Monday, October 31, 2011

Agent pleads guilty, taken into custody

Former Washington insurance agent Jasmine Jamrus-Kassim pleaded guilty this morning to 10 counts of theft for stealing more than $1 million in retirement funds from elderly insurance clients.

Jamrus-Kassim, who had been free on bond, was immediately taken into custody.

From 2007 to late 2009, several of Jamrus-Kassim's clients cashed out large portions of their retirement accounts, apparently thinking they were re-investing the money. In reality, the money went to Jamrus-Kassim, who spent tens of thousands of dollars on a psychic hotline, clothes, jewelry and a trip to Mexico.

An investigation by the Washington insurance commissioner's Special Investigations Unit led to her arrest in March.

And Bankers Life and Casualty, one of the companies that Jamrus-Kassim worked for, agreed last month to repay the money that Jamrus-Kassim stole

Sentencing in King County Superior Court is slated for Nov. 18.

Diwali!, by blogger of the month Ariella Krones

I will have three New Years this year!  First was Rosh Hashanah, last will be January 1, and today we celebrated Diwali, the Hindu festival of lights.  Though (I think) the 5-day festival is over, Saturday night worked the best for a low-key celebration.  And, because we have a pool and a substantial outdoor space, we were asked to host the celebration.  This holiday is about a lot of things, and is celebrated in many different ways.  As one of the stories was told to me, a prince was exiled from his city for many years, and when he returned, the city lit up with lights in celebration.   Hence, we light candles, preferably floating in water, and eat sweets.  These things I can do!

A tradition that one of our classmates keeps is to say a prayer or wish as she lights a candle.  So as we sat around the pool and watched our tinfoil boats of tea lights move, we each said something that we were thankful for.  I realized, listening to my classmates (from 1st, 2nd and 3rd year) how much each of us appreciates both this education and each other.   We had finished long days and yet we took the time to sit, listen to and learn from one another.  After we had each spoken, Maya led us in an ‘ohm.’  I hope that every week can begin with a group affirmation of the sound of the earth beginning.  - (thanks to Andrew for the pictures of the lights!)  October blogger of the month, Ariella Krones

The China Study II: Gender, mortality, and the mysterious factor X

WarpPLS and HealthCorrelator for Excel were used to do the analyses below. For other China Study analyses, many using WarpPLS as well as HealthCorrelator for Excel, click here. For the dataset used, visit the HealthCorrelator for Excel site and check under the sample datasets area. As always, I thank Dr. T. Colin Campbell and his collaborators for making the data publicly available for independent analyses.

In my previous post I mentioned some odd results that led me to additional analyses. Below is a screen snapshot summarizing one such analysis, of the ordered associations between mortality in the 35-69 and 70-79 age ranges and all of the other variables in the dataset. As I said before, this is a subset of the China Study II dataset, which does not include all of the variables for which data was collected. The associations shown below were generated by HealthCorrelator for Excel.

The top associations are positive and with mortality in the other range (the “M006 …” and “M005 …” variables). This is to be expected if ecological fallacy is not a big problem in terms of conclusions drawn from this dataset. In other words, the same things cause mortality to go up in the two age ranges, uniformly across counties. This is reassuring from a quantitative analysis perspective.

The second highest association in both age ranges is with the variable “SexM1F2”. This variable is a “dummy” variable coded as 1 for male sex and 2 for female, which I added to the dataset myself – it did not exist in the original dataset. The association in both age ranges is negative, meaning that being female is protective. They reflect in part the role of gender on mortality, more specifically the biological aspects of being female, since we have seen before in previous analyses that being female is generally health-protective.

I was able to add a gender-related variable to the model because the data was originally provided for each county separately for males and females, as well as through “totals” that were calculated by aggregating data from both males and females. So I essentially de-aggregated the data by using data from males and females separately, in which case the totals were not used (otherwise I would have artificially reduced the variance in all variables, also possibly adding uniformity where it did not belong). Using data from males and females separately is the reverse of the aggregation process that can lead to ecological fallacy problems.

Anyway, the associations with the variable “SexM1F2” got me thinking about a possibility. What if females consumed significantly less wheat flour and more animal protein in this dataset? This could be one of the reasons behind these strong associations between being female and living longer. So I built a more complex WarpPLS model than the one in my previous post, and ran a linear multivariate analysis on it. The results are shown below.

What do these results suggest? They suggest no strong associations between gender and wheat flour or animal protein consumption. That is, when you look at county averages, men and women consumed about the same amounts of wheat flour and animal protein. Also, the results suggest that animal protein is protective and wheat flour is detrimental, in terms of longevity, regardless of gender. The associations between animal protein and wheat flour are essentially the same as the ones in my previous post. The beta coefficients are a bit lower, but some P values improved (i.e., decreased); the latter most likely due to better resample set stability after including the gender-related variable.

Most importantly, there is a very strong protective effect associated with being female, and this effect is independent of what the participants ate.

Now, if you are a man, don’t rush to take hormones to become a woman with the goal of living longer just yet. This advice is not only due to the likely health problems related to becoming a transgender person; it is also due to a little problem with these associations. The problem is that the protective effect suggested by the coefficients of association between gender and mortality seems too strong to be due to men "being women with a few design flaws".

There is a mysterious factor X somewhere in there, and it is not gender per se. We need to find a better candidate.

One interesting thing to point out here is that the above model has good explanatory power in regards to mortality. I'd say unusually good explanatory power given that people die for a variety of reasons, and here we have a model explaining a lot of that variation. The model  explains 45 percent of the variance in mortality in the 35-69 age range, and 28 percent of the variance in the 70-79 age range.

In other words, the model above explains nearly half of the variance in mortality in the 35-69 age range. It could form the basis of a doctoral dissertation in nutrition or epidemiology with important  implications for public health policy in China. But first the factor X must be identified, and it must be somehow related to gender.

Next post coming up soon ...

Friday, October 28, 2011

The Brain Controls Insulin Action

Insulin regulates blood glucose primarily by two mechanisms:
  1. Suppressing glucose production by the liver
  2. Enhancing glucose uptake by other tissues, particularly muscle and liver
Since the cells contained in liver, muscle and other tissues respond directly to insulin stimulation, most people don't think about the role of the brain in this process.  An interesting paper just published in Diabetes reminds us of the central role of the brain in glucose metabolism as well as body fat regulation (1).  Investigators showed that by inhibiting insulin signaling in the brains of mice, they could diminish insulin's ability to suppress liver glucose production by 20%, and its ability to promote glucose uptake by muscle tissue by 59%.  In other words, the majority of insulin's ability to cause muscle to take up glucose is mediated by its effect on the brain. 

Read more »

Thursday, October 27, 2011

Children's open enrollment ends Monday, Oct. 31

If you need an individual health plan for your child or want to add them to your insurance, you have until Monday, Oct. 31. After that, unless you meet certain requirements, you'll have to wait until March 15-April 30, 2012.

There are some exceptions that allow children to be enrolled anytime during the year. Parents must apply for their child within 31 days of the following events if either they or their child:
  • No longer qualify for a state program.
  • Lose coverage due to a divorce.
  • Lose employer-sponsored coverage (including COBRA).
  • Move and their plan is not available where they live.
  • Also, parents or guardians can apply year-round for individual coverage within 60 days of birth, adoption, or placement of a child for adoption.

Monday, October 24, 2011

Does insurance cover space junk crashing to earth?

If pieces of a satellite crash on your home or car -- or on you -- does insurance cover that?

Yes, according to the Insurance Information Institute:

"Damages caused by falling objects are generally covered under standard auto, business, homeowners, and life insurance policies..."

the industry group says. It also noted, however, that the odds of being struck by space debris are extremely low.

The China Study II: Animal protein, wheat, and mortality … there is something odd here!

WarpPLS and HealthCorrelator for Excel were used in the analyses below. For other China Study analyses, many using WarpPLS and HealthCorrelator for Excel, click here. For the dataset used, visit the HealthCorrelator for Excel site and check under the sample datasets area. I thank Dr. T. Colin Campbell and his collaborators at the University of Oxford for making the data publicly available for independent analyses.

The graph below shows the results of a multivariate linear WarpPLS analysis including the following variables: Wheat (wheat flour consumption in g/d), Aprot (animal protein consumption in g/d), Mor35_69 (number of deaths per 1,000 people in the 35-69 age range), and Mor70_79 (number of deaths per 1,000 people in the 70-79 age range).

Just a technical comment here, regarding the possibility of ecological fallacy. I am not going to get into this in any depth now, but let me say that the patterns in the data suggest that, with the possible exception of some variables (e.g., blood glucose, gender; the latter will get us going in the next few posts), ecological fallacy due to county aggregation is not a big problem. The threat of ecological fallacy exists, here and in many other datasets, but it is generally overstated (often by those whose previous findings are contradicted by aggregated results).

I have not included plant protein consumption in the analysis because plant protein consumption is very strongly and positively associated with wheat flour consumption. The reason is simple. Almost all of the plant protein consumed by the participants in this study was probably gluten, from wheat products. Fruits and vegetables have very small amounts of protein. Keeping that in mind, what the graph above tells us is that:

- Wheat flour consumption is significantly and negatively associated with animal protein consumption. This is probably due to those eating more wheat products tending to consume less animal protein.

- Wheat flour consumption is positively associated with mortality in the 35-69 age range. The P value (P=0.06) is just shy of the 5 percent (i.e., P=0.05) that most researchers would consider to be the threshold for statistical significance. More consumption of wheat in a county, more deaths in this age range.

- Wheat flour consumption is significantly and positively associated with mortality in the 70-79 age range. More consumption of wheat in a county, more deaths in this age range.

- Animal protein consumption is not significantly associated with mortality in the 35-69 age range.

- Animal protein consumption is significantly and negatively associated with mortality in the 70-79 age range. More consumption of animal protein in a county, fewer deaths in this age range.

Let me tell you, from my past experience analyzing health data (as well as other types of data, from different fields), that these coefficients of association do not suggest super-strong associations. Actually this is also indicated by the R-squared coefficients, which vary from 3 to 7 percent. These are the variances explained by the model on the variables above the R-squared coefficients. They are low, which means that the model has weak explanatory power.

R-squared coefficients of 20 percent and above would be more promising. I hate to disappoint hardcore carnivores and the fans of the “wheat is murder” theory, but these coefficients of association and variance explained are probably way less than what we would expect to see if animal protein was humanity's salvation and wheat its demise.

Moreover, the lack of association between animal protein consumption and mortality in the 35-69 age range is a bit strange, given that there is an association suggestive of a protective effect in the 70-79 age range.

Of course death happens for all kinds of reasons, not only what we eat. Still, let us take a look at some other graphs involving these foodstuffs to see if we can form a better picture of what is going on here. Below is a graph showing mortality at the two age ranges for different levels of animal protein consumption. The results are organized in quintiles.

As you can see, the participants in this study consumed relatively little animal protein. The lowest mortality in the 70-79 age range, arguably the range of higher vulnerability, was for the 28 to 35 g/d quintile of consumption. That was the highest consumption quintile. About a quarter to a third of 1 lb/d of beef, and less of seafood (in general), would give you that much animal protein.

Keep in mind that the unit of analysis here is the county, and that these results are based on county averages. I wish I had access to data on individual participants! Still I stand by my comment earlier on ecological fallacy. Don't worry too much about it just yet.

Clearly the above results and graphs contradict claims that animal protein consumption makes people die earlier, and go somewhat against the notion that animal protein consumption causes things that make people die earlier, such as cancer. But they do so in a messy way - that spike in mortality in the 70-79 age range for 21-28 g/d of animal protein is a bit strange.

Below is a graph showing mortality at the two age ranges (i.e., 35-69 and 70-79) for different levels of wheat flour consumption. Again, the results are shown in quintiles.

Without a doubt the participants in this study consumed a lot of wheat flour. The lowest mortality in the 70-79 age range, which is the range of higher vulnerability, was for the 300 to 450 g/d quintile of wheat flour consumption. The high end of this range is about 1 lb/d of wheat flour! How many slices of bread would this be equivalent to? I don’t know, but my guess is that it would be many.

Well, this is not exactly the smoking gun linking wheat with early death, a connection that has been reaching near mythical proportions on the Internetz lately. Overall, the linear trend seems to be one of decreased longevity associated with wheat flour consumption, as suggested by the WarpPLS results, but the relationship between these two variables is messy and somewhat weak. It is not even clearly nonlinear, at least in terms of the ubiquitous J-curve relationship.

Frankly, there is something odd about these results.

This oddity led to me to explore, using HealthCorrelator for Excel, all ordered associations between mortality in the 35-69 and 70-79 age ranges and all of the other variables in the dataset. That in turn led me to a more complex WarpPLS analysis, which I’ll talk about in my next post, which is still being written.

I can tell you right now that there will be more oddities there, which will eventually take us to what I refer to as the mysterious factor X. Ah, by the way, that factor X is not gender - but gender leads us to it.

Sunday, October 23, 2011

Harvard Food Law Society "Forum on Food Policy" TEDx Conference

Last Friday, it was my pleasure to attended and present at the Harvard Food Law Society's TEDx conference, Forum on Food Policy.  I had never been to Cambridge or Boston before, and I was struck by how European they feel compared to Seattle.  The conference was a great success, thanks to the dedicated efforts of the Food Law Society's presidents Nate Rosenberg, Krista DeBoer, and many other volunteers. 

Dr. Robert Lustig gave a keynote address on Thursday evening, which I unfortunately wasn't able to attend due to my flight schedule.  From what I heard, he focused on practical solutions for reducing national sugar consumption, such as instituting a sugar tax.  Dr. Lustig was a major presence at the conference, and perhaps partially due to his efforts, sugar was a central focus throughout the day.  Nearly everyone agrees that added sugar is harmful to the nation's health at current intakes, so the question kept coming up "how long is it going to take us to do something about it?"  As Dr. David Ludwig said, "...the obesity epidemic can be viewed as a disease of technology with a simple, but politically difficult solution".

Read more »

Boost Your Immunity!

Achoo! Tis' the season of colds and flu viruses. A recent published in the British Medical Journal said that the best defense against the flu is good hygiene including washing your hands and covering your mouth and nose when you sneeze. In addition to good hygiene, it is important to keep your immune system in tip top shape! Follow these 10 quick tips to boost your immunity and stay healthy through this flu season:

1. Eat the rainbow! Stalking up on raw fruits and vegetables will give your body the anti-oxidants, vitamins, minerals, fiber and enzymes it needs to run smoothly. They will protect the cells of your body and turn you into a disease fighting machine. Aim towards 9-10 servings of fresh fruit and vegetables a day.

2. Step out into the sun and get some exercise! It’s great if you head to the gym daily for at least 30 minutes of cardio. Exercise is important for good health. But to boost your immune system while getting your cardio in, head to the great outdoors. Sadly, most Americans spend more than 80% of their day inside. Exercising outside in the fresh air will release endorphins and set your body on a natural high. The chilly weather will stimulate your thyroid gland and the added sunshine is important for Vitamin D levels…..

3. Start taking a multi-vitamin that includes sufficient amounts of Vitamin D. Recent studies have shown there are clear links between Vitamin D deficiency and obesity, insulin resistance, depression, certain cancers, heart disease, stroke, parathyroid problems and reduced immune function. Adult women need between 3000 and 5000 i.u's of D3 daily. For more information on Vitamin D deficiency in women see this article from

4. Kick the sugar addiction. If there is one thing you can do that will boost your immune system it’s the reduction and elimination of refined, white sugar from your diet. On average, Americans eat more than 150 pounds of refined, white sugar each year or about ½ cup each day. Unfortunately, our bodies are not designed to digest that amount of sugar. Too much sugar overworks and exhausts our white blood cells and weakens the immune system. White blood cells need protein to function. Excess sugar in our diet means that protein in the diet will not be digested and assimilated properly leading to reduced white blood cell function! Try reducing your sugar intake by replacing refined sugars with natural sugar alternative including honey, maple syrup or agave nectar. Avoid artificial sweeteners as they are more toxic than refined cane sugar.

5. Eat your protein! The proper amount of protein is essential to promote cell production and support the immune system. Eating protein will also prevent loss of lean muscle mass as well as boost your energy. Protein does not have to come from animal products, there are great vegetarian sources of protein that include broccoli, nuts, seeds, tofu and spinach!

6. Get your sleep! Not getting enough sleep at night has been shown to trigger inflammatory response in the cells of the body. Cellular inflammation will aggravate autoimmune disorders, specifically in females. Even modest sleep deprivation can play a role in many immune disorders. Sleep is vitally important to maintain a healthy immune system.

7. Drink water! Staying hydrated is so important for your health! To find out how much water you need and ways to make water drinking enjoyable check out our previous blog entry, Glamorous Hydration.

8. Enjoy a cup of tea! Switch out that cup of coffee for a cup of green tea. Green tea is loaded with antioxidants that will help to strengthen your immune system. Not only will green tea boost your immune system but it lower your cholesterol and blood pressure, a great benefit to your heart health!

9. Add garlic! Garlic is a potent immune system booster. It is an anti-microbial agent that is effective against bacteria, viruses, fungi and parasites. Add fresh garlic to your salads, soups, sauces and sandwiches. To kick your immune system into high gear try this garlic immune booster shot: Juice together 4 cloves of garlic with a good sized chunk of ginger root, add a dash of cayenne and a table spoon of flax oil. It may not taste the best, but it will super charge your immune system!

10. Pamper yourself! Take time out for you. Treat yourself to one thing a week that will make you feel relaxed and loved. This could be as simple as hunkering down in your favorite chair to enjoy an hour of a new book, call a best friend who lives hours away, get a massage, taking a bubble bath or baking cookies. Taking time to nurture yourself and treat yourself to something special will reduce your stress level naturally boosting your immune system.

Following these 10 tips will help keep you happy and healthy throughout the fall and winter season.

Keep it Fresh!

Friday, October 21, 2011

Some travelling, physically and mentally, by blogger of the month Ariella Krones

It’s the beginning of the end of our last long break in our first semester of med school.  Whew.  In celebration and badly in need of a break from studying, I took a nap in the hammock outside.  [background: by some stroke of luck, I ended up living in an apartment with a lovely yard and lovely neighbors who own a hammock].  It is finally getting chilly here, which for some reason made the half hour so enjoyable.  Maybe Be’ersheva is finally starting to feel like a home?

Many students at MSIH travel for the sukkot break.  I went with a few friends to Crete.  We were not really sure what to expect, but none of us had been before and we all wanted some change of scenery.  We got that, in many ways, including a day and half of rain.  While we did not get to do as much hiking and exploring as we would have liked, I loved it.  We went for a walk in the pouring rain along the old Venetian harbor, marveling at how the waves that splashed up from the Mediterranean Sea onto our feet looked dark, sharp and altogether cartoonish. 

The old Venetian harbor in Crete on a less-wet day.

When our feet started to squish, we ducked into what looked like an old mosque- domed, but with no turret, and with Arabic artwork outside and in.  There was a small art exhibit inside.  After looking around for a bit at the range of pieces this one artist had made, we went back outside, into the rain.  We then saw another exhibition, and so, with questions about the beautiful leaning buildings and the art space/mosque on the harbor, went in.  After puzzling vocally over the translated explanations of the slice of Cretan history, a very nice man helped us out, explaining that, until about WWI, Crete had been governed by a series of empires including the Venetians and the Ottomans.  Crete is still a fantastically beautiful island, and for the rest of the trip it was fun to work out when the buildings we saw might have been built, and why. 

Lots of cats in Be'ersheva.  Lots of cats in Crete.  Somehow,
the cats in Crete seem to be many times more healthy
and friendly than the cats in Be'ersheva.  Odd.

As you may have surmised by my initial story of napping instead of studying, settling back into class after such a break is a process.  Part of that process, for me, is refocusing on exactly why I am where I am (in medical school).   I have spent some time reading about the new malaria vaccine that has been shown to reduce malarial infections in children by half.  This is very exciting.  The efforts to eradicate malaria have gone through many different phases in the past.  Researchers have attempted to refine mechanisms to remove the parasite from humans, remove the parasite from the vector, most often mosquitoes, and remove the vector from the environment.  The most recent push has been to use bed nets to protect people from the mosquito vectors.   A vaccine in combination with other protective measures could truly change the face of malaria treatment. 

While any advance toward a vaccine for malaria, or a parasitic disease for that matter, is a good one, there are a lot of questions raised.  First in my mind concerns the fact that this is a parasitic disease.  Even if the vaccine worked 100% of the time on all strains of bacteria, would that be enough, or would the parasite be able to live in the vector?  There are also questions of resistance.  Will the parasite evolve beyond the reach of the vaccine, and will immunogenicity wear off?  (Time to start studying immunology)  Most pressing to someone in my position as a medical student, how would we practically integrate a vaccine with less than 100% success rate into primary care settings, along with other methods of prevention, treatment and education, especially when the places that are hardest hit by malaria are often the places with very little primary care?   - blogger of the month Ariella Krones

Some articles to read about malaria:  Follow the links inside the articles to learn more.
Assessing Strategy and Equity in the Elimination of Malaria:

Wednesday, October 19, 2011

Special Advisor for Global Health Partnerships Addresses Complexities of Global Health Funding

Shatreen Masshoor, Yale College ’12

As part of the Global Health Seminar series, Special Advisor for Global Health Partnerships under the U.S. Department of State, John Monahan recently spoke at Yale. During his talk, he highlighted that the U.S. is the largest donor to the Global Fund, in their partnership with the Global Fund to Fight AIDS, tuberculosis and malaria. With 3.2 million people receiving antiretroviral treatment, 8.2 million cases of tuberculosis treated and detected, and over 190 million bed nets distributed, the Global Fund results are staggering.

As a student interested in global health, I had never realized the interdependence of U.S. government bilateral programs and Global Fund initiatives. For example, the Global Fund allows for purchases of antiretroviral drugs, while PEPFAR (President’s Emergency Plan for AIDS Relief) has programs that support test kits, training, and delivery of these antiretrovirals to patients.

Juxtaposed with these examples of successful initiatives were questions about the Global Fund. In recent months, the Global Fund was rocked by scandal regarding mismanagement of funds. Monahan addressed this by discussing how the High-Level Independent Review Panel on Fiduciary Controls and Oversight Mechanism was convened. This panel was formed to assess the current management of funds within the Global Fund and to make recommendations. Monahan echoed the panel’s sentiment that the “failure of the Global Fund would be a global health catastrophe.” Both the panel and Monahan recognized that three trends would create change within the Global Fund: austerity, accountability, and innovation.

After hearing Monahan speak, I emerged with a better understanding of the relationship between the United States and the Global Fund, as well as a sense that the Global Fund is attempting to reform itself. As such powerful players in the global health field, both the United States government and the Global Fund must be self-reflexive and open to reform, to ensure sustained advances in global health.

Tuesday, October 18, 2011

Is the weather really getting worse? Insurer's data suggests yes

Munich Re, a major reinsurance company, this summer released a very interesting report on natural disasters, and the data suggests that, as one newspaper columnist put it, it's not your imagination. The weather really is getting worse. Click on that link, and take a look at the chart you'll see.
Munich Re's full report is online and entitled the 2011 Half-Year Natural Catastrophe Review. There's also a 47-minute webinar on the topic posted online.

Monday, October 17, 2011

Losing Fat With Simple Food-- Two Reader Anecdotes

Each week, I'm receiving more e-mails and comments from people who are successfully losing fat by eating simple (low reward) food, similar to what I described here.  In some cases, people are breaking through fat loss plateaus that they had reached on conventional low-carbohydrate, low-fat or paleo diets.  This concept can be applied to any type of diet, and I believe it is an important characteristic of ancestral food patterns.

At the Ancestral Health Symposium, I met two Whole Health Source readers, Aravind Balasubramanian and Kamal Patel, who were interested in trying a simple diet to lose fat and improve their health.  In addition, they wanted to break free of certain other high-reward activities in their lives that they felt were not constructive.  They recently embarked on an 8-week low-reward diet and lifestyle to test the effectiveness of the concepts.  Both of them had previously achieved a stable (in Aravind's case, reduced) weight on a paleo-ish diet prior to this experiment, but they still carried more fat than they wanted to.  They offered to write about their experience for WHS, and I thought other readers might find it informative.  Their story is below, followed by a few of my comments.

Read more »

Red cars, insurance and speeding tickets

There's an urban myth out there that holds that the color of a car affects your insurance rate. The rumor is so pervasive that some insurers mention it on their corporate websites.

It's not true. In our experience, the color of a car has nothing to do with how much you pay for auto coverage. We review auto insurance rates (among many others) here in Washington state, and we can't recall ever seeing an auto insurance rate schedule that takes color into account. Insurers do often raise rates for high performance vehicles, which may be more likely to come in red, but color itself is meaningless in determining rates.

(Here are the sorts of factors insurers take into account, including things that might surprise you -- like your credit score.)

While we're on the topic, how about the widespread belief that red cars get more speeding tickets?, the rumor-busting website, says that doesn't seem to be true, either:

"...It does not appear that red cars get cited for speeding more often than they statistically should."

Book review: Perfect Health Diet

Perfect Health Diet is a book that one should own. It is not the type of book that you can get from your local library and just do a quick read over (and, maybe, write a review about it). If you do that, you will probably miss several important ideas that form the foundation of this book, which is a deep foundation.

The book is titled “Perfect Health Diet”, not “The Perfect Health Diet”. If you think that this is a mistake, consider that the most successful social networking web site of all time started as “The Facebook”, and then changed to simply “Facebook”; which was perceived later as a major improvement.

Moreover, “Perfect Health Diet” makes for a cool and not at all inappropriate acronym – “PHD”.

What people eat has an enormous influence on their lives, and also on the lives of those around them. Nutrition is clearly one of the most important topics in the modern world - it is the source of much happiness and suffering for entire populations. If Albert Einstein and Marie Curie were alive today, they would probably be interested in nutrition, as they were about important topics of their time that were outside their main disciplines and research areas (e.g., the consequences of war, and future war deterrence).

Nutrition attracts the interest of many bright people today. Those who are not professional nutrition researchers often fund their own research, spending hours and hours of their own time studying the literature and even experimenting on themselves. Several of them decide to think deeply and carefully about it. A few, like Paul Jaminet and Shou-Ching Jaminet, decide to write about it, and all of us benefit from their effort.

The Jaminets have PhDs (not copies of their books, degrees). Their main PhD disciplines are somewhat similar to Einstein’s and Curie’s; which is an interesting coincidence. What the Jaminets have written about nutrition is probably analogous, in broad terms, to what Einstein and Curie would have written about nutrition if they were alive today. They would have written about a “unified field theory” of nutrition, informed by chemistry.

To put it simply, the main idea behind this book is to find the “sweet spot” for each major macronutrient (e.g., protein and fat) and micronutrient (e.g., vitamins and minerals) that is important for humans. The sweet spot is the area indicated on the graph below. This is my own simplified interpretation of the authors' more complex graphs on marginal benefits from nutrients.

The book provides detailed information about each of the major nutrients that are important to humans, what their “sweet spot” levels are, and how to obtain them. In this respect the book is very thorough, and also very clear, including plenty of good arguments and empirical research results to back up the recommendations. But this book is much more than that.

Why do I refer to this book as proposing a “unified field theory” of nutrition? The reason is that this book clearly aims at unifying all of the current state of the art knowledge about nutrition, departing from a few fundamental ideas.

One of those fundamental ideas is that a good diet would provide nutrients in the same ratio as those provided by our own tissues when we “cannibalize” them – i.e., when we fast. Another is that human breast milk is a good basis for the estimation of the ratios of macronutrients a human adult would need for optimal health.

And here is where the depth and brilliance with which the authors address these issues can lead to misunderstandings.

For example, when our body “cannibalizes” itself (e.g., at the 16-h mark of a water fast), there is no digestion going on. And, as the authors point out, what you eat, in terms of nutrients, is often not what you get after digestion. It may surprise many to know that a diet rich in vegetables is actually a high fat diet (if you are surprised, you should read the book). One needs to keep these things in mind to understand that not all dietary macronutrient ratios will lead to the same ratios of nutrients after digestion, and that the dietary equivalent of “cannibalizing” oneself is not a beef-only diet.

Another example relates to the issue of human breast milk. Many seem to have misunderstood the authors as implying that the macronutrient ratios in human breast milk are optimal for adult humans. The authors say nothing of the kind. What they do is to use human breast milk as a basis for their estimation of what an adult human should get, based on a few reasonable assumptions. One of the assumptions is that a human adult’s brain consumes proportionally much less sugar than an infant’s.

Yet another example is the idea of “safe starches”, which many seem to have taken as a recommendation that diabetics should eat lots of white rice and potato. The authors have never said such a thing in the book; not even close. "Safe starches", like white rice and sweet potatoes (as well as white potatoes), are presented in the book as good sources of carbohydrates that are also generally free from harmful plant toxins. And they are, if consumed after cooking.

By the way, I have a colleague who has type 2 diabetes and can eat meat with white potatoes without experiencing hyperglycemia, as long as the amount of potato is very small and is eaten after a few bites of meat.

Do I disagree with some of the things that the authors say? Sure I do, but not in a way that would lead to significantly different dietary recommendations. And, who knows, maybe I am wrong.

For example, the authors seem to think that dietary advanced glycation end-products (AGEs) can be a problem for humans, and therefore recommend that you avoid cooking meat at high temperatures (no barbecuing, for example). I have not found any convincing evidence that this is true in healthy people, but following the authors’ advice will not hurt you at all. And if your digestive tract is compromised to the point that undigested food particles are entering your bloodstream, then maybe you should avoid dietary sources of AGEs.

Also, I think that humans tend to adapt to different macronutrient ratios in more fundamental ways than the authors seem to believe they can. These adaptations are long-term ones, and are better understood based on the notion of compensatory adaptation. For instance, a very low carbohydrate diet may bring about some problems in the short term, but long-term adaptations may reverse those problems, without a change in the diet.

The authors should be careful about small errors that may give a bad impression to some experts, and open them up to undue criticism; as experts tend to be very picky and frequently generalize based on small errors. Here is one. The authors seem to imply that eating coconut oil will help feed colon cells, which indeed seem to feed on short-chain fats; not exactly the medium-chain fats abundantly found in coconut oil, but okay. (This may be the main reason why indigestible fiber contributes to colon health, by being converted by bacteria to short-chain fats.) The main problem with the authors' implied claim is that coconut oil, as a fat, will be absorbed in the small intestine, and thus will not reach colon cells in any significant amounts.

Finally, I don’t think that increased animal protein consumption causes decreased longevity; an idea that the authors seem to lean toward. One reason is that seafood consumption is almost universally associated with increased longevity, even when it is heavily consumed, and seafood in general has a very high protein-to-fat ratio (much higher than beef). The connection between high animal protein consumption and decreased longevity suggested by many studies, some of which are cited in the book, is unlikely to be due to the protein itself, in my opinion. That connection is more likely to be due to some patterns that may be associated in certain populations with animal protein consumption (e.g., refined wheat and industrial seed oils consumption).

Thankfully, controversial issues and small errors can be easily addressed online. The authors maintain a popular blog, and they do so in such a way that the blog is truly an extension of the book. This blog is one of my favorites. Perhaps we will see some of the above issues addressed in the blog.

All in all, this seems like a bargain to me. For about 25 bucks (less than that, if you trade in quid; and more, if you do in Yuan), and with some self-determination, you may save thousands of dollars in medical bills. More importantly, you may change your life, and those of the ones around you, for the better.

Friday, October 14, 2011

Don't get fooled by official-looking health insurance website

The federal Centers for Medicare and Medicaid Services (CMS) is warning consumers about a site that "has the appearance of being an official government website" but isn't. The website is Here's a partial screenshot:

From CMS:
This new not maintained by any government programs and consumers are strongly urged not to submit any personal information requested by this website under the assumption that it is a government website.
The site includes a small disclaimer acknowledging that it's not a government-run site, but is:
"rather (a) solicitation by a licensed insurance entity/agent/broker seeking to assist and enroll individuals in the PCIP program or other insurance products."
Pre-existing Condition Insurance Plans -- PCIPs for short -- were created under federal health care reform. They're a good option for people who have a problem getting insurance due to a pre-existing medical condition. Here's our official, real website that explains more about Washington's PCIP program.

Not in Washington? Here's the official federal PCIP site.

Thursday, October 13, 2011

Premera refiles rate request

Premera Blue Cross has refiled a rate change for its individual health plans - this time seeking a 4.7 percent increase. We disapproved it's earlier request for a 3.1 percent increase in September. We have 60 days to review the request and make a decision.

The new rate, if approved would take effect on Jan. 1, 2012 and would impact approximately 3,874 people.

You can view the entire rate filing, a summary of key date supplied by Premera and why we turned down their last request at

Wednesday, October 12, 2011

Wanderings, by Ariella Krones, October blogger of the month

So I promised pictures at the end of my last post.  But alas, I have none.  Just stories.  And proof that, yes, in fact, everything except Soroka Hospiial shuts down for Yom Kippur.

Erev Yom Kippur we went for a walk.  It was beautiful.  The evening had started by going to dinner at another classmate’s apartment, and then walking over to a synagogue we had heard was good.  It wasn’t my style, so I went outside and ended up doing a little meditation of my own.   When the service finished up, we went our separate ways until it got a bit later.   Around 10pm, we made our way to Rager Street, the three lane highway that runs straight down the middle of Be’ersheva.  We live right near the emergency entrance to the hospital, so when we started out there were cars and ambulances going in and out, infrequently but enough to notice.  As we wandered further down Rager, though there were fewer and fewer cars and more and more people, on foot, bikes or other form of wheel.  We cartwheeled in the middle of the south bound lane and took pictures as we went to pick up some more friends. 

I was feeling pretty quiet, just enjoying the people and the cool air (very cool for the negev), but it was definitely the most festive I have ever been on Yom Kippur.  There were small groups of kids on bikes, finally safe from the cars that usually pay little attention to them, as well as families walking their dogs.  I have talked to other friends about what they did that evening, and it seems the mood around the city was pretty consistent.  Some people went biking themselves, and said that they were probably the oldest people on wheels.  Some neighborhoods were much busier than others, with entire families out playing, while others were pretty empty.

A few of us had planned to have a breakfast at the end of the holiday (for those who don’t know, there is traditionally a fast on Yom Kippur for 25 hours, with a break the fast at the end).  We invited people who we knew were fasting, and mentioned it casually to others.  However, with all that was going on, I neglected to follow up with many people.  The following is an example of one of my favorite things about MSIH so far.  I’m not sure if it’s because the program is so small or because it attracts a certain kind of incredibly self-sufficient person, but the dinner turned out to be lovely, as people called or stopped by of their own intiative with a dish to contribute. 

As demonstrated, the MSIH student body is a more collaborative group than I have ever been part of.    The group of us, for the most part, is in class together for 6-8 hours a day, and then are also each other’s main resource for social events and learning about Be’ersheva.  There is a stream of emails and phone calls asking for and offering support that looks something like this:

Is anyone cabbing to the airport on Thursday?  I have a flight in the evening around 7. 
Organized a yoga class every Tuesday and wanted to get a count of people interested…
I have a car for the day!  Four seats available for a good shopping trip if anyone needs.

There is a concern for your classmates’ well-being and success, a conscious effort on the part of individuals to make the collective experience here a good one.  With that said, we are all on our separate ways (more or less) for Sukkot vacation.  Ten days, and how many countries?  After spending some time in the empty streets of Be’ersheva I’m excited to wander around Crete for a bit! - blogger of the month Ariella Krones

Monday, October 10, 2011

Insurance company not paying a life insurance claim? Here's what you can do...

Generally, insurance companies can only deny life insurance proceeds within the first two policy years for two reasons. This is called the "contestability period." After the two years, the insurer generally cannot contest the benefits.

The two reasons are if the death of the insured:

1. Is due to suicide (this does not apply to group life policies).
2. Didn't tell the truth on the application for coverage. This is called the “contestability period.” After the two years, the insurance company cannot contest the benefits.

(Bonus round: Here's a link to our ever-popular post on "How to find old life insurance policies.")

If you’re the beneficiary of a life insurance policy and you think the insurer is wrongly denying your claim for benefits, file a complaint with our office, if you live in Washington state. (If you don't, here's a handy map showing how to contact your own state insurance regulator.) We'll look into the matter and see if we can help you resolve the problem. File a complaint online or give us a call at 1-800-562-6900.

Certain mental disorders may have evolved as costs of attractive mental traits

I find costly traits fascinating, even though they pose a serious challenge to the notion that living as we evolved to live is a good thing. It is not that they always deny this notion; sometimes they do not, but add interesting and somewhat odd twists to it.

Costly traits have evolved in many species (e.g., the male peacock’s train) because they maximize reproductive success, even though they are survival handicaps. Many of these traits have evolved through nature’s great venture capitalist – sexual selection.


Certain harmful mental disorders in humans, such as schizophrenia and manic–depression, are often seen as puzzles from an evolutionary perspective. The heritability of those mental disorders and their frequency in the population at various levels of severity suggests that they may have been evolved through selection, yet they often significantly decrease the survival prospects of those afflicted by them (Keller & Miller, 2006; Nesse & Williams, 1994).

The question often asked is why have they evolved at all? Should not they have been eliminated, instead of maintained, by selective forces? It seems that the most straightforward explanation for the existence of certain mental disorders is that they have co-evolved as costs of attractive mental traits. Not all mental disorders, however, can be explained in this way.

The telltale signs of a mental disorder that is likely to be a cost associated with a trait used in mate choice are: (a) many of the individuals afflicted are also found to have an attractive mental trait; and (b) the mental trait in question is comparatively more attractive than other mental traits that have no apparent survival costs associated with them.

The broad category of mental disorders generally referred to as schizophrenia is a good candidate in this respect because:
    - Its incidence in human males is significantly correlated with creative intelligence, the type of intelligence generally displayed by successful artists, which is an attractive mental trait (Miller & Tal, 2007; Nettle, 2006b).
    - Creative intelligence is considered to be one of the most attractive mental traits in human males, to the point of females at the peak of their fertility cycles finding creative but poor males significantly more attractive than uncreative but wealthy ones (Haselton & Miller, 2006).

The same generally applies to manic–depression, and a few other related mental disorders.

By the way, creative intelligence is also strongly associated with openness, one of the "big five" personality traits. And, both creative intelligence and mental disorders are seen in men and women. This is so even though it is most likely that selection pressure for creative intelligence was primarily exerted by ancestral women on men, not ancestral men on women.

Crespi (2006), in a response to a thorough and provocative argument by Keller & Miller (2006) regarding the evolutionary bases of mental disorders, makes a point that is similar to the one made above (see, also, Nettle, 2006), and also notes that schizophrenia has a less debilitating effect on human females than males.

Ancestral human females, due to their preference for males showing high levels of creative intelligence, might have also selected a co-evolved cost that affects not only males but also the females themselves though gene correlation between the sexes (Gillespie, 2004; Maynard Smith, 1998).

There is another reason why ancestral women might have possessed certain traits that they selected for in ancestral men. Like anything that involves intelligence in humans, the sex applying selection pressure (i.e., female) must be just as intelligent as (if not more than) the sex to which selection pressure is applied (i.e., males). Peahens do not have to have big and brightly colored trains to select male peacocks that have them. That is not so with anything that involves intelligence (in any of its many forms, like creative and interpersonal intelligence), because intelligence must be recognized through communication and behavior, which itself requires intelligence.

Other traits that differentiate females from males may account for differences in the actual survival cost of schizophrenia in females and males. For example, males show a greater propensity toward risk-taking than females (Buss, 1999; Miller, 2000), and schizophrenia may positively moderate the negative relationship between risk-taking propensity and survival success.

Why were some of our ancestors in the Stone Age artists, creating elaborate cave paintings, sculptures, and other art forms? Maybe because a combination of genetic mutations and environmental factors made it a sexy thing to do from around 50,000 years ago or so, even though the underlying reason why the ancestral artists produced art may also have increased the chances that some of them suffered from mental disorders.

A heritable trait possessed by males and perceived as very sexy by females has a very good chance of evolving in any population. That is so even if the trait causes the males who possess it to die much earlier than other males. In the human species, a male can father literally hundreds of children in just a few years. Unlike men, women tend to be very selective of their sexual partners, which does not mean that they cannot all select the same partner (Buss, 1999).

So, if this is true, what is the practical value of knowing it?

It seems reasonable to believe that knowing the likely source of a strange and unpleasant view of the world is, in and of itself, therapeutic. A real danger, it seems, is in seeing the world in a strange and unpleasant way (e.g., as a schizophrenic may see it), and not knowing that the distorted view is caused by an underlying reason. The stress coming from this lack of knowledge may compound the problem; the symptoms of mental disorders are often enhanced by stress.

As one seeks professional help, it may also be comforting to know that something that is actually very good, like creative intelligence, may come together with the bad stuff.

Finally, is it possible that our modern diets and lifestyles significantly exacerbate the problem? The answer is "yes", and this is a theme that has been explored many times before by Emily Deans. (See also this post, by Emily, on the connection between mental disorders and creativity.)

(All cited references are listed in the article below. If you like mathematics, this article is for you.)

Kock, N. (2011). A mathematical analysis of the evolution of human mate choice traits: Implications for evolutionary psychologists. Journal of Evolutionary Psychology, 9(3), 219-247.

Friday, October 7, 2011

The Case for the Food Reward Hypothesis of Obesity, Part II

In this post, I'll explore whether or not the scientific evidence is consistent with the predictions of the food reward hypothesis, as outlined in the last post.

Before diving in, I'd like to address the critique that the food reward concept is a tautology or relies on circular reasoning (or is not testable/falsifiable).  This critique has no logical basis.  The reward and palatability value of a food is not defined by its effect on energy intake or body fatness.  In the research setting, food reward is measured by the ability of food or food-related stimuli to reinforce or motivate behavior (e.g., 1).  In humans, palatability is measured by having a person taste a food and rate its pleasantness in a standardized, quantifiable manner, or sometimes by looking at brain activity by fMRI or related techniques (2).  In rodents, it is measured by observing stereotyped facial responses to palatable and unpalatable foods, which are similar to those seen in human infants.  It is not a tautology or circular reasoning to say that the reinforcing value or pleasantness of food influences food intake and body fatness. These are quantifiable concepts and as I will explain, their relationship with food intake and body fatness can be, and already has been, tested in a controlled manner. 

1.   Increasing the reward/palatability value of the diet should cause fat gain in animals and humans

Read more »

Where you can find a flu shot

Here's a new site, developed by the feds, where you can type in your zip code and immediately get a list of local pharmacies, etc. that have the flu vaccine. (Your doctor or clinic's probably got the shots, too.)

We thought it was pretty clever and useful.

Insurance agent who sold fake policies sentenced to more than two years in prison

An insurance agent who sold hundreds of thousands of dollars in fake business-insurance policies has been sentenced to more than two years in prison.

Brenda MacLaren-Beattie, 68, of Des Moines, Wash., was sentenced Thursday in King County Superior Court to 26 months in prison. She was immediately taken into custody. She was also ordered to pay back $532,659 in restitution.

“I’m very pleased that the court took this as seriously as we did,” said Insurance Commissioner Mike Kreidler. “This agent sold fictitious coverage to dozens of medical offices in Washington and Oregon, often for years. People thought they had coverage and they didn’t.”

An investigation by Kreidler’s office found that from late 2001 through 2009, MacLaren-Beattie issued fake insurance to 25 oral surgeons in Washington and 16 in Oregon. During that time, she is believed to have collected more than $532,000 in premiums for fictitious insurance policies, often issuing counterfeit certificates of insurance to doctors and clinics. Her insurance license expired in 2009. (And here's the cease-and-desist order issued at the time.)

In a few cases – a lost camera, some water damage – she paid out small insurance claims herself. One of her clients became suspicious after a claim check was issued by MacLaren-Beattie, rather than from an insurance company.

The fictitious policies were for business owners’ general liability insurance, which typically covers things like slip-and-fall accidents, employee theft, and damage to rented property.

MacLaren-Beattie pleaded guilty in August to eight counts of first-degree theft, a felony. On Thursday, she received eight 26-month sentences, which will run concurrently.

How to avoid buying a flood-damaged car

With hurricane and storm season winding down, an insurance industry organization is warning about the likelihood that flood-damaged vehicles will be sold to salvage dealers, their flood-damage history illegally hidden, and sold as normal cars in the used-car market.

An anti-fraud group, the National Insurance Crime Bureau, has created an online tool where you can look up -- for free -- a car's vehicle identification number and see if it's been declared a salvage vehicle by an insurer. (The VIN number is typically visible through the front windshield, where the windshield meets the car's hood. It's usually a long combination of numbers and letters.)

Also, the Insurance Information Institute suggests being on the lookout for several warning signs that a car may have been flooded:

 Mildew, debris and silt in places where it wouldn't normally be found, such as under the carpeting in the trunk, or around the engine compartment

 Rust on screws and other metal parts

 Waterstains or faded upholstery; discoloration of seatbelts and door panels

 Dampness in the floor and carpeting; moisture on the inside of the instrument panel

 A moldy odor or an intense smell of Lysol or deodorizer; this is a tactic frequently used by dealers to cover up an odor problem

If you suspect that your local car dealer is committing fraud by knowingly selling flooded cars as regular used cars, the III suggests contacting your insurance company, local law enforcement agency or the NICB at 800-TEL-NICB.

Tuesday, October 4, 2011

Scammed seniors will be repaid more than $1 million

Retirees who lost more than $1 million to an unscrupulous insurance agent will be repaid, under an agreement reached between the insurance company and state Insurance Commissioner Mike Kreidler.

Bankers Life and Casualty, one of the companies that the independent agent worked for, has agreed to replace the money allegedly stolen by the agent.

An investigation by Kreidler’s office found that several of Jasmine Jamrus-Kassim’s clients repeatedly cashed out large portions of their annuities with Banker’s Life and Casualty from late 2007 to late 2009. The money was then pocketed by Kassim.

Jamrus-Kassim, of Kent, was arrested in March 2011 and charged with 21 counts of first-degree theft. Her trial is pending in King County Superior Court.

“I commend Bankers Life for stepping up and making these victims whole, to the extent possible,” said Kreidler. “I’m deeply saddened that one victim, stripped of his life’s savings, has already passed away. In his case, restitution will go to his estate.”

The victims, who ranged from age 74 to 90, typically made out their checks to “S.A. Saad” and gave them to Kassim. Several said they believed that S.A. Saad was an insurance company official. They thought their money was being reinvested.

In reality, Kassim has two daughters, both with the initials and surname “S.A. Saad.” Most of the money was deposited briefly in the girls’ accounts, then moved to Kassim’s personal credit union account. Kassim’s financial records show thousands of dollars spent on clothes, jewelry, and a trip to Mexico. They also show large payments to online psychic advisors, including $20,000 in charges from one psychic website in one month.

The victims live in Bellevue, Renton and Seattle. The payment amounts are:

• $512,112

• $488,071

• $116,070

• $65,321

• And $929

Bankers has also agreed to pay interest.

Class-action settlement covers hundreds of thousands of insurance customers

Hundreds of thousands of people who were led to expect more interest than they got from annuities are eligible for a multi-million dollar class-action settlement – if they sign up on time.

“Consumers across the country were misled, and I’m very glad to see this case finally resolved with restitution,” said Insurance Commissioner Mike Kreidler. “I urge anyone who qualifies to sign up for their share of the settlement.”

The settlement involves Northern Life Insurance Company’s marketing of tax-sheltered fixed annuities, primarily to teachers, starting in 1995. (The company, which was based in Seattle, merged with Minnesota-based Reliastar Life Insurance Co. in 2002.)

The annuity documents, Kreidler said, misrepresented to consumers the way that interest would be calculated over the life of the annuities. Instead, Northern Life paid a high interest rate only in the first year of the contract, reducing the rate during all the remaining years.

Under the settlement, Northern Life has agreed to pay $29 to $40 for each $10,000 in value of a person’s annuity. The settlement provides up to $31 million for the payments. A King County Superior Court judge recently approved the mediated settlement, in which Northern Life did not admit wrongdoing.

Northern Life has notified 406,000 account holders that they are potentially affected by the settlement. An estimated 20,000 of those people are in Washington state.

“People are naturally skeptical of mailings,” said Kreidler, “but don’t just toss this one in the trash.”
The one-page claim form, also available at, must be mailed back on or before Oct. 17, 2011. (It can also be scanned and emailed by that date.) Under penalty of perjury, signers must certify that they owned a fixed annuity issued by Northern Life sometime between Jan. 1, 1995 and the present time.

Typical payments are likely to range from $60 to $80, although some will be significantly larger.
The claimants were represented by private attorneys in the 10-year court case, which involved more than 1 million pages of documents.

Kreidler’s office investigated the issue and filed an amicus brief in the case, saying that consumers had been substantially harmed by misleading marketing.

Monday, October 3, 2011

Revisitng Work in Ethiopia

Erika Linnander, associate director, Yale Global Health Leadership Institute

Each time I visit Ethiopia, I witness the growth and deepening impact of GHLI programs. Recently, I visited Addis Ababa University (AAU) to teach health economics to the first group of students in the Master’s of Healthcare Administration (MHA) program at AAU. The passion and drive of the students in the MHA program is inspiring. One student shared that he travels three days to get from his hospital to the university for class, a sacrifice he said he is willing to make because he has seen how what he learns in class directly applies to making improvements for the patients at his hospital. Despite the student’s challenges of balancing the demands of full-time school with running a hospital in a limited resource setting, they all demonstrated a positive attitude and interest in what they were learning.

The students are preparing to start their capstone projects – culminating experiences that will test their ability to apply their training to a real world challenge in hospital management. The Ministry of Health, has recently endorsed a set of 36 key performance indicators (KPIs) to measure hospital performance over time. Together, these indicators are designed to serve as a sort of “balance scorecard” – a tool we use in the U.S. to assess organizational performance from multiple, balanced perspectives. The students will lead efforts to measure the KPIs in their own health care facility.

When GHLI began the Ethiopian Hospital Management Initiative (EHMI) seven years ago, we worked with 16 hospitals to help find ways to improve their management systems and organizational structures, with an emphasis on a strong mentoring model for capacity building. Since then, thanks to the continued support from the Ministry of Health and from great partners like the Clinton Health Access Inititative, we have seen vast improvements in the management of hospitals across Ethiopia. The next step in the evolution of EHMI is to develop a quality alliance to promote networking and the sharing of best practices among the emerging critical mass of health care executives to eventually create a health system that offers efficient, high quality care for patients across the country.

Being able to see such positive progress on our work with each visit inspires me and the GHLI team to continue with our endeavors, supporting the Ministry of Health in fulfillment of their vision.

The beginning of fall: mostly Rosh Hashanah by blogger of the month Ariella Krones

My first Rosh Hashanah in Israel has come and gone!    It was a great weekend, and a much appreciated break.   Rosh Hashanah, for those who don’t know, is the Jewish New Year.  As Adie translated so adeptly, it literally means head, rosh, of the year, hashanah.  2 interesting things about Israel from this weekend:

1.      1.   This is the New Year here.  January 1 is a work day; Rosh Hashanah is the time for huge meals and big outdoor music festivals (next year…)

2.      2.   Never believe anyone who tells you that absolutely everything is shut down for the holidays.  I found this was only mostly true, and as a result, I am still wondering what Yom Kippur here will be like. 

Puppy dog eyes!  I’ve been missing having a
dog since I left home a
few years ago.  This feeling was mitigated
slightly by going to the
parks in Manhattan and petting any dogs that
wandered my way.  The number of stray dogs
in Be’er Sheva
makes this a less wise solution, but Nomi here
is more than enough.  My cousins took her in
off the street maybe a year and half ago, and she
 is the most lovable, devoted dog.  She also has
 an odd thing for licking people, which
can be a surprise,
 but having your feet licked is as good excuse
as any to take a study break.
For the holiday at home, we usually go to synagogue and then see family either in Washington D.C. or Frederick, MD, where I am from.  It’s always a really nice two days, and important in the Jewish scheme of things, but understated.  Here, as I said, there is a much more festive atmosphere.  I was pretty eager to take a break from Be’er Sheva, so as soon as class was over Tuesday afternoon,   I jumped on the train to Tel Aviv to spend the long weekend (we had Wednesday and Thursday off) with some distant cousins.  My cousin and I cooked all day Wednesday, making quinoa, gazpacho, chicken, tofu and honey cake… many of my favorite things.  There were some friends over Wednesday night for a more formal dinner, and Thursday was all family.   My cousins have a great three-generation compound family, only some of whom I had met, and needless to say, it was a lot of fun.   

I had hoped to be able to see Tashlich in Tel Aviv.  Tashlich is a tradition where people will throw bread in a flowing river or ocean to symbolize their sins for the year being taken away.  Don’t ask me more about it, I really don’t know any more!  Once again, in D.C. it’s a pretty quiet thing, and it’s really just nice to go walk in Rock Creek Park with family.  In Tel Aviv, though, on the Mediterranean?!  That would be pretty cool.  Anyway, I ended up napping after a huge afternoon meal, and going for a walk later that night in HaYarkon Park.  While I did not see anyone throwing bread crumbs, I saw maybe the highest concentration of young families EVER.  It was like a carnival.  So!  Not everything shuts down, and things are definitely not quiet.

CAPTION: Since I’m not really a big picture taker (I got a smartphone here so that I didn’t have to also remember to bring a camera around all the time), here is a screenshot of HaYarkon Park in Tel Aviv!  There is a brand new walkway along the river and at the port that is so nice and filled with people during the holiday.   I had fun dodging bikes and small children; there are lanes for pedestrians and cyclists, though in true Israeli fashion, the lanes are all just a suggestion!

Till next time.  I promise to have more stories of classmates, and more pictures, this time of Be’er Sheva! - blogger of the month Ariella Krones

Turned down for life insurance? Here's what you can do...

If you apply for life insurance and get rejected, it's usually due to a specific health condition. Here’s what you can do to appeal their decision:

1. Ask the insurer to tell you, in writing, what specific condition disqualified you for coverage and where they obtained that information.

2. Review their information for accuracy. If you find any discrepancies, contact the doctor and ask him or her to correct the information. If the information is accurate, discuss the condition with your doctor. If the doctor thinks the condition is not a major health risk, ask him or her if they’d be willing to write a letter on your behalf to the insurer.

Other options:

• Asking the company if they would consider issuing coverage at what's called a "rated premium."

• Applying to other companies. Just because one company doesn’t want to take on your risk doesn’t mean another one won’t. Each company determines which risk they are willing to take. (Brokers can help with this.)

• If ultimately, you don’t qualify for coverage through a standard life insurance company, consider applying for coverage through a company that offers covereage specifically for high-risk people. You’d pay more, but at least you'd have coverage.

Great evolution thinkers you should know about

If you follow a paleo diet, you follow a diet that aims to be consistent with evolution. This is a theory that has undergone major changes and additions since Alfred Russel Wallace and Charles Darwin proposed it in the 1800s. Wallace proposed it first, by the way, even though Darwin’s proposal was much more elaborate and supported by evidence. Darwin acknowledged Wallace's precedence, but received most of the credit for the theory anyway.

(Alfred Russel Wallace; source: Wikipedia)

What many people who describe themselves as paleo do not seem to know is how the theory found its footing. The original Wallace-Darwin theory (a.k.a. Darwin’s theory) had some major problems, notably the idea of blending inheritance (e.g., blue eye + brown eye = somewhere in between), which led it to be largely dismissed until the early 1900s. Ironically, it was the work of a Catholic priest that provided the foundation on which the theory of evolution would find its footing, and evolve into the grand theory that it is today. We are talking about Gregor Johann Mendel.

Much of the subsequent work that led to our current understanding of evolution sought to unify the theory of genetics, pioneered by Mendel, with the basic principles proposed as part of the Wallace-Darwin theory of evolution. That is where major progress was made. The evolution thinkers below are some of the major contributors to that progress.

Ronald A. Fisher. English statistician who proposed key elements of a genetic theory of natural selection in the 1910s, 1920s and 1930s. Fisher showed that the inheritance of discrete traits (e.g., flower color) described by Gregor Mendel has the same basis as the inheritance of continuous traits (e.g., human height) described by Francis Galton. He is credited, together with John B.S. Haldane and Sewall G. Wright, with setting the foundations for the development of the field of population genetics. In population genetics the concepts and principles of the theories of evolution (e.g., inheritance and natural selection of traits) and genetics (e.g., genes and alleles) have been integrated and mathematically formalized.

John B.S. Haldane. English geneticist who, together with Ronald A. Fisher and Sewall G. Wright, is credited with setting the foundations for the development of the field of population genetics. Much of his research was conducted in the 1920s and 1930s. Particularly noteworthy is the work by Haldane through which he mathematically modeled and explained the interactions between natural selection, mutation, and migration. He is also known for what is often referred to as Haldane’s principle, which explains the direction of the evolution of many species’ traits based on the body size of the organisms of the species. Haldane’s mathematical formulations also explained the rapid spread of traits observed in some actual populations of organisms, such as the increase in frequency of dark-colored moths from 2% to 95% in a little less than 50 years as a response to the spread of industrial soot in England in the late 1800s.

Sewall G. Wright. American geneticist and statistician who, together with Ronald A. Fisher and John B.S. Haldane, is credited with setting the foundations for the development of the field of population genetics. As with Fisher and Haldane, much of his original and most influential research was conducted in the 1920s and 1930s. He is believed to have discovered the inbreeding coefficient, related to the occurrence of identical genes in different individuals, and to have pioneered methods for the calculation of gene frequencies among populations of organisms. The development of the notion of genetic drift, where some of a population’s traits result from random genetic changes instead of selection, is often associated with him. Wright is also considered to be one of pioneers of the development of the statistical method known as path analysis.

Theodosius G. Dobzhansky. Ukrainian-American geneticist and evolutionary biologist who migrated to the United States in the late 1920s, and is believed to have been one of the main architects of the modern evolutionary synthesis. Much of his original research was conducted in the 1930s and 1940s. In the 1930s he published one of the pillars of the modern synthesis, a book titled Genetics and the Origin of Species. The modern evolutionary synthesis is closely linked with the emergence of the field of population genetics, and is associated with the integration of various ideas and predictions from the fields of evolution and genetics. In spite of Dobzhansky’s devotion to religious principles, he strongly defended Darwinian evolution against modern creationism. The title of a famous essay written by him is often cited in modern debates between evolutionists and creationists regarding the teaching of evolution in high schools: Nothing in Biology Makes Sense Except in the Light of Evolution.

Ernst W. Mayr. German taxonomist and ornithologist who spent most of his life in the United States, and is believed, like Theodosius G. Dobzhansky, to have been one of the main architects of the modern evolutionary synthesis. Mayr is credited with the development in the 1940s of the most widely accepted definition of species today, that of a group of organisms that are capable of interbreeding and producing fertile offspring. At that time organisms that looked alike were generally categorized as being part of the same species. Mayr served as a faculty member at Harvard University for many years, where he also served as the director of the Museum of Comparative Zoology. He lived to the age of 100 years, and was one of the most prolific scholars ever in the field of evolutionary biology. Unlike many evolution theorists, he was very critical of the use of mathematical approaches to the understanding of evolutionary phenomena.

William D. Hamilton. English evolutionary biologist (born in Egypt) widely considered one of the greatest evolution theorists of the 20th Century. Hamilton conducted pioneering research based on the gene-centric view of evolution, also know as the “selfish gene” perspective, which is based on the notion that the unit of natural selection is the gene and not the organism that carries the gene. His research conducted in the 1960s set the foundations for using this notion to understand social behavior among animals. The notion that the unit of natural selection is the gene forms the basis of the theory of kin selection, which explains why organisms often will instinctively behave in ways that will maximize the reproductive success of relatives, sometimes to the detriment of their own reproductive success (e.g., worker ants in an ant colony).

George C. Williams. American evolutionary biologist believed to have been a co-developer in the 1960s, together with William D. Hamilton, of the gene-centric view of evolution. This view is based on the notion that the unit of natural selection is the gene, and not the organism that carries the gene or a group of organisms that happens to share the gene. Williams is also known for his pioneering work on the evolution of sex as a driver of genetic variation, without which a species would adapt more slowly in response to environmental pressures, in many cases becoming extinct. He is also known for suggesting possible uses of human evolution knowledge in the field of medicine.

Motoo Kimura. Japanese evolutionary biologist known for proposing the neutral theory of molecular evolution in the 1960s. In this theory Kimura argued that one of the main forces in evolution is genetic drift, a stochastic process that alters the frequency of genotypes in a population in a non-deterministic way. Kimura is widely known for his innovative use of a class of partial differential equations, namely diffusion equations, to calculate the effect of natural selection and genetic drift on the fixation of genotypes. He has developed widely used equations to calculate the probability of fixation of genotypes that code for certain phenotypic traits due to genetic drift and natural selection.

George R. Price. American geneticist known for refining in the 1970s the mathematical formalizations developed by Ronald A. Fisher and William D. Hamilton, and thus making significant contributions to the development of the field of population genetics. He developed the famous Price Equation, which has found widespread use in evolutionary theorizing. Price is also known for introducing, together with John Maynard Smith, the concept of evolutionary stable strategy (ESS). The EES notion itself builds on the Nash Equilibrium, named after its developer John Forbes Nash (portrayed in the popular Hollywood film A Beautiful Mind). The concept of EES explains why certain evolved traits spread and become fixed in a population.

John Maynard Smith. English evolutionary biologist and geneticist credited with several innovative applications of game theory (which is not actually a theory, but an applied branch of mathematics) in the 1970s to the understanding of biological evolution. Maynard Smith is also known for introducing, together with George R. Price, the concept of evolutionary stable strategy (EES). As noted above, the EES notion builds on the Nash Equilibrium, and explains why certain evolved traits spread and become fixed in a population. The pioneering work by John Maynard Smith has led to the emergence of a new field of research within evolutionary biology known as evolutionary game theory.

Edward O. Wilson. American evolutionary biologist and naturalist who coined the term “sociobiology” in the 1970s to refer to the systematic study of the biological foundations of social behavior of animals, including humans. Wilson was one of the first evolutionary biologists to convincingly argue that human mental mechanisms are shaped as much by our genes as they are by the environment that surrounds us, setting the stage for the emergence of the field of evolutionary psychology. Many of Wilson’s theoretical contributions in the area of sociobiology are very general, and apply not only to humans but also to other species. Wilson has been acknowledged as one of the foremost experts in the study of ants’ and other insects’ social organizations. He is also known for his efforts to preserve earth’s environment.

Amotz Zahavi. Israeli evolutionary biologist best known for his widely cited handicap principle, proposed in the 1970s, which explains the evolution of fitness signaling traits that appear to be detrimental to the reproductive fitness of an organism. Zahavi argued that traits evolved to signal the fitness status of an organism must be costly in order to the reliable. An example is the large and brightly colored trains evolved by the males of the peacock species, which signal good health to the females of the species. The male peacock’s train makes it more vulnerable to predators, and as such is a costly indicator of survival success. Traits used for this type of signaling are often referred to as Zahavian traits.

Robert L. Trivers. American evolutionary biologist and anthropologist who proposed several influential theories in the 1970s, including the theories of reciprocal altruism, parental investment, and parent-offspring conflict. Trivers is considered to be one of the most influential living evolutionary theorists, and is a very active researcher and speaker. His most recent focus is on the study of body symmetry and its relationship with various traits that are hypothesized to have been evolved in our ancestral past. Trivers’s theories often explain phenomena that are observed in nature but are not easily understood based on traditional evolutionary thinking, and in some cases appear contradictory with that thinking. Reciprocal altruism, for example, is a phenomenon that is widely observed in nature and involves one organism benefiting another not genetically related organism, without any immediate gain to the organism (e.g., vampire bats regurgitating blood to feed non-kin).

There are many other more recent contributors that could arguably be included in the list above. Much recent progress has been made in interdisciplinary fields that could be seen as new fields of research inspired in evolutionary ideas. One such field is that of evolutionary psychology, which has emerged in the 1980s. New theoretical contributions tend to take some time to be recognized though, as will be the case with ideas coming off these new fields, because new theoretical contributions are invariably somewhat flawed and/or incomplete when they are originally proposed.