminders to customers last year who hadn’t complied with preventive health screenings.

While the State-provided health management comes with preventive wellness care, “free” health risk assessments and health “coaches,” and “free” case management — should recipients actually need medical care, that will cost them… increasingly more. Free isn’t really free. BCBSNC plan participants already have more out-of-pocket costs for medical expenses (12.1%) than any other major health plan in the state — 68% more than United, 60% more than Humana, 50% more than Aetna and 29% more than Cigna. This most hurts those who have real medical needs, especially older workers and those of lower socio-economic class and certain hereditary predispositions. The discriminatory aspects of preventive wellness mandates and the healthy lifestyle movement is the elephant in the room.

It is also yet to be seen if the State Health Plan will survive legal challenges for violating the Final Rules of the HIPAA, Nondiscrimination and Wellness Programs in Health Coverage in the Group Market. As ruled by the Department of Labor, these laws prohibit discrimination of employees in employee wellness programs based on hereditary features and health indices (measurements). It had also ruled that discrimination exemptions for wellness programs referred only to supplemental coverages and could not be those that are part of the primary health coverage.

Without an understanding of sound science, “for your health” can make discrimination seem acceptable … until it comes for you. Your boss will weigh you now.

© 2009 Sandy Szwarc

* North Carolina Workplace Wellness Privacy and Terms:

…The information we collect falls into two categories: (1) user-provided personal information such as information that you provide to us when you register to use our Web site, and (2) certain anonymous information that we collect as you navigate through the WorkplaceWellnessNC.com pages. You also provide personal information when choosing to participate in various activities on WorkplaceWellnessNC.com such as uploading videos, photos, posting messages on our site, entering contests or sweepstakes, taking advantage of promotions, responding to surveys, or subscribing to newsletters or other mailing lists… Once you register with WorkplaceWellnessNC.com and sign in to our site, you are not anonymous to us…

Please keep in mind that whenever you voluntarily make your personal information available for viewing by third parties on our site - for example, in a post, comment, classified ad, event listing or Yellow Pages review, or on other areas of our site - that information can be seen, collected and used by anyone who visits the site…

We may disclose your personal information to trusted partners who work on behalf of WorkplaceWellnessNC.com under confidentiality agreements. These companies may use your personal information to help us serve you…

We may disclose your personal information to conform to legal requirements or to respond to a subpoena, search warrant or other legal process received by WorkplaceWellnessNC.com, whether or not a response is required by applicable law.

We may disclose your personal information to enforce our WorkplaceWellnessNC.com Terms of Use Agreement, or to protect the rights, property or safety of members of the WorkplaceWellnessNC.com community, other visitors to our site, our advertisers and other customers, the public, or WorkplaceWellnessNC.com and its employees

As our business grows, we may buy or sell various assets. In the event that WorkplaceWellnessNC.com or some or all of our assets are acquired by another company, information about our users may be among the transferred assets…

No warranties: you agree that use of the workplacewellnessnc.com website and any material or information available through this site is entirely at your own risk. This site is provided by BCBSNC on an "as is" and "as available" basis. BCBSNC makes no representations or warranties of any kind, express or implied, as to the operation of this site or the accuracy, completeness, currentness, noninfringement, merchantability or fitness for a particular purpose of the information available through this site, nor do we guarantee that the site will be error-free, continuously available, or free of viruses or other harmful components… Indemnification by you: you agree to indemnify and hold harmless BCBSNC, its affiliates, agents, employees, representatives and licensors against any liability of any nature arising out of any content posted on the workplacewellnessnc.com site by you or by others…

Click here for complete article (and single page version).

Who will speak out for you?

Two New Mexico nurses have paid a heavy price for following their consciences and the basic tenet of the nurse’s Code of Ethics — the ethical duty to protect and advocate for the rights, health and safety of patients. After unsuccessfully going up the chain of command at the Winkler County Memorial Hospital, a small West Texas hospital in Kermit, Texas, they made an anonymous report to the Texas Medical Board with concerns about a doctor selling his own sham herbal remedies to patients in the hospital’s emergency department and at a health clinic.

When the Texas Medical Board contacted the doctor to investigate him for poor quality of care, the doctor went to the Winkler County Sheriff who left no stone unturned to learn the identity of the nurses, including accessing confidential patient records and issuing a search warrant to seize their work computers. The whistle blower nurses were fired from their jobs, imprisoned and criminally prosecuted, and later let out on $5,000 bonds. They will finally face a jury trial next week for third-degree felony charges, carrying potential penalties of two-to-ten years’ imprisonment and maximum fines of $10,000.

Experienced nurses, whose only “crime” was to report to the appropriate medical agency something they felt was medically unsound and unethical, were imprisoned, their livelihoods taken, and criminally prosecuted.

In America.

The Court case

The court documents and exhibits (available in Plaintiff’s original complaint here), describe what has been described in an editorial published in the Austin American Statesmen as “a stunning display of good ol' boy idiocy and abuse of prosecutorial discretion.” The registered nurses, Ann Mitchell and Vickilyn Galle, had each been employed by the hospital for about two decades with good work histories. They were co-medical staff coordinators who worked in its quality improvement and utilization management department. Their responsibilities included credentialing physicians and reviewing patient quality issues and following patients throughout their hospital stay to ensure compliance with state and federal regulations.

Dr. Rolando Arafiles, Jr., M.D., had been hired by the hospital in April 2008 and at the time of hire was still subject to a three-year order by the Texas Medical Board prohibiting him from supervising or delegating prescription writing. Since then, two physicians at the hospital, and emergency room and clinic staff, had presented to the hospital’s administrator and Board of Control concerns about his standard of care and performance of medical procedures, but no action was ever taken. When the hospital’s chief of staff had requested a meeting with the doctor and hospital administrator and the nurses, the hospital administrator cancelled three meetings in a row and Dr. Arafiles was granted privileges. After three months of efforts, the chief of staff was able to present his concerns to the hospital board which included documentation and case reviews.

Finally, the nurses, believing they had an ethical and legal duty to report to licensing boards care that they had reasonable cause to believe exposed a patient to substantial risk of harm, filed an anonymous report to the Board with concerns about Dr. Arafiles selling herbal remedies that were not in the hospital formulary to patients. Afraid that if they signed their names the administrator would fire them, their letter was anonymous.

On April 15, 2009, the Texas Medical Board sent a letter to Dr. Arafiles, informing him that it had received a complaint and was investigating complains of quality of care and non-therapeutic prescribing or treatment and directed him to respond. The doctor took it to the Winkler County Sheriff, Robert Roberts.

Sheriff Roberts and Dr. Arafiles were business associates in an herbal supplement business, according to the court documents.

Sheriff Roberts sent the Texas Medical Board a letter requesting a copy of the complaint, stating he was conducting a criminal investigation of the complainants for the offenses of misuse of official information and harassment of the doctor. He then began an investigation and personally contacted every patient in the letter from the Texas Medical Board, trying to learn the identity of the nurses. When that didn’t work, he learned from their letter to the Texas Medical Board that they were female, over 50 years of age and had worked at the hospital since the 1980s, which helped him narrow down his search. On May 19^th, a search warrant was issued for their work computers and their computers were seized and the letter was found. The nurses were then fired on June 1^st by the hospital administrator for reporting a patient safety issue to the licensing authority. Not because of any unsatisfactory job performance.

By June 11^th, the nurses had been indicted for third degree felonies, charged with “misuse of official information,” with Sheriff Roberts as the only witness to the Grand Jury

Mari Robinson, Executive Director for the Texas Medical Board, sent a letter to the attorneys on June 17^th stating that all information provided to the Board was confidential and not subject to subpoena or other means of legal compulsion for release to anyone other than the Board and that the Board depends on reports from healthcare professionals to carry out its duty of protecting the public from improper practitioners. The Board supported the nurses in sharing chart numbers of patients to verify their concerns, stating that the Board is exempt from HIPAA and has the statutory access to hospital records and releasing any such information is not in violation of any laws. They also stated that the legal protections of the nurses and those who provide information to the Board, according to the Medical Practice Act under which the board is statutorily mandated, were being violated. She added:

It is our understanding that, as a result of your actions, the nurses who you allege provided information to the Board have been fired from their jobs at the hospital, have been indicted, been required to hire counsel, and each had to pay $5,000 bond. This action undertaken by your office has adversely impacted the Board’s investigation by its peace officers in this case. Further, it has potentially created a significant chilling effect on the cooperation of any other hospital personnel who might have been able to provide additional information needed by the Board in the completion of its investigation. This is of grave concern to the Board in its implications for this case, as well as other cases…

As part of its investigation of the complaint involving the licensee physician in question, a relevant inquiry will be whether that physician engaged in any activity that was designed to intimidate witnesses or complainants. Such activity is a violation of the Act and constitutes unprofessional and dishonorable conduct…

Ann and Vicky are fighting back and filed suit in federal court alleging they’ve been victims of retaliation for advocating for patients, as well as for violations of their civil rights and due process.

Why’d they do it?

While the court documents give a glimpse of the legal and professional nightmare these nurses have been enduring this year, they don’t reveal what was so troubling to them in the first place and what was going on at the hospital that they felt compelled to speak out. The media stories have glossed over that.

The court documents made passing reference to a prior disciplinary action against the doctor by the Texas Medical Board. The full story is on the Texas Medical Board’s website. Dr. Arafiles, who had received his medical degree from the University of the East, Quezon City in the Philippines in 1977, had been disciplined by the state licensing Board in April 2007. While working as a contracting supervising physician at a weight loss clinic, for months Dr. Arafiles had signed off on the prescriptions written by his physician assistant. The clinic protocol called for use of phentermine for obesity, even in patients whose BMI was under 30, as well as use of diuretics for potential side effects of hypertension, even in patients who weren’t experiencing hypertension or edema. The Board found that Dr. Arafiles had only reviewed his physician assistant’s files and was present at the clinic about 5% of the time the clinic was open, rather than the required supervision of his delegate a minimum of 20%. The Texas Medical Board took disciplinary action against Dr. Arafiles based on “unprofessional or dishonorable conduct that is likely to deceive, defraud or injure the public… because he, acting through his delegate, failed to practice medicine in acceptable professional manner consistent with public health and welfare.” He was prohibited from supervising physician assistants or nurse practitioners, assessed a $1,000 penalty, and made to complete continuing education on medical ethics, medical records and the treatment of obesity.

The nurses’ complaint expressed concern about his selling alternative herbal remedies to patients in the emergency department and a rural health clinic, but it’s easy to get a better understanding of the full extent of his medical practice that troubled them enough to speak out. Here are a couple of publicly-available examples:

Biotherapy. The February 17, 2000 issue of the Victoria Advocate advertised an Alzheimer’s Disease Support Group meeting presented by Dr. Arafiles, discussing nutritional therapy, screening for Alzheimer’s and dementia and offered a “biological terrain assessment.” He was the medical director at the BioTherapy Clinics of Texas, an alternative mind-body clinic offering “Immune System Restoration,” as well as ultra-darkfield microscopy, acupuncture, bio-terrain analysis, chiropractic, energy management, deep tissue massage, emotional therapy, bodywork, colonics, lymphatic drainage, hormone testing, nutritional and diet counseling , magnetic therapy, food allergy testing, human performance, metabolic programs, weight management, genetic marker testing, dendritic cell therapy, biologic response modifier concepts and more.

Alkaline-reduced water. Describing himself as the medical director of Texas Innovative Health Options and Wellness Center, he endorsed a water “alkanizer,” writing:

I know that you realize that unless we conscientiously find ways to protect ourselves from the barrage of xenobiotics in our food, environment, air and other aspects of life then we begine [sic] to lose whatever is healthy in our body. It is no secret today that the three leading causes of premature aging or degeneration are the uncontrolled activity of free radicals in the body, chronic dehydration and a chronic cellular acidity. I still am amused at the looks I see on my patient's face when I tell them that drinking 6~8 glasses of water may solve 50% of some of their ailments. You can thumb through the hundreds of peer-viewed medical literature and find that free radicals and its deleterious effects on the body are well documented. The acidic cellular pH is also now recognized as a hot bed too.

I would not have enough space to mention all the thousands of diseases but one in particular is cancer. Cancer thrives in an acid environment and changing that pH to neutral 6.5~7 may be one of the ways to inhibit cancer growth and/or even make it susceptible to the natural killer cells of the immune system. Fortunately the water from an Alkalizer™ covers these three causes.

I have been sharing this information with my patients. I have made the alkaline reduced water available in my office and treatment rooms… I personally have been blessed by drinking alkaline reduced water. I have reduced the number of supplements that I take. My allergies are less frequent. I have maintained my waist size at 34 inches since I dropped from 38 inches.

Keep up with the good work. together with the rest of health professionals that believe in the use of natural options to health we will keep touching more lives and helping people attain the quality of life they choose.

The website for the alkanizer claims that ionization makes water more hydrating, that its electrons make free radicals harmless, that drinking alkaline water will help flush the acidity and toxins out of your body, and that alkaline water balances today’s acidic diet and lifestyle and enable the body to heal naturally. Purportedly, the more alkalized water you drink, the healthier you’ll be. Among the numerous benefits of alkaline water claimed, are for treating:

Blood pressure

Osteoporosis

Constipation

Migraines

Urea stones

Faster healing

Acne

Fibromyalgia

Low energy/sluggishness

Morning sickness

Blood circulation

Diarhhea [sic]

Muscle aches after exercise

Water retention

Obesity

Acid reflux / heartburn

Arthritis

Nausea

Hyper-acidity

Colds

Hangovers

Body odor

Chronic fatigue

Cholesterol

Cancer

Stress

As covered at JFS repeatedly, all of this — ionized alkaline water, the need to drink lots of water for health, weight control or to flush toxins from the body and detox — is pseudoscience and quackery. You can learn more water pseudoscience at Dr. Stephen Lower’s H2O.con. The science on the other alternative modalities in his biotherapies can be researched by following the JFS links above and using the Google search tool on the right hand side bar of JFS. It is easy to understand why experienced medical professionals and these nurses might have been so concerned about the supplements and goodness knows what else patients in the emergency room were being sold.

Consequences

Medical professionals, especially nurses who are generally lower on the food chain, so to speak, are increasingly reticent to speak out when they see unsound, unethical or corrupt things going on in healthcare. It is hard to do the right thing. They know and see the consequences of following their consciences and the Code of ethics. This is not an isolated incident. Three California nurses were suspended after they reported a doctor who later admitted giving a lethal injection to a child and another nurse was threatened with firing after refusing to follow a doctor’s verbal order to administer morphine until a patient stopped breathing. A California nurse was threatened with firing for reporting unsafe patient care practices. A registered nurse in San Antonio was fired when she voiced concerns about unsafe staffing at a dialysis center. A San Antonio hospital posted a notice to employees that anyone who went outside the hospital with a report of unsafe or unethical practices violated the state’s “Safe Harbor Law” and would face discipline and even termination. This “violates the basic premise of whistle-blower laws — to free up an individual from the internal politics of the workplace,” wrote Linda R. Srungaram, RN, an experienced emergency room nurse.

Ann and Vicky courageously did the right thing and had the expertise to understand how patients could be harmed. Yet, they only came up against the interests of a single doctor. What do you think happens to nurses who might dare to report something unethical or corrupt that affects entire institutions, comes up against well-funded drug companies or counters powerful political interests?

If nurses following their professional ethics and good consciences are prosecuted for speaking out on behalf of patients, how many nurses will avert their eyes and shut their mouths when they see unsafe, unsound or unethical patient care or corruption, for fear of being hauled off on criminal charges?

All nurses and healthcare professionals will be watching what happens to these nurses in court next week.

But so should each of us.

© 2009 Sandy Szwarc

Click here for complete article (and single page version).

How some food can make us sick

Do you have friends who say that they feel physically sick and develop headaches, heart palpitations, nausea and dizziness when they eat sugar or anything with high fructose corn syrup? Do you know others who report feeling tired, bloated and nauseous when they eat meat or saturated fats, especially fatty meats processed with nitrates? Do you know people who say that they feel less energetic or alert when they eat processed foods or who feel nervous, shaky and irritable when they drink something with an artificial sweetener in it? Do you know people who develop rashes and congestion when they eat or drink various foods or who feel depressed and fatigued when they eat refined white flour or carbohydrates?

A reader recently wrote puzzled about a strange phenomenon she was seeing among a large and growing number of healthy, nondiabetic young women. They complain of feeling jittery, dizzy and sick the rest of the day after consuming “too much sugar,” she said. When she pins them down, they define “too much sugar” as the amount in a scoop of ice cream or can of soda — yet they say they have to “detox for a week because of ‘all that sugar’,” she wrote. “Detox … from sugar?” They’ve become so afraid of sugar that if they enjoy even the smallest treat, it ruins their entire day, she lamented. “What is going on here? Are all of these people losing their minds because of the hysteria they’re being whipped into? Could you shine a sane light onto this sucrophobia?”

There is a name for the ill health effects reported associated with our modern diet.

It’s called the nocebo effect and it’s far more widespread than many people realize.

Nocebo

The nocebo effect is negative stepsister of the placebo effect, where we feel good after eating foods, taking a remedy or doing something we believe is healthy.

With the nocebo effect, people can experience real and extraordinary physical and mental symptoms of illness, even paralysis, when they believe they’ve eaten or been exposed to something they think or fear could be harmful. The nocebo effect is behind most fears of unseen dangers lurking around us, especially in our food, and explains how people can sincerely believe that something is making them sick … even when there is no biological basis for their symptoms. When we’re told, or know, there is no scientific basis for what we’re experiencing, it’s still hard to believe that our minds can be that powerful.

Psychologists have cautioned that public health and nutrition information, or simply reading about scary diseases, triggers the nocebo effect. The growing trend to issue precautionary advice concerning health risks, even when there is no evidence for any credible risk to people’s health, can also feed the nocebo effect. Fears are not benign and the nocebo effect can have real and harmful effects and there are growing examples in the medical literature.

Dr. Nicholas Christakis, M.D., Ph.D., MPH, professor of medical sociology at Harvard Medical School, described the phenomena where healthy people develop anxiety about a perceived danger, then, being around others who are anxious, serves to heighten one’s own sense of fear. In other words, fear is contagious. “Mass hysteria,” also called “mass psychosomatic reaction” or “mass sociogenic illness,” is an epidemic of physical symptoms without biological basis that spread through a group of people, often young women, who share beliefs about their fears and symptoms. The Canadian Medical Association Journal noted that these events are common. Besides disrupting lives and communities, they can also place enormous burdens on emergency and public health services to care for people suffering from a mass psychosomatic reaction.

The preventive health movement, concerns over health risk factors, and being inundated by health information and health warnings has not only changed our entire concept of what it means to be healthy, it is transforming us into a nation of worried well. Although we have the greatest supply of nourishing food and we’re healthier and freer from serious illnesses than ever before, we’re more worried than ever about our health. Even benign aches and pains and symptoms that are part of normal human experience can be misinterpreted as signs of something wrong. The nocebo effects of healthism costs all of us, too. The worried well account for one-third of all primary care visits and incur healthcare costs 14 times higher than average.

Nocebo means “I will harm,” Jack Dini wrote in the Hawaiian Reporter last week. His article, “The Nocebo Effect — Think Sick and You’ll Be Sick,” gave a fascinating list of examples of nocebo. For example:

● In a study in the early 1980s, 34 college students were told an electric current would be passed through their heads, and the researchers warned that the experience could cause a headache. Though not a single volt of current was used, more than two-thirds of the students reported headaches.

● Drinking water fluoridation was first introduced in Grand Rapids, Michigan in 1945. Calls began coming in to city offices from people complaining of sore gums and peeling tooth enamel. One woman even claimed that all her teeth had fallen out. These calls arrived in early January, when some press reports had stated that fluoridation would begin, but some weeks before the actual advent of fluoridation on January 25.

● Call it fear of spraying. In one study researchers spewed distilled water from planes over residential neighborhoods without telling anyone what the spray contained. The intent was to gauge public phobia of chemicals. Sure enough, the experimenters were soon deluged with complaints from frightened folks who claimed the spray was causing cows to abort, dogs to shed and children to get sick…

● A Paris household blamed three installed cell phone antennas in their area for causing headaches, nosebleeds and a metallic taste in the mouths of some residents. The one problem with this complaint—the antennas were never activated.

Nocebo and healthy eating

Most troubling is how nocebo is used on unsuspecting consumers. The nocebo effect is not only well recognized in medicine and science research, it’s well-recognized by marketing professionals. Nocebo is why fear has become the most widely used political and marketing technique, especially when it comes to food and health. Fear sells. This natural human phenomenon has been the bread-and-butter for proponents of various alternative diets and nostrums over the decades.

Sadly, it’s hard for people to differentiate fear-based marketing from science and to see how the effects of nocebo and placebo have influenced what they’ve come to believe is food that is healthy and unhealthy for them. Nocebo-driven fears hurt people’s health and well-being, leave them less able to enjoy foods, and cost them normal relationships with food.

While there is no sound evidence that any food is actually harmful (excluding, of course, rotted, germ-ridden foods and people with severe allergies or rare metabolic disorders), from the age of two, people are being scared into believing that they’ll develop cancer or another chronic disease, get fat, and die prematurely if they eat “unhealthy” foods or are exposed to ‘chemicals’.

One of the most troubling and powerful examples of the use of the nocebo effect is in a food curriculum for elementary children across the country to scare them into believing that conventionally-grown foods, animal products, fats, sugars and processed foods poison their bodies and will give them cancer, heart disease and dementia, and cause them to be fat, have acne and deviant behaviors, and make them feel less energetic or able to learn.

What may be surprising is that these unsupported nocebo/placebo dietary tenets — such as metabolic typing, enzyme, healthy, macrobiotic or intuitive eating — are not really new. They resurface every generation, different renditions of the same basic fears, with new names and twists. And each new generation is largely unaware that these alternative beliefs are not grounded in science and have failed to hold up in clinical research time and again.

These tenets have in common the belief that chronic degenerative diseases of aging, such as cancers, type 2 diabetes and heart disease, are caused by unhealthy diets or processed foods and a build-up of toxins. Conversely, they hold that chronic diseases can be prevented and optimal wellness achieved by all-natural diets rich in antioxidants, “healthy” fats and fiber; whole foods made without added sugars, salts or preservatives; and flushing toxins from the body by drinking lots of water or detoxification.

Nocebo is also behind beliefs that each person should eat “in tune with their body and how foods make them feel.” The belief is that every body has different dietary needs for optimal health, maximum energy and mental clarity; to naturally control food cravings and maintain a healthy weight, strengthen immunity and slow down the aging process. The restrictive eating encouraged by the nocebo avoidance effects of ‘unhealthy’ foods are also weight loss techniques, and not surprisingly, eating intuitively is most intensely marketed to people concerned about their weight.

These nostrums, remember, have not been supported in scientific research. They are correct about one thing, though: there is no “one size fit all” diet. But that’s only because eating a certain way doesn’t matter as much as many think. People around the world have a wide range of diets with no consistent relationships to health or lifespans.The most common cause of poor nutrition and deficiencies isn’t eating “bad” foods, but eating too few calories and trying to restrict eating.

The origin of beliefs of diet and degenerative disease date back at least to the 1920s and 30s when a couple of dentists theorized that the “modern” diets of more developed countries were associated with degenerative diseases — diseases that were seldom seen among under developed regions of the world. Their theories have repeatedly failed to hold up to scientific scrutiny, however, which has noted they’d failed to account for the fact that people in more industrialized countries live longer and have different hereditary characteristics. Poor people in remote underdeveloped countries don’t live long enough to get degenerative diseases of aging.

By the 1950s, theories that eating according to one’s individual autonomic nervous system balance gave way to Dr. Roger Williams’ theory of optimal diets according to “biochemical individuality” and metabolic profiles. Another dentist, Dr. William D. Kelley, originated the metabolic typing diet by the 1960s. His assistant, William L. Wolcott, continued to develop metabolic typing in the 1980s, which promoted that every person had unique dietary requirements according to their metabolic type.

Through the use of questionnaires and other suggestive techniques, people are guided to think about how certain foods make them feel when they eat them, and to believe that this is their body telling them what they should eat. (Based on the answers to their “metabolic typing” profile, for example, people are divided into protein types, carbo types or mixed types, and told what type of personalities they have, their food cravings and what foods they should avoid and what foods are supposed to be best for them.) Invariably, of course, what foods their body is telling them they should eat is always ‘healthy’, based on the same underlying fears of modern diets as causing degenerative diseases and weight gain.

One holistic health counselor of “integrative nutrition” describes what can be learned by getting in touch with how your body feels when you eat certain foods and eating intuitively. Based on Wolcott’s 60 questions, carbo types, for instance, are described as characteristically having a “weaker appetite, higher tolerance for sweets, type A personalities, caffeine dependency” and should avoid foods high in fat (and use oils sparingly), heavy proteins, caffeine, sugar and “thyroid suppressing foods.” They are encouraged to eat whole grains, fruits and vegetables. For protein, they can eat “sustainable seafood, lighter chicken and turkey meats, pasture-raised eggs, low-fat dairy (if tolerated), tempeh, tofu and beans.” To feel more energetic and alert all day, she also advises drinking more water. “I don’t mean some water — I mean a lot of water. Eight 12 ounce glasses a day at least” to keep your system “healthier and better flushed.” And eat more fiber for more energy, she says, to lose that heavy feeling from food not processed effectively.

Nocebo and health frauds

These unsound dietary beliefs become even more dangerous when they become unsupported clinical guidelines or public health policies to prevent diseases. Or worse, when they’re used in treatments.

Kelley’s diet became part of a treatment regimen for cancer, as outlined in his Newsletter on Cancer Remedies in 1980. Kelley was convicted of practicing medicine without a license in 1970 and had his dental license suspended for five years in 1976, reported Dr. Saul Green, Ph.D., former professor of biochemistry at Sloane-Kettering Cancer Institute and a board member of the National Council Against Health Fraud. Still, Kelley continued to promote his methods through his “International Health Institute” in Dallas, where “certified metabolic technicians” administered his metabolic typing questionnaires and produced long computerized instructions for diets and supplements, detoxification and healthy lifestyle changes.

Kelley’s regimen was duplicated in the cancer regimen of Dr. Nicholas Gonzales, M.D., who has been found guilty of professional negligence and incompetence more than once. Proponents of the Kelly and Gonzalez regimen believe that toxins from sources such as processed foods and environmental pollution are responsible for human cancers, according to the National Cancer Institute. "If these toxins could be neutralized and eliminated from the body, proponents believe, both early and established cancers would be halted, and general health would be restored."

As Dr. Green explained, Kelley’s and Gonzales’ regimen was based on the discredited theory that cancer is caused by the growth of ectopic germ cells in the wrong place and a lack of digesting enzymes. Kelley invented a Malignancy Index based on a patient’s “metabolic classification as a sympathetic dominant, parasympathetic dominant or a balanced metabolizer,” and his cancer treatment was supposed to clear the body of toxins. Concerning his diet, wrote Dr. Green:

Kelley initially proposed a strict vegetarian diet, but later advocated that diet must be tailored to each patient's need. He developed ten basic diets with 95 variations. These ranged from pure vegetarian to exclusively meat. The diets forbade processed foods, pesticide residues, milk, soy beans, peanuts, food concentrates, white sugar and white rice. It allowed almonds, low protein grains and nuts, yogurt, "organic" raw vegetable and fruit juices, salads and whole grain cereals….

Kelley/Gonzalez diets are not unique and have been referred to variously as nutritional, enzyme, metabolic, holistic, macrobiotic, nontoxic and oxidative. Advocates of these diets also recommend "all natural foods" grown without pesticides or chemical fertilizers, and prepared without added sugar, salt, artificial coloring or preservatives. They also recommend large vitamin doses, mineral and glandular supplements and amino acids.

But no one has ever identified those supposed toxins in processed foods, said Dr. Green. Such beliefs are not grounded in science, but from fears of unseen and misunderstood chemicals. Nor has any credible evidence ever surfaced that they poison the body and lead to cancer, or that pancreatic enzyme deficiency is related to cancer, or that enzymes supplied from animal or vegetable sources can replace human enzymes, or that pancreatic enzymes seek out and kill cancer cells. Nor have Kelly or Gonzales every produced evidence that their regimens are more effective than placebo for cancer, he said. In fact, their claims are biologically implausible.

Memorial Sloan-Kettering Cancer Center has cautioned that nutritional metabolic therapies — such as Kelley’s metabolic typing based on claims that a “healthy natural diet” of whole foods, fresh fruits and vegetables, vitamins and detoxification practices to flush toxins from the body can help the body heal naturally — show no evidence of efficacy. They can, however, cause life-threatening complications while deterring people from seeking medical care that can help them.

National Center for Complementary and Alternative Medicine (NCCAM) actually put Gonzales’ pancreatic proteolytic enzyme treatment to the test in a clinical trial begun in November, 1999 at the Herbert Irving Comprehensive Cancer Center at Columbia University in New York. Because most patients refused randomization, the trial was changed in 2001 to a controlled, observational study with participants allowed to volunteer for the regimen. The results were just published in the Journal of Clinical Oncology and reported that those on the Gonzales enzyme regimen did considerably worse than those receiving chemotherapy, living one-third as long and with poorer quality of life. Even more troubling, the patients did worse than average patients with pancreatic cancer in the SEER Database. Regardless of the weaknesses in this study, the bottom line is that the dietary interventions were unable to demonstrate any benefits.

There have been a string of null studies recently published that disprove (again) many popular beliefs about healthful eating in tune with one’s body’s natural healing and that prevents degenerative diseases of aging. Since the media has largely ignored them, upcoming posts will take a look.

© 2009 Sandy Szwarc

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The man who fed the world

You can't build a peaceful world on empty stomachs and human misery. — Dr. Norman Ernest Borlaug (1914-2009)

One man is credited with saving more lives than any other person in world history. Born to Norwegian migrant parents in his grandparent’s Iowa farmhouse, Dr. Norman Ernest Borlaug grew up during the Great Depression and the hunger he witnessed had a profound effect on him.

He devoted his life to ending the human misery of famine in destitute third world countries, often living and working in harsh, squalid conditions in remote regions of Mexico to Africa. He also understood that large numbers of miserable, hungry people contributes to world instability. He didn’t seek fame and fortune for himself, and few people outside of the scientific field have even heard of him.

Through his pioneering scientific work in plant pathology, developing fungus and disease-resistant crops, drought-resistant farming methods, and increasing crop yields, he saved an estimated one billion people from starvation. As the father of the Green Revolution, through this work, world food production doubled between 1960 and 1990, and quadrupled in India and Pakistan. He continued his work on world hunger well into his 90s and won the Nobel Peace Prize, the Presidential Medal of Freedom and the Congressional Gold Medal.

Dr. Borlaug died tonight at the age of 95. He embodied kindness, compassion, and a conviction to save the lives of fellow human beings, regardless of their race, creed and religion. No other man in human history can compare to his legacy of service to mankind.

“He made the world a better place,” said close friend Dr. Ed Runge, retired head of Texas A&M University's Department of Soil and Crop Sciences. "A much better place."

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A Day to Remember — September 11, 2001

America Attacked 911

Dedicated to the men, women and children who lost their lives, those brave people who gave their lives, and the heroes who responded to the emergency 11 September 2001. We will never forget you.

911 Phone Calls

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Reality check — How have scary predictions about swine flu held up to reality?

The flu season is winding down in Australia, where their winter is nearing end. How did the expert claims, speculations and predictions of the deadly pandemic hold up to the facts?

Three months ago, public health experts and even the President of the Australian Medical Association were warning that one-third of the population would get swine flu. As late as last month, the Australian government had ordered 21 million doses of swine flu vaccine, enough to vaccinate the entire population.

In reality, as of noon today, the Australian Department of Health and Ageing reports that Australia has had 35,775 confirmed cases of pandemic H1N1. The experts had overstated the numbers who would get sick by 203-fold. There have been 162 deaths — a fraction (5.4%) of the 3,000 Australians who typically die from the seasonal flu each year.

It’s a similar story here in the United States. In July, we were hearing projections that as many as 40 percent of Americans could come down with the flu over the next two years and several hundred thousand could die. The government ordered 160 million doses of vaccine.

In reality, the pandemic H1N1 variant has proven to remain far less virulent (to be milder) than the seasonal flu here, just it's been in Australia. As of last week, according to the U.S. Centers of Disease Control and Prevention data, the total number of influenza-related deaths in the United States — including from the H1N1 pandemic — have remained below epidemic levels and resulted in 2009 being the mildest flu year in more than a decade.

Despite perceptions among the public and portrayals in the media of extreme risks, medical professionals recognize that, while the H1N1 flu may spread easily, it causes a relatively mild flu in most people and there is no evidence that is has or is likely to mutate and become deadlier. “If we have to have influenza, I would clearly choose novel H1N1,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University, just told the Wall Street Journal.

Fear Sells

The facts make the latest FDA and FTC consumer warnings about fraudulent H1N1 flu products on the market attempting to take advantage of people’s fears even more tragic.

Since May, when a H1N1 pandemic was declared, the U.S. Food and Drug Administration and the Federal Trade Commission have issued consumer warnings about fraudulent products being marketed claiming to diagnose, prevent, treat or cure H1N1 virus that are not approved, cleared or authorized by the FDA.

Yesterday, the FTC announced that CVS Pharmacy, Inc. has agreed to stop making false and deceptive advertising claims that its AirShield supplement boosts the immune system and can prevent colds and flu and to pay nearly $2.8 million.

On Monday, the FDA issued its latest list of 133 H1N1 products believed to be fraudulent and of criminal activity associated with the swine flu virus The list of fraudulent products include air purifying systems, body washes and shampoos, protective devices, masks and gloves, hand sanitizers and gels, inhaler products, herbal flu remedies, sprays, supplements and teas, and H1N1 tests.

Rather than let fears get the better of us and spend gobs of money and believe that spurious products are keeping us safe, the most effective thing we can all do to help protect from getting sick is use plain old-fashioned common sense and soap and water. Wash our hands. Not nearly as glamorous, but a whole lot more effective.

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Look before we LEAP again

Clinical guidelines are used to measure the quality of care provided by physicians and are purportedly evidence-based. National childhood overweight and obesity policies in the United States, United Kingdom and Australia call for primary care physicians and pediatricians to monitor children’s BMIs and to counsel youngsters with BMIs ≥85^th percentile and their families on diet, physical activity, sedentary behaviors and adopting healthy lifestyles.

“Evidence supporting such an approach in primary care, however, is conspicuously lacking,” said pediatrician Dr. Melissa Wade M.D., associate director of the Centre for Community Child Health at the Royal Children’s Hospital and the Murdoch Children’s Research Institute in Melbourne, Australia, and colleagues.

To determine the effectiveness of screening and counseling for child overweight and obesity, a second Live, Eat and Play (LEAP) randomized controlled trial was launched. The long-awaited results were just published in the British Medical Journal.

As readers will remember, the first LEAP trial had been conducted at 29 Melbourne medical clinics and involved 3 months of interventions by primary care physicians to teach overweight children and their families healthy lifestyle changes, with 12 months of follow-up. The doctor-based weight management program failed to make any sustained changes in the larger children’s BMIs, failed to change obesity rates, and failed to make any difference in the children’s health status compared to the control group. Thinking a larger study, more training for the doctors and more intense interventions might be able to demonstrate a benefit, LEAP 2 was begun. This larger study began in May 2005 and was due to be completed in September 2007.

Overview of LEAP 2

This trial (registered ISRCTN 52511065), included 45 family practices and 66 general practitioners in Melbourne. From May 2005 through July 2006, nearly 4,000 children, aged 5 to 10 (average 7.5 years old), were screened and 258 who were overweight or obese, according to the International Obesity Taskforce definitions, were enrolled into the study. They were independently randomized, with 139 in the intervention group and 119 in the control group, and were well matched by every measure evaluated. The study investigators remained blinded to who was participating in the study, and the physicians were blinded to the children among their large patient base in the control group. The physicians received training on weight management counseling, which included five hours of instructions, role modeling scenarios and two simulated counseling session, and only those with high scores were allowed to participate.

The children and their families received targeted information on healthy behavioral changes (reducing sedentary time, increasing physical activity, increasing water consumption, improving family eating habits and making low-fat food selections) and agreed to change contracts. For three months, the parents were offered four physician consultations which reinforced family-focused healthy weight, diet and lifestyles changes, with an average of one counseling per month attended.

The family’s socioeconomic status was quantified using the Australian census based Index of Relative Socio-economic Disadvantage score, and the parents BMIs were followed. The parents completed 4-day food diaries on the children, and completed questionnaires on their physical activity and weight concerns. The children’s health status was followed by their pediatricians and graded on 23 quality measures; their weights, heights, waists and activity levels (measured by accelerometry) were followed at six and 12 months; and the children completed questionnaires to evaluate their body dissatisfaction, perceived physical appearance and self worth.

Findings

There was no statistical difference between the intervention and control groups after 6 months or after 12 months in the:

● children’s BMI

● children’s waist circumference

● either parents’ BMIs

● children’s physical activity (counts/minute on accelerometry) or percentage of time spent moderately to vigorously active or percentage of time spent in low activity

● children’s diets

● children’s physical or psychosocial health scores

● children’s degree of body dissatisfaction

● children’s positive/negative feelings about their appearance or self worth

There was no statistical difference in outcomes among children whose parents attended all the consultations and those who attended fewer. There was no statistical differences based on socioeconomic status. Healthcare costs were significantly higher in the intervention group, based on the costs of adhering to the intervention guidelines.

The sample size and consistent follow-up with their doctors for a full year, and the extremely high retention rates (92.8% and 96.6%), enabled the researchers to conclude that there was no clinically meaningful benefit from the diet and activity interventions — as called for in clinical guidelines and public health policies — on the children’s BMI trajectory, physical activity or nutrition.

These findings are at odds with national childhood overweight and obesity policies, including in Australia, UK and the US, the authors concluded. All childhood overweight and obesity policies and guidelines are similar (work to improve diets and increase physical activity) and have similarly been shown to be ineffective. Despite high political appeal, they said, recent systematic reviews of the evidence have been unable to support screening children for overweight or obesity because of the lack of weight management strategies that have demonstrated efficacy and the lack of evidence that benefits outweigh the harms. The authors were unable to find a clinical trial of primary care interventions and screening for child overweight and obesity that had been shown to be effective, as the few trials had all proven to be ineffective in reducing BMI compared to controls.

These findings concur with every other comprehensive intervention trial, including school, state and community based, as well as the findings of the U.S. Preventive Service Task Force, which reviewed nearly 40 years of evidence on screening and interventions for childhood and adolescent overweight — some 6,900 studies and abstracts. The USPSTF had concluded that there is no quality evidence to support that overweight or obesity in youth is related to health outcomes or predicts fitness, blood pressure, body composition or health risks. The USPSTF found insufficient evidence to recommend routine screening for overweight in children and adolescents as a means to improve health outcomes. It did, however, note potential harms of screening programs. According to the USPSTF Childhood Obesity Working Group, no scientific review has been able to find quality evidence that any program to reduce or prevent childhood obesity — no matter how well-intentioned, comprehensive, restrictive, intensive, long in duration, and tackling diet and activity in every possible way — has been effective, especially in any beneficial, sustained way. Nor has any program been able to demonstrate improved health outcomes or physiological measures, such as blood lipids (“cholesterol”), glucose tolerance, blood pressure or physical fitness. Nor has any diet or exercise intervention in children been shown to lead to better health outcomes in adulthood. Not only did the USPSTF find no evidence to support the effectiveness of counseling for healthy eating in young people, it also found no evidence to support low-fat diets in children and, instead, found growing evidence for harm. Politically popular childhood obesity interventions don’t work, of course, because they’re based on false premises about the causes of children’s sizes.

How many more years and how many more times does the evidence have to continue to show the same thing before the public and medical professionals say “enough” and demand evidence-based public health policies and clinical guidelines for our children?

How long before taxpayers begin to hold politicians and stakeholders accountable for the massive amounts of public moneys and resources spent in the name of a childhood obesity epidemic that could have gone towards improving educational opportunities and healthcare for children and families?

© 2009 Sandy Szwarc

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