Lately I keep running into the idea that the proper way to do science is to continually strive to disprove a hypothesis, rather than support it*. According to these writers, this is what scientists are supposed to aspire to, but I've never actually heard a scientist say this. The latest example was recently published in the Wall Street Journal (1). This evokes an image of the Super Scientist, one who is so skeptical that he never believes his own ideas and is constantly trying to tear them down. I'm no philosopher of science, but this idea never sat well with me, and it's contrary to how science is practiced. Descending from the writings of Karl Popper, apparently the idea has been strongly criticized by a number of other philosophers of science.
I'd go further and say that the idea is commonly abused by non-scientist contrarians who need an excuse to wholesale reject a body of scientific evidence that is inconvenient for them (along with Thomas Kuhn's writing on paradigms). It's also abused by writers who want to make a dramatic story by creating a sense of outrage or superiority in the reader (i.e., "these people are supposed to be scientists, but they can't even get the scientific method right!").
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health system, also sometimes referred to as health care system or healthcare system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations.
New Review Paper by Yours Truly: High-Fat Dairy, Obesity, Metabolic Health and Cardiovascular Disease
My colleagues Drs. Mario Kratz, Ton Baars, and I just published a paper in the European Journal of Nutrition titled "The Relationship Between High-Fat Dairy Consumption and Obesity, Cardiovascular, and Metabolic Disease". Mario is a nutrition researcher at the Fred Hutchinson Cancer Research Center here in Seattle, and friend of mine. He's doing some very interesting research on nutrition and health (with an interest in ancestral diets), and I'm confident that we'll be getting some major insights from his research group in the near future. Mario specializes in tightly controlled human feeding trials. Ton is an agricultural scientist at the University of Kassel in Germany, who specializes in the effect of animal husbandry practices (e.g., grass vs. grain feeding) on the nutritional composition of dairy. None of us have any connection to the dairy industry or any other conflicts of interest.
The paper is organized into three sections:
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The paper is organized into three sections:
- A comprehensive review of the observational studies that have examined the relationship between high-fat dairy and/or dairy fat consumption and obesity, metabolic health, diabetes, and cardiovascular disease.
- A discussion of the possible mechanisms that could underlie the observational findings.
- Differences between pasture-fed and conventional dairy, and the potential health implications of these differences.
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What Causes Type 2 Diabetes, and How Can it be Prevented?
In the comments of the last post, we've been discussing the relationship between body fatness and diabetes risk. I think this is really worth understanding, because type 2 diabetes is one of the few lifestyle disorders where 1) the basic causes are fairly well understood, and 2) we have effective diet/lifestyle prevention strategies that have been clearly supported by multiple controlled trials.
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Interview with Aitor Calero of Directo al Paladar
Aitor Calero writes for the popular Spanish cooking and nutrition blog, Directo al Paladar ("straight to the palate"). We did a written interview a while back, and he agreed to let me post the English version on my blog. The Spanish version is here and here.
Without further ado, here it is:
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Without further ado, here it is:
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The Game’s Not Over, and It May Not Even Be The Real Game
by Brian Klepper
Like most health law watchers, I was surprised by the recent Supreme Court decision. I'm sure that on this issue, as with everything else, zealous responses rationalize the result and split the country down the middle.
I expected the Court to be purely partisan, but apparently Chief Justice John Roberts, acknowledging the gravity of his role, saw his way clear to support the
Like most health law watchers, I was surprised by the recent Supreme Court decision. I'm sure that on this issue, as with everything else, zealous responses rationalize the result and split the country down the middle.
I expected the Court to be purely partisan, but apparently Chief Justice John Roberts, acknowledging the gravity of his role, saw his way clear to support the
Why Did Energy Expenditure Differ Between Diets in the Recent Study by Dr. Ludwig's Group?
As discussed in the previous post, a recent study by Dr. David Ludwig's group suggested that during weight maintenance following fat loss, eating a very low carbohydrate (VLC) diet led to a higher metabolic rate (energy expenditure) than eating a low-fat (LF) diet, with a low glycemic index (LGI) diet falling in between the two (1). The VLC diet was 30 percent protein, while the other two were 20 percent. It's important to note that these were three dietary patterns that differed in many ways, and contrary to claims that are being made in the popular media, the study was not designed to isolate the specific influence of protein, carbohydrate or fat on energy expenditure in this context.
Not only did the VLC diet lead to a higher total energy expenditure than the LF and LGI diets, the most remarkable finding is that it led to a higher resting energy expenditure. Basically, people on the VLC diet woke up in the morning burning more energy than people on the LGI diet, and people on the LGI diet woke up burning more than people on the LF diet. The VLC dieters burned 326 more calories than the LF dieters, and 200 more than the LGI dieters.
It's always tempting to view each new study in isolation, without considering the numerous studies that came before it, but in this case it's essential to see this study through a skeptical lens that places it into the proper scientific context. Previous studies have suggested that:
With that, let's see what could have accounted for the differences observed in Dr. Ludwig's study.
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Not only did the VLC diet lead to a higher total energy expenditure than the LF and LGI diets, the most remarkable finding is that it led to a higher resting energy expenditure. Basically, people on the VLC diet woke up in the morning burning more energy than people on the LGI diet, and people on the LGI diet woke up burning more than people on the LF diet. The VLC dieters burned 326 more calories than the LF dieters, and 200 more than the LGI dieters.
It's always tempting to view each new study in isolation, without considering the numerous studies that came before it, but in this case it's essential to see this study through a skeptical lens that places it into the proper scientific context. Previous studies have suggested that:
- The carbohydrate:fat ratio of the diet has little or no detectable impact on energy expenditure in people who are not trying to lose weight (2, 3).
- The carbohydrate:fat ratio of the diet has little or no detectable impact on energy expenditure in people who are being experimentally overfed, and if anything carbohydrate increases energy expenditure more than fat (4, 5).
- The carbohydrate:fat ratio of the diet has little or no detectable impact on energy expenditure during weight loss (6, 7, 8), and does not influence the rate of fat loss when calories are precisely controlled.
With that, let's see what could have accounted for the differences observed in Dr. Ludwig's study.
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Do You Have Any Idea How Close the Affordable Care Act Came to Being Toast?
I expected Supreme Court Justice Anthony Kennedy to vote to toss the individual mandate. I had no doubt the other three conservative justices would want the whole of the Affordable Care Act thrown out.
I also expected the four liberal justices to support both the individual mandate as well as the entire law.
About everyone expected Roberts and Kennedy to vote alike.
If Roberts had gone with
I also expected the four liberal justices to support both the individual mandate as well as the entire law.
About everyone expected Roberts and Kennedy to vote alike.
If Roberts had gone with
New Study: Is a Calorie a Calorie?
A new study in JAMA led by Dr. Cara B. Ebbeling and colleagues purports to challenge the idea that all calories are equally fattening (1). Let's have a look. When thinking about the role of calorie intake in body fatness, there are basically three camps:
1. Calories don’t matter at all, only diet composition matters.
2. Calories are the only thing that matters, and diet composition is irrelevant.
3. Calories matter, but diet composition may also play a role.
The first one is an odd position that is not very well populated. The second one has a lot of adherents in the research world, and there’s enough evidence to make a good case for it. It’s represented by the phrase ‘a calorie is a calorie’, i.e. all calories are equally fattening. #1 and #2 are both extreme positions, and as such they get a lot of attention. But the third group, although less vocal, may be closest to the truth.
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1. Calories don’t matter at all, only diet composition matters.
2. Calories are the only thing that matters, and diet composition is irrelevant.
3. Calories matter, but diet composition may also play a role.
The first one is an odd position that is not very well populated. The second one has a lot of adherents in the research world, and there’s enough evidence to make a good case for it. It’s represented by the phrase ‘a calorie is a calorie’, i.e. all calories are equally fattening. #1 and #2 are both extreme positions, and as such they get a lot of attention. But the third group, although less vocal, may be closest to the truth.
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The Supreme Court Ruling on Health Care, Its Impact on Medicaid, and 29 Republican Governors--Be Careful You Might Get What You Wish For
Conservatives wanted the Supreme Court to do the work of killing the Affordable Care Act (ACA) for them. They didn’t get their wish but the Court may have put conservatives into a political corner they will find very uncomfortable.
Under the new health law, the Medicaid program will be substantially expanded. Those making up to 133% of the federal poverty level (about $30,000 in annual income
Under the new health law, the Medicaid program will be substantially expanded. Those making up to 133% of the federal poverty level (about $30,000 in annual income
The Supreme Court's Decision on the Affordable Care Act
In the immortal words of Rosane Rosana Dana, "Never mind."From the SCOTUS blog live in the court room: "Chief Justice Roberts' vote saved the ACA."On to the elections.
What Puts Fat Into Fat Cells, and What Takes it Out?
Body fatness at its most basic level is determined by the rate of fat going into vs. out of fat cells. This in/out cycle occurs regardless of conditions outside the cell, but the balance between in and out is influenced by a variety of external factors. One of the arguments that has been made in the popular media about obesity goes something like this:
A number of factors can promote the release of fat from fat cells, including:
Can you spot the logical error in this argument?
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A number of factors can promote the release of fat from fat cells, including:
Epinephrine, norepinephrine, adrenocorticotropic hormone (ACTH), glucagon, thyroid-stimulating hormone, melanocyte-stimulating hormone, vasopressin, and growth hormoneBut only two promote fat storage:
Insulin, and acylation-stimulating protein (ASP)*Therefore if we want to understand body fat accumulation, we should focus on the latter category, because that's what puts fat inside fat cells. Simple, right?
Can you spot the logical error in this argument?
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What Would Health Insurance Cost if the Supreme Court Overturns the Individual Mandate But Leaves the Insurance Reforms in Place?
That will be the big question on Thursday if the Court throws out the mandate and the parallel insurance reforms that would require health plans to take all comers without regard to their health status and require insurers to cover pre-existing conditions.
But before we get to that scenario, let’s look at another possibility.
The Court Overturns Both the Individual Mandate and the Insurance
But before we get to that scenario, let’s look at another possibility.
The Court Overturns Both the Individual Mandate and the Insurance
A Pressure Cooker for the 21st Century
Pressure cookers are an extremely useful kitchen tool. They greatly speed cooking and reduce energy usage by up to 70 percent. This is because as pressure increases, so does the boiling point of water, which is the factor that limits cooking speed in water-containing foods (most foods). If it weren't for my pressure cooker, I'd rarely eat beets or globe artichokes. Instead of baking, boiling or steaming these for 60-90 minutes, I can have them soft as butter in 30. But let's face it: most people are intimidated by pressure cookers. They fear the sounds, the hot steam, and the perceived risk of explosion. I escaped this because I grew up around them.
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The Medical Loss Ratio (MLR) Report—Just Fiddling While Rome is Burning
Today’s headline was, “Millions Expected To Receive Insurance Rebates Totaling $1.3 Billion.”The Kaiser Family Foundation estimates that 3.4 million people in the individual market will receive $426 million in consumer rebates because of the Affordable Care Act's new MLR rules. In the small group market 4.9 million enrollees will see $377 million in rebates, and 7.5 million people will get $540
What Would Individual Health Insurance Cost if the Court Strikes the Mandate Down and Still Requires Insurers to Cover Everyone?
With the Supreme Court justices sounding like they might strike the mandate down, this is a question I've been getting a lot lately.I have pointed to New Jersey as a real life example of what can happen when insurance reforms take place but there is no incentive for consumers to buy it until the day they need it.In 1992, New Jersey passed health insurance reform that required insurance carriers
If the Supreme Court Overturns the Individual Mandate
First, trying to predict how the Court will rule is at best just speculation. I know what Justice Kennedy said both today and yesterday and it certainly doesn’t look good for the Obama administration and upholding at least the mandate.But I will remind everyone, based upon oral arguments, most Court watchers expected a ruling in favor of the biotech industry on a recent case involving health care
Will the Pace of Innovative Change Overtake the Financial Imperative to Slash Spending?
I thought it was worth passing along the comments by Jim Tallon, president of New York's United Hospital Fund, in a recent post.Tallon reflected on an international meeting he attended with health care leaders from a number of industrial nations--"nations whose health care systems, indeed underlying philosophies, ranged from market orientation through hybrids to government authority:" "Across
"Five Myths About Medicare"
I recommend you read John Rother's recent op-ed in the Washington Post, "Five Myths About Medicare."John argues that each of these statements is a myth:Medicare is inefficient and fails to control costs--the CBO has projected that per capita spending will grow only 1% more than inflation over the next decade.The well-off don't pay enough for their Medicare benefits--working age premiums as well
ICD-10 To Be Delayed Indefinitely--Never Mind!
After years of telling us they are serious this time and everyone in the health care system had better be ready on time to implement the new disease coding system, CMS said today the whole project is going to be delayed indefinitely.The new ICD-10 system requires payers and providers to convert from the old system of 13,000 codes to the new system of 68,000 codes.All payers and providers were
There is No Free Lunch and There is No Free Contraception
The otherworldy Obama Administration solution to the contraception firestorm might work politically but it makes no sense in the real world.The President, hoping to quell a growing political firestorm, today announced a new policy that no longer requires religiously affiliated organizations to provide employees with contraception coverage in health-insurance plans.Under the new policy, insurance
Dismantling the Affordable Care Act: The Obama Supreme Court Argument + 51 Republican Senators
I have no idea which way the Supreme Court will rule this year on the Affordable Care Act. Let me go out on a limb and predict a 5-4 vote on the question of whether the individual mandate is Constitutional. Just don’t ask me which way the vote goes.I found the recent Obama administration brief submitted to the Court on the mandate question somewhat ironic. Not surprisingly, the Obama Justice
Medicare Advantage Premiums Drop an Average of 7% and Enrollment up 10%—That Must Make Republicans Just Want to Cry
Medicare Advantage would appear to be a fantastic success—senior premiums are dropping and enrollment is increasing.Listening to Health and Human Services Secretary Sebelius last week, you would think private Medicare plans were a Democratic idea and this is their success. Many industry observers, including me, have worried that Medicare Advantage benefits would shrink and premiums would rise
The Wyden-Ryan Plan Will Be the Foundation for Serious Medicare Reform—and Maybe More
In two companion articles in January’s New England Journal of Medicine, Henry Aaron with Austin Frakt, and Joe Antos critique the Wyden-Ryan Medicare reform proposal.Senator Ron Wyden (D-OR) and Representative Paul Ryan (R-WI) are proposing a hybrid Medicare reform proposal combing both Republican defined contribution free market principles—a premium support scheme—with Democratic defined
The New Health Law Needs to Be Repealed, Expanded, and Replaced—So Long As It Doesn’t Have a Mandate
Last week’s State of the Union speech was notable because the President hardly mentioned the new health care reform law.Avoiding what is supposed to be the centerpiece domestic accomplishment of President Obama’s first term stuck out like a sore thumb.He said almost nothing because the Obama team simply doesn’t know what to say.The fact is the Affordable Care Act (ACA) is generally unpopular, and
Important Research From Medicare Demonstration Projects: Almost Nothing Works
I will suggest that most of us believe the way to control health care costs, and at the same time maintain or improve quality, is to both use the managed care tools we have developed over the years, and perhaps more importantly, change the payment incentives so that both cost control and quality are upper most in the minds of providers and payers.The Congressional Budget Office (CBO) has just
Will the Feds Be Ready With the Fallback Insurance Exchanges by October 2013?
Insurance exchanges have to be up and running in all of the states by October 2013 in order to be able to cover people by January 1, 2014.If the states don't do it, the feds have to be ready with a fallback exchange. States have to tell HHS if they intend to be ready by January 1, 2013.The White House just released a report saying that good progress is being made in 28 states. That begs the
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