HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

A Member of the Law Professor Blogs Network

Friday, February 1, 2008

Bad Public Health Initiative

The blog, JunkFood Science reports on a Mississippi legislator's attempt to combat the obesity epidemic: banning restaurants from serving food to anyone who is "obese" (a term defined by the State of Mississippi).  If the restaurants fail to comply, their permits to serve food will be revoked.   Sandy Szwarc at JunkFood Science provides further information: 

House Bill 282 was introduced in the 2008

Mississippi

legislative session on Friday by Representative W.T. Mayhall, Jr., a retired pharmaceutical salesman with DuPont-Merk. Its co-authors are Bobby Shows, a businessman, and John Read, a pharmacist.

The full text reads:

HOUSE BILL NO. 282

An act to prohibit certain food establishments from serving food to any person who is obese, based on criteria prescribed by the state department of health; to direct the department to prepare written materials that describe and explain the criteria for determining whether a person is obese and to provide those materials to the food establishments; to direct the department to monitor the food establishments for compliance with the provisions of this act; and for related purposes. Be it enacted by the legislature of the state of Mississippi:

SECTION 1.

(1) The provisions of this section shall apply to any food establishment that is required to obtain a permit from the State Department of Health under Section 41-3-15(4)(f), that operates primarily in an enclosed facility and that has five (5) or more seats for customers.

(2) Any food establishment to which this section applies shall not be allowed to serve food to any person who is obese, based on criteria prescribed by the State Department of Health after consultation with the Mississippi Council on Obesity Prevention and Management established under Section 41-101-1 or its successor. The State Department of Health shall prepare written materials that describe and explain the criteria for determining whether a person is obese, and shall provide those materials to all food establishments to which this section applies. A food establishment shall be entitled to rely on the criteria for obesity in those written materials when determining whether or not it is allowed to serve food to any person.

(3) The State Department of Health shall monitor the food establishments to which this section applies for compliance with the provisions of this section, and may revoke the permit of any food establishment that repeatedly violates the provisions of this section.

SECTION 2. This act shall take effect and be in force from and after July 1, 2008.

Perhaps we need to re-think whether obesity should be viewed as a disability - discrimination based on weight in our society seems to be on an upswing.  Thanks to the blog, Feministe for the link. 

February 1, 2008 | Permalink | Comments (0) | TrackBack (0)

More News on Chocolate . . .

Slate.com's Medical Examiner's "Your Health This Week" column concerns whether chocolate is bad for women's bones.  (Yikes - say it isn't so!)   Slate reports: 

Question: One of the plusses of chocolate is that it contains materials called flavonoids. These are known to enhance bone health. But does chocolate do more harm than good to the bones?

Research: Jonathan M. Hodgson and his associates looked at whether calcium supplements might prevent the loss of minerals from the bones of older women, which leads to weakness and risk of fractures. As part of their study of about 1,000 randomly selected elderly women, these scientists examined the effects of diet. One of the foods they studied was chocolate, both as a solid and as cocoa. Given chocolate's flavonoids, they expected that it would improve calcium absorption into bone, which they measured using the standard method: X-ray densitometry.

Findings: To the great surprise of the researchers, the women who ate a lot of chocolate—on average, more than one portion a day (a cup of cocoa, say, or a bar of chocolate)—had lower bone density five years after the experiment began than the women who didn't. The chocolate-eaters and -drinkers were also, unexpectedly, more energetic and leaner.

Explanation: The authors speculate that the lower bone density may be due to another natural ingredient in chocolate: oxalic acid. Oxalic acid can bind the calcium in our diet (from leafy green vegetables and dairy products) and block its absorption, so its presence in chocolate might prevent some calcium from ever reaching the bones. But, as always, we need to keep in mind that association doesn't necessarily imply causation. It may be that some other factor, having nothing to do with chocolate, controls the intake and absorption of calcium.

Speculation: Here's another thought, or really speculation: The chocolate-eaters in the study were somewhat lower in weight and body fat than the women who avoided chocolate. Especially in older women, body fat contributes to estrogen level, which, in turn, promotes increased bone calcium. Perhaps the slightly heavier post-menopausal women in the study, who ate less chocolate, had higher levels of calcium in their bones, on average, because of the additional estrogen produced by their body fat.

Conclusion: So, does this study also apply to younger women or to men? It's hard to say, since we don't know the true mechanism which leads to lower bone density in older women who like chocolate. But we do know one thing which helps maintain and increase bone density and strength: exercise. Which certainly seems preferable to giving up chocolate.

I must admit that I tend to be rather picky as to which of these scienfic studies on dietary issues I believe; i.e.,  Dark chocolate good for you - completely scientifically sound.  A glass of wine good for you - again completely scientifically sound.  Chocolate potentially not so good - I am suspicious about the scientific method used in this study  . . . .

February 1, 2008 | Permalink | Comments (0) | TrackBack (0)

Thursday, January 31, 2008

Balancing the Budget through Medicare and Medicaid Cuts

The New York Times reports today on President Bush's announcement that he will "call for large cuts in the growth of Medicare, far exceeding what he proposed last year, and he will again seek major savings in Medicaid."

Health care savings are a crucial part of Mr. Bush’s plan to put the nation on track to achieve a budget surplus by 2012. But before then, the officials said Wednesday, the White House anticipates higher deficits in 2008 and 2009, reflecting the current weakness of the economy and the cost of a stimulus package. . . .

Mr. Bush has repeatedly said that the costs of Medicare and Medicaid, which dwarf spending for lawmakers’ pet projects, are unsustainable. The two health programs account for nearly one-fourth of all federal spending, and their combined cost — $627 billion last year — is expected to double in a decade.

Budget documents show that Mr. Bush will propose legislative changes in Medicare to save $6 billion in the next year and $91 billion from 2009 to 2013. In his last budget, by contrast, his legislative proposals would have saved $4 billion in the first year and $65.6 billion over five years.

The president’s budget also takes aim at Medicaid, the insurance program for low-income people. He would pare $1.2 billion from it next year and nearly $14 billion over five years.  Those figures do not include tens of billions of dollars that Mr. Bush wants to save through new regulations. Such rules are not subject to approval by Congress, but could be revised by a future administration.

Congressional Democrats often pronounce Mr. Bush’s budget dead on arrival, and they have no reason to make unpopular cuts in this election year.  But lawmakers say they feel obliged to pass a Medicare bill in the first half of this year, to spare doctors from a 10 percent cut in Medicare fees that would otherwise take effect on July 1. . . .

Most of the Medicare savings in the budget would be achieved by reducing the annual update in federal payments to hospitals, nursing homes, hospices, ambulances and home care agencies.  The budget would not touch payments to insurance companies for private Medicare Advantage plans, even though many Democrats and independent experts say those plans are overpaid.

In the next five years, the largest amount of Medicare savings, by far, would come from hospitals: $15 billion from an across-the-board reduction in the annual updates for inpatient care; $25 billion from special payments to hospitals serving large numbers of poor people; and $20 billion from capital payments for the construction of hospital buildings and the purchase of equipment.  In addition, the president’s budget would reduce special Medicare payments to teaching hospitals, including many in the New York area, by $23 billion over the next five years.

This sounds like a terrific way to save money . . . .

January 31, 2008 | Permalink | Comments (0) | TrackBack (1)

Lifetime Benefit Caps

TPM Cafe's Cindy Zeldin has a great discussion of today's Washington Post article on the issues and problems surrounding lifetime benefit caps on insurance spending.  She writes,

Today’s Washington Post explores lifetime benefit caps, provisions of most private health insurance policies that limit the total amount of expenditures an insurer will pay, with these limits typically falling in the one- to two-million dollar range. These lifetime caps and other insurance gaps like high out-of-pocket maximums and uncovered medical services are colliding with escalating health care costs to force questions about just what it means to have health insurance anyway. . . .

A few years back, the Institute of Medicine released a series of reports that painstakingly analyzed the importance of health insurance in accessing health care, highlighting the myriad problems that result from uninsurance, both to individuals and to society. We know that health insurance matters. Thanks to a growing body of research, at the heart of which is Professor Warren's findings on medical bankruptcies, we also know that, while insurance is crucial, it isn't always enough. Even the insured can face barriers to care and bills that exceed their ability to pay. The Washington Post article notes that the National Hemophilia Foundation is embarking on a lobbying effort to increase the amount of health insurance caps. If we move down the road of health reform in '09, we're going to wrestle with questions about how much individuals should be expected to pay and how much insurance should cover--questions we haven't exactly built a consensus around as a society but which threaten to fracture the public support that is building for health reform if left unaddressed.

January 31, 2008 | Permalink | Comments (0) | TrackBack (0)

Wednesday, January 30, 2008

Volunteer Opportunity for ACS

The American Constitution Society has requested volunteers to help with their "Constitution in the Classroom" program.  From their website: 

CALLING ALL CLASSROOM VOLUNTEERS!

ACS is pleased to announce the expansion of one of our signature programs: Constitution in the Classroom, which will include an ACS-wide volunteer effort this Spring!

Our expanded Spring 2008 Constitution in the Classroom project will include a national volunteer effort, placing ACS volunteers in classrooms across the country. As a volunteer, ACS will help you find a classroom and provide you with grade-specific lesson plans.

Get Involved

If you are interested in participating in Constitution in the Classroom, either by volunteering in a classroom or becoming a Project Coordinator to implement an effort on behalf of your chapter, please sign up online HERE, or email us at classroom@acslaw.org. For more information about Constitution in the Classroom, please visit us at www.acslaw.org/conclass.

January 30, 2008 | Permalink | Comments (0) | TrackBack (1)

Death Without Dignity

Ezra Klein points us toward a post by Andrew Kline about his father and his father's cancer.  Mr. Kline writes about his frustration and concern he experiences as he deals with the medical treatment his father has received.  He provides a moving statement that may sound familiar to those who have experience when dealing with end-of-life situations at the hospital.  He states,

I'm back home, a thousand miles away from my father. But he had another setback, and he is back in the main hospital.

I am not expecting any miracles. I know that the clock has been ticking ever since his cancer diagnosis. My frustration is with trying to get the system to share my goals. . . . .  Similarly, what I want for my father is the best possible combination of dignity, lucidity, and absence of pain. The operative word is possible, because what is attainable is limited. Moreover, there are trade-offs among these goals.

But what you deal with are people who are doing their job. For example, the cardiologist's job is to make sure his heart does not give out, even if it means he lies on his back for so long that the prospects for restoring diginity recede. Everyone wants to shunt him around, giving him more Hansonian medicine, which detracts from his ability to remain lucid.

For the larger goal of trying to do the best with his remaining life, nobody is in charge and nobody is empowered. Particularly in that big hospital. I'll probably be back there soon, but I don't know what medical decisions would best serve our goals and I don't know how to get the system to work for us.

I hope that he finds his answers.

January 30, 2008 | Permalink | Comments (0) | TrackBack (0)

Tuesday, January 29, 2008

The NewsHour and Health Care

This week the NewsHour is running a series on the upcoming primary states and issues that are important to voters in each state.  The first state under review was New Jersey and the focus was health care.  It was a panel discussion with Judy Woodruff and it really brought home how much we need to reform our health care system.  The audio and transcript are available here.

January 29, 2008 | Permalink | Comments (0) | TrackBack (0)

The Upcoming Silver Tsunami and Medical School Training

Reuters reports on medical schools responding to an increasing aging population by adding more courses in geriatric care.  The article reports,

Just a few years ago, a graduate from Brown University medical school had just an inkling about how to care for the elderly.  Now, Brown and other U.S. medical schools are plugging geriatric courses into their curricula and adding specially trained faculty members as they respond to an imminent boom in the number of older Americans and the need to better understand how to properly care for the elderly.

The U.S. Census Bureau projects the number of elderly Americans will nearly double to 71 million by 2030, leaving one physician trained in geriatric care for every 7,665 seniors. 
The first members of the Baby Boomer generation, so named for the explosion in births in the years after World War Two, turn 65 in three years. In addition, people are living longer than ever.

"The first ripples of the silver tsunami are lapping at the shores of our country, but there is not a coordinated or strategic response taking place in America," said Richard Besdine, who is director of the geriatrics division at Brown University medical school in Providence, Rhode Island, and past president of the American Geriatrics Society.

Geriatrics has never been a field of choice for young doctors. Elderly care doctors are paid less than most other physicians and surgeons and the aged can be hard to treat. . . .

I haven't heard much attention paid to the aging of our population beyond the social security/medicare issues on payment and costs.  Obviously other concerns will need to be addressed and it is interesting to see how medical schools are responding and encouraging graduates to consider a different specialty.

January 29, 2008 | Permalink | Comments (0) | TrackBack (3)

Junk Food Diet and Violence

The Independent (UK) reports on a new Oxford University study of British prisons that reviews prison diets and prisoner behavior to determine whether a link exists between diet and behavior.  The Independent reports,

Some of Britain's most challenging young prisoners are to be given food supplements in a study aimed at curbing violent behaviour.  Scientists from Oxford University say the effect of nutrition on behaviour has been underestimated. They say increases in consumption of "junk" food over the past 50 years have contributed to a rise in violence.  The university will lead the £1.4m study in which 1,000 males aged 16 to 21 from three young offenders' institutions in England and Scotland will be randomly allocated either the vitamin-and-mineral supplements or a placebo, and followed over 12 months.

In a pilot study of 231 prisoners by the same researchers, published in 2002, violent incidents while in custody were cut by a more than a third among those given the supplements. Overall, offences recorded by the prison authorities fell by a quarter.

John Stein, professor of physiology at Oxford University, said: "If you could extrapolate from those results you would see a reduction of a quarter to a third in violent offences in prison. You could reduce violent offences in the community by a third. That would have a huge economic benefit."

"Our initial findings indicated that improving what people eat could lead them to behave more sociably as well as improving their health. This is not an area currently considered in standards of dietary adequacy. We are not saying nutrition is the only influence on behaviour but we seem to have seriously underestimated its importance." . . .

The theory behind the trial is that when the brain is starved of essential nutrients, especially omega-3 fatty acids, which are a central building block of brain neurons, it loses "flexibility". This shortens attention spans and undermines self-control. Even though prison food is nutritious, prisoners tend to make unhealthy choices and need supplements, the researchers say.

Bernard Gesch, a senior research scientist in the department of physiology and the director of Natural Justice, a charity that investigates the causes of offending, said the prisoners would be given the supplement containing 100 per cent of the recommended daily amount of more than 30 vitamins and minerals plus three fish-oil capsules totalling 2.25g on top of their normal diet.  "We are trying to rehabilitate the brain to criminal justice. The law assumes crime is a matter of free will. But you can't exercise free will without involving your brain and the brain can't function properly without an adequate nutrient supply. It may have an important influence on behaviour." . . .

The Ministry of Justice is backing the three-year study, which will start in May. David Hanson, the Prisons minister, said he hoped it would shed further light on the links between nutrition and behaviour.  The Food Standards Agency says there is not enough evidence to show harm from additives or benefit from fish-oil supplements.

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January 29, 2008 | Permalink | Comments (0) | TrackBack (0)