Friday, July 30, 2010

Auto glass company owner charged with theft in $1.5 million insurance-fraud case

A Burien, Wash. auto glass company owner has been charged with three counts of first-degree theft for a billing scheme that’s believed to have cost insurers more than $1.5 million.


Charges against Michael Alan Perkins, 43, were filed Thursday in King County Superior Court. Perkins is the owner of Autoglass Express Inc. and Premier Auto Glass, LLC., which are run out of Perkins’ Burien home. The glass shops are suspected of overbilling State Farm, Allstate and MetLife insurance companies.

An investigation by the state insurance commissioner’s office found 4,840 instances in which the company told insurers that higher-priced Original Equipment Manufacturer (OEM) glass had been installed, when workers were actually installing lower-cost aftermarket glass.

State Insurance Commissioner Mike Kreidler’s anti-fraud Special Investigations Unit, which spent months combing through more than 10,000 records, found $1,520,234 in deceptive billing by Perkins’ companies between September 2005 and December 2009.

“We found instances in which companies paid full price for car windows that actually came from auto wrecking yards,” said Kreidler. “One company was billed more than $1,000 for a Toyota windshield that actually cost $92.”

Click here to read more.

Health care by numbers, putting healthy people at risk

I was speaking to a patient today who was having some muscular problems and was concerned about.  He had just had his creatine levels checked (http://ezinearticles.com/?Creatine-Levels&id=405381) and the level was high.  Creatine levels that are high with cholesterol lowering drugs injestion is one of the reasons we need to be checked frequently when on these meds. I also suggested that some of his muscle stiffness and problems could be due to the drug.  When I asked him why he was having the problem, he said that his heart had a problematic valve which has likely been there all his life. When I asked him about his cholesterol levels, it was well under 200 which really is not high.

The important question is this:  Does the benefit outweigh the risk?  The patient has a known problem that is probably developmental.  Decreasing cholesterol levels that are near normal has no effect on heart function.  Taking cholesterol meds 5 times per week puts him at risk for liver and muscular problems, as well as adding medical costs to monitor him.  Since we are looking at a what if scenario which scares people because nobody wants a heart attack or a blockage to create a life threatening, what if we did nothing?  What if he got hit by a car tomorrow?

I know that is ridiculous but giving a perfectly healthy person dangerous (http://www.thepeopleschemist.com/view_learning.php?learning_id=11)  meds that potentially create problems he never would have had with constant monitoring makes little sense to me.  It is not preventative care, and has a detrimental effect, rather than a benefit over the short term. True preventative care prevents known outcomes such as foot problems creating back problems for instance, since it is mechanical and easily identifiable.  Shadow boxing with what if scenarios by physicians for dubious prevention of rare events is bad medicine.  Taking potentially harmful cholesterol lowering drugs that are likely to have no benefit but cause problems you do not have is not preventative, its foolish and a bad way to spend our health care dollars. Statistics show that statin's have a very small effect on extending ones life (http://www.dailymail.co.uk/health/article-432395/Statins-truth.html), and their benefits are way overstated. The best doctors question everything, including some of the practices of their own profession.  I have certainly done this as a chiropractor.  If you are a person who is on statins and has naturally low levels of cholesterol, but were advised these meds are a good idea, think about this article, the resources in it and have a fair and honest discussion with your doctor.  It is never about your doctors practice style, it is about your health and knowing the difference between prevention and an intervention that is good for your health vs. one that is not good for it.

What do you think, I value your opinion.

Working together to create leaders in health care


Advanced Leadership Foundations (ALF)
The ALF acronym is a catchy one, which many were quick to liken to the 1980s TV show. But there’s nothing alien about ALF to the management teams of Rouge Valley Health System (RVHS) and Lakeridge Health (LH), who have jointly rolled out the program. ALF team members, from left, are: Bill Hamilton, learning consultant, RVHS; Kathy Gooding, director, human resources, RVHS; Wanda Leach, director, human resources, LH; Darrell Sewell, joint vice-president, human resources; plus the ALF stuffies! (Absent are: Rahim Moledina, learning consultant, RVHS; Petra Bingley, learning consultant, LH; and Marguerite O’Neal, learning consultant, LH.)
___________________________________________
Blog by Darrell Sewell
Joint Vice-President, Human Resources
Rouge Valley Health System and Lakeridge Health


Great leadership is not about any one outstanding individual. After all, how could leadership happen if there were only one person? Rather, leadership is defined by the act of working with others.

Bearing that in mind, it seems quite fitting that Rouge Valley Health System (RVHS) and Lakeridge Health (LH) have been delivering a comprehensive leadership training program to our management teams by doing just that—working together. Now at the mid-way point of the program, we can’t help but step back and take a celebratory look at what we have collectively achieved.

In January 2010, our two hospitals jointly launched the Advanced Leadership Foundations (ALF) program. This program was designed to help our over 250 managers build a strong foundation of leadership skills and to keep them on the cutting edge of leadership fundamentals within Ontario health care.

The ALF program is based on a set of 12 leadership competencies established by the Ontario Hospital Association’s Leadership Development Institute, in collaboration with the Hay Group. These competencies define the skill sets and qualities that all health care leaders in the province should have. Building on the 12 leadership competencies, RVHS and LH developed an additional 12 management competencies focused on operational knowledge. And all twenty-four competencies were the basis for the creation of the training modules that make up ALF.

Between January and June 2010 we have delivered 12 training modules—six leadership and six management competency modules. Delivering two modules per month, we started off in January with Visionary Leadership (leadership competency) and Role of the Manager (management competency) and we recently wrapped up the first half of the program in June with Business Acumen (leadership competency) and Managing Finances (management competency).

We could not have gotten this far without three important groups. First, there’s the team of staff who worked so diligently to build the curriculum for the program and coordinate its delivery. As joint vice-president of human resources for both RVHS and LH it has been an absolute pleasure to guide this initiative and participate with the following ALF Team members who have been key in putting ALF into action:

• Kathy Gooding, director, human resource, RVHS
• Rahim Moledina, learning consultant, RVHS
• Bill Hamilton, learning and media consultant, RVHS
• Wanda Leach, director, human resource, Lakeridge Health
• Marguerite O’Neal, learning consultant, Lakeridge Health
• Petra Bingley, learning and media consultant, Lakeridge Health

The second group that has been instrumental in the success of ALF is the guest presenters who have been responsible for delivering some of the core training. This group of professionals—from administrative areas of both hospitals (i.e. CEOs; human resource; finance; labour relations; occupational health, safety & wellness; decision support)—has worked closely with the ALF Team members to provide training on their particular areas of expertise. They have done an exceptional job, and we wish to thank them for their commitment to ALF and our management teams.

Finally, we need to congratulate all of the management staff, who have participated in the first six months of the program. ALF is a mandatory program for management staff and leaders, and we are happy that everyone is making the time to take part. Thank you for your commitment to your hospital, the work you do, and ultimately, to the patients we care for.

This has been an extraordinary experience for everyone involved, and it is a true success story for Rouge Valley and Lakeridge Health. The development and rollout of ALF reflects leadership at its best. It demonstrates what can be accomplished when two hospitals take the initiative to come together and make something happen. We were not discouraged by a limited budget. Rather, we used our resources wisely, and took advantage of some or most valuables assets: our expertise, our innovation, and our teamwork.

The result has been a top-quality product, which is unique in many ways. With 12 leadership modules and another 12 management modules, ALF has certainly got to be one of the most robust leadership training programs delivered within hospitals in Ontario. Matching this comprehensiveness is the program’s intensiveness. In six months, we delivered 12 training modules to more than 250 managers across two large community hospitals.

And of course, by delivering the program jointly, we have afforded our managers with a number of opportunities to develop relationships with colleagues across the two hospitals. The training modules were offered at RVHS and Lakeridge sites in Scarborough, Ajax and Oshawa, allowing staff and presenters to learn together and from each other.

Another unique aspect of ALF is its evaluative component. At both hospitals, we have introduced Halogen Software systems to evaluate managers specifically on the leadership competencies introduced in ALF. This closes the loop on their training, and helps to ensure that managers are applying in their work what they have learned in ALF.

It has truly been a thrilling start to this program. During the summer, we have taken a pause, but ALF will get going again in the fall. Between September and March, we will complete the program with the remaining 12 competency modules. I am looking forward to the second half of this program. In fact, we have a really exciting kick off planned for September, so stay tuned!

This kind of learning isn’t just about building leaders for our two hospitals. We are creating leaders for our future health care system, and you can’t help but to want to be a part of that.

Thursday, July 29, 2010

Study suggests that unusual paint colors on cars are an effective deterrent to theft

If you want to deter car thieves, get a car with an unusual color. So says the Family Home Security blog, citing a study out of the Netherlands.

Here's the theory: since thieves value quick resale of a stolen car, look for colors that are unusual, like pink. In the cited study, black and silver were the two most-stolen colors. The researcher suggested that an uncommon car color, if you can put up with it, might be at least as good a deterrent as an expensive car alarm.

Wednesday, July 28, 2010

Can sitting shorten your life? A new study suggests it will.

I read an article today regarding sitting and how it can shorten your life (http://www.usatoday.com/news/health/2010-07-27-sitting-death_N.htm) .  In a 14 year study, they found that people who sit for longer periods of time (many of us do this at work for hours) are more likely to die from heart disease than those who get up and move around alot. Apparently, mixing alittle exercise with sitting did little to change the outcome.  Apparently, there was a sedentary physiology that develops with those who sit alot.  Please read the article.  Very interesting.

Too much complexity! I like the simplicity of Ricky’s Weather Forecasting Stone

Too much complexity in the last few posts and related comments: multivariate analyses, path coefficients, nonparametric statistics, competing and interaction effects, explained variance, plant protein and colorectal cancer, the China Study, raw plant foods possibly giving people cancer unless they don’t …

I like simplicity though, and so does my mentor. I really like the simplicity of Ricky’s Weather Forecasting Stone. (See photo below, from … I will tell you in the comments section. Click on it to enlarge. Use the "CRTL" and "+" keys to zoom in, and CRTL" and "-" to zoom out.)


Can you guess who the gentleman on the photo is?

A few hints. He is a widely read and very smart blogger. He likes to eat a lot of saturated fat, and yet is very lean. If you do not read his blog, you should. Reading his blog is like heavy resistance exercise, for the brain. It is not much unlike doing an IQ test with advanced biology and physiology material mixed in, and a lot of joking around.

Like heavy resistance exercise, reading his blog is hard, but you fell pretty good after doing it.

Saturday, July 24, 2010

Parkour Visions Summit and Talk

On August 13-15th, my friends Rafe Kelley and Tyson Cecka are hosting a parkour summit at their Seattle gym Parkour Visions. For those of you not familiar with the sport, here's a description from the Parkour Visions site:
"The essence of Parkour can be stated simply: it is the art of overcoming obstacles as swiftly and efficiently as possible using only your body. The fundamentals include running, jumping, and climbing, and we build on these fundamentals to improve our ability to pass over, under, around and through obstacles with more complex movements. Parkour is a system of fitness training that improves strength, speed, agility, co-ordination, stamina, endurance, and precision. It offers a full-body workout at any level of experience, and improves your ability to move, to harness your confidence, to change how you see the world. Parkour practitioners are called traceurs."
The summit will include seminars on strength training, injury prevention and rehab, and nutrition, as well as parkour jams, a roundtable and a dinner. I'll be giving a talk titled "Natural Eating for Sustainable Athletic Performance" on Saturday, August 14 from noon to 1:00 pm.

Registration is $40 for the whole summit. You can read a description of it here, and find a link to the registration system at the bottom of this page.

The China Study one more time: Are raw plant foods giving people cancer?

In this previous post I analyzed some data from the China Study that included counties where there were cases of schistosomiasis infection. Following one of Denise Minger’s suggestions, I removed all those counties from the data. I was left with 29 counties, a much smaller sample size. I then ran a multivariate analysis using WarpPLS (warppls.com), like in the previous post, but this time I used an algorithm that identifies nonlinear relationships between variables.

Below is the model with the results. (Click on it to enlarge. Use the "CRTL" and "+" keys to zoom in, and CRTL" and "-" to zoom out.) As in the previous post, the arrows explore associations between variables. The variables are shown within ovals. The meaning of each variable is the following: aprotein = animal protein consumption; pprotein = plant protein consumption; cholest = total cholesterol; crcancer = colorectal cancer.


What is total cholesterol doing at the right part of the graph? It is there because I am analyzing the associations between animal protein and plant protein consumption with colorectal cancer, controlling for the possible confounding effect of total cholesterol.

I am not hypothesizing anything regarding total cholesterol, even though this variable is shown as pointing at colorectal cancer. I am just controlling for it. This is the type of thing one can do in multivariate analyzes. This is how you “control for the effect of a variable” in an analysis like this.

Since the sample is fairly small, we end up with insignificant beta coefficients that would normally be statistically significant with a larger sample. But it helps that we are using nonparametric statistics, because they are still robust in the presence of small samples, and deviations from normality. Also the nonlinear algorithm is more sensitive to relationships that do not fit a classic linear pattern. We can summarize the findings as follows:

- As animal protein consumption increases, plant protein consumption decreases significantly (beta=-0.36; P<0.01). This is to be expected and helpful in the analysis, as it differentiates somewhat animal from plant protein consumers. Those folks who got more of their protein from animal foods tended to get significantly less protein from plant foods.

- As animal protein consumption increases, colorectal cancer decreases, but not in a statistically significant way (beta=-0.31; P=0.10). The beta here is certainly high, and the likelihood that the relationship is real is 90 percent, even with such a small sample.

- As plant protein consumption increases, colorectal cancer increases significantly (beta=0.47; P<0.01). The small sample size was not enough to make this association insignificant. The reason is that the distribution pattern of the data here is very indicative of a real association, which is reflected in the low P value.

Remember, these results are not confounded by schistosomiasis infection, because we are only looking at counties where there were no cases of schistosomiasis infection. These results are not confounded by total cholesterol either, because we controlled for that possible confounding effect. Now, control variable or not, you would be correct to point out that the association between total cholesterol and colorectal cancer is high (beta=0.58; P=0.01). So let us take a look at the shape of that association:


Does this graph remind you of the one on this post; the one with several U curves? Yes. And why is that? Maybe it reflects a tendency among the folks who had low cholesterol to have more cancer because the body needs cholesterol to fight disease, and cancer is a disease. And maybe it reflects a tendency among the folks who have high total cholesterol to do so because total cholesterol (and particularly its main component, LDL cholesterol) is in part a marker of disease, and cancer is often a culmination of various metabolic disorders (e.g., the metabolic syndrome) that are nothing but one disease after another.

To believe that total cholesterol causes colorectal cancer is nonsensical because total cholesterol is generally increased by consumption of animal products, of which animal protein consumption is a proxy. (In this reduced dataset, the linear univariate correlation between animal protein consumption and total cholesterol is a significant and positive 0.36.) And animal protein consumption seems to be protective again colorectal cancer in this dataset (negative association on the model graph).

Now comes the part that I find the most ironic about this whole discussion in the blogosphere that has been going on recently about the China Study; and the answer to the question posed in the title of this post: Are raw plant foods giving people cancer? If you think that the answer is “yes”, think again. The variable that is strongly associated with colorectal cancer is plant protein consumption.

Do fruits, veggies, and other plant foods that can be consumed raw have a lot of protein?

With a few exceptions, like nuts, they do not. Most raw plant foods have trace amounts of protein, especially when compared with foods made from refined grains and seeds (e.g., wheat grains, soybean seeds). So the contribution of raw fruits and veggies in general could not have influenced much the variable plant protein consumption. To put this in perspective, the average plant protein consumption per day in this dataset was 63 g; even if they were eating 30 bananas a day, the study participants would not get half that much protein from bananas.

Refined foods made from grains and seeds are made from those plant parts that the plants absolutely do not “want” animals to eat. They are the plants’ “children” or “children’s nutritional reserves”, so to speak. This is why they are packed with nutrients, including protein and carbohydrates, but also often toxic and/or unpalatable to animals (including humans) when eaten raw.

But humans are so smart; they learned how to industrially refine grains and seeds for consumption. The resulting human-engineered products (usually engineered to sell as many units as possible, not to make you healthy) normally taste delicious, so you tend to eat a lot of them. They also tend to raise blood sugar to abnormally high levels, because industrial refining makes their high carbohydrate content easily digestible. Refined foods made from grains and seeds also tend to cause leaky gut problems, and autoimmune disorders like celiac disease. Yep, we humans are really smart.

Thanks again to Dr. Campbell and his colleagues for collecting and compiling the China Study data, and to Ms. Minger for making the data available in easily downloadable format and for doing some superb analyses herself.

Thursday, July 22, 2010

3 Healthy Chicks - July Newsletter!

Be sure to check out 3 Healthy Chick's July Newsletter packed with a few great summer recipes and other fun summer health tips!

For love of an Avocado....

Oh dear sweet avocado. I love this little fruit. Stephen and I have a baby avocado plant at home (Avi). Avi is 2 years old and grown from seed by Stephen's grandmother. We're hoping by next summer Avi will start producing delicious fruit for us to enjoy! So, allow me to go on a little about this beautiful fruit.

Besides its subtle, sweet flavor and silky texture, one virtue of the avocado is that only one-sixth of it's fat is saturated, which is a much smaller portion than in meats, butter, cheese or even sour cream. The texture of a ripe avocado is actually a lot like butter. If you have a ripe avocado hanging around and you're guacamole'd out, try using it instead of butter on your morning toast or bagel with a slice of tomato! You can also try avocado instead of cheese on your lunch sandwich. Try sprouted grains bread with tomato, watercress and avocado (add some turkey if you roll with the animal protein).

Avocado is also fabulous in salads!! My friend Missy (who is raw and fabulous) gave me this kale and avocado salad recipe when I was on the 21 day Vegan challenge. It blew my taste buds away. Try it!!

Kale Salad
a head kale (any variety), shredded
1 cup tomato, diced
1 cup avocado, chopped
2 1/2 tablespoons olive oil
1 1/2 tablespoons lemon juice
1 teaspoon sea salt
1/2 teaspoon cayenne

In a mixing bowl toss all ingredients together,
squeezing as you mix to wilt the kale and cream the avocado. Dig in and squeeze it with your hands...I think food tastes so much better when you play with it first. ;-)

~Keep it Fresh!
Terra

The China Study again: A multivariate analysis suggesting that schistosomiasis rules!

In the comments section of Denise Minger’s post on July 16, 2010, which discusses some of the data from the China Study (as a follow up to a previous post on the same topic), Denise herself posted the data she used in her analysis. This data is from the China Study. So I decided to take a look at that data and do a couple of multivariate analyzes with it using WarpPLS (warppls.com).

First I built a model that explores relationships with the goal of testing the assumption that the consumption of animal protein causes colorectal cancer, via an intermediate effect on total cholesterol. I built the model with various hypothesized associations to explore several relationships simultaneously, including some commonsense ones. Including commonsense relationships is usually a good idea in exploratory multivariate analyses.

The model is shown on the graph below, with the results. (Click on it to enlarge. Use the "CRTL" and "+" keys to zoom in, and CRTL" and "-" to zoom out.) The arrows explore causative associations between variables. The variables are shown within ovals. The meaning of each variable is the following: aprotein = animal protein consumption; pprotein = plant protein consumption; cholest = total cholesterol; crcancer = colorectal cancer.


The path coefficients (indicated as beta coefficients) reflect the strength of the relationships; they are a bit like standard univariate (or Pearson) correlation coefficients, except that they take into consideration multivariate relationships (they control for competing effects on each variable). A negative beta means that the relationship is negative; i.e., an increase in a variable is associated with a decrease in the variable that it points to.

The P values indicate the statistical significance of the relationship; a P lower than 0.05 means a significant relationship (95 percent or higher likelihood that the relationship is real). The R-squared values reflect the percentage of explained variance for certain variables; the higher they are, the better the model fit with the data. Ignore the “(R)1i” below the variable names; it simply means that each of the variables is measured through a single indicator (or a single measure; that is, the variables are not latent variables).

I should note that the P values have been calculated using a nonparametric technique, a form of resampling called jackknifing, which does not require the assumption that the data is normally distributed to be met. This is good, because I checked the data, and it does not look like it is normally distributed. So what does the model above tell us? It tells us that:

- As animal protein consumption increases, colorectal cancer decreases, but not in a statistically significant way (beta=-0.13; P=0.11).

- As animal protein consumption increases, plant protein consumption decreases significantly (beta=-0.19; P<0.01). This is to be expected.

- As plant protein consumption increases, colorectal cancer increases significantly (beta=0.30; P=0.03). This is statistically significant because the P is lower than 0.05.

- As animal protein consumption increases, total cholesterol increases significantly (beta=0.20; P<0.01). No surprise here. And, by the way, the total cholesterol levels in this study are quite low; an overall increase in them would probably be healthy.

- As plant protein consumption increases, total cholesterol decreases significantly (beta=-0.23; P=0.02). No surprise here either, because plant protein consumption is negatively associated with animal protein consumption; and the latter tends to increase total cholesterol.

- As total cholesterol increases, colorectal cancer increases significantly (beta=0.45; P<0.01). Big surprise here!

Why the big surprise with the apparently strong relationship between total cholesterol and colorectal cancer? The reason is that it does not make sense, because animal protein consumption seems to increase total cholesterol (which we know it usually does), and yet animal protein consumption seems to decrease colorectal cancer.

When something like this happens in a multivariate analysis, it usually is due to the model not incorporating a variable that has important relationships with the other variables. In other words, the model is incomplete, hence the nonsensical results. As I said before in a previous post, relationships among variables that are implied by coefficients of association must also make sense.

Now, Denise pointed out that the missing variable here possibly is schistosomiasis infection. The dataset that she provided included that variable, even though there were some missing values (about 28 percent of the data for that variable was missing), so I added it to the model in a way that seems to make sense. The new model is shown on the graph below. In the model, schisto = schistosomiasis infection.


So what does this new, and more complete, model tell us? It tells us some of the things that the previous model told us, but a few new things, which make a lot more sense. Note that this model fits the data much better than the previous one, particularly regarding the overall effect on colorectal cancer, which is indicated by the high R-squared value for that variable (R-squared=0.73). Most notably, this new model tells us that:

- As schistosomiasis infection increases, colorectal cancer increases significantly (beta=0.83; P<0.01). This is a MUCH STRONGER relationship than the previous one between total cholesterol and colorectal cancer; even though some data on schistosomiasis infection for a few counties is missing (the relationship might have been even stronger with a complete dataset). And this strong relationship makes sense, because schistosomiasis infection is indeed associated with increased cancer rates. More information on schistosomiasis infections can be found here.

- Schistosomiasis infection has no significant relationship with these variables: animal protein consumption, plant protein consumption, or total cholesterol. This makes sense, as the infection is caused by a worm that is not normally present in plant or animal food, and the infection itself is not specifically associated with abnormalities that would lead one to expect major increases in total cholesterol.

- Animal protein consumption has no significant relationship with colorectal cancer. The beta here is very low, and negative (beta=-0.03).

- Plant protein consumption has no significant relationship with colorectal cancer. The beta for this association is positive and nontrivial (beta=0.15), but the P value is too high (P=0.20) for us to discard chance within the context of this dataset. A more targeted dataset, with data on specific plant foods (e.g., wheat-based foods), could yield different results – maybe more significant associations, maybe less significant.

Below is the plot showing the relationship between schistosomiasis infection and colorectal cancer. The values are standardized, which means that the zero on the horizontal axis is the mean of the schistosomiasis infection numbers in the dataset. The shape of the plot is the same as the one with the unstandardized data. As you can see, the data points are very close to a line, which suggests a very strong linear association.


So, in summary, this multivariate analysis vindicates pretty much everything that Denise said in her July 16, 2010 post. It even supports Denise’s warning about jumping to conclusions too early regarding the possible relationship between wheat consumption and colorectal cancer (previously highlighted by a univariate analysis). Not that those conclusions are wrong; they may well be correct.

This multivariate analysis also supports Dr. Campbell’s assertion about the quality of the China Study data. The data that I analyzed was already grouped by county, so the sample size (65 cases) was not so high as to cast doubt on P values. (Having said that, small samples create problems of their own, such as low statistical power and an increase in the likelihood of error-induced bias.) The results summarized in this post also make sense in light of past empirical research.

It is very good data; data that needs to be properly analyzed!

Wednesday, July 21, 2010

5 Ways to Keep it Fresh (and exciting) in Summer 2010!

Woah, it's HOT on the Jersey shore. As I drove home from my Wise Mamas Prenatal and Mommy and Me classes last tuesday, the temp actually reached 105?! Seriously, I think 105 is out of line! Regardless, summer is here, it's in full force and everyone should take advantage of it.


Summer is like the season of the possible. The plants are blooming (my cantaloupe plant is currently exploding with fruit on my balcony, thanks to the bumble bees!) and the sun makes you feel vibrant and radiant. The longer days and increased vitamin D makes it feel like we can accomplish anything. The funny thing is, when we feel like we can accomplish anything - we can!

All you have to do is harness that energy, ride the wave of summer and try something new!


Throughout the year, most of us live extremely buys lives. We move through our tasks with an intense pace and oftentimes get stuck in a routine. Don't get me wrong, routine isn't always bad. It's great to have consistency. However, if we choose consistency for the sake of efficiency or simply out of the fear of change our chances for the extraordinary drop. Lack of variety stagnates not only our mind, but our body and heart.


Breaking our routine brings the fresh and exciting into our our life. It keeps us on our toes and every aspect of our life, including our health, vibrant! Sometimes change and trying new things can be scary, but almost always it brings health, vitality and excitement to our lives.


Check out our top 5 ways to Keep it Fresh this summer:


1. Be In the Moment. We’re human beings, not human doings. Let go of the past and the future in order to savor every juicy moment of the present. Surfing is an amazing way to be in the moment while enjoying the summer sun. Don't know how to surf? Take a lesson! Contact Shawn Zappo at Yoga Basin, hit the Asbury Park Boardwalk and catch some waves!


2. Move Your Body and Sweat Once a Day. It will flush toxins from the largest organ of the body – your skin! Movement gets your endorphins pumping, creates more energy and just makes you feel good! Try Terra's Monday 9:00am Soul Sweat class or Lauren's Thursday 9:00am Gentle Haltha class at Asbury Park Dance & Yoga. If you want to really dust off those dancing shoes, check out the other amazing class opportunities at AP Dance including zumba, belly dance, tap, tango, hip hop and caberet. There's no excuse not to shake your groove thang!


3. Try It Raw. Eat more living, fresh foods in the warm months including unprocessed fresh fruits and vegetables, nuts, seeds and sprouted grains. Their vibrant energy and nutrient density will leave you looking and feeling great! For amazing raw cuisine check out The Cinnamon Snail every Sunday at the Red Bank Farmers Market.


4. Add Music To Your Life. Go see or listen to your favorite artist every chance you get. The vibration of your favorite music is so healthy for your mind, body and soul. The Jersey Shore has a rich music history tons of great venues that schedule talented musicians on the regular! Check out a couple of our favorite venues, the Stone Pony and The Saint to catch a great show and dance the night away!


5. Nothing Left To Do But Smile, Smile, Smile. Everyone has heard the saying it takes 13 muscles to smile and 33 to frown, why over do it? Give a friendly smile to each person you encounter throughout your day. At the end of the day, reflect back on how great your day went. Enjoy the happiness you brought to another person’s day!


Whatever adventure or way to Keep it Fresh calls to you, use the summer months to make it happen and fully enjoy your life! Increasing new experiences and excitement in your life can decrease your dependence on artificial stimulants like caffeine and sugar, this naturally leads to vibrant health! When you try new things and keep your life fresh and exciting you will see massive improvements in your physical well being, mental acuity and motivation. Plus you'll have a whole portfolio filled with summer fun!


Keep it Fresh!

~Terra


Tuesday, July 20, 2010

Real Food XI: Sourdough Buckwheat Crepes

Buckwheat was domesticated in Southeast Asia roughly 6,000 years ago. Due to its unusual tolerance of cool growing conditions, poor soils and high altitudes, it spread throughout the Northern latitudes of Eurasia, becoming the staple crop in many regions. It's used to a lesser extent in countries closer to the equator. It was also a staple in the Northeastern US until it was supplanted by wheat and corn.

Buckwheat isn't a grain: it's a 'pseudograin' that comes from a broad-leaved plant. As such, it's not related to wheat and contains no allergenic gluten. Like quinoa, it has some unusual properties that make it a particularly nutritious food. It's about 16 percent protein by calories, ranking it among the highest protein grains. However, it has an advantage over grains: it contains complete protein, meaning it has a balance of essential amino acids similar to animal foods. Buckwheat is also an exceptional source of magnesium and copper, two important nutrients that may influence the risk of insulin resistance and cardiovascular disease (1, 2).

However, like all seeds (including grains and nuts), buckwheat is rich in phytic acid. Phyic acid complexes with certain minerals, preventing their absorption by the human digestive tract. This is one of the reasons why traditional cultures prepare their grains carefully (3). During soaking, and particularly fermentation of raw batters, an enzyme called phytase goes to work breaking down the phytic acid. Not all seeds are endowed with enough phytase to break down phytic acid in a short period of time. Buckwheat contains a lot of phytase, and consequently fermented buckwheat batters contain very little phytic acid (4, 5). It's also high in astringent tannins, but thorough soaking in a large volume of water removes them.

Buckwheat is fermented in a number of traditional cultures. In Bhutan, it's fermented to make flatbreads and alcoholic drinks (6). In Brittany (Bretagne; Northwestern France), sourdough buckwheat flour pancakes are traditional. Originally a poverty food, it is now considered a delicacy.

The following simple recipe is based on my own experimentation with buckwheat. It isn't traditional as far as I know, however it is based on traditional methods used to produce sourdough flatbreads in a number of cultures. I used the word 'crepe' to describe it, but I typically make something more akin to a savory pancake or uttapam. You can use it to make crepes if you wish, but this recipe is not for traditional French buckwheat crepes.

It's important that the buckwheat be raw and whole for this recipe. Raw buckwheat is light green to light brown (as in the photo above). Kasha is toasted buckwheat, and will not substitute properly. It's also important that the water be dechlorinated and the salt non-iodized, as both will interfere with fermentation.

For a fermentation starter, you can use leftover batter from a previous batch (although it doesn't keep very long), or rice soaking water from this method (7).

Ingredients and Materials


  • 2-3 cups raw buckwheat groats
  • Dechlorinated water (filtered, boiled, or rested uncovered overnight)
  • Non-iodized salt (sea salt, pickling salt or kosher salt), 2/3 tsp per cup of buckwheat
  • Fermentation starter (optional), 2 tablespoons
  • Food processor or blender
Recipe
  1. Cover buckwheat with a large amount of dechlorinated water and soak for 9-24 hours. Raw buckwheat is astringent due to water-soluble tannins. Soaking in a large volume of water and giving it a stir from time to time will minimize this. The soaking water will also get slimy. This is normal.
  2. Pour off the soaking water and rinse the buckwheat thoroughly to get rid of the slime and residual tannins.
  3. Blend the buckwheat, salt, dechlorinated water and fermentation starter in a food processor or blender. Add enough water so that it reaches the consistency of pancake batter. The smoother you get the batter, the better the final product will be.
  4. Ferment for about 12 hours, a bit longer or shorter depending on the temperature and whether or not you used a starter. The batter may rise a little bit as the microorganisms get to work. The smell will mellow out. Refrigerate it after fermentation.
  5. In a greased or non-stick skillet, cook the batter at whatever thickness and temperature you prefer. I like to cook a thick 'pancake' with the lid on, at very low heat, so that it steams gently.
Dig in! Its mild flavor goes with almost anything. Batter will keep for about four days in the fridge.

Thanks to Christaface for the CC licensed photo (Flickr).

Summer Playlist 2010!

As promised in my last newsletter, here is my Summer 2010 Playlist! I create "mix CDs" for each season (yea, I'm a huge nerd, I have years and years of these dating back to when I was a pre-teen recording songs off the radio onto cassette tapes!) and below is this summers. I keep an archive of them and love popping an old one in randomly. It brings me right back to wherever I was in my life at that time. Music is such a wonderful thing and the power of a song can be so moving for so many reasons! It can stir up so many memories and emotions that you didn't even know were still there.
Click on my playlist below to see some of what I've been jammin' out to lately and feel free to share some of your favorite summer 2010 songs below!
Stay cool & rock on!!!
Keep it fresh!
- Lauren

What's a nice doctor like you doing in a plan like this. The story behind why after only four months in ASHN's management of Cigna, we are leaving their network.

Ah, what is an ethical doctor to do?  Last January, we received a letter telling us that we can only continue our participation in Cigna Open Access Plus and the PPO if we become credentialed with a company called American Specialty Health Networks.  We did not accept the Cigna HMO since ASHN took over their network around 1999, when their other vendor went out of business because or the perceived reputation that ASHN had. I was not thrilled, since two years previous, I had helped save Cigna's previous HMO network who was also hurting chiropractors financially by underfunding a capitated plan and not communicating with Cigna that a problem existed.  Cigna historically likes to use vendors instead of administrating certain professions such as chiropractors directly.  We did credential with ASHN for a short time about 11 years ago and quickly left when we saw what was required of doctors in the network (reams of paperwork and faxes).  Over the last 10 years, Cigna had grandfathered us into their PPO without having to deal with ASHN which gave us the freedom to do what we thought was best for our patients.  A few years ago,A Cigna representative convinced us to join their Open Access Plus networks as well which we joined under the condition that we did not have do deal with ASHN.  Cigna's management under Open Access Plus and PPO plans was transparent and they allowed us to do what was necessary.  We had many patients in the expanding Open Access Plus network and it worked well for the past few years.

Fast forward to 2010, we felt compelled to credential with ASHN, despite their reputation among my colleagues as being a paper and payment nightmare because Cigna now said that we can only continue our participation by joining the network.  Some of my colleagues were exiting the network as I was credentialing however, I was willing to give it 6 months to try the network out.

They send us a large credentialing packet on CD with all the plans, their fee schedules and most of what I needed to decide if this could work, since we handle many managed care plans.  The Cigna HMO fee schedule was quite low, if not below our cost of doing business however, the local rep assured us they would be fair but conservative. We were told that they would put us in a tier allowing us 5 office visits before any paperwork was necessary on their HMO patients.  We were also told that Open access plus and the PPO, who had similar fee schedules in their packets to the ones under Cigna directly did not require any paperwork.  In other words, things would not change other than who we bill through.

We officially joined as of 4/1/10 and had our first two HMO patients, and had programmed our computers to handle the fee schedules for their other plans as well under Cigna.  There was little training for their paperwork and the first two were problematic because they gave us far fewer visits than we asked for.  I finally spoke with the doctor in charge of the NJ reviews who stated that Cigna under ASHN's management is an acute only plan and does not cover any rehab.  He agreed to cover the 12 visits one patient had and the 8 visits the other needed and explained that the paperwork should have been filled out for the 1st visit, even though we do not need to submit it until the 5th.  We were told to fill it out after the 5th. After that conversation, all our Cigna HMO patients thereafter were required to sign an agreement saying they understand they can rehab, however, at their own cost.

We thought everything was fine until we did not receive any Cigna payments for their other plans for over two months.  When we received them, the payments were far less than we expected and then when we inquired about the Open Access Plus claims being paid improperly, we were given a different fee schedule than the one in the packet, that was markedly lower in many ways.  We also then found out that all their plans required certification, including non gaited plans (PPO and Open Access Plus) and we had been lied to or deliberately misinformed.  This meant we now had to scramble to do precertification paperwork on a bunch of people, some who could not fill out questionaires since they were no longer under care.  We submitted these care plans and they either denied increased treatment past 5 visits or gave us visits but reduced time frames that we billed within.  We called and their staff said to file for extensions which were of course denied.  I then requested that I speak with their medical reviewer who stated that during our last conversation in June, he believed that he was clear on the acute thing.  I said I was and then he could not believe we were misinformed by their staff,  offering little other than an apology and suggested more paperwork in the form of a continuing care paper form, to add to the other stuff we were already sending in, to get paid at less than were were paid before.

The final straw for us was a bounced check from ASHN, on services that we waited for payment for over two months.

As our patients know, I do my best for them.  Back injuries, neck injuries, shoulder injuries and other problem we see patients for all require rehab to get the problem corrected.  I believe it is wrong to tell someone that we will serve them half way for their co pay and then the rest is their problem. It just isn't right. It also is not right for an employer who to buys benefits that are advertised for up to 60 per year to have their employees find out it is limited it to 6 or 7. Bait and switch plans are not ethical.

Last night, after less than four months, I mailed and faxed in my resignation to ASHN.  They are indeed a nightmare.  They call themselves conservative.  I call them intrusive and overbearing.  I can now understand how they single handedly destroyed the economic viability for chiropractors who work in California, where they yield alot of influence.

For those of you who wish to continue under our care, we will continue to participate until the 60 days or so that are required have expired.  After that, we will be out of network as a provider for Cigna.  It is better that way and I believe our patients will find their out of network benefits are more beneficial without the interference of ASHN. For anyone else reading my blog, including other doctors in my profession, I am not suggesting any course of action, however, if your experience is similar to mine, you will have some thinking to do.

Was leaving the right thing to do?  I believe it was.  Working harder for less reimbursement and cheating patients out of their benefits was not what I signed up for.  In my office, it is quality or nothing.  In the case of the Cigna plans, I would rather be out of network where quality can exist. What do you think?  I value your input.

My transformation: I cannot remember the last time I had a fever

The two photos below (click to enlarge) were taken 4 years apart. The one on the left was taken in 2006, when I weighed 210 lbs (95 kg). Since my height is 5 ft 8 in, at that weight I was an obese person, with over 30 percent body fat. The one on the right was taken in 2010, at a weight of 150 lbs (68 kg) and about 13 percent body fat. I think I am a bit closer to the camera on the right, so the photos are not exactly on the same scale. For a more recent transformation update, see this post.


My lipids improved from borderline bad to fairly good numbers, as one would expect, but the two main changes that I noticed were in terms of illnesses and energy levels. I have not had a fever in a long time. I simply cannot remember when it was the last time that I had to stay in bed because of an illness. I only remember that I was fat then. Also, I used to feel a lot more tired when I was fat. Now I seem to have a lot of energy, almost all the time.

In my estimation, I was obese or overweight for about 10 years, and was rather careless about it. A lot of that time I weighed in the 190s; with a peak weight of 210 lbs. Given that, I consider myself lucky not to have had major health problems by now, like diabetes or cancer. A friend of mine who is a doctor told me that I probably had some protection due to the fact that, when I was fat, I was fat everywhere. My legs, for example, were fat. So were my arms and face. In other words, I lot of the fat was subcutaneous, and reasonably distributed. In fact, most people do not believe me when I say that I weighed 210 lbs when that photo was taken in 2006; but maybe they are just trying to be nice.

If you are not obese, you should do everything you can to avoid reaching that point. Among other things, your chances of having cancer will skyrocket.

So, I lost a whopping 60 lbs (27 kg) over about 2-3 years. That is not so radical; about 1.6-2.5 lbs per month. There were plateaus with no weight loss, and even a few periods with weight gain. Perhaps because of that and the slow weight loss, I had none of the problems usually associated with body responses to severe calorie restriction, such as hypothyroidism. I remember a short period when I felt a little weak and miserable; I was doing exercise after long fasts (20 h or so), and not eating enough afterwards. I did that for a couple of weeks and decided against the idea.

There are no shortcuts with body fat loss, it seems. Push it too hard and the body will react; compensatory adaptation at work.

My weight has been stable, at around 150 lbs, for a little less than 2 years now.

What did I do to lose 60 lbs? I did a number of things at different points in time. I measured various variables (e.g., intake of macronutrients, weight, body fat, HDL cholesterol etc.) and calculated associations, using a prototype version of HealthCorrelator for Excel (HCE). Based on all that, I am pretty much convinced that the main factors were the following:

- Complete removal of foods rich in refined carbohydrates and sugars from my diet, plus almost complete removal of plant foods that I cannot eat raw. (I do cook some plant foods, but avoid the ones I cannot eat raw; with a few exceptions like sweet potato.) That excluded most seeds and grains from my diet, since they can only be eaten after cooking.

- Complete removal of vegetable oils rich in omega-6 fats from my diet. I cook primarily with butter and organic coconut oil. I occasionally use olive oil, often with water, for steam cooking.

- Consumption of plenty of animal products, with emphasis on eating the animal whole. All cooked. This includes small fish (sardines and smelts) eaten whole about twice a week, and offal (usually beef liver) about once or twice a week. I also eat eggs, about 3-5 per day.

- Practice of moderate exercise (2-3 sessions a week) with a focus on resistance training and high-intensity interval training (e.g., sprints). Also becoming more active, which does not necessarily mean exercising but  doing things that involve physical motion of some kind (e.g., walking, climbing stairs, moving things around), to the tune of 1 hour or more every day.

- Adoption of more natural eating patterns; by eating more when I am hungry, usually on days I exercise, and less (including fasting) when I am not hungry. I estimate that this leads to a caloric surplus on days that I exercise, and a caloric deficit on days that I do not (without actually controlling caloric intake).

- A few minutes (15-20 min) of direct skin exposure to sunlight almost every day, when the sun is high, to get enough of the all-important vitamin D. This is pre-sunburn exposure, usually in my backyard. When traveling I try to find a place where people jog, and walk shirtless for 15-20 min.

- Stress management, including some meditation and power napping.

- Face-to-face social interaction, in addition to online interaction. Humans are social animals, and face-to-face social interaction contributes to promoting the right hormonal balance.

When I was fat, my appetite was a bit off. I was hungry at the wrong times, it seemed. Then slowly, after a few months eating essentially whole foods, my hunger seemed to start “acting normally”. That is, my hunger slowly fell into a pattern of increasing after physical exertion, and decreasing with rest. Protein and fat are satiating, but so seem to be fruits and vegetables. Never satiating for me were foods rich in refined carbohydrates and sugars – white bread, bagels, doughnuts, pasta etc.

Looking back, it almost seems too easy. Whole foods taste very good, especially if you are hungry.

But I will never want to each a peach after I have a doughnut. The peach will be tasteless!

What's a nice doctor like you doing in a plan like this. The story behind why after only four months in ASHN's management of Cigna, we are leaving their network.

Ah, what is an ethical doctor to do?  Last January, we received a letter telling us that we can only continue our participation in Cigna Open Access Plus and the PPO if we become credentialed with a company called American Specialty Health Networks.  We did not accept the Cigna HMO since ASHN took over their network around 1999, when their other vendor went out of business.  Cigna historically likes to use vendors instead of administrating particular professions directly.  We did credential with ASHN for a short time about 11 years ago and quickly left when we saw what was required of doctors in the network (reams of paperwork and faxes).  Over the last 10 years, Cigna had grandfathered us into their PPO without having to deal with ASHN which gave us the freedom to do what we thought was best for our patients.  A few years ago, their representative convinced us to join their Open Access Plus networks as well.  Cigna's management was transparent and they allowed us to do what was necessary.  We had many patients in the expanding Open Access Plus network and it worked well.

Fast forward to 2010, we felt compelled to credential with ASHN, despite their reputation among my colleagues as being a paper and payment nightmare.  Some of them were exiting the network as I was credentialing however, I was willing to give it 6 months.

They send us a large credentialing packet on CD with all the plans, their fee schedules and most of what I needed to decide if this could work, since we handle many managed care plans.  The Cigna HMO fee schedule was quite low, if not below our cost of doing business however, the local rep assured us they would be fair. We were told that they would put us in a tier allowing us 5 office visits before any paperwork was necessary on their HMO patients.  We were also told that Open access plus and the PPO, who had similar fee schedules in their packets to the ones under Cigna did not require any certifications.  In other words, things would not change other than who we bill to.

We officially joined as of 4/1/10 and had our first two HMO patients, and had programmed our computers to handle the fee schedules for their other plans as well under Cigna.  There was little training for their paperwork and the first two were problematic because they gave us far fewer visits than we asked for.  I finally spoke with the doctor in charge of the NJ reviews who stated that Cigna under ASHN's management is an acute only plan and does not cover any rehab.  He agreed to cover the 12 visits one patient had and the 8 visits the other needed and explained that the paperwork should have been filled out for the 1st visit, even though we do not need to submit it until the 5th.  After that conversation, all our Cigna HMO patients thereafter were required to sign an agreement saying they understand they can rehab, however, at their own cost.

We thought everything was fine until we did not receive any Cigna payments for their other plans for over two months.  When we received them, the payments were far less than we expected and then when we inquired about the Open Access Plus claims being paid improperly, we were given a different fee schedule than the one in the packet, that was markedly lower in many ways.  We also found out that all their plans required certification, including non gaited plans (PPO and Open Access Plus) and we have been lied to or deliberately misinformed.  This meant we now had to scramble to do precerts on a bunch of people, some who could not fill out questionaires since they were no longer under care.  We submitted these care plans and many of them did not give us what we needed, or ended care prematurely either by visit or by date.  We called and their staff said to file for extensions which were of course denied.  I then requested that I speak with their medical reviewer who stated that during our last conversation in June, he believed that he was clear on the acute thing.  I said he was and then he could not believe we were misinformed by their staff, and offered little other than an apology and suggested more paperwork in the form of a continuing care paper form, to add to the other stuff we were already sending in, to get paid at less than were were before.

The final straw for us was a bounced check from ASHN, on services that we waited for payment for over two months.

As our patients know, I do my best for them.  Back injuries, neck injuries, shoulder injuries and other problem we see patients for all require rehab to get the problem corrected.  I believe it is wrong to tell someone that we will serve them half way for their co pay and then the rest is their problem. It just isn't right.It also is not right for a company to buy benefits that are advertised for up to 60 per year and limit it to 6 or 7 and then tell the patient sorry, while I need to fan the flames of someone who was sold a bait and switch plan.

Last night, after less than four months, I mailed and faxed in my resignation to ASHN.  They are indeed a nightmare.  They call themselves conservative.  I call them intrusive and overbearing.  I can now understand how they single handedly destroyed the economic viability for chiropractors who work in California, where they yield alot of influence.

For those of you who wish to continue under our care, we will continue to participate until the 60 days or so that are required have expired.  After that, we will be out of network as a provider for Cigna.  It is better that way and I believe our patients will find their out of network benefits are more beneficial without the interference of ASHN.

Was leaving the right thing to do?  I believe it was.  Working harder for less reimbursement and cheating patients out of their benefits was not what I signed up for.  What do you think?  I value your input.

What's a nice doctor like you doing in a plan like this. The story behind why after only four months in ASHN's management of Cigna, we are leaving their network.

Ah, what is an ethical doctor to do?  Last January, we received a letter telling us that we can only continue our participation in Cigna Open Access Plus and the PPO if we become credentialed with a company called American Specialty Health Networks.  We did not accept the Cigna HMO since ASHN took over their network around 1999, when their other vendor went out of business.  Cigna historically likes to use vendors instead of administrating particular professions directly.  We did credential with ASHN for a short time about 11 years ago and quickly left when we saw what was required of doctors in the network (reams of paperwork and faxes).  Over the last 10 years, Cigna had grandfathered us into their PPO without having to deal with ASHN which gave us the freedom to do what we thought was best for our patients.  A few years ago, their representative convinced us to join their Open Access Plus networks as well.  Cigna's management was transparent and they allowed us to do what was necessary.  We had many patients in the expanding Open Access Plus network and it worked well.

Fast forward to 2010, we felt compelled to credential with ASHN, despite their reputation among my colleagues as being a paper and payment nightmare.  Some of them were exiting the network as I was credentialing however, I was willing to give it 6 months.

They send us a large credentialing packet on CD with all the plans, their fee schedules and most of what I needed to decide if this could work, since we handle many managed care plans.  The Cigna HMO fee schedule was quite low, if not below our cost of doing business however, the local rep assured us they would be fair. We were told that they would put us in a tier allowing us 5 office visits before any paperwork was necessary on their HMO patients.  We were also told that Open access plus and the PPO, who had similar fee schedules in their packets to the ones under Cigna did not require any certifications.  In other words, things would not change other than who we bill to.

We officially joined as of 4/1/10 and had our first two HMO patients, and had programmed our computers to handle the fee schedules for their other plans as well under Cigna.  There was little training for their paperwork and the first two were problematic because they gave us far fewer visits than we asked for.  I finally spoke with the doctor in charge of the NJ reviews who stated that Cigna under ASHN's management is an acute only plan and does not cover any rehab.  He agreed to cover the 12 visits one patient had and the 8 visits the other needed and explained that the paperwork should have been filled out for the 1st visit, even though we do not need to submit it until the 5th.  After that conversation, all our Cigna HMO patients thereafter were required to sign an agreement saying they understand they can rehab, however, at their own cost.

We thought everything was fine until we did not receive any Cigna payments for their other plans for over two months.  When we received them, the payments were far less than we expected and then when we inquired about the Open Access Plus claims being paid improperly, we were given a different fee schedule than the one in the packet, that was markedly lower in many ways.  We also found out that all their plans required certification, including non gaited plans (PPO and Open Access Plus) and we have been lied to or deliberately misinformed.  This meant we now had to scramble to do precerts on a bunch of people, some who could not fill out questionaires since they were no longer under care.  We submitted these care plans and many of them did not give us what we needed, or ended care prematurely either by visit or by date.  We called and their staff said to file for extensions which were of course denied.  I then requested that I speak with their medical reviewer who stated that during our last conversation in June, he believed that he was clear on the acute thing.  I said he was and then he could not believe we were misinformed by their staff, and offered little other than an apology and suggested more paperwork in the form of a continuing care paper form, to add to the other stuff we were already sending in, to get paid at less than were were before.

The final straw for us was a bounced check from ASHN, on services that we waited for payment for over two months.

As our patients know, I do my best for them.  Back injuries, neck injuries, shoulder injuries and other problem we see patients for all require rehab to get the problem corrected.  I believe it is wrong to tell someone that we will serve them half way for their co pay and then the rest is their problem. It just isn't right.It also is not right for a company to buy benefits that are advertised for up to 60 per year and limit it to 6 or 7 and then tell the patient sorry, while I need to fan the flames of someone who was sold a bait and switch plan.

Last night, after less than four months, I mailed and faxed in my resignation to ASHN.  They are indeed a nightmare.  They call themselves conservative.  I call them intrusive and overbearing.  I can now understand how they single handedly destroyed the economic viability for chiropractors who work in California, where they yield alot of influence.

For those of you who wish to continue under our care, we will continue to participate until the 60 days or so that are required have expired.  After that, we will be out of network as a provider for Cigna.  It is better that way and I believe our patients will find their out of network benefits are more beneficial without the interference of ASHN.

Sincerely,

William D Charschan DC,CCSP .

 

Sunday, July 18, 2010

AIDS Conference 2010: A cross road of humanity



(L to R) Dr. Yigeremu Abebe, Country Director of Ethiopia for the Clinton Health Access Initiative (CHAI); Patrick Byam, Project Manager for the Yale Global Health Leadership Institute; Abraham Zerihun, EMRI Monitoring and Evaluation Officer for CHAI.


Hello from Austria!

I am here in Vienna for the XVIII International AIDS conference taking place from July 18-30th. What a beautiful city to play host to the conference…there is just so much history and culture within this city. The architecture is has been restored incredibly well, there is a great mix of medieval and modern design. It has been interesting to learn some German and to try wiener schnitzel while meeting people from all over the world here for the AIDS 2010 conference.

I feel like this conference is a cross roads of humanity. You can meet anyone from Bill Clinton to
Bill Gates to HIV/AIDS activists to human rights activists to world renowned scientists all within the same week. I am here to present a poster on the Ethiopian Millennium Rural Initiative (EMRI) project of which Yale Global Health Leadership Institute (GHLI) is an external evaluator. The Clinton Health Access Initiative (CHAI) is currently implementing a health system strengthening initiative at 30 government health centers in the four major regions of Ethiopia: Amhara region, Oromia region, Tigray region and the Southern Nations and Nationalities People’s region (SNNPR). The aim of the EMRI project is to develop a model of primary health care that can be scaled up and replicated throughout the country. GHLI is responsible for evaluating the impact of this project and studying the impact of this program. I am here with my Ethiopian colleague, Abraham Zerihun, head of Monitoring and Evaluation for the EMRI initiative, presenting a poster on the first phase of the EMRI program. This is a lot more exciting than our usual work developing monitoring and evaluation tools, writing quarterly reports and conducting site visits to ensure data quality. Our poster presents both quantitative and qualitative data from the first 1.5 years of the EMRI initiative.  

Patrick Byam, GHLI Project Manager

Saturday, July 17, 2010

Minger Responds to Campbell

Hot off the presses: Dr. Colin Campbell's response to Denise Minger's China Study posts, and Minger's retort:

A Challenge and Response to the China Study


The China Study: My Response to Campbell

This is required reading for anyone who wants to evaluate Dr. Campbell's claims about the China Study data. Denise points out that Dr. Campbell's claims rest mostly on uncorrected associations, which is exactly what he was accusing Minger, Chris Masterjohn and Anthony Colpo of doing. He also appears to have selectively reported data that support his philosophy, and ignored data that didn't, even when the latter were stronger. This is true both in Dr. Campbell's book, and in his peer-reviewed papers. This type of thing is actually pretty common in the diet-health literature.

I respect everyone's food choices, whether they're omnivores, carnivores, or raw vegans, as long as they're doing it in a way that's thoughtful toward other people, animals and the environment. I'm sure there are plenty of vegans out there who are doing it gracefully, not spamming non-vegan blogs with arrogant comments.

As human beings, we're blessed and cursed with an ego, which is basically a self-esteem and self-image reinforcement machine. Since being wrong hurts our self-esteem and self-image, the ego makes us think we're right about more than we actually are. That can take the form of elaborate justifications, and the more intelligent the person, the more elaborate the justifications. An economic policy that makes you richer becomes the best way to improve everyone's bottom line. A dietary philosophy that was embraced for humane reasons becomes the path to optimum health... such is the human mind. Science is basically an attempt to remove as much of this psychic distortion as possible from an investigation. Ultimately, the scientific method requires rigorous and vigilant stewardship to achieve what it was designed to do.

Subcutaneous versus visceral fat: How to tell the difference?

The photos below, from Wikipedia, show two patterns of abdominal fat deposition. The one on the left is predominantly of subcutaneous abdominal fat deposition. The one on the right is an example of visceral abdominal fat deposition, around internal organs, together with a significant amount of subcutaneous fat deposition as well.


Body fat is not an inert mass used only to store energy. Body fat can be seen as a “distributed organ”, as it secretes a number of hormones into the bloodstream. For example, it secretes leptin, which regulates hunger. It secretes adiponectin, which has many health-promoting properties. It also secretes tumor necrosis factor-alpha (more recently referred to as simply “tumor necrosis factor” in the medical literature), which promotes inflammation. Inflammation is necessary to repair damaged tissue and deal with pathogens, but too much of it does more harm than good.

How does one differentiate subcutaneous from visceral abdominal fat?

Subcutaneous abdominal fat shifts position more easily as one’s body moves. When one is standing, subcutaneous fat often tends to fold around the navel, creating a “mouth” shape. Subcutaneous fat is easier to hold in one’s hand, as shown on the left photo above. Because subcutaneous fat tends to “shift” more easily as one changes the position of the body, if you measure your waist circumference lying down and standing up, and the difference is large (a one-inch difference can be considered large), you probably have a significant amount of subcutaneous fat.

Waist circumference is a variable that reflects individual changes in body fat percentage fairly well. This is especially true as one becomes lean (e.g., around 14-17 percent or less of body fat for men, and 21-24 for women), because as that happens abdominal fat contributes to an increasingly higher proportion of total body fat. For people who are lean, a 1-inch reduction in waist circumference will frequently translate into a 2-3 percent reduction in body fat percentage. Having said that, waist circumference comparisons between individuals are often misleading. Waist-to-fat ratios tend to vary a lot among different individuals (like almost any trait). This means that someone with a 34-inch waist (measured at the navel) may have a lower body fat percentage than someone with a 33-inch waist.

Subcutaneous abdominal fat is hard to mobilize; that is, it is hard to burn through diet and exercise. This is why it is often called the “stubborn” abdominal fat. One reason for the difficulty in mobilizing subcutaneous abdominal fat is that the network of blood vessels is not as dense in the area where this type of fat occurs, as it is with visceral fat. Another reason, which is related to degree of vascularization, is that subcutaneous fat is farther away from the portal vein than visceral fat. As such, it has to travel a longer distance to reach the main “highway” that will take it to other tissues (e.g., muscle) for use as energy.

In terms of health, excess subcutaneous fat is not nearly as detrimental as excess visceral fat. Excess visceral fat typically happens together with excess subcutaneous fat; but not necessarily the other way around. For instance, sumo wrestlers frequently have excess subcutaneous fat, but little or no visceral fat. The more health-detrimental effect of excess visceral fat is probably related to its proximity to the portal vein, which amplifies the negative health effects of excessive pro-inflammatory hormone secretion. Those hormones reach a major transport “highway” rather quickly.

Even though excess subcutaneous body fat is more benign than excess visceral fat, excess body fat of any kind is unlikely to be health-promoting. From an evolutionary perspective, excess body fat impaired agile movement and decreased circulating adiponectin levels; the latter leading to a host of negative health effects. In modern humans, negative health effects may be much less pronounced with subcutaneous than visceral fat, but they will still occur.

Based on studies of isolated hunger-gatherers, it is reasonable to estimate “natural” body fat levels among our Stone Age ancestors, and thus optimal body fat levels in modern humans, to be around 6-13 percent in men and 14–20 percent in women.

If you think that being overweight probably protected some of our Stone Age ancestors during times of famine, here is one interesting factoid to consider. It will take over a month for a man weighing 150 lbs and with 10 percent body fat to die from starvation, and death will not be typically caused by too little body fat being left for use as a source of energy. In starvation, normally death will be caused by heart failure, as the body slowly breaks down muscle tissue (including heart muscle) to maintain blood glucose levels.

References:

Arner, P. (2005). Site differences in human subcutaneous adipose tissue metabolism in obesity. Aesthetic Plastic Surgery, 8(1), 13-17.

Brooks, G.A., Fahey, T.D., & Baldwin, K.M. (2005). Exercise physiology: Human bioenergetics and its applications. Boston, MA: McGraw-Hill.

Fleck, S.J., & Kraemer, W.J. (2004). Designing resistance training programs. Champaign, IL: Human Kinetics.

Taubes, G. (2007). Good calories, bad calories: Challenging the conventional wisdom on diet, weight control, and disease. New York, NY: Alfred A. Knopf.

Friday, July 16, 2010

Right to die with dignity - NJ sees a new billboard campaign

I read an article the other day about right to die groups and how they are getting out their message (http://www.nj.com/news/index.ssf/2010/07/national_campaign_guiding_ill.html).  Apparently, there are many groups that are taking Dr. Kevorkians message and putting their own spin on people being able to be allowed to die if the conditions warrant it.  In my opinion, many people die in hospitals, with tubes out their body in misery.  There have been many instances where these same people have been given an overdose of a medication to put them out of their misery, however, this is considered illegal.  I agree that is someone is terminal, and miserable, and has an extremely poor quality of life, they should have the option to end it.  Many religions oppose this because the value of life is too great.  In reality, many of these religions have been around for thousands of generations, long before we had the equipment to keep the near dead alive.  Statistics show that we consume at least 1/3 of all our health care costs at the end of life, with the end being the same.  When did it become ethical to torture the dying?  We not only torture them, but we drain them and their family financially, emotionally, without having a rational alternative unless a living will is present. The outcome, statistics show is the same;  death, which is a normal part of our lifecycle.  We should educate ourselves about how to prepare and take a healthier view during the emotional end of a loved one, rather than try things that decrease the quality of life at the end and worsen the suffering.

Without being morbid, I do believe in advanced directives, and I believe it is wrong to keep dying people alive artificially, to prolong their suffering.  We surely do not usually do this with our pets who may die with more dignity when the terminally ill pet is put to sleep painlessly. 

These groups have a valid point.  We should have the option if we are terminal and have poor quality of life to end our own suffering. That is my opinion because it is humane.  Regarding the use of billboards, this makes a big statement.  Sometimes these types of statements are offensive however, often if you have not offended someone, you really did not get your point across effectively.  BTW, the ensuing articles published by the newspaper on these signs is great marketing and PR.

What to you think? I always value your opinion.

Dr C

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Wednesday, July 14, 2010

The China Study: With a large enough sample, anything is significant

There have been many references recently on diet and lifestyle blogs to the China Study. Except that they are not really references to the China Study, but to a blog post by Denise Minger. This post is indeed excellent, and brilliant, and likely to keep Denise from “having a life” for a while. That it caused so much interest is a testament to the effect that a single brilliant post can have on the Internet. Many thought that the Internet would lead to a depersonalization and de-individualization of communication. Yet, most people are referring to Denise’s post, rather than to “a great post written by someone on a blog.”

Anyway, I will not repeat what Denise said on her post here. My goal with this post is bit more general, and applies to the interpretation of quantitative research results in general. This post is a warning regarding “large” studies. These are studies whose main claim to credibility is that they are based on a very large sample. The China Study is a good example. It prominently claims to have covered 2,400 counties and 880 million people.

There are many different statistical analysis techniques that are used in quantitative analyses of associations between variables, where the variables can be things like dietary intakes of certain nutrients and incidence of disease. Generally speaking, statistical analyses yield two main types of results: (a) coefficients of association (e.g., correlations); and (b) P values (which are measures of statistical significance). Of course there is much more to statistical analyses than these two types of numbers, but these two are usually the most important ones when it comes to creating or testing a hypothesis. The P values, in particular, are often used as a basis for claims of significant associations. P values lower than 0.05 are normally considered low enough to support those claims.

In analyses of pairs of variables (known as "univariate", or "bivariate" analyses), the coefficients of association give an idea of how strongly the variables are associated. The higher these coefficients are, the more strongly the variables are associated. The P values tell us whether an apparent association is likely to be due to chance, given a particular sample. For example, if a P value is 0.05, or 5 percent, the likelihood that the related association is due to chance is 5 percent. Some people like to say that, in a case like this, one has a 95 percent confidence that the association is real.

One thing that many people do not realize is that P values are very sensitive to sample size. For example, with a sample of 50 individuals, a correlation of 0.6 may be statistically significant at the 0.01 level (i.e., its P value is lower than 0.01). With a sample of 50,000 individuals, a much smaller correlation of 0.06 may be statistically significant at the same level. Both correlations may be used by a researcher to claim that there is a significant association between two variables, even though the first association (correlation = 0.6) is 10 times stronger than the second (correlation = 0.06).

So, with very large samples, cherry-picking results is very easy. It has been argued sometimes that this is not technically lying, since one is reporting associations that are indeed statistically significant. But, by doing this, one may be omitting other associations, which may be much stronger. This type of practice is sometimes referred to as “lying with statistics”.

With a large enough sample one can easily “show” that drinking water causes cancer.

This is why I often like to see the coefficients of association together with the P values. For simple variable-pair correlations, I generally consider a correlation around 0.3 to be indicative of a reasonable association, and a correlation at or above 0.6 to be indicative of a strong association. These conclusions are regardless of P value. Whether these would indicate causation is another story; one has to use common sense and good theory.

If you take my weight from 1 to 20 years of age, and the price of gasoline in the US during that period, you will find that they are highly correlated. But common sense tells me that there is no causation whatsoever between these two variables.

There are a number of other issues to consider which I am not going to cover here. For example, relationships may be nonlinear, and standard correlation-based analyses are “blind” to nonlinearity. This is true even for advanced correlation-based statistical techniques such as multiple regression analysis, which control for competing effects of several variables on one main dependent variable. Ignoring nonlinearity may lead to misleading interpretations of associations, such as the association between total cholesterol and cardiovascular disease.

Note that this post is not an indictment of quantitative analyses in general. I am not saying “ignore numbers”. Denise’s blog post in fact uses careful quantitative analyses, with good ol’ common sense, to debunk several claims based on, well, quantitative analyses. If you are interested in this and other more advanced statistical analysis issues, I invite you to take a look at my other blog. It focuses on WarpPLS-based robust nonlinear data analysis.