Saturday, October 31, 2020

Saturday Stories: The Election, The World Series, And The Expectations


Ed Yong, in The Atlantic, predicts what the future of COVID in America will look like following a Biden or a Trump election win.

Jeff Passan, in ESPN, discusses how this year's World Series was a metaphor for 2020 America.

Helen Branswell, in STAT, on how now might be the time for us to reset our expectations of when vaccines will pull us out of this mess.

Photo By TonyTheTiger - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=62897879



Saturday, October 24, 2020

Saturday Stories: Respecting Uncertainty, Rapid Home Testing, And Herd Immunity


George Davey Smith, Michael Blastland, and Marcus Munafò, in the BMJ, on how when it comes to COVID, certainty is a red flag.

Amy McDermott, in PNAS, on how it'll likely be rapid home COVID testing that brings back some sense of normalcy - it can't come soon enough

Christie Aschwanden, in Nature, on the false promise of herd immunity.

Photo by By Tkarcher - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=56760604



Thursday, October 22, 2020

RDs! We're Hiring! Looking To Fill A Full-Time Permanent Position With My New Venture Constant Health (Telecommuters Welcome!)


Since 2004, Constant Health’s expert team has been at the forefront behavioural weight management, and now, by leveraging the best that technology has to offer, the goal is to share that expertise while eliminating geographic boundaries. Our headquarters are in Ottawa, but our team stretches across Canada from Halifax to Vancouver.

We believe that there is no one best way to lose weight, but rather that every individual has a healthiest life that they can enjoy and Constant Health is there to try to help people cultivate theirs and in so doing, help them to find their best weights.

Using the latest research into weight management, behavioural psychology, and nutrition, Constant Health’s data driven approach provides the regular feedback required both for clients to improve their weights, but also for our team to continually improve our technology.

In addition to our strong clinical team, we have a team of experienced professionals with deep expertise in mobile design, development, integration, and project delivery for iPhone, iPad and Android platforms.

If you have a passion for health, fitness, and technology we'd love to hear from you.

Job description

Constant Health, a dietitian delivered chronic disease management company that utilizes its own proprietary behavioural intervention technology tools is looking for a permanent full time dietitian to join our professional and unique team.

We are looking for an individual who loves working with people and technology, is great at multi-tasking, is a team player, thrives off of challenges and responsibility, and wants to utilize his or her skills in making a dramatic positive difference in people’s lives.

Responsibilities will include:

  • Collaboration with interprofessional team members.
  • One-on-one virtual counselling sessions via Constant Health’s proprietary platform to motivate and help patients live the healthiest lives they can with an emphasis on diabetes and/or weight management
  • Design individualized nutrition plans based on each individuals’ unique lifestyles, and dietary likes and dislikes.
  • Write for Constant Health’s different social media outlets: Website, blog, vlog, and monthly newsletter.

The skills you’ll need:

  • Exceptionally strong motivational counselling skills.
  • Must have excellent listening skills, empathetic and sensitive to patient’s needs. We do not ever utilize negative reinforcement in our counselling.
  • Able to adapt nutrition advice to recent scientific research with thoughtful critical appraisal and for a wide variety of diets – from keto and intermittent fasting, to balanced deficits, to plant-based whole foods, to everything in between, because at Constant Health we recognize that the key to long term success is actually enjoying your chosen diet.
  • Must be innovative and give patients realistic and helpful nutrition advice.
  • Positive and non-restrictive approach to weight management.
  • Comfortable giving presentations.
  • Possess sound professional judgment, initiative and enthusiasm.
  • Good time management skills and ability to organize.
  • Excellent computer skills, and comfort with social media
  • Strong cooking skills.

The requirements we’re looking for:

  • Minimum one year of clinical experience
  • Registered Dietitian
  • Member of the College of Dietitians of Ontario and in good standing (or willingness and ability to join).
  • Master level clinicians and/or Certified Diabetes Educators are preferred, although not required.
  • Previous experience working in weight management and diabetes care is an asset.

Because we are looking for the best candidate our wages are highly competitive with those in the community ($59K - 70K/year depending on qualifications) and after the 3 month probation period, medical and dental benefits are part of our package.

Interested candidates can send along their CV to careers @ constanthealth.ca

We look forward to hearing from and meeting with you.



Saturday, October 17, 2020

Saturday Stories: The Scamedemic, The "Great" Barrington Declaration, Sweden, And The John Snow Memorandum

 


Tony Scott, in SFGate, on how he used to call it the 'scamedemic'. He doesn't anymore. 

Marc Lipsitch, Gregg Gonsalves, Carlos del Rio, and Rochelle P. Walensky, in The Washington Post, on the why the so-called Great Barrington Declaration is far from well named.

Kelly Bjorklund and Andrew Ewing, in Time, cover the disastrous truths of COVID in Sweden.

And as a response to renewed interest in herd immunity and that Great Barrington Declaration comes a competing declaration, the John Snow Memorandum, which explains why herd immunity strategies are dangerous and why, and unlike the Barrington document, does not include the signatures of Dr. Person Fakename, Professor Notaf Uckingclu, Dr. Johnny Fartpants, Dr. Very Dodgy Doctor, Dr. Brian Blessed Doctor in Winged Flight (truly, they are actual Barrington signatories)



Saturday, October 10, 2020

Saturday, October 03, 2020

Saturday Stories: Vaccine Chaos And What Did You Expect?


Sarah Zhang, in The Atlantic, on why vaccine chaos may be looming

David Frum, also in The Atlantic, asks, what did you expect?



Saturday, September 19, 2020

Saturday Stories: Considering Risk and Great Fences


Aaron E. Carroll, in The New York Times, with a useful read on how most of us have been considering and responding to risk backwards.

Tomás Pueyo, also in The New York Times, on the need for great fences.

Photo: Ongayo / CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0)


Saturday, September 12, 2020

Saturday Stories: COVID Winter, Circular Errors, Mutations, And Obesity

Irfan Dhalla, in The Globe and Mail, on COVID and the rapidly approaching Canadian winter.

Ed Yong, in The Atlantic, on the recurrent errors being made that hamper progress on COVID.

Edward Holmes, in The New York Times, covers the mutating SARS-CoV2 virus and why we needn't be worried (yet).

And in case you missed it, I had the chance to chat with some friends from McGill's Science in Society division about COVID, obesity, moral panics, and more:



Saturday, September 05, 2020

Mark Earnest, in The New England Journal of Medicine, on becoming a plague doctor.

James Hamblin, in The Atlantic, on why herd immunity isn't a strategy.

Jesmyn Ward, in Vanity Fair, on losing her husband to COVID. 

Jon Cohen, in Science, interviews Moncef Slaoui, the head of operation Warp Speed who says he'll quit if politics trump science on vaccine safety and distribution.

Saturday, August 15, 2020

Tuesday, August 04, 2020

Canada's Obesity In Adults: A Clinical Practice Guideline, Released Today, A Huge Step Forward

I'm proud to have played a small part in the release of today's Obesity In Adults: A Clinical Practice Guideline as it is the first (I think, though I'm biased) to truly take a patient-centred approach while simultaneously treating obesity like a chronic disease

Not a small endeavour, this years long effort includes chapters never before seen in any other obesity treatment guideline including those on weight bias and stigma, virtual medicine, commercial weight loss programs, living with obesity, as well as issues specific to indigenous peoples.

It explicitly steers away from diet culture (but does speak to the need for individualized medical nutrition therapy), teaches readers that neither BMI nor weight measures the presence or absence of health and introduces them to the concept that obesity should be considered a chronic disease only when excess adiposity impairs health, and it recognizes that obesity is anything but a choice.

While going through the entirety of the guideline isn't doable in a short blog post, here are the guideline's overarching summary points:
  • Obesity is a prevalent, complex, progressive and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity), that impairs health.
  • People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of weight or body mass index.
  • This guideline update reflects substantial advances in the epidemiology, determinants, pathophysiology, assessment, prevention and treatment of obesity, and shifts the focus of obesity management toward improving patient-centred health outcomes, rather than weight loss alone.
  • Obesity care should be based on evidence-based principles of chronic disease management, must validate patients’ lived experiences, move beyond simplistic approaches of “eat less, move more,” and address the root drivers of obesity.
  • People living with obesity should have access to evidence-informed interventions, including medical nutrition therapy, physical activity, psychological interventions, pharmacotherapy and surgery.
Kudos to all of my fellow authors and especially to Dr. Sean Wharton the project's chief cat wrangler.

To have a peek at the CMAJ's published guideline summary, click here.

To access the guideline in its 19 chapter entirety, click here.

Saturday, August 01, 2020

Saturday, July 04, 2020

Saturday Stories: No Heroes In Science, Selflessness, School Reopening, And Vaccine Developments

Stuart Richie, in Unherd, reminds us why there should be no such thing as science heroes.

Wency Leung, in The Globe and Mail, discusses her decision to donate one of her kidneys to a stranger and reflects on selflessness in the time of COVID

Carl Zimmer, in The New York Times, on the phenomenon of COVID19 super spreaders.

Hilda Bastian, in her blog Absolutely Maybe, brings us up to date on all the developments in the race to the first COVID19 vaccine.

Sarah Cohodes, on Twitter (and you don't need an account to read), with a terrific thread on considerations around school reopening.

Saturday, June 20, 2020

Saturday, June 13, 2020

Saturday Stories: COVID files

Dr. Stephan Kamholz - Chair of Medicine at Maimonides Medical Center, died of COVID19 on June 11th, 2020. May his memory be a blessing 
Sharon Begley and Helen Branswell, in STAT, spoke with 11 epidemiologists to explore what we need to ensure such that we don't screw up dealing with COVID's inevitable second wave.

Tomas Pueyo, in Medium, on whether we should all be striving to respond more like Sweden?

Jonathan Corum and Carl Zimmer, in The New York Times, with a coronavirus vaccine tracker.

Siddhartha Mukherjee, in The New York Times, moderates a discussion about whether or not a coronavirus vaccine can be produced in record time

Rachel R. Hardeman, Eduardo M. Medina, and Rhea W. Boyd, in The New England Journal of Medicine, discuss stolen breaths and racial inequities in medicine.

Saturday, June 06, 2020

Saturday Stories: Some Anti-Racism Resources #BlackLivesMatter

May his memory be a blessing
Corrine Shutak, in Medium, with 75 Things White People Can Do for Racial Justice.

A non-bylined Google Doc of anti-racism resources for white people.

Quakelabs' collection of Canadian specific anti-racist resource.

Farrah Penn, in Buzzfeed, with 23 Phenomenal Young Adult Books By Black Authors From The First Half Of 2020

The University of Toronto's Office of Inclusion and Diversity with their collection of recent stories and resources on anti-racism.

@antisocialbritt, on Twitter, with her thread of children's books that discuss racism.

@bronze_bae, on Twitter, with her thread of young adult books that discuss racism.

Photo By Lorie Shaull - https://www.flickr.com/photos/number7cloud/49959004213/, CC BY-SA 2.0, Link

Saturday, May 30, 2020

Saturday Stories: This Week's COVID Selections

Dr. Earline Austin, 63 yo NYC Physician, died on 4/3. Originally from Guyana, she lived in Fresh Meadows and was affiliated with Staten Island University Hospital. Attended Ross University for Medical School. May her memory be a blessing
Emily Chung, in the CBC, with everything you need to know to understand R-naught values.

Andy Larsen, in the Salt Lake City Tribune, with a breakdown of different locations and events and what we know of their risks in terms of spreading COVID.

Kimberly A. Prather, Chia C. Wang, and Robert T. Schooley, in Science, on how if you want life to return to some remote semblance of before's normal, if you're not already doing so, you need to start wearing a damn mask

Clayton Dalton, in The New Yorker, on what we lose when we become numb to mass death.

Saturday, May 23, 2020

Saturday Stories: The COVID files

Dr.Sudheer Singh Chauhan, Internal Medicine Physician and Associate Program Director IM Residency Program at Jamaica Hospital, New York, died of COVID19 on May 19th. May his memory be a blessing
Kai Kupferschmidt, in Science, on why only some people are COVID super spreaders 
Natalie Kofler and Françoise Baylis, in Nature, on the perils, pitfalls, and disparities of "immunity passports". 
And if you don't follow me on Twitter or Facebook, here's a segment I did with CTV's The Social on the very real impact these scary times has on our physical and mental well being


Saturday, May 09, 2020

Saturday Stories: The COVID Roundup

Dr. Bredy Pierre-Louis, Family Physician, Brooklyn, Died From COVID19. May his memory be a blessing
Caitlin Flanagan, in The Atlantic, on having stage IV colon cancer during the time of COVID19 (if you only read one piece this week, make it this one)

Orac, in Respectful Insolence, discusses Plandemic.

Tomas Pueyo, in Medium, on testing and contact tracing.

Ed Yong, in The Atlantic, covers whether or not we should be currently worried about coronavirus mutations

Monday, May 04, 2020

FREE Help From My New Venture For Ontarians With Newly Diagnosed Type 2 Diabetes Or Prediabetes But Stranded By COVID19

Are you an Ontario resident recently diagnosed with either type 2 diabetes or pre-diabetes where COVID19 has prevented you from receiving comprehensive support to help manage and understand your new condition? If so, my new venture can help, and better yet, for FREE. Built initially to support weight management, Constant Health, our new digital behavioural intervention, is being re-positioned to help people with newly diagnosed diabetes and pre-diabetes who in turn have been left stranded by COVID19.

Constant Health's iOS app (note, this opportunity is currently only available for those with iPhones or iPads as the Android app is still in development), will provide you with 12 weeks of private and secure (PHIPA compliant) access to both a Mayo clinic certified health coach as well as a registered dietitian who together, by way of text messaging and video chats, will work collaboratively with you on your diet and lifestyle to help improve your blood sugar control and teach you about your new condition.

Constant Health's technology includes a robust, open-ended collaborative goal setting engine, a built-in food diary, a searchable and filterable database of millions of the web's most popular recipe sites, along with a proprietary real-time dashboard which will allow our team to applaud and encourage your success as well as to help troubleshoot your struggles.

As with my office's practice (the Bariatric Medical Institute), Constant Health's services aren't limited to any particular dietary strategy, but instead work with you on whatever approach you feel would best suit your life and preferences. From low-fat, to keto, to vegan and everything in between Constant Health can help.

Rest assured, there are no strings whatsoever. Currently, thanks to an unrestricted grant from Novo Nordisk, we have a limited number of spots available to freely offer and plainly, we are not currently accepting paid patients. However due to provincial medical licensing regulations for both MDs and RDs, and the need for physician screening, we can currently only extend this offer to Ontarians.

If you're interested, live in Ontario, and have an iPhone, simply fill out this quick survey and if eligible, our office will contact you to book a consultation with me so that I can explore your medical history and have a peek at your lab results for us to mutually determine if the program is for you.

Saturday, May 02, 2020

Saturday Stories: This Week in #COVID19

Arlene Reid, 51, mother of 5 and PSW in Ontario working in LTC, died from COVID19 on April 27th. May her memory be a blessing.
Gid MK, in Medium, with his meta-analysis of reported infection fatality rates for COVID19

Jeanne Lenzer and Shannon Brownlee, in Inside, on the out of control "science" of this pandemic.

Joss Fong, in Vox, with a great explainer on how to understand that graph of all the countries' COVID cases you keep seeing. 

Ed Yong, in The Atlantic, with a spectacular guide on how to make sense of the all over the place that is COVID19.

Caitlin Flanagan, in The Atlantic, with the 2020 commencement speech you're never hear (but you should so read).

Saturday, April 11, 2020

Saturday Story: Only One, Because For First Time in 15 Years, I Accidentally Deleted The Rest

Dr. Doug Bass, may his memory be a blessing, the first physician in NYC to die from COVID9
Sorry to those who enjoy these reads, but by accident, deleted the lot of them save one

Dhruv Khullar, in The New Yorker, on his work as a physician in NYC during the time of COVID19, and adrenaline, duty and fear.

Saturday, April 04, 2020

Saturday, March 28, 2020

Saturday, March 21, 2020

Saturday, March 14, 2020

Saturday Stories: #COVID19 #FlattenTheCurve #CancelEverything Edition

7 views on why social distancing is so important right now and why we have to "cancel everything". If you think that #COVID19 isn't a big deal, do take the time to read these pieces to learn why you're wrong (ordered solely by way of the order I happened to read them in).

Eliza Barclay and Dylan Scott, in Vox.

Tomas Pueyo in Medium

Yascha Monk, in The Atlantic

Helen Branswell, in STAT

André Picard, in The Globe and Mail

Sharon Kirkey in The National Post

Kaitlyn Tiffany in The Atlantic

Also, here's Wency Leung, in The Globe and Mail, on what you should do if you think you have COVID19, and here is the Toronto Star's infographic on what self-isolation should look like if it's determined that you've contracted the virus.

Siouxsie Wiles and Toby Morris / CC BY-SA

Monday, March 09, 2020

TikTok Is All About Fat Shaming These Days

I was driving with my 13 year old daughter on Saturday and we were just chatting. I asked her what was trending these days on her TikTok stream (in the past she'd been served up antisemitism)? Apparently it's fat shaming Lizzo.

I asked her to share some videos with me.

She sent over 10 in less than a minute.

Some representative examples to follow, but all this to say, TikTok, while hugely entertaining, is a cesspool of hate and bullying, and if your children use it, probably worth asking them every once in a while what's trending on their streams so that you can take the time at least to talk about it.
@noahswitzer98

Everyone please ##stop making ##lizzo memes ##fyp

♬ original sound - noahswitzer98
@nickring4

When you lose Lizzo while your whale watching 😂 ##greenscreen ##lizzo ##meme ##xyzbca ##xyzcba ##joke ##fyp ##memes ##tiktokmemes ##comedy ##comedicgenius

♬ ITs ANIT new girlfriend of your ex - its_anit
@yaboyg35

##greenscreenvideo ##lizzo ##meme ##tacticalnuke ##mw2

♬ original sound - yaboyg35


Saturday, March 07, 2020

Monday, March 02, 2020

Australian Food Industry Launches World's Least Aggressive New Voluntary Self-Regulatory Effort

Waiting for any industry to self-regulate itself is just plain dumb. Honestly, industry's job is to protect and promote sales, and that's of course true for the food industry as well.

Self-regulation tends to crop up not out of altruism or doing the right thing, but rather as a means to forestall legislative regulatory efforts which in turn would prove to be more damaging to sales.

Take this recent initiative out of Australia which will see the food industry not advertising their junk to kids within 150m (500ft) of schools. 150 whole metres! While certainly not likely to do anything at all, it'll be especially useless perhaps in that the school buses themselves will be exempt, as of course will be the bus stops' shelters.

Oh, and as toothless as it is, it's also voluntary.

Really the only thing this initiative will do is provide the food industry with ammunition if and when facing calls for legislated regulation (something we're hearing more and more calls for) and to pretend that they care about anything other than profits.

It's always best to remember, as I've written before, the food industry is neither friend, nor foe, nor partner.

Saturday, February 29, 2020

Saturday Stories: Coronavirus Edition

James Hamblin, in The Atlantic, on how yes, you're probably going to get the coronavirus.

Peter Daszak, in The New York Times, welcomes you to the age of pandemics.

Vivian Wang, in The New York Times, with the bad good news that most coronavirus cases are likely to be mild.

Zeynep Tufekci, in Scientific American, on what you can do to prepare for when the coronavirus spreads to your country.

Monday, February 24, 2020

Health Canada Fails Science And Canadians By Allowing Any Purported Weight Loss Supplements To Be Sold

The latest of many systematic reviews and meta-analyses of herbal supplements for weight loss plainly makes the case that there is no justification for their sale.

They. Don't. Work.

None of them.

None. Of. Them.

So why does Health Canada license and allow the sale of 1,128 natural products whose listed purported use is for weight management? Or of the 671 products that purport they'll improve sexual enhancement? Or of pretty much any of them?

Maybe the answer lies somewhere in the taxation of the $1.8 billion annual Canadian sales of vitamins and supplements?

Maybe it lies in well-intentioned hope?

Maybe it lies is political contributions and lobbying?

But the one place where it doesn't lie is in science. Shouldn't that be the only place that matters?

Wednesday, February 19, 2020

Oh My God The Nutrition World Is Painful

Short post to say that watching people aggressively argue about their preferred diets of choice, and seeing reputable people willing to prop up the most shameless of medical hucksters if they happen to share a nutritional belief, and confirmation bias cherrypicking, and the endless debates about physiology, and meal timing, and breakfast, and fasting, and macronutrients, and lipids, and anti-science shilling, and multi-level marketing, and so much more, is so very tiresome.

As a clinician I know that what actually matters is how to help the person sitting in front of me, remembering that science, meal patterns, macronutrients, and physiology, may not always matter the way some study says they could or should in the face of an individual's life and personal preferences. Ultimately, and regardless of what I think is "right" on paper or right for me, my job is to help patients make sustainable changes that in turn lead them towards the healthiest life that they can actually enjoy.

Similarly, as a public health advocate, I know that if there were any amount of education, or a brilliantly crafted public health message, that in turn would effectively drive societal behaviour change we'd have all already changed all of our behaviours. I can also tell you that energies spent on initiatives relegated to personal responsibility, including but not restricted to those promoting one person's diet tribe, pale in importance to energies spent on initiatives relevant to changing the food environment. And there's no shortage of targets that span all dietary dogmas - from advertising to kids, front-of-package health claim reforms, junk food fundraising, the provision of free cooking skills to kids and adults, national school food programs and improvements, tax incentives and disincentives, and more.

All this to say, it's my opinion that these two flawed foci, that there's one best or right way and that personal responsibility will be our salvation, are the two main reasons why we can't have nice things in nutrition and nutrition related public health.

Saturday, February 15, 2020

Tuesday, February 11, 2020

Why Service Provision Fatally Confounds All Diet Studies (5:2 Intermittent Fasting Edition)

Last week I posted about a 5:2 intermittent fasting study that demonstrated terrible adherence with a 58% 5:2 drop out rate by the end of year one and where the average loss was 11lbs.

In response, Erik Arnesen shared another year long 5:2 intermittent fasting vs. continuous energy restriction study where the drop out rate at the end of year one was just 7% and the average loss was 20lbs! (and actually I blogged about this one in the past - tl;dr no difference in outcomes but 5:2 participants were hungrier)

If the diets were identical, why the tremendous difference in adherence and weight loss at a year?

Sure, could be different patient populations, but I'm guessing the much larger factor was the service provision. Because at the end of the day that's a huge part of what's being measured in any organized diet study. Not just in terms of how many visits or touch-points a particular program has, or what collateral materials and support they provide their participants, but also the rapport development, motivational ability, and teaching skills of the service providers themselves.

Having led an inter-professional team for 16 years, I can tell you that who you've got helping your patients/participants has a tremendous impact on their outcomes even within the same program's delivery.

So the next time you consider the outcomes of any study's diet arm, a question worth pondering is how much of those outcomes are consequent to the prescribed diet itself, and how much are consequent to the health care professionals administering it?

Saturday, February 08, 2020