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Warren J. Dew

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I previously posted on how we in the U.S. could save perhaps half of our health care costs by eliminating useless treatments that are given only because of the urge to "do something":

http://psychohist.livejournal.com/42141.html#cutid1

I still owed a post on the other half of the solution: how to improve health care substantially without significant additional costs. Unfortunately, this is not that post, because I haven't had time to write it yet. However, I can at least provide a couple of tidbits that won't take as long to post.

First, a result on cancer. There was a recent experiment that gave 1179 women aged 55 or over either a placebo, or 1400-1500 mg/d of calcium supplement, or the calcium supplement plus 1100 IU of vitamin D3. Statistically significant results were found only with the group that got vitamin D. How significant? Cancer incidence after the first year was reduced by 77%, with a highly significant P < 0.005.

Unfortunately, there was no group that took the vitamin D only, so we don't really know if the calcium is important here. We also don't know if vitamin D helps prevent cancer in men or in premenopausal women, though there are some indications that it might. Still, 77% of cancers in women 55 and up amounts to 27% of all cancers in the U.S., even without any benefits to any other groups.

The second is an epidemiological study, and so less conclusive, but since it found a factor of two difference rather than the normal single digit percentage differences for a simple macronutrient change, I think it's significant and worth paying attention to. It's again a result on women, and it found that in a group of 32,578 Italian women, the 25% that ate the most carbohydrate were twice as likely to get coronary heart disease - basically, heart attacks - as the 25% of women that ate the least carbohydrate, with P < 0.04. Reducing carbohydrate intake of all women to that of the lowest 25% should reduce heart attacks in women by about a third. Since women suffer about 46% of all coronary heart disease, That amounts to a total population reduction of about 15%.

So, cutting cancer by 27% and heart attacks by 15% - not a bad start, eh? Sorry I have nothing for the men, though.

"Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial"
http://www.ajcn.org/content/85/6/1586.full

Statistics on cancer incidence by sex and age:
http://apps.nccd.cdc.gov/uscs/cancersbyraceandethnicity.aspx

"Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort"
http://archinte.ama-assn.org/cgi/content/abstract/170/7/640

Statistics on coronary heart disease by sex:
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6001a13.htm?s_cid=su6001a13_x

Later post on the topic of vitamin D preventing cancer:
http://psychohist.livejournal.com/67372.html
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Recently a lot of strangers seem to be remarking on how tall Margaret is when they find out she is two. The fact is, though, that Margaret is exactly the average height for girls her age. I've been trying to figure out the reason for this discrepancy. Possibilities are:

(1) "Tall" may be considered a compliment, even for girls. In this case, the people who happen to think Margaret is tall may be saying it, while those who think she's short are keeping their mouths shut.

(2) Margaret may actually be taller than average for this area. Certainly it seems like the younger adults in the Cambridge/Somerville area are shorter than average, so perhaps the toddlers are too.

(3) Margaret looks taller than she really is. In this case, the question is why: does she stand up straighter, does her smile make her look bigger and taller, do her clothes emphasize height?

Probably the most likely is (1), the most boring explanation. It would be more interesting if it were (2) or (3), though.
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I kind of owe an article on how I would cut government health care expenditures in half by improving the efficiency of care. Unfortunately if I write everything I want to write, that article is going to be a long time in coming. So here's a "short" article on why I think a large fraction of all medical expenditures in the U.S. - like about half - are probably waste and could be cut out completely without affecting the quality of care, even with no other improvements in efficiency.

Read more...Collapse )
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Weight gain happens when you eat more calories than you use, right? Not so fast. Here's a really excellent presentation given at the Dartmouth Hitchcock medical center on why that might not be the cause of weight gain, after all:

http://www.dhslides.org/mgr/mgr060509f/f.htm

The speaker, Gary Taubes, is highly entertaining and provides a compelling presentation. It is a 45 minute presentation, though, so you might want an hour or so free before you watch it.

Edit: the above link no longer works. Try this one:

http://video.google.com/videoplay?docid=4362041487661765149
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Some readers may remember coverage of a concept called "caloric restriction" in science journals in the late 1980s. Caloric restriction - restricting the amount of food eaten - had been shown to increase life span almost proportionally in numerous species, from paramecia to mice. Studies were in progress or being started in a variety of other animals.

Yesterday, one of those studies - using rhesus monkeys as a subject, who are considerably more closely related to humans than mice - published their first set of statistically significant results. What they found was that caloric restriction, as compared to free feeding controls, resulted in:

- statistically significant reductions in "age related diseases" such as cancer, heart disease, and diabetes, including complete elimination of diabetes

- statistically significant reduction in mortality from age related diseases 20 years into the study, which had started with adult rhesus monkeys between 7 and 14 years old

- a reduction in total mortality - including causes not related to age, such as death from anesthesia and endometriosis - that is suggestive but not statistically significant at this point in the study.

This is of particular interest to me because I inadvertently practiced caloric restriction until age 35 or so. I'm also trying to get back into it now, as I didn't start having kids until 48 and I'd kind of like to see them have children.

If anyone gets Science magazine and doesn't mind lending the current issue to me so I can see the whole article, I'd appreciate it. In the meantime, there's a summary here:

http://www.sciencedaily.com/releases/2009/07/090709110836.htm
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Our family has been on a diet for the past three months.

It's not the ordinary kind of diet, the kind one is on to try to lose weight. Rather, it resulted from our attempts to eat healthy during Elizabeth's pregnancy and lactation period, because we were kind of single minded in trying to give Margaret the best possible start on life. It's "our" attempts because, although we were specifically interested in the nutrients passing through Elizabeth, I do the cooking and thus most of the dietary planning.

It started with thinking about what nutrients we'd need to build a new baby while preserving Elizabeth's health.Collapse )

In the course of this research, I ran into an interesting diet idea. The idea is this: we should eat what our ancestors ate during the paleolithic period, from roughly 5 million years ago to about 10,000 years ago. Why? Because a significant amount of human evolution, including the parts that differentiated us from the apes - and also, presumably, including evolution involving our diets - happened during those millions of years of hunting and gathering. In contrast, the 10,000 years of neolithic herding and agriculture have not been long enough for us to evolve new genes for that even newer diet; it's barely enough time for us to have had a few gross point mutations.

For someone who believes in evolution, this is a compelling theory. It also dovetails nicely with some of our other findings.Collapse ) So I started using other aspects of the "paleo diet". It's a fairly simple diet.Collapse )

Once we fully shifted to this diet, we noticed some changes beyond a healthy baby. The frequent bouts of painful gas that we'd both been having cleared up, as did Elizabeth's constipation. I felt clearer headed; it seemed easier to concentrate at work. Elizabeth no longer felt hungry during the day, despite being on a 1200 calorie diet - though she's sometimes hungry for dinner if I'm home late and she skips her daily snacks or breakfast. We've both lost unwanted weight.Collapse ) And we both feel like we're eating a lot better than we ever have before, what with the steak, fish, and fresh fruits and vegetables.

There are a few disadvantages. I spend two or three times as much time cooking - maybe 20 minutes for dinner instead of 5-10 before, plus time to prepare Elizabeth's lunches. Typically we need two grocery trips instead of one each week. I'm not sure how much alkaline vegetables we need to prevent bone density loss.

Still, that's a lot better than spending several hours a day gathering and hunting - and risking broken bones in the process - as our real paleolithic ancestors did.
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The UK has government health care. Sometimes, their National Health Service funds IVF. When it does, it usually just funds one cycle. Still, even that one cycle is sometimes successful. A successful cycle means one or more children, which means more health care costs.

The solution? Put in rules that force clinics to transfer fewer embryos - preferably only one. The claimed benefit is that that will reduce the chances of twins, but it will do so mostly by reducing the chances of success at all. Fewer pesky children to deal with means lower health care costs.

Fortunately, the UK now allows people to pay for their own health care if they want more than their national health insurance provides. If people need IVF, it seems fair to ask them to pay for their own, right? Unfortunately, the new rules will apply to clinics across the board - even prospective parents willing to pay for their own IVFs will now have to deal with lower success rates due to government restrictions.

Of course, it could be worse. The system could prohibit people from buying health care outside the government system at all, which is what some people are advocating in the U.S.
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