Saturday Stories: Vaping Illness, Genetic Risks, and "Sin Taxes"

Robert Langreth and Lauren Etter, in Bloomberg, on how early signs of the new mystery vaping illness might well have been missed or ignored.

Timothy Caulfield, in Think, on whether or not knowing more about our genetic risks and daily performance metrics really makes us healthier.

Anna Purdie, Kent Buse, and Sarah Hawkes, in the BMJ, on how words matter and how we need to reframe how we talk about risk when it comes to things like "sin taxes".

Weekly Elementary School Pizza Sales Nets Just $8.57 Per Student Per Year

Last week I gave a talk to some parents at my youngest daughter's elementary school.

The talk was about our ridiculous food environment where we are all the proverbial frogs in pots of water that have slowly been heated to a boil, where food, especially junk food, is constantly used to reward, pacify, and entertain our children as well as to fundraise for every cause.

Ironically, the day before the talk I received an email from the school's parent council extolling me to sign my daughter up for weekly pizza days. In it I was told,

"The most valuable fundraiser is Pizza Mondays. $0.50 of every order, every week goes to the [redacted]. It's a win/win/win! One less lunch for you to make, a delicious (and nutritious) slice of pizza for your child and $16.50 to the [redacted]!"

Looking past the wisdom (or lack thereof) of children been taught by their school week in and week out, from Kindergarten to Grade 7, that fast food pizza is a normal, weekly, "nutritious", meal, I couldn't help but wonder just how valuable it really was in terms of fundraising, and so I asked principal.

She told me that the school's Pizza Mondays cut raises $6,000 per year (12,000 slices served).

There are 700 students in the school.

$6,000/700 students/year = $8.57/student/year

And if Pizza Mondays are the most valuable fundraiser, then perhaps it'd be fair to assume that in total, the school raises $10,000/year in food sale initiatives. That would be $14.30 per kid per year.

Is there really no other way to raise $14.30 per kid than selling them, and normalizing, weekly (or multiple times per week) junk food?

I think there probably is, and here are 3 suggestions each of which by itself might do the job, let alone together (and these are just 3 ideas, there are so many more out there as well).

Fundscrip
Fundscrip is simple to describe. Parents buy gift cards from Fundscrip for stores they already shop at (supermarkets, gas stations, hardware stores, clothing stores, business and school supply stores, toy stores, book stores, electronic stores, restaurants etc.). The gift cards work just like regular gift cards (meaning they work just like cash) and are mailed directly to parents' homes, and the school receives 2-5% (depending on the store) of the value of the gift cards. Given the average family of 4 in Canada's weekly grocery bill runs in at a reported $220, if even only 10% of the school's parents got involved, and if they only used the cards to cover half of their grocery costs, the 3% kickback to the schools would raise $12,000. And that's just by way of groceries!

Grandparents' Day
Many schools run grandparents' days. Simply put they involve inviting all the kids' grandparents to school, putting on some sort of song and dance production, giving the proud grandparents a tour, and either charging them a nominal fee for tickets ($5), or simply soliciting donations during the event (and perhaps annually having a singular cause which then gets branded for that year's grandparents if monies raised). 700 elementary students should conservatively mean at least 1400 grandparents. If only half of them attended, and an average of $5/grandparent was raised, that would bring in $3,500.

School Parents' Goods and Services Auction
With 700 families in our child's school, there are clearly a great many different professions represented among the parents. Creating a night whereby parents can donate goods or services (with a cut to the school) is a great way to both raise money, and raise interest and awareness of the parent body's businesses. Lawyers might donate a discounted will consultations, I could donate work with one of our RDs, or with our personal trainers, artists could donate their art, restauranteurs could donate meals, etc. Done right, and certainly once established as a valuable annual event, there's no reason why this couldn't raise $3,000-$10,000.

The bottom line is that schools truly don't need to sell junk food to children to raise money as there are plenty of other means to do so. Yes, school sold junk food is convenient for parents who aren't keen on making lunches every day, but given we are literally building our children out of what we feed them, and that weekly (daily in some cases) school junk food sales teaches kids, even those who don't order them, that daily junk food is a normal, healthy part of life, taking the time to pack those lunches (or to teach our kids how to pack lunches themselves) is well worth it.

Saturday Stories: Admission Offers, Fat Cycling, Medical Errors, And Fanboy Me On This Week's Science Vs Podcast

Anonymous MD, in CMAJ blogs, with perhaps a more truthful offer of admission to a future physician.

Kailey Kornhauser, in Bicycling, on cycling while fat.

Benjamin Mazer, in Medscape (and yes, I know you need to register to read their free content), on the commonly cited myth that medical errors are not the third leading cause of death.

[And in case you don't follow me on social media, as a huge fanboy, I can truly say it was my great pleasure to chat with the talented Wendy Zuckerman for her podcast Science Vs and her episode on what exercise can and can't do]

Canadians Who Care About Science Might Not Want To Vote NDP

I have to admit, I found this story jaw dropping.

The federal NDP health critic, Don Davies, is opposed to plans geared to rein in the wild, wild, west of natural health products and supplements that prey on desperate Canadians.

The proposed regulations are meant to require, gasp, that natural health products have evidence to prove they're both safe and effective before they're allowed to be sold.

In the CBC story, Davies even parroted the common line that it's too expensive for supplement makers to conduct studies to prove their products work. That statement contrasts poorly with the other one he gave in the same article where he reports the natural health industry enjoys $12 billion in Canadian revenue and $2 billion in exports.

But even were it true, that there's a presumably want-to-be federal Health Minister arguing we shouldn't require proof of safety and efficacy for products being sold to Canadians in the name of treating their medical conditions, for anyone who cares even an iota about science, should be a non-starter.

And it gets worse.

Davies, in trying to push his post-science world view, was encouraging people to sign a petition developed by the Health Action Network Society (HANS), a Vancouver charity with a history of spreading anti-vaccination claims, but they themselves noted that they were not working with him directly.

Shame, shame, shame, indeed.

Let's Stop Using The Terms "Healthy Weight" And "Normal Weight"

Words matter, and your weight cannot determine whether you're "healthy", or "normal".

Honestly.

Firstly, scales don't measure the presence or absence of health, and so the term "healthy weight", means literally nothing.

Secondly, the CDC defines a "normal weight" as one giving a person a BMI between 18.5 and 24.9 yet if we were using the word normal correctly, it would differ by country and would reflect its population's mean BMI. So in Nauru for instance normal weight would be a person whose BMI was 32.5, whereas in Eritrea it would be someone whose BMI was 20.5. Given mean BMIs in the US and Canada are 28.8 and 27.2 respectively, in North America, it should be considered abnormal to have a BMI between 18.5 and 24.9.

So what could we use instead?

Risk based terms.

Weight, though not a guarantee for any medical problem, does increase the risk of many, and so I'm proposing that rather than terms which confer judgment, we categorize weight as low-risk, medium-risk, and high-risk, and by doing so we'll stop the erroneous use of healthy and normal terminology that constantly and insidiously promotes weight bias, shame, and stereotype.

Saturday Stories: Crane Wife, Domestically Violent Cops, and Brain Boosting

CJ Hauser, in The Paris Review, with the crane wife.

Kyle Hopkins, in Propublica, on the village where every cop has been convicted of domestic violence.

Kaitlyn Tiffany, in Vox, on brain boosting.

If There Were Quick, Easy, Flying Leaps That Lasted, You'd Have Already Taken Them

The saying is that long journeys begin with first steps, not flying leaps, and if there were flying leaps that routinely led to lasting change, you'd have already taken them.

It's a straightforward message, but when applied to weight management, diet culture regularly asks us to ignore it.

The inconvenient truth of healthy living is that it will certainly require effort.

Yes, there are likely those who will succeed by changing everything all at once, but for most, slowly building and layering change, and respecting the fact that their roads will absolutely also see their share of disappointments and setbacks, is the way to finally get somewhere.

Your first step might be as small as losing one restaurant meal a week in place of cooking, or trying to reduce your sugar sweetened beverages by 50%, or actually scheduling a day to buy, or a service to deliver, weekly groceries, but if you choose steps you can actually accomplish without suffering, you're more likely not to fall, which in turn, will help keep you moving forward.

Saturday Stories: Running While Fat, Running While Female, And Frustrating, Confusing, Israel

Kate Brown, in Runners World, on running while fat.

Cara Harbstreet, in Human Parts, on running while female.

David Horowitz, in The Times of Israel, with an incredibly insightful interview with Matti Friedman with some background on how and why for many, Israel may baffle or infuriate.

Why You Should Turn Off Your TV And Holster Your Devices Before You Eat

Ok, it's a short study and it relied on dietary recall, but if taken at face value, the results certainly suggest you should be turning off your devices and eating away from the TV.

The study involved the 3 day recall of both diet and media use among 473 individuals.

Plainly, researchers found that meals that were consumed along with some form of media distraction contained 149 more calories. They also found that people consuming those extra calories at a media meal did not compensate by eating less at their next meal.

Given how easy it is to do this, and how by doing so you might even strengthen some interpersonal relationships by eating with friends or family around a table, you really have almost nothing to lose by trying, except perhaps a few calories.

Saturday Stories: Suicide, Goop, Vaccines, And Kurbo

Connie Schultz, in Creators, on what to say (and not say) to someone whose loved one has died by suicide.

Amanda Mull, in The Atlantic, on what Goop really sells.

Richard Conniff, in National Geographic, on the world before vaccines.

[And if you don't follow me on Twitter or Facebook, here's my take on Weight Watcher's new kids Kurbo app and how while Weight Watchers might know kids aren't likely to lose much weight, do the kids?]

The Rewards Project - A Registered UK Charity Geared At Putting An End To Sugary School Rewards

So it's back to school time, and zero doubt, many of your kids are going to have teachers and schools who will use candy and junk food as a reward.

It's a shame too, not just because they'll be providing your kids with junk, but also because they'll be teaching them, over and over and over, that junk is a reward for anything and everything.

I've written before about easy non-junk food rewards for teachers, I've also written about how you might want to approach things with your kids' sugar pushers, and I even kept track one year of just how much junk other people were offering my kids. What was clear from the response to all of these pieces was just how prevalent this problem was, and just how frustrated parents are.

Well as a sign of those times, in the UK, a new charity has popped up called The Rewards Project and its mission is trying to change this common practice. Click through and you'll find some sample letters to send to your child's school (though I think they'd be much better were they to offer some alternatives and suggestions in them and as I wrote about and linked above, lead with praise for the school and its teachers).

All this to say, if there are charities popping up geared at tackling this issue, clearly there's a real appetite out there for change. In turn this suggests - and my experiences with my kids' schools and more would definitely support this notion - that your kids' schools and teachers might be more open to changing things than you might think.

You'll never know unless you try.

(Thanks to Dr. Miriam Berchuk for sending this my way)

Saturday Stories: Fitness Evolution, Soda Taxes, and Tick Saliva

James Steele, in The Evolution Institute, on how evolution best informs exercise.

Jeremy B. White, in The Agenda, on how the food industry may be winning the war against soda taxes.

Sarah Zhang, in The Atlantic, marvels about tick saliva.

9 Great Suggestions For Improving The Quality Of Dietary Research (And 1 That According To @JamesHeathers Is "Deeply Silly")

Last week saw the publication of an op-ed authored by Drs. David Ludwig, Cara Ebbeling, and Steven Heymsfield entitled, "Improving the Quality of Dietary Research". In it they discuss the many limitations of dietary research and chart a way forward that includes the following 9 great suggestions,

1. Recognize that the design features of phase 3 drug studies are not always feasible or appropriate in nutrition research, and clarify the minimum standards necessary for diet studies to be considered successful.
2. Distinguish among study design categories, including mechanistic, pilot (exploratory), efficacy (explanatory), effectiveness (pragmatic), and translational (with implications for public health and policy). Each of these study types is important for generating knowledge about diet and chronic disease, and some overlap may invariably exist; however, the findings from small-scale, short-term, or low-intensity trials should not be conflated with definitive hypothesis testing.
3. Define diets more precisely when feasible (eg, with quantitative nutrient targets and other parameters, rather than qualitative descriptors such as Mediterranean) to allow for rigorous and reproducible comparisons.
4. Improve the methods for addressing common design challenges, such as how to promote adherence to dietary prescriptions (ie, with feeding studies and more intensive behavioral and environmental intervention), and reduce dropout or loss to follow-up.
5. Develop sensitive and specific biomeasures of adherence (eg, metabolomics), and use available methods when feasible (eg, doubly labeled water method for total energy expenditure).
6. Create and adequately fund local (or regional) cores to enhance research infrastructure.
7. Standardize practices to mitigate the risk of bias related to conflicts of interest in nutrition research, including independent oversight of data management and analysis, as has been done for drug trials.
8. Make databases publicly available at time of study publication to facilitate reanalyses and scholarly dialogue.
9. Establish best practices for media relations to help reduce hyperbole surrounding publication of small, preliminary, or inconclusive research with limited generalizability."

But there is one recommendation that seems at odds with the rest,

Acknowledge that changes to, or discrepancies in, clinical registries of diet trials are commonplace, and update final analysis plans before unmasking random study group assignments and initiating data analysis.

For those who aren't aware, clinical registries are where researchers document in advance the pre-specified methods and outcomes being studied by way of an observational experiment. The purpose of pre-registration is to reduce the risk of bias, selective reporting, and overt p-hacking that can (and has) occurred in dietary research.

Now to be clear, I'm a clinician, not a researcher, and I'm not sure how commonplace changes to or discrepancies in clinical registries of diet trials are, but I'm also not sure that's an argument in their favour even if they are. I do know that recently two of the authors claiming registry changes are commonplace were found to have modified one of their pre-specified statistical analysis plans which if it had been adhered to, would have rendered their results non-significant.

But commonplace or not, is it good science?

To answer that question I turned to James Heathers, a researcher and self-described "data thug" whose area of interest is methodology (and who you should definitely follow on Twitter), who described the notion of accepting that changes and discrepancies to clinical registries were commonplace was, "deeply silly".

He went on to elaborate as to why,

First of all - the whole definition of a theory is something which sets your expectations. the idea that 'reality is messy' does not interfere with the idea that you have hypothesis driven expectations which are derived from theories.

Second: there is nothing to prevent you saying "WE DID NOT FIND WHAT WE EXPECTED TO FIND" and then *following it* with your insightful exploratory analysis. In fact, that would almost be a better exposition of the facts by definition as you are presenting your expectations as expectations, and your after-the-fact speculations likewise.

Third: if you have a power analysis which determines there is a correct amount of observations necessary to reliably observe an effect, having the freedom to go 'never mind that then' is not a good thing by definition.

Fourth: The fact that changes were made is never ever included in the manuscript. i.e. they are proposing being able to make changes to the protocol in the registry *without* having to say so. it's a 'new plan' rather than a 'changed plan'.

Fifth: If you can still do the original analysis then no-one will ever believe that you didn't change the plan after looking at the data. you have to protect yourself, and the best way to do that is to follow your own damned plans and be realistic from the get.

Lastly, Heathers is unimpressed with the argument that registry changes are A-OK because they're commonplace, and he discussed ancient Aztecan punishments for those citing it.

All this to say, there's plenty of room to improve the quality of dietary research. Here's hoping the bulk of these suggestions are taken to heart, but please don't hold your breath.

Saturday Stories: Morning People, In Sickness, And Mom Bods

Olga Khazan, in The Atlantic, discusses people like me - cursed to wake up every day before 5:30am.

Mark Lukach, in The Pacific Standard, discusses love in the face of severe mental illness.

Alice Sueffert, in ScaryMommy, discusses finally showing her mom bod some love.

Kellogg's Partners With Random House To Use Free Books To Sell Ultra-Processed Sugary Junk Food To Children

To be clear, neither Random House, nor Kellogg's, should be fairly expected to do the right thing when it comes to health.

Kellogg's job is to sell food. Random House's job is to sell books. Nothing more, nothing less.

So it's hard to get mad with either company for their "Feeding Reading" initiative which provides parents with permission or excuse to buy their children such health foods as:

• Frosted Flakes
• Pop-Tarts
• Eggos
• Nutrigrain Bars
• Froot Loops
• Rice Krispie Treats
• Apple Jacks
• Frosted Mini-Wheats (note, unfrosted mini-wheats are not eligible)
• Corn Pops
• Raisin Bran
• Krave
• Keebler cookies
• Cheez-its
• Austin crackers
• Pringles

Truly, not a single choice parents or children should be encouraged to make. All ultra-processed, sugary, junk (and some crackers and potato chips).

Again, no reason to expect either Random House or Kellogg's to be doing the right thing by kids, but in my opinion, their clear partnership in doing the wrong thing here certainly doesn't reflect well on either of them.

Saturday Stories: Apples, Crystals, and Mindfulness

James Hamblin, in The Atlantic, on how fresh apples (and other fruit) are perhaps the only probiotics you should be buying.

Emily Atkin, in The New Republic, explains why even if you believe in the nonsense around healing crystals, you probably shouldn't be buying them.

Sahanika Ratnayake, in Aeon, with some truths about mindfulness.

[And in case you don't follow me on social media, in Medscape this week I ask does the anger, zealotry, and ugliness of the more vocal parts of the low-carb community hinder its wider adoption?]

The Recipe For Aging Gracefully And Adding Life To Your Years

No one wants aging to happen to them, and yet.

While eventually we'll all lose the fight, that doesn't mean we can't go down swinging, and the good news is the recipe for aging without frailty is exceedingly straight forward and was recently spelled out in a systematic review published in the British Journal of General Practice.

The magic formula the 46 included studies pointed to? A mix of regular strength training with regular protein supplementation.

Spelled out a bit further?

20-25 minutes of strength training 4x per week and the purposeful inclusion of protein with every meal and snack (or alternatively, two daily protein supplements providing 25g of protein each).

Though the aforementioned formula won't guarantee a long life, the evidence certainly suggests it'll help to provide a better one adding life to your years if not years to your life.

Saturday Stories: Defending Indefendibles, Assisted Suicide, And Archie MacIsaac-Vacon

Glenn C. Loury, in The New York Times, asks why are democrats defending "an ambulance-chasing, anti-Semitic, anti-white race hustler"?

Susie Adelson, in Toronto Life, on throwing her grandmother an assisted suicide party.

Charlene Vacon, in LinkedIn, with a heartbreaking must-read story about her son Archie. 

Most Generous Conclusion Of Chocolate Milk In Exercise Systematic Review And Meta-Analysis? It Will Increase Your Time To Exhaustion By 47 Seconds Over Placebo

Literally every time I write about chocolate milk being a beverage worth actively minimizing in your diet (have the smallest amount of it you need to like your life), someone inevitably chimes in to tell me I'm wrong because it's great for exercise recovery.

And I'm not sure how I missed this when it came out, but last year, the European Journal of Clinical Nutrition, published a systematic review and meta-analysis of randomized controlled trials involving chocolate milk and exercise recovery.

After excluding studies that didn't meet their inclusion criteria, the (non-conflicted) authors were left with 12 studies, 2 deemed of high quality, 9 of fair quality, and 1 of low quality with 11 having extractable data on at least one performance/recovery marker including ratings of perceived exertion, time to exhaustion, heart rate, serum lactate, and serum creatine kinase.

Their overall conclusion?

The systematic review and meta-analysis revealed that chocolate milk consumption had no effect on any of those variables when compared to placebo or other sport drinks.

Their most generous conclusion?

If they excluded one study from their analysis of the effect of chocolate milk on time to exhaustion then chocolate milk was found to increase time to exhaustion by 47 seconds over a placebo beverage. They also found, in another subgroup analysis, that lactate was slightly attenuated in chocolate milk drinkers compared to placebo (a finding that was not present in the high quality RCT looking at same).

(for a brief discussion on the stats involved and the subgroup analysis, here's a post on same from epidemiologist @GidMK who concluded that chocolate milk is "not a fitness drink").

Happy to have this post published so that I can share the next time someone inevitably tries to suggest that chocolate milk is magic.

Saturday Stories: #Keto, Gullibility, And Lyme Disease

Julia Belluz, in Vox, with a terrific overview of the keto diet.

Kera Bolonik, in The Cut, with a bizarre and gripping read about "the most gullible man in Cambridge"

Molly Fisher, also in The Cut, with a great read on when lyme disease becomes an identity.