Tuesday, February 14, 2017
Perils of being a health nut
A doctor reports:
A lady came to me with renal failure many years ago, and was indignant because she was a health nut and took great pride in all the vitamins she took to "stay healthy." At that time a kidney angiogram was standard (injecting dye directly into the kidney through the blood vessels). Before I injected the first drop I noticed on the fluoroscope that both kidneys looked like great, white stones.
I asked her, "How much Vitamin D do you take?" She proudly announced that she took about 75 times the recommended dose. "Well, I said, you have turned your kidneys to stone." She pronounced me a quack and we terminated the procedure. Last I heard of her, she was on dialysis.
The wrong-headed war on salt again
Another shot at the salt nonsense below. Excerpt only. The term "sodium" below refers to NaCl, table salt
Since Dahl's work in the 1960s, a steady stream of high-quality evidence has shown that dietary sodium can indeed influence blood pressure. But most showed a surprising, but statistically insignificant inverse correlation between salt and blood pressure, as well. That means some people with higher dietary sodium also had lower blood pressure.
More recent work has demonstrated that, even though groups of people averaged together may show a uniform trend in the association between sodium and blood pressure, there are wildly different blood pressure responses to dietary sodium within populations. For example, research indicates that about 25 percent of the population is "salt sensitive," meaning their blood pressure rises as dietary sodium is increased. However, most-perhaps upwards of 75 percent-are insensitive to moderate increases and decreases in dietary salt. A small percentage, an estimated 11 to 16 percent, however, are "inverse-salt-sensitive," and will experience higher blood pressure as dietary sodium is decreased. The cause of this heterogeneity in response to dietary sodium is not yet known but may be related to the other components of a person's diet, their genetic background, and other lifestyle factors.
Furthermore, an increasing body of research has shown that decreasing salt consumption-even if it does lower blood pressure-may not be associated with better health. Blood pressure is, of course, merely a marker of health not an outcome; people don't die as a result of high blood pressure, but rather from the conditions closely associated with blood pressure like heart attack and stroke.
What does all this mean? Frankly, it means the research is inconclusive for population-wide sodium recommendations. For certain individuals, like those who are salt-sensitive and consuming higher than average sodium intakes, sodium restriction may make sense. On the other hand, for certain groups, such as those who are inverse salt-sensitive, or those who are diabetic (for whom studies have found lower salt increases mortality risk) it might not be the best approach. Put more simply: the research doesn't support sodium restriction in the general population consuming average sodium levels as a means to reduce blood pressure.
Perhaps the most interesting finding, however, is that the literature has been quietly affirming the effectiveness of other-possibly more appropriate-ways to lower blood pressure. At the top of the list is dietary potassium, which researchers had identified as lowering blood pressure at nearly the same time they began studying the effects of sodium on blood pressure. Consistently, almost without fail and on both sides of the sodium debate, studies have shown that doubling dietary potassium is as effective as halving dietary sodium. More importantly, the effect has been observed in almost every population in which it has been studied, regardless of race, sex, age, location, and other genetic and lifestyle factors.
Covered California Misery Still Getting Worse
Since the dawn of Covered California, the state's wholly owned subsidiary of the federal Affordable Care Act, health journalist Emily Bazar has tracked the dysfunctions. The skyrocketing premiums, cancellations and "glitches" of the $454 million computer system were responsible for "widespread consumer misery," not exactly a ringing endorsement. Covered California also dropped 2,000 pregnant women from their plans, causing them to lose their prenatal appointments. More recently, victims of Covered California protested a massive "bait and switch" trick that makes glowing promises then sticks them with expensive, inferior coverage. On the other hand, victims who think Covered California can't get any worse are sadly mistaken.
In her most recent column, Emily Bazar charts how Covered California slammed victims by nearly doubling their premiums and depriving them of their tax credits. Covered California boss Peter Lee cited "systems issues that had never occurred before," an allusion to the $454 million computer system that Covered California blames for everything. Lee helpfully added that "real people" have been affected. One of them is Mike Connelly, 62, of Granite Bay, who like others was mistakenly kicked over to Medi-Cal. "After they have you," Connelly told Bazar, "they won't let you go," and that is not a good thing. Medi-Cal service is shaky and as Bazar noted, they "demand posthumous payback from enrollees 55 and older for a broad range of medical costs," even if they didn't use any medical services. All victims of the ACA, meanwhile, should understand that actual health concerns are secondary.
The Affordable Care Act is perhaps the greatest "taking" in U.S. history. It takes away the plans the people like and gives them only what the government wants them to have. The ACA increases the size and power of government and lays the groundwork for government monopoly health care, the "public option." The people ought to beware because once that system has you, it won't let you go. Even if you don't like the plan, you have to keep it.
Replace Obamacare, Don't "Repair" It
Rumor has it that many Republicans in Congress are rethinking "repeal and replace" in favor of "repair." This is both unnecessary and unsound. According to Independent Institute Senior Fellow John C. Goodman, GOP lawmakers can replace Obamacare without leaving anyone behind. All they need to do is to enact legislation such as the proposal that Senator Bill Cassidy introduced in the Senate and that he and Representative Pete Sessions introduced in both houses of Congress.
"The Sessions/Cassidy proposal in particular is designed to encourage employers to help their employees get health insurance," Goodman writes in Forbes. It does this through five main features: a refundable tax credit, access to group insurance, access to limited-benefit insurance, a reliable safety net, and reform of the individual market.
"Interestingly, a model for reform is the small-business section of the CURES Act, which passed with huge bipartisan majorities in both houses of Congress," Goodman writes. "One way to think about the Sessions/Cassidy legislation is to see that it will extend these same features to the rest of the healthcare system."
The West was protectionist before Trump
Obama and the EU pursued trade wars long before The Donald arrived. Tariffs are only one way of burdening producers in other countries
Is Trump intent on starting a trade war? After proclaiming, in his inaugural address, that `protection will lead to great prosperity and strength', Trump has withdrawn from the Trans-Pacific Partnership. He may impose a 20 per cent border tax on imports, starting with Mexico. He wants to renegotiate the North American Free Trade Agreement with Mexico and Canada. He's promised to raise tariffs on Chinese goods to 45 per cent of their value, and wants US manufacturers to reshore production back to America. Now commentators fret that Trump is walking in the `ominous' and `dark' footsteps of the 1930 Smoot-Hawley Tariff Act, which taxed some imports at 60 per cent of their value and is today widely seen as contributing to the international disorder of the 1930s.
We will have to see what Trump does. But nobody should be under any illusions: over two terms, Obama's own protectionism, much of it directed against the EU, fully prepared the world for the Trumpian protectionism of today. So too did the protectionism emanating from Brussels. The narrative that Trump is a qualitative break from a previous era of peaceful, liberal, free-trade globalisation is simply untrue.
In trade and investment, Obama always played hardball. He took sanctions against Russia and Syria. He only eased sanctions against Iran in January 2016, and left the historic US sanctions in place around Cuba. Obama also imposed tariffs of more than 500 per cent on some Chinese steel products. In the World Trade Organisation, his representatives aggressively pursued `enforcement' actions against trade rivals.
Yet Obama also played a new kind of softball. For decades, economists used to lament growing `non-tariff barriers to trade' - niggly regulations that would, for example, bar foreign carmakers if their bumpers weren't right. And for decades trade has been growing in services, where national technical regulations and standards are especially tricky for foreign firms to adhere to (the EU Single Market, for example, does not work well for services). What's more, foreign direct investment (FDI) is actually more important than trade. Apart from the imposition of old-fashioned sanctions and a few harsh tariff barriers, then, Obama repeatedly engaged in other unilateral, arbitrary and intimidating actions against foreign firms active in the US.
His people fined Britain's BP billions of dollars for the 2010 Deepwater Horizon oil disaster, and Obama himself castigated BP as British Petroleum. In 2012, Obama's Department of Justice (DoJ) fined UK pharmaceutical giant GlaxoSmithKline three billion dollars for bribing doctors to prescribe anti-depressants to children. On a much smaller scale, the US Securities and Exchange Commission fined Dutch auditors KPMG in 2014 for iffy accounting, going on to fine Ernst & Young for much the same in 2016. Last year, too, the Supreme Court awarded Apple $399million in damages against Korea's Samsung for making smartphones with `a rectangular front face with rounded edges and a grid of colourful icons on a black screen'. Obama's DoJ also fined Volkswagen $4.3 billion for faking its diesel emissions, arranging for a German VW executive to be shackled in Miami and threatened with life in jail. Finally, in its dying days, the Obama DoJ fined Britain's Rolls Royce $170million for bribery.
Obama's fierceness toward inward investors was only `soft' in that it singled foreign companies out for longstanding Democratic Party anti-corporate gripes around the environment, safety and corruption. In this sense, we can say that Obama initiated trade wars under the guise of culture wars against the bad behaviour of foreign firms.
The EU has replied in kind. Brussels might not agree that its measures amount to a trade war, but it has been unrelenting in its pursuit of US companies - especially IT companies. The EU issued anti-monopoly fines against Microsoft ($731million, 2013), Intel ($1.4 billion, 2009) and Google (up to $7.45 billion, 2016), and attacked Apple for not paying enough tax. It now has Google, Apple, Facebook and WhatsApp in its sights over internet privacy.
US IT companies remain, in the eyes of the EU, just a little too big for their boots. They lack the finesse of, say, European companies. In this way the EU's politically correct protectionism can distract from its failure to build a computer and software industry like the US.
The `Trump means trade war' narrative gets still more shallow when people say that just as Trump will make trade hard, so other authoritarian national leaders - not just Trump, but also Turkey's Recep Tayyip Erdogan, India's Narendra Modi, Russia's Vladimir Putin and China's Xi Jinping - will promise to do the same. Thus Guardian economics editor Larry Elliott believes that `just as in the 1930s, there is a prevailing cult of the strong man' around the world; so if Trump could `bring the globalisation of the past quarter of a century to a juddering halt', he might be aided and abetted by multiple Trumps abroad.
This is preposterous. Even Thomas Carlyle, the father of the `Great Man' school of history, would blush at such a personalised, almost Freudian account of world trade. By focusing on easily disliked dictatorial figures, this knowing whitewash completely exonerates liberal politicians, on both sides of the Atlantic.
It is all far too convenient. Trump may well like the brutish, tariff-based protectionism of the pre-war era. But he will also continue the modern, righteous protectionism pioneered by Obama and the EU. The forces of world economy and politics are bigger than any one man.
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Posted by JR at 1:24 AM