TALKING about a New Year's Resolution

I like social media.  It's a fun way to stay in contact with friends.  Since I've lived in so many places (and gone through so many years of education), I have friends all over.  Since people are so busy, social media makes it easy for me to stay up to date with what my friends are up to.  In the last few years, I've felt like I've been in contact with more people than usual.  This is good, as social connection is a key to human happiness.

Only so much can be conveyed over social media.  Sure I can see who was married and what movies my friends like.  But a lot of human communication is through tone of voice and facial expression.  Status updates do not convey feelings or emotions the way a face-to-face conversation does.  Though I feel more connected to more people now, I feel less deeply connected to my close friends.

My new year's resolution: Call a friend.

Let's be more specific. Training Peaks says not to make resolutions, but to make plans.  I plan to talk 2 friends a month.  The preferred method is via face-to-face conversation.  This is pretty easy for my friends in California.  For those far away, I plan a video chat.  So friends, do not be surprised if I randomly video call you.  I know that a recent NPR report said that many were uncomfortable with video chat, because the person you are calling may be having a bad hair day.  But, the expert reminded us: "Your parents, maybe your siblings or a very close friend, the people that you really want to video-call with are probably people that wouldn't mind if you're having a bad-hair day. They've seen your bad-hair days. They don't care."

I know that 2 friends a month seems like a small task, but think of how many of you I actually spoke to in a real face-to-face conversation in the past year.  Want to get the year started off to a good start?  Be one of the first to help me with my plans.  Contact me and let me know when you are free.  You can find me on Facebook, Gmail, Google+ (hangout preferred!), or your other favorite social media.

Why you don't need fasting blood work

For a long time, the "guidelines" of medicine have insisted that we get fasting cholesterol levels on patients.  Why?  The theory was that we really need to target LDL ("bad") cholesterol, and the only way to find out "exactly" what your LDL was required getting a fasting blood sample.

There are many holes in this guideline.  First, the "lipid hypothesis" has mostly blown over.  Many studies have shown that you can treat lipids really well, but do nothing for the patient.  We can target that LDL to the lowest level, but still not affect whether the patient gets a heart attack or stroke.  A great overview is on this is in this podcast, from the guys at TEC.

Secondly, you don't really need an LDL to make a general risk assessment of how high risk a patient is for a heart attack.  As you can see from this chart, you really only need to know your total cholesterol and HDL ("good" cholesterol) to get an idea of your risk.  The LDL doesn't matter that much.

Now we have a great new study published in the Archives of Internal Medicine, showing that it does not really matter if patients fast or not.  The cholesterol levels do not change appreciably enough that it would affect treatment.  The related commentary falls a little short of advocating for docs to stop doing fasting cholesterol tests, but says that doing so is reasonable for most patients.

Finally, I often had patients come to my office at 2 pm, having fasted all day, just to get their cholesterol test.  This is just inhumane.  I do not feel good when I fast, and I don't think my patients do either.  Doctors need to start accommodating patients instead of following guidelines.

One more thing.  Does your doctor say you need a fasting blood sugar to screen for diabetes?  Nope.  We can screen for that with an A1C test, which doesn't require fasting.

Doctors: Let's start eating like we want our patients to eat

In my new viewpoint in JAMA, I propose that at all the meetings health professionals go to, there should be healthy food.  This may sound like a simple idea, but it has yet to materialize.  Physicians get "mad" at patients for not eating a healthy diet, and then go to a lunch seminar and eat roast beef and cookies.

It is hard to eat healthy in today's America.  Even when I'm at meetings, it's difficult to not take (at least a piece) of a cookie, when they are offered for free.  So let's make it easier by not providing junk food (cookies, soda, chips) at meetings.

Then we can make sure our meals are consistent with the dietary guidelines: they should be mostly made up of vegetables.  Once we do that, we can help our communities eat healthier.  Let's clean up our own eating habits and set an example for our community.

Politics and the Family

In tonight's Republican Convention speeches, we saw two different takes on American culture: the Strict Father and the Nurturing Mother.

For those who follow my blog and politics, you know that I am a fan of George Lakoff's family model of politics.  Briefly, it says that most Americans have two mindsets: a father model, where respect and obedience are of primary importance; and a mother model, where nurturing and love are primary.

We saw both of these models tonight.  Ann Romney spoke mostly about love.  She spoke about struggling families and the love in their relationship bringing them through hard times:

And I want us to think tonight about the love we all share for those Americans, our brothers and sisters, who are going through difficult times, whose days are never easy, nights are always long, and whose work never seems done.

This is exactly the progressive mindset that Lakoff describes.  The interesting point is that Lakoff's research shows that talking in this nurturing model makes people think more progressively and more likely to vote Democratic.  She finished with this:

I said tonight I wanted to talk to you about love. Look into your hearts.

This is our country.

This is our future.

These are our children and grandchildren.

Gov. Christie was next.  He spoke in a different model:

 [My mother] said to always pick being respected, that love without respect was always fleeting — but that respect could grow into real, lasting love.....Tonight, we choose respect over love.

This is Lakoff's father model, which gets people to think like a Republican and vote more conservatively.  Clearly, Christie is more in tune to politics that Ann Romney.  Romney's speech could actually persuade many women to vote Democratic.  But even Christie showed some of the motherly frame of mind:

Instead, the people of New Jersey stepped up and shared in the sacrifice.

This "shared sacrifice" terminology is something that Obama uses regularly to talk about progressive agendas.  Sharing brings up the progressive mindset.  Sharing leads to policies that promote the greater good: health care for all, unemployment assistance, well funded public education, and quality infrastructure.

My parents instilled in me the importance of love more than respect.  I'm not saying that I wasn't taught respect.  Again, all of our minds have both typologies.  But, the strongest underlying theme in my family was that love and nurturing were more important than obedience and respect.  Love and nurturing leads to respect, rather than Christie's claim of vice versa.

The love in my family led me to believe in progressive values.  How has your upbringing made you think about politics?  Have you thought about these mindsets before?

(And thank you to tonight's speakers for possibly convincing a few more people to think like Obama.)

America is Eating Healthy (According to one App)

I'm a big fan of mobile eating apps.  I think they have the potential to change eating habits and change our food environment.  However, I think many of them are purely driven by tech and gaming experts.  This is not a bad thing.  But without involving people who understand medicine and nutrition, the apps are unlikely to actually help people become healthier.

One of the hot new apps is The Eatery, as discussed in this article:
App Shows Promise for Hacking Eating Behavior - Technology Review

Users take a picture of their food.  Other users rate how healthy it is.  10 (green) means super health and 0 (red) means very unhealthy.  Here's a map of the ratings of healthy meals:

Now anyone who understands nutrition will be puzzled by the fact that most of the United States is green, meaning most of the meals people take pictures of are healthy.  Thus, we are all eating healthy and there isn't really a problem with poor eating in this country.

So there are two possibilities:
     1. The people who use the app are mostly healthy eaters.  (Then what purpose does the app have?)
     2. Most of the user ratings are false.  (Most people don't know what a healthy meal looks like.)

I think either possibility is true.  Option 1 will be fixed when there is an expansion of mobile technologies.  Also, if research shows these apps work, then professionals might recommend them to "unhealthy" eaters, expanding the reach of the apps.

To fix option 2, tech companies need to align with nutrition and medical professionals.  This is difficult, as the two types of industries often have different goals.  But it is possible, and together we could change the way we all eat.

Salt: Bad, Good, or We Don't Know?

The following article was the most emailed of last Sunday's New York Times, and is worth a read:

We Only Think We Know the Truth About Salt - NYTimes.com

The questions on the "clear" relationship between high salt intake and mortality are not new.  The article speaks about some of them, but even I remember these questions being raised.  When I was a freshman studying nutrition at Cornell, my introductory nutrition professor, David Levitsky, raised doubts about salt's connection to poor health.

In my favorite class at Cornell, "Mineral Nutrition and Chronic Disease," taught by Charles McCormick, we spent weeks delving into the literature on sodium, blood pressure, and heart disease.  As I left the class, I had serious doubts about the link.  There were clearly some salt-sensitive people with high blood pressure, for which salt reduction reduced their numbers.  But should we reduce the whole population's salt intake?

Still, I thought that even if the benefit of reducing salt was small on an individual level, the population benefits were likely large.  Even a small reduction in everyone's blood pressure could probably prevent deaths.  So in medical school I worked on a petition to the FDA, filed by CSPI, to limit salt in foods.

Now, even if salt itself is not a cause of increased mortality, it may be a marker of something else: poor eating habits.  Maybe the people who eat salt just eat a long of junk food.  Maybe limiting salt would still be a good thing, as people will drink less sugary beverages to quench their thirst.  But it may be prudent to have more research on this public health policy before we cause harm.

We do not want salt to go the way fat went: It was bad, and then it was good.  One thing I know is good: make sure 1/2 of every plate is vegetables and you are walking daily.

We are Winning the Soda War

This week New York Mayor Bloomberg proposed limiting the size of sugary beverages.  This is his latest tactic in reducing consumption of these beverages.  Earlier, he proposed a soda tax.  He also proposed prohibiting SNAP (food stamp) participants from purchasing sodas with government money.  Both of these measures failed because he needed outside approval (i.e. the Stata or Federal government).

His legal team indicates that no outside approvals are needed for this measure.  They have authority under the restaurant laws in New York.  I still think it is likely that the soda and restaurant industries will sue the city.  (McDonald's makes most of their money from soda.)

It would be great if this measure went through.  This intervention is just changing the default size of the drinks, a clear behavioral economic intervention.  People can still buy 2 or 3 or 5 drinks if they want.  It might even be the same price.  The freedom of choice is still there.

The best news from all of this is that we are winning the war on soda.  The industry is becoming defensive.  All of the publicity is giving soda a bad rap.  That's the purpose.  The soda industry spends billions of dollars a year marketing beverages to kids.  All of this negative media around soda gives us a chance to fight against that marketing.

Thank you Mayor for leading us in this war.

Choosing Contraception

The study below provides more evidence on the most effective form of birth control is Long Acting Reversible Contraception (LARC).  LARC includes Intrauterine Devices (a small device that is inserted into the cervix during an office visit) and Implantable Contraception (a small device inserted under the skin).  The advantage of these is that one procedure lasts 3-10 years.  No pills to take, things to insert, shots or anything else for the duration of the implant.  And, if you decide to get pregnant, they can easily be taken out.

Effectiveness of Long-Acting Reversible Contraception — NEJM

This research as others shows that they are more effective than other types of contraception (pills, patches, vaginal rings, etc.).  Here are some visual pictures to help everyone understand.  The numbers are approximate based on the data they show.  Each face below represents one woman over a year.  In the thousand women below, about 2 will have a pregnancy while on a LARC:

For women on a pill, patch or ring, about 48 more (smiley faces with the X's) will have a pregnancy:

LARCs also save money for the patient and the health care system.  There also have minimal side effects.  For instance, some women get increased bleeding with the IUD, but most get less or the same amount of monthly bleeding.

I talk to a lot of women about contraception, but many still choose a pill.  Why?  I'm interested in hearing the perspectives of women.  I think we all have the goal of reducing pregnancies that are not desired.

(Thanks to NNTonline.com for help creating the graphs.)

Gay Marriage: An Economist's Perspective

I'm not an economist, but I like to listen to economists.  They are usually pretty smart.

Today Obama stated that he supports gay marriage.  I support his decision to not take away rights from any individual in this country.  (I'm not going to discuss whether this was the right political decision, as I'm not a political scientist.)

This issue is clearly a wedge issue that divides many Americans.  However, there is an interesting solution from the economists Thaler and Sunstein, who wrote the bestseller book, Nudge:

"Under our approach, the only legal status states would confer on couples would be a civil union, which would be a domestic partnership agreement between any two people.  Marriages would be strictly private matters, performed by religious and other private organizations.  Within broad limits, marriage-granting organizations would be free to choose whatever rules they like for a marriage conducted under their auspices. ....  Instead of channeling every partnership into the same one-size-fits-all arrangement of state marriage, couples could choose the marriage-granting organization that best suits their needs and desires.  Government would not be asked to endorse any particular relationships by conferring on them the term marriage."

There's a solution that should not be as divisive.  Make marriage a private institution, while the government support equality by granting civil unions.  

Can you look at this growth on my back?

Dermatologists often do not like to admit that they look at skin growths all day.  Because the next thing they know, there is someone at a cocktail party asking them to look at a mole on their backside.  (And yes, all Dermatologists regularly attend cocktail parties.)

Should physicians diagnose or treat their friends and family members?  It is a tough issue.  Once you complete medical school (or sometimes even before), you are immediately seen as the know-it-all of everything medicine related.  Physicians want to be helpful to friends and family.  But how far should we go?

Let me start with diagnosis.  This is the most common thing I'm asked by friends and family.  "What do you think is wrong?  Could he have cancer? Why is my pee green?"  The process of diagnosis is probably the most complicated thing most physicians do.  Diagnosis is not as simple as looking in a book at the causes of green pee.  We spend hours in medical school learning how to arrange a proper diagnostic encounter, including how to look at the patient, what tone to use, what words to use, and even which way to cross our legs.  (Crossing your legs away from the patient signals that you are closed to hearing what they have to say.)

When I see a patient in my office, I start by asking open ended questions and letting the patient talk.  Based on what the patient is saying and how they are saying it, I continue down a path until I think I have a diagnosis.  I am also cuing into patients non-verbal responses, which can lead me to new and important questions.  This whole process is disrupted when a family member calls and asks, "Why is my pee green?"  Without the rhythm of the normal diagnostic encounter, the correct diagnosis could be missed.  

There is another reason diagnosis with friends and family members is difficult: some questions are off limits.  If my friend calls me and asks me why she is fatigued, I don't want to ask her if she could be pregnant, how heavy her periods are, or if she has any blood in her stool.  (Weird and awkward, but all causes of anemia.) If my friend asks me about some new joint pain, I don't want to ask him if he's a new sexual encounter, especially if I'm friends with his wife!

Finally, the hardest part of diagnosing friends and family is giving bad news.  What if I think my family member has cancer?  Is it right for me to have to give them that information?  It's unfair to both the physician and the patient.  Giving this type of news is something that only an unbiased physician should do.

Are there diagnostic questions that are ok to ask? Yes.  If I'm riding bikes with you and you fall off your bike, I'm happy to help you decide if you need an ambulance, or if you have a broken bone.  Why?  There's not much of a story to tell.  There are no questions about your sex life involved in broken bones (usually), and it's not likely we will have to address prognosis.  So most urgent situations are fine.

Treatment.  "So my doctor says I have high cholesterol.  Do you think I should take medicine?"  Most of you that know me would probably guess that I would say, "No. Eat more vegetables and ride a bike."  But, that's not fair, because that's my opinion.  Treatment decisions are another complicated interaction between a physician and a patient.  The dyad needs to account for the values of the patient and the long term implications of taking a medication.

But what can I ask you about treatment?  I'm actually much more open to talk about treatment with a family or friend, as long as the decision is made with the treating physician.  I'm happy to give you my opinion if it's in area I know about or can look up.  It actually can be helpful for me to arm you with some questions that you would want to ask your doctor.  But you should always make the final decision with your physician.

Summary: Being a physician that's asked questions by a family or friend is a tough situation. We always want to help, but do not want to hurt.  It's always ok to ask me about my opinion on something, but do not be offended if I suggest you talk to your doctor.  I'm not being rude.  I'm just trying to help.  

Older Is Better, even with oral contraceptives

New stories, including this one,

Bayer Withheld Yasmin Data From U.S., Former Agency Chief Tells Court - Bloomberg

highlight the elevated risks with the new oral contraceptives. The one under major scrutiny is drospirenone, also known as Yaz or Yasmin.

First, the most important thing: The increased risk of blood clots is small. Your risk of blood clots is probably still higher if you are pregnant. Yes. Your risk of blood clots is higher being pregnant, than being on Yaz or Yasmin. So, patients: Please do not suddenly stop your OCP suddenly. Talk to your doctor first.

When you do talk to your doctor, consider switching to an older contraceptive. One of my mantras in prescribing is that older drugs are usually better, as we know more about their safety. One of my mentors told me, "Never be the first or last to prescribe a new drug." I tend to use norethindone, but any older oral contraceptive will do.

I never understood the hype of Yaz and Yazmin. The drug companies just did a good job marketing it as an acne drug. The truth is, most OCPs work for acne. It appears that Bayer also did a good job of hiding drospirenone's side effects. How many times will we hear this story?

McDonald's: Doing it Wrong

San Francisco's ordinance on free give away toys at fast food restaurants was intended to nudge restaurants to improve the health of their kids meals. The ordinance requires meals that have free toys to meet certain nutritional requirements. The ordinance is a great idea, as the toys are just marketing gimmicks, designed to create brand loyalty with McDonald's.

As this article states, McDonald's, instead of improving their meals, will charge 10 cents for each toy. This will get them around the ordinance and allow them to change meals on their own terms. Still, the pressure from this law got McDonald's to make some changes to the kids meals, such as reducing the portion of fries. But, they are still not healthy. The extra charge will also likely prevent some from buying the toy, as it's not included with that meal.

So it's time to put more pressure on McDonald's, and we have more legal tools that we can use. I want to know why McDonald's has to sell toys. Aren't they in the business of selling food? Why should food establishments sell toys? Why not create a law that states that restaurants cannot sell toys? I'm not yet sure if this is legal, but I would like to find out.

Do Kids Need 3-4 servings of Milk a Day?

Many of you know that I have long said that the benefits of milk were overstated. The article below does a good job of reviewing the evidence why:

Wisconsin milk board overstates dairy’s benefits to children, some experts say | WisconsinWatch.org

The key statements are this:

“The so-called calcium requirement in the United States is based on very short-term studies (that are) irrelevant to long-term calcium needs,”

-Dr. Walter Willett, who chairs the nutrition department at the Harvard School of Public Health

“We know that those individuals who avoid milk and animal products that contain calcium do just fine in terms of their growth, their development, and their bone health,” - Jennifer Nelson, director of clinical dietetics at the Mayo Clinic

“I wonder how the marketing board explains why the highest rates of osteoporosis are found in countries that drink the most milk, or how cows manage to make huge bones that support their weight while eating mostly grass?”- Marion Nestle, Chair of Nutrition at NYU

“It’s hard not to be sarcastic about this kind of marketing,” Nestle added. “Milk is a fine food if you like it, but it is not an essential nutrient.”

Healthy Checkout At Walmart

This video is a great example of a couple of things:

1. Creating healthy checkout aisle shows that behavioral economics works: kids want fruit when it's in their check out aisle.

2. Walmart is doing some more great things in encouraging healthy eating. This was however, a local store initiative. Big Walmart is not yet doing this. Let's how they do.

3. Federal money can work for good. The reason these changes happened was because West Virginia got a grant from the CDC, likely as part of the Affordable Care Act. Federal Money -> States -> Promoting Healthy Changes and Increased Sales.

WATCH IT HERE:

Life in the health lane - News - The Charleston Gazette - West Virginia News and Sports -

Is the Food Industry a Partner in Battling Obesity?

Check out this debate about whether the food industry can be a partner in fighting obesity.  Our study is featured about half way through.



Food Industry Friend or Foe Debate: Yoni's opening arguments from Yoni Freedhoff on Vimeo.

This is just the first in a series of videos by Yoni.  For more, see his blog.

Every day is Medicine Day. But, today is Food Day.

Every day is Medicine Day.  Every time a family doctor like me sees a patient who struggles with weight gain, diabetes, or high blood pressure, I give them medicine.  But today is different.  Today is Food Day.

To be honest, I have long tried to emphasize the importance of food choices in preventing and treating disease.  I high-five my patients when they lose weight or cut out sugar-loaded beverages from their diet.  When people pick a food to eat, they are making one of the most important health decisions of their day.  The vast majority of problems I see in primary care are related to what people eat.  Our food system and our health system are closely linked.  It's no surprise that the faults or our food system contribute to the problems of our health system.  

Our general taxes fund massive giveaways to large agribusinesses, so that they can grow corn (for sugar) and soy.  This makes the major ingredients for most processed foods and beverages cheap, allowing the big food companies to spend billions of dollars a year getting Americans to eat a lot of junk.  And it works. Obesity and diabetes rates are skyrocketing, leading to increased patient suffering and corresponding health care costs.  Guess who pays for those costs?  The same taxes that fund agricultural subsidies help our seniors buy the medications to treat the conditions the subsidies helped cause.

There is a very simple way to break this cycle.  And we don't have to rely on politicians to do it.  All we have to do is know where our food comes from.  Then we just vote with our fork and start eating food that is not part of the industrial food system.

This is the idea behind the first annual Food Day, today, October 24^th (www.foodday.org).  Food Day was founded on six national priorities: reduce diet-related disease by promoting healthy foods, support sustainable farms & cut subsidies to big agribusiness, expand access to food and alleviate hunger, protect the environment & animals by reforming factory farms, promote health by curbing junk-food marketing to kids, and obtain fair wages for all workers in the food system.

One of the best ways to do this is to visit a farmer’s market.  At farmer’s markets we can directly ask the food producer: Where does this strawberry come from?  Did you spray it with pesticide?  Is there any chance it is infected with bacteria from a nearby animal slaughterhouse?  How much do you pay your farm workers?  So visit your farmer's market this week, ask these questions, buy some fruits and vegetables, and provide your family with a few healthy meals.

For those of you who want to celebrate food day in other ways, you can celebrate Meatless Monday by not eating any meat or poultry today (and every Monday).  You can turn your child's television (and internet) off so they do not see all the junk food ads.  Stand outside McDonald's or Taco Bell and warn people about the dangerous food they are planning to eat.  Celebrate water by joining the "Life is Sweeter" campaign and get sugar-loaded beverages out of the buildings where you work.  Or grow a tomato plant on your porch.  You can involve your family in any of these activities, while teaching your children where food comes from.  

While I'm hoping that the 2012 Farm Bill will fix some of the problems with our food system, I'm not optimistic.  However, I am optimistic that many of our food issues can be solved without relying on politicians. By choosing to eat non-industrial food, we can start our own food movement.  

So when I see patients tonight, instead of picking up my pen and writing a prescription for a new medicine, I'm going to write a food prescription for my patients.  I'll give my patients three choices of what I can write: "Eat seven vegetables a day," "Don't Drink Sugar-loaded beverages," or "Give up meat on Mondays."  I hope other doctors follow my lead, and that my patients do too.

Protecting your Prostate and your Package

According to reports out today, the United States Preventive Services Task Force will give a D rating to prostate cancer screening. This means they recommend men should not get the test.

Physicians who have watched the data on prostate cancer screening for awhile could have seen this coming. When I counsel men on PSA (the antigen that screens for prostate cancer) screening, I tell them that the test more likely to harm them then help them. Most prostate cancers are slow growing and never cause problems. How can this be? Cancer is a growth of abnormal cells in your body. The body is always fighting off abnormal growths. It often suppresses early cancers through the immune system and other mechanisms. Even if a cancer continues to grow, it may take years and years to cause something bad. Most people die of a heart attack before the prostate cancer does anything bad.

Now there are a very small amount of people where prostate cancer kills people. The problem is that medicine does not have a way to detect these people. So as in breast cancer, universal screening of women under 40 will result in a lot of people getting mastectomies to prevent one "bad" cancer in women. In prostate cancer, if we screen everyone, we will make millions of men unable to get an erection or be able to hold on to their urine while trying to prevent one prostate cancer.

Screening is not the best way to stop cancer deaths. The best way to prevent them is to stop them in the first place. According to the World Cancer Research Report, you can prevent prostate cancer by eating a lot of fruits, vegetables, and whole grains; and by avoiding a high calcium diet. And that doesn't involve becoming impotent or incontinent.

A Contagious Blog

Having loved the movie "Outbreak," I had to go see Contagion. I was hoping it was going to bring as much intensity as "Traffic." It didn't reach that level. This is not to say it was a bad movie. It was a fairly realistic portrayal of what could happen with an outbreak of a global pandemic.

I felt the most compelling pieces were about who gets what first. We will surely have to ration in a situation like this. Who should get the vaccine or treatment first? Of course, we don't think about rationing in our current health system, even though we do it all the time. Who gets cancer treatment first? Probably the rich insured patients. But not many people are up in arms over this. Things will be different when massive amounts of people are dying daily.

Another lesson of the movie is that most of these emerging viruses are likely to come from humans being close to dead animals. We can do a lot to assure a non-infectious animal. However, even the USDA does not have enough animal inspectors, and Republicans are currently trying to cut food safety initiatives. Compare this to other countries, where there are even less regulations in food preparation. Animal agriculture will continue to create risks for humans in many ways. Kind of makes me want to continue to the call for more people to eat less meat. If you do eat meat, know exactly where it came from. (I.e. buy it yourself from a local farmer.)

The movie also remind us about preparation. Everyone procrastinates this. If we were actually prepared, there would be no rush to the grocery stores last minute. Ready.gov has some good examples of what you need. If you are a camper, you might have many of the supplies already: a stove, freeze-dried food, and a lantern. If you are not a camper, get started! Everyone should remember to get a few jugs of water and leave them in a closet.

The biggest thing we can do to get prepared for these things, is to get vaccinated for things we know about. Influenza kills people. Last year it killed young people. I see too many patients that are afraid of getting the flu shot. I've heard, "It gives you the flu," over and over again. It does not give you the flu. It can't. Some people get an immune response to the vaccine which makes them feel under the weather for a day. For most people, this is tolerable. Consider the other option: dying. It happens. Get your flu shot!!

Most of all, this movie reminds us how critical our public health departments are to our health. We forget about them. But everyday they are investigating new viruses, food poisonings, and poor sanitary conditions. The current climate talks about defunding all governments institutions. This is clearly not the smart thing to do.

Why I Race Bikes

A few weeks ago I participated in the Leesville Gap Road Race. It was my hardest race of the season: 64 miles, horrible roads, climbing, headwinds, with temperatures near 38 Celsius. (That is 100 Farenheit. One thing I learned this year is that to be a cool cyclist, everything has to be Euro.) I almost didn’t finish due to the heat and dehydration, despite drinking over 3 liters of fluid and consuming 1000 calories while riding. After the race my Mom asked me, “Why are you doing this? What are you trying to prove?” I’ve been thinking a lot about that question.

I started cycling with the UCLA cycling team last fall. I joined them to have a group of people to ride with. I never thought I would race. I don’t remember what changed my mind, but I wanted to race. It’s been an amazing year, where I thought I’d stop racing at least twice. Yet I continued on and finished my last (13th) race of the year yesterday.

I sacrificed a lot this year: Thousands of dollars in bike equipment, sports massages, and energy foods; not skiing at all this year so I could keep up with my training and racing (despite a great snow season); weekends with my friends and girlfriend; and SLEEP (especially on those mornings I wanted to stay in bed).

So why sacrifice all this?

Maybe it was all the friends I was making in the cycling community. Maybe it was that I like gear, and cycling has a lot of it. Maybe it was I just wanted a regular way to stay active and in shape.

But I could have been in good shape just riding my bike a few times a week, and not pushing myself with an aggressive training plan. I could have trained for charity/century rides. I could have just exercised on my bike and not taken the risks of racing, which sometimes includes crashes and broken bones. (I’ve been in a few of them this year, but got out with only a few scrapes.)

So why race?
I like winning.

Whether it is in academics, sports, or a debate over some issue, I like to win. There is no winner in exercising. There is no winner in charity rides. (Not that I think charity rides are a bad idea. I may do one this fall.) I know life isn’t all about winning. But winning is what propels humans. It gives us a sense of our ability and purpose.

I just finished watching the Tour de France, which I believe is one of the hardest sporting events in the world to win. (Maybe only second to the Stanley Cup.) If you look a the faces on the winners as they cross the finish line, you will see the excitement in bike racing. While I haven’t won a race, nor done heroin, I think the two probably give a similar feeling.

I almost won a race. I was in the #6 position at the Stanford Road Race with 200 meters to go. But there was a crash from the front and I didn’t get the chance. But that feeling of almost winning is still with me. It was so close and felt so good.

But, as I started in my first non-collegiate races, I realized that winning would be tough. While I still believed, I wasn’t sure I’d win one in my first season. Still, I wanted to race, despite the pain of pushing my legs to their limit in 2-3 hour races. Why?

What else would I be doing? Spending time on facebook? Cleaning my apartment? Watching TV? Reading? Writing a research grant? So many people just sit on their bums all day. Our bodies are not built for that. Pushing myself hard on a bike reminds me what my body was built for: to push, to endure, to work hard.

As Peter Flax said, “We spend our so-called modern lives coddled-breezing through airports on people movers, accepting meeting requests nestled in Aeron chairs, engaging in cruise control to avoid the demands of the gas pedal. Our amazing muscles and capillaries and neural pathways are built to do something far more profound if we put them to the test.” My day job requires me to test my mind. Bike racing allows me to test my body and forget about my day job for a few hours.

There is something primal about racing. One human against another, with a prize at the end. Humans were meant to battle and to pursue speed. Cycling combines the two.

I feel alive on my bike. And I’m having fun. What I’ve described above may not sound like fun to some of you. But, remember that first time you were able to ride a bike? Remember the freedom to push your body into the wind? Remember racing your friend down the street? Remember the feeling of triumph?

Bike racing is fun. I don’t think I need another reason to continue. Except for the fact that I still want to win.

(This post is dedicated to all my team members and my Koach who pushed me beyond my limits this year. I’ll wait for you all at the top of Latigo.)

It's time to stop marketing junk food to kids

(cross post from the NPA Blog)

I’m often faced with parents who want to know what do do with their kids who are overweight. There are a lot of causes of obesity, but the major causes are soda and junk food. The increase in consumption is due to the food industry’s aggressive marketing of junk food to kids.

In 2009, the fast-food industry spent $4.9 billion on marketing. How are parents supposed to fight with an industry that is telling kids to eat more junk food at school, while watching tv, and while on the internet? It’s time to make parenting easier. It’s time for the food industry to stop marketing to kids.

A bi-partisan bill in Congress asked a group of government organizations to come up with VOLUNTARY standards for the food industry on what products it’s ok to market to kids. They came up with very good guidelines. But, they are under big pressure from big food to be weakened, even though they are VOLUNTARY. The government group (the Interagency Work Group- IWG) needs to hear from you on why these standards are really important. They will provide a blueprint on where we should start in stopping marketing junk food to kids.

Please click here to add your comments. Parents around the country will thank you.