Facts and ideas from anywhere (2024)

EFFECT OF CALORIC LABELS ON BODY MASS INDEX

Partha Deb and Carmen Vargas, both of Hunter College, focused on what happened to people's body mass index (BMI) from 2003 to 2012 (1). They used data from the Behavioral Risk Factor Surveillance System, the annual nationally representative survey conducted by the Centers for Disease Control and Prevention (CDC) in collaboration with state health departments, to collect information on self-reported height and weight as well as demographic information. The caloric labeling in restaurants was started in New York City by Mayor Bloomberg and was required by President Barack Obama's health care law. The men's BMI was significantly reduced after the introduction of caloric labels. The reduction was largest among the obese (BMI >30 kg/m²), next largest among the overweight (BMI 26–30), and smallest for those with normal BMI (≤25). For women, the effect was statistically significant only for those who were overweight. These two investigators found that both men and women in the normal weight class tended to live in high-income areas and be college graduates, and the group showed little or no effect from the caloric labels. Among the men and women who showed the largest effects, an unusually high percent tended to have no education beyond high school, to be older, and to be Hispanic. These results make a lot of sense. People of normal weight have no reason to change their behavior because they do not have a weight problem. By contrast, men and women with weight problems have good reason to try to lose weight, and the labels have helped them to do just that. And if consumers are less educated, the caloric labels may be more likely to tell them something that they did not know.

US NAVY CHANGING BODY FAT REQUIREMENTS

For decades the US Navy required its men aged 17 to 39 to have no more than 22% body fat and its women of similar age to have no more than 33% body fat (2). Sailors 40 and older were allotted one additional percentage point. The number of sailors booted from the Navy annually because they did not meet these physical standards increased from 694 in 2011 to 1536 in 2014. As a result, the Navy believed it was losing too many good sailors. A change occurred in January 2016, and the new limits allow sailors to pass with a maximum 26% body fat for men and 36% for women. The Navy allowed about 2400 sailors who passed a preliminary test under the new rules to stay in the Navy. The changes are the latest by the military looking to improve its abilities to recruit and retain talented people as it builds up its cyberwarfare strategy. A 2014 Pentagon study found that roughly two-thirds of Americans would not qualify to enlist in the armed services as a result of health problems, obesity, and the failure to complete a high school education. Too bad our standards are getting more lenient.

SUPPLEMENTS

Congress lets companies market supplements without proving that they are safe and effective (3). Senior citizens are often the target. Scores of supplements promise to do away with aching joints, memory loss, and hearing problems, according to Michael F. Jacobson, PhD, the president of the Center for Science in the Public Interest. Prevagen is a synthetic jellyfish protein supplement that improves memory according to the manufacturer. Its evidence is a weak study conducted by Prevagen employees. Hawking unnecessary pills to seniors can do more than just pick their pockets. Researchers found a surprising increase since 2005 in the number of older patients who also bought fish oil when they filled a prescription for the blood thinner warfarin. It is very doubtful that supplements for arthritis or high blood pressure work and are safe. In 2015, the Food and Drug Administration (FDA) uncovered >100 supplements with “potentially hazardous” hidden ingredients. Thirty-four were “weight loss” products that were adulterated with sibutramine, a drug the agency banned in 2010 because it caused heart attacks and strokes. The US attorney general recently said, “Some of these supplements are simply a waste of money. … Some contain harmful ingredients causing consumers to fall ill. Others falsely claim to cure illness and disease.” She also indicated that people sometimes take worthless supplements instead of drugs that could treat their illnesses. The Department of Justice has brought civil or criminal cases against >100 supplement manufacturing companies. The US needs a strong law that requires companies to prove that their products work and are safe before they can be sold. But, the supplement industry has Congress firmly in its hands.

PREVENTING DEMENTIA

There are two major causes of cognitive decline in older people (4): 1) Alzheimer's, accumulation of abnormal fragments of amyloid in the brain, and 2) vascular dementia, resulting from decreased blood flow in the brain. The brain's white matter shrinks in both advanced Alzheimer's and advanced vascular dementia. The following have been suggested as helpful in preventing dementia. 1) Prevent hypertension. There are now over 80 drugs to reduce blood pressure. The Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure. In a 4-month intervention using the DASH diet, there were improvements in executive function, processing speed, and some aspects of learning and memory in the group that got the weight loss DASH diet and aerobic exercise. 2) Keep the blood glucose level down. Diabetes mellitus causes disease in many body organs, including the heart, kidney, eyes, and also the brain. 3) Use your brain. Live an intellectual lifestyle to delay symptoms of cognitive decline. 4) Use “brain foods.” The Mediterranean–DASH Intervention for Neurodegenerative Delay (MIND) diet is a hybrid of those two diets with a few tweaks. Instead of any fruit, for example, the MIND diet includes only berries, largely blueberries. The 10 “brain health” food groups: green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and wine. The five unhealthy groups include red meats, butter and stick margarine, cheese, pastries and sweets, and fried and fast foods. 5) Do aerobic exercise 2 to 5 times a week. 6) Do strength training 1 to 2 times a week. 7) Prevent hearing loss. Hearing loss is strongly linked to a higher cognitive decline. The percentage of people with hearing loss doubles every decade. By the time they reach their 70s, nearly two-thirds of individuals have a clinically significant hearing impairment. Poor hearing may not affect blood vessels or risk of Alzheimer's, but hearing loss may be an independent hit on the brain. 8) Stay mentally and socially active.

LEAD IN WATER

While the national spotlight focuses on the drinking water crisis in Flint, Michigan, a USA Today network investigation has identified almost 2000 additional water systems spanning all states where testing has shown excessive levels of lead contamination in the last 4 years (5). The water systems that reported lead levels exceeding Environmental Protection Agency (EPA) standards collectively supply water to 6 million people. The investigation found that at least 180 water systems failed to notify consumers about the high lead levels as federal rules require. Many of the highest reported lead levels were found at schools and daycares. A water sample at a Maine elementary school was 42 times higher than the EPA limit of 15 parts per billion, while a Pennsylvania preschool had samples that were 14 times higher. The analysis of EPA enforcement data identified 600 water systems in which tests at some taps showed lead levels topping 40 parts per billion, which is more than double the EPA's action level limit.

Even at small doses, lead poses a health threat, especially for pregnant women and young children. Lead can damage growing brains and cause reduced IQs, attention disorders, and other problem behaviors. Infants fed formula made with contaminated tap water face significant risks. Adults are not immune. Evidence links lead exposure to kidney problems, hypertension, and increased risk of cardiovascular death. The FDA stresses that there is no safe level of lead exposure.

Most Americans get their drinking water from a fragmented network of about 155,000 different water systems serving everything from big cities to individual businesses and schools. The EPA determines that a system has exceeded the lead standard when more than 10% of the samples show lead levels >15 parts per billion. That level is called an “action level” because surpassing it requires water systems to take action to reduce contamination. Enforcement, which is implemented state by state, can be inconsistent and spotty: 373 systems have failed repeatedly, and tests continue to find excessive lead months or years later. The systems also have widely varying levels of financial resources and staff training.

The testing required by the government can include samples from as few as 5 or 10 taps in a year or even over multiple years. The system is designed only to give an indication of whether homes or buildings with lead pipes and plumbing may be at higher risk of lead leaching into the water. Even the biggest water systems in cities are required to test just 50 to 100 taps. The limited and inconsistent testing means the full scope of the lead contamination problem could be more widespread. People in thousands more communities served by water systems that have been deemed in compliance with the FDA's lead rules have no assurance that their drinking water is safe from the brain damage toxin.

Drinking water typically is not contaminated with lead when it leaves the treatment plant. It becomes contaminated as it travels through lead service lines on individual properties and lead plumbing fixtures inside homes. At best, the EPA's rules and testing are a sentinel system, alerting officials of the need to treat their water with anticorrosion chemicals. Doing so reduces but does not eliminate the lead in water reaching the tap.

About 75 million homes across the country were built before 1980 and are the most likely to contain some lead plumbing. That is more than half of the country's housing units, according to the Census Bureau. The heaviest concentrations of homes with lead pipes are in New York, Rhode Island, Massachusetts, Connecticut, and Pennsylvania.

The way tap water becomes contaminated—at or even inside individual homes—poses a vexing problem for regulators, utilities, and consumers. A home with a lead service line and older internal plumbing may have high levels of lead in the tap water. A nearby newly constructed home may have no lead. The only way to know if your home is at risk is to find out about its waterline and plumbing.

Treatment of water with anticorrosion chemicals can only reduce, not eliminate, lead from leaching into tap water in invisible and tasteless doses. That's why the EPA's National Drinking Water Advisory Council wrote agency leaders in December 2015 calling for removal of lead service lines to the greatest degree possible. That's a daunting recommendation since, in most cases, the water utility owns part of the line and the rest belongs to the homeowner.

CONCUSSIONS AND FOOTBALL

The National Football League acknowledged a link between concussions and the degenerative brain disease known as chronic traumatic encephalopathy (6). Chronic traumatic encephalopathy was found in the brains of 94 National Football League football players and in 45 of 55 college players whose brains were examined at autopsy. The University Interscholastic League, which governs school sports in Texas, indicated that in 2014 there were 295 football-related concussions in a statewide sample of 263 Texas schools. There were 2500 concussions related to all sports at about 40 Dallas–Fort Worth area districts in 2014 according to another investigation. According to the CDC, there are 3.8 million sports-related concussions nationwide each year. My daughter will not let her two boys, both of whom are good athletes, play football. It is understandable.

TEEN BIRTH RATE

The birth rate among American teenagers, at crisis levels during the 1990s, has fallen to an all-time low, according to an analysis for the CDC (7). The decline of the past decade has occurred in all regions of the country and among all races, but the most radical changes have been among Hispanic and black teens, whose birth rates have dropped nearly 50% since 2006. Births per 1000 females aged 15 to 90 years of age in the USA are 18 for whites, 37 for blacks, and 40 for Hispanics. Although the US has made remarkable progress in reducing teen pregnancy, too many American teens are still having babies. The birth rates for Hispanic and black teens, while lower than in the past, still are twice as high as that of white teens.

DRIVER DISTRACTIONS AND ACCIDENTS

A Virginia Tech study found that driver distractions are a significant cause of accidents (8). New technologies are adding ways to distract people. The risk of a crash caused by various distractions with a person driving while sober and paying attention is 1.0. The Virginia Tech study followed 3500 drivers in 6 states with >1600 crashes over a 2-year study period. The types of distractions and the risk number are as follows: dialing phone, 12; reading/writing, 10; reaching for object, 9; extended glance outside, 7; texting, 6; reaching for phone, 5; interacting with phone, 4; phone browsing, 3; adjusting climate controls, 2; talking on the phone, 2; overall distraction risk, 2; tuning radio, 2; eating, 2; drinking (nonalcohol), 2; interacting with passenger, 1; and managing personal hygiene, 1. Consumers, technology, and auto industry executives likely will wrestle for a long time with the trade-offs between safety, convenience, and privacy.

CAR LOCKING SYSTEMS

According to a report from Mothers Against Drunk Driving, car-locking systems have stopped about 1.8 million incidents of drunk driving since states first passed laws requiring offenders to install them in 1999 (9). The data come from the 11 main manufacturers of ignition interlock systems. The devices are wired into vehicles. A convicted drunken driver must blow into the device to get a blood alcohol content reading before the vehicle will start. The system sends a signal back to the manufacturer with the reading. Twenty-five states have laws that require ignition interlocks for all offenders following any drunken-driving offense. Every state has enacted some kind of ignition-interlock law, but some require the devices only for certain levels of offenses and blood alcohol levels or give judges discretion. Mothers Against Drunk Driving wants other states to tighten their laws.

PREDICTIVE POLICING

This policy seeks not just to fight crime but to anticipate and prevent it. It uses cutting-edge technology and big data—some from past analyses and some that stream in real time to an on-board computer in a patrol car—to identify high-risk areas, which can then be flooded with police. The aim is not to make arrests but to deter crime before it occurs (10).

Predictive policing relies on community engagement; it can work only when the police are seen as part of the neighborhood, rather than as an occupying presence. At a time when police-community relations are frayed and many cities face rising violent crime rates as well as renewed concerns about terrorist threats, the approach may provide a better way forward. Every police department in cities of 100,000 people will probably be using some form of predictive policing in the next few years.

The use of information to respond to crime has always been part of the history of policing, an essential part to solving crime after the fact. When Sir Robert Peel, Home Secretary in the early 19th century, created the British Metropolitan Police Force, nicknamed the Met1y, Peel had nine principles of policing that focused on the prevention of crime.

Before Peel created the Met in 1838, London was policed by the Bow Street Runners, six officers who constituted the city's first professional police force and solved crimes as a civic service—not as professional “thief-takers” previously did, for a fee. The force was founded in 1749 by Henry Fielding, author of Tom Jones. It disbanded in 1839, the year after Peel created the Met as a civilian police presence and an alternative to a military force. The Met's authority depended on public approval. To Peel, this meant that the police—nicknamed “Bobbies” for Peel's first name—had to behave respectfully, succeeding not through compulsion but through the willing cooperation of citizens.

Bobbies traditionally did not carry firearms; when force was necessary, it was to be minimal. The police were not the judiciary. Bobbies did not judge guilt or innocence, did not punish or avenge. “The police are the public, and the public are the police,” Peel stated. “The Met proved itself, not by the number of criminals it caught but by the absence of crime.”

In the US, policing initially took shape along Peelian principles: cops walking the city beat deterred crime by their presence. They got to know the neighbors and the neighborhood. But after World War II the neighborhoods became less stable. In the early days of US policing, homicides were rare and few cops ever had cause to pull a gun. In New York City a weapon was drawn only in life-threatening situations, and when it was drawn it was used to “shoot to kill.”

William Bratton, who began his police career in 1970, served as chief of police in Boston, New York City, and Los Angeles, and is now again the top cop in New York City. He recently spoke of his early days as an officer in Boston, about what worked and what did not and about what can work better in the future. He indicated that now is a time of great transition. The 1960s was a time of social turbulence. Police had become reactive instead of a benign presence designed to prevent crime. They spent more and more time in their squad cars, responding to calls. At a time when people were attacking police, throwing bricks off the roofs and using guns and Molotov co*cktails and fomenting revolution in the streets, patrol cars were seen as safer and more efficient. Officers could cover a greater area more quickly in a car than on foot. Random patrols and responses to calls—counterpunching—supplanted an assigned beat. It was “an ultimately damaging refocusing of the police mission and responsibility.”

The introduction of the 911 calling system reinforced the trend to reactive policing, as did a technological revolution in everything from ballistics to serology. The lab replaced the street. Suddenly, cops had a new toolbox of crime-solving techniques. Cops were more professional. There was better training, better education, and more focus on solving crime than preventing it. Now it looks like the “preventing crime” viewpoint is coming to the forefront again. If that happens there will be fewer gunshot victims in our emergency rooms.

GENETICALLY MODIFIED ORGANISMS

At least 64 countries require labeling of genetically modified organisms (GMOs) in food (11). American consumers now appear to be demanding GMO labeling. In the past decade, countless ballot measures and 70 bills have been introduced in >30 states to require labeling, but no bill has passed Congress. Some states have taken the issue into their own hands. In 2014, the Vermont legislature passed a law requiring GMO labeling in the state starting in July 2016. The US Congress might be stimulated to pass a national bill requiring GMO labeling if more states act. Americans have been eating GMOs for years—nearly 80% of foods contain them—with no detectable ill effects. Scientific evidence can easily fall victim to scary warnings based on emotion but devoid of fact. This explains why so many people believe that vaccines are dangerous, for example, despite exhaustive studies that prove otherwise or why people persist in believing that climate change is a hoax, despite overwhelming evidence to the contrary. The scaremongering over GMOs has been just as effective. While nearly 90% of scientists believe GMOs are safe, only 37% of Americans do. GMO critics prey on this doubt. Using science to make crops more resistant to drought or insects builds on the ancient practice of selectively breeding plants to produce better characteristics. Doing this in a lab at the genetic level makes it faster, more precise, and more effective. But it also makes the issue harder for nonscientists to grasp. That leaves a big opening for misinformation and fearmongering, which critics of GMOs have exploited to make people afraid. The facts, however, are reassuring. “The science is quite clear,” said the American Association for the Advancement of Science. “Crop improvement by the modern molecular techniques of biotechnology is safe.” And after looking at >130 research projects over a quarter century, the European Union found that GMOs are not per se more risky than conventional plant breeding.

RUNNING BOOM OVER

After 2 decades of furious growth in footrace participants, the number of finishers dropped 9% in 2015 compared to 2014 according to the industry-funded research group Running USA (12). The same organization indicated that the number of footrace finishers had reached an all-time peak of 19 million in 2013. Running is losing its hold particularly among 18- to 34-year-olds. Millennials, in their late teens to mid-30s, recently passed baby boomers as the nation's largest living generation. In footraces and other running events, however, their presence is shrinking.

Most runners of course do not compete in marathons, half-marathons, 10Ks, or 5Ks. The larger pool of noncompetitive runners also is shrinking, however, especially among millennials, according to the Sports and Fitness Industry Association. Overall, the number of adults who run 50 times a year or more declined 11% from 2013 to 2015. In the same span, the total number of frequent runners, aged 25 to 34, dropped 19%. Runners aged 18 to 24 dropped 23%. That translates into about 2.5 million fewer young people who run consistently.

Millennials, however, are not sedentary. Rather, they are fueling the proliferation of studios that specialize in everything from cycling, CrossFit, and boxing to ballet barre workouts, boot camp, and weight training. Their hunger for variety is reflected in the success of ClassPass, which offers entry to a range of fitness classes in 31 US cities for a monthly fee. The service has booked 18 million reservations in less than 3 years, most of them for people in their 20s.

Millennials, according to Rachel Bachman writing in The Wall Street Journal, also drove the success of untimed events that are not competitive. A decrease in running will affect industry. Commercially, running is the largest US athletic footwear category by retail sales, hitting $7.1 billion in 2015, according to industry tracker SportsOneSource. Running accessories include watches, apps, and apparel. Starting and directing races has also been a fast-growing profession.

Nevertheless, running remains widely popular. It is harder than ever to get into the nation's premier marathons—Boston, New York, and Chicago. More than 48 million people said they ran at least once in 2015. That is twice the number of people who played basketball. Among older runners in particular, growth continues. In the last 2 years, the number of frequent runners aged 45 to 64 rose slightly while the number of those 65 and older surged 26%.

The hips and knees might be pleased with this new development, but the heart I suspect will suffer a bit.

RUNNER ED WHITLOCK

Ed Whitlock, now 85 years old, has been running since he was 40 (13). He grew up in England and later moved to Canada where he worked as a mining engineer. Over the last 2 decades, the retired engineer from Milton, Ontario, has become one of the planet's great master runners, assembling an astonishing collection of age group world records. At age 73, for example, Whitlock ran a full (26.2-mile) marathon in 2.55 hours; at 80, he ran one in 3:16 hours; at age 85, he ran a half-marathon in 1:51 hours. These are just a few of his records. Although he does not get a thrill out of training, he runs in a cemetery near his home, small loops for hours on end. Whitlock weighs 112 pounds and stands 67 inches in height. He runs in the winter cold and in the hot summer. Ed is an inspiration to many.

WEIGHT WATCHERS ENROLLMENT UP

Weight Watchers International Inc. increased its membership rolls in the last quarter for the first time in 4 years (14). The number of active members rose 5% to 3.1 million in the quarter ending April 2, 2016, reversing a streak of quarterly declines stretching back to 2012. Thus, running is down and weight watching is up.

SEEKING MENTAL HEALTH CARE VERSUS CAREER ADVANCEMENT

The most recent health survey of US troops from 2011 shows that 37% of active-duty service members, nearly 600,000, felt that seeking mental health care through the military would probably or definitely hurt their careers. Suicides across the military rose precipitously from 2005 to 2009 and have remained at record numbers since then, according to Pentagon data and reported by Gregg Zoroya (15). The most recent suicide rate provided by the Pentagon for 2014 is 20 per 100,000. The national civilian rate for that year was 13 per 100,000, according to the American Foundation for Suicide Prevention. Posttraumatic stress disorder, depression, and traumatic brain injuries have soared in Iraq and Afghanistan. Despite a 2012 directive from the secretary of defense that seeking mental health care should not adversely impact security clearances, this practice continues. One key problem is that many Defense Department policies covering job assignments and security clearances still discriminate against anyone who receives mental health care. Troops seeking a therapist are at risk at least temporarily of losing their access to classified information.

ASSISTED DEATH BILL

Canada, in April 2016, unveiled an assisted death bill designed to ease the end of life for terminally ill patients while slamming the door on “suicide tourism” to ensure Americans and others will not flock there to die (16). People with psychiatric problems also would be excluded, and no advance consent would be allowed. The bill is now in Parliament for approval. The US states of Washington, Oregon, Vermont, and Montana also allow the practice, and California will join them in June 2016. Germany, Japan, and Columbia are among countries allowing assisted deaths. The new bill will allow Canadians to apply for a peaceful death and protect the conscience of health care providers who provide suicide assistance. The Canadian bill sets a minimum age of 18 and requires a 15-day “reflection period” to avoid quick decisions after a dark diagnosis. Patients also must be eligible for Canada's national health care, a rule that would preclude foreigners from going to Canada to end their lives. Patients must be “suffering intolerably” and facing a “foreseeable death” to end their lives.

GROWING CHICKENS MORE SLOWLY

It is my understanding that in the USA we kill about 15 million chickens every day. According to Kelsey Gee (17), the US chicken industry has spent decades figuring out how to grow its birds faster. A typical commercial chicken has been bred to grow to twice the size of birds from 50 years ago in about half the time. The faster pace, of course, has meant big savings and fatter profits for the meatpackers that raise them. Recently, however, companies such as Whole Foods Market and Starbucks are urging producers to grow their chickens at a slower pace. Among nine chicken breeds catalogued in Gee's article, some grow as rapidly as 28 g per day and others as much as 63 g per day. There is considerable variation in the weight of these birds at 42 days after birth: the JA57 X weighs 1057 g and the Hubbard Classic weighs 2885 g.

The growing demand for meat from animals raised more slowly reflects a broader shift in consumer taste for food and farm practices regarded as more humane and “natural.” The debate over how food should be raised has powered a flood of changes by meat companies that for decades have worked to drive down costs and scale up production. The cost of meat from slow-growing birds, which are often raised outdoors, can range from 20% to 3 times more than the price of conventional chicken raising. Most people are not willing to pay the additional cost to eat the slow-growing birds.

The breeding companies stress that the modern chicken's feed efficiency—its ability to pack on more pounds with less feed than pigs or cattle—makes poultry ideally suited to feed a growing global population that is incorporating more protein in their diet. Global chicken production in 2016 is expected to surge to a record 90 million tons, according to the US Department of Agriculture. Some chicken breeds such as JA57 X crossbreeds reach full growth in 81 days, whereas the Rowan Ranger chickens are fully grown in roughly 56 days. Whole Foods expects its transition to selling slower-growing breeds to take roughly 8 years. It will involve repopulating farms with chickens that grow about 23% slower than the industry standard or at roughly 50 g a day. That is partly because the current supply of slow-growing birds is paltry, with estimates ranging from <1% to 3% of commercial chickens globally. The slower-growing chickens will raise prices for consumers and use up more resources. Nevertheless, it seems like a good idea to me if one is not willing to forego chickens at all.

CLIMATE CHANGE AND WATER

The World Bank released a report in May 2016 indicating that climate change may have its greatest effect on water supplies (18). Warm temperatures cause more evaporation of water from landscapes, and changes in precipitation lead to more intense individual downpours but also swings of drought conditions. The threat affects not just what people drink but what they eat. The human activity that consumes the most water is agriculture. Then, there is the sea-level rise. It can push into coastal aquifers, as is happening in Florida, and threaten to make them more saline and less useful. The report also indicated that 1.6 billion people on Earth already live in conditions of water scarcity. Other research has put that number even higher, finding that 4 billion face conditions of severe water scarcity at least at some time of the year. The problem will be exacerbated by larger populations overall and more demand for water due to increased needs in the electricity generation and agricultural sectors. The report indicated that in the next 30 years, “the global food system will require 40 to 50 percent more water.” When water shortages happen, the poor will inevitably be hit the hardest when it comes to both food and drinking water, because they may not be able to purchase supplies from elsewhere to get them through shortages.

GLOBAL WARMING AND THE FLORIDA KEYS CORAL REEF

According to a new study (19), scientists have documented the long-term effects of ocean acidification on the coral reefs in the upper Florida Keys. This finding is called a leading indicator of climate change. The northern part of the Florida Keys reef has lost about 12 pounds per square yard of limestone over the past 6 years. Over the length of the reef, that's more than 6 million tons!

THE PHARMACY IN THE BACK OF THE STORE

CVS Health now owns approximately 9600 in-store pharmacies, and when Walgreens and Rite Aid merge near the end of 2016, Walgreens will own nearly 13,000 in-store pharmacies (20). Wal-Mart presently has 4500 in-store pharmacies. CVS has focused on scooping up pharmacy benefit managers (PBMs), which administer prescription drug plans for health insurers and employers. The company now fills more than 20% of retail prescriptions in the USA. The theory: drive more business to the back of the store—the pharmacies that account for 67% of CVS's revenue. They, in other words, are a combination of being both a PBM and a retail drugstore. Walgreens is equally dependent on its pharmacy business, with similar revenue coming from the back of the store. The chain has also made a big commitment to health services; Walgreens now has 400 in-store clinics nationwide. But Walgreens has largely stayed out of the PBM game. It has taken a buzz saw to costs as it expands through acquisitions. The Rite Aid acquisition should allow the chain even more buying clout and leverage with retail suppliers, although Walgreens will probably have to divest hundreds of stores to avoid antitrust concerns. These two giants will be battling for the prize of 75 million baby boomers whose spending on prescriptions and health care should steadily multiply.

MOVING TO TEXAS

Census data show that in 2015, 170,103 more residents moved into Texas from other states than left—averaging 486 new Texans each day (21)! That was the biggest gain in more than 2 decades, excluding people who left Louisiana for Texas after Hurricane Katrina in 2005. The largest number of domestic migrants came from California. Coupled with international immigration and natural population increases, domestic migration—as movement from one state to another is known—has helped propel Texas to the top of the list of the fastest-growing states over the last decade. Texas' population grew the most of any state on average each year from 2005 to 2013—by 460,251, the state demographic report stated. California's population increased an average of 315,043 residents every year during that period. California's recent growth, however, has come largely through international immigration. In terms of domestic migration, California lost residents from 2013 to 2014. Texas and California are routinely the biggest trading partners when it comes to residents. In recent years, the flow of migration has shifted from Texas to California to California to Texas. The fact that Texas was the first state to recover from the financial meltdown in 2009 served as an incentive for domestic immigration. New residents are more likely than average Texans to have a bachelor's degree or other higher education credentials. The fact that Texas is a more diverse economy now than in its past as a cattle and oil state can be attributed to the arrival of domestic migrants in a broad range of industries. The mean race/ethnicity percent distribution in the total Texas population as of 2013 is as follows: Asian, 4%; black, 11%; Hispanic, 37%; white, 46%; and other, 2%.

MILLENNIALS' TOP CITY

Moving company Mayflower said that Dallas was the number 1 US city that millennials moved to in 2015 (22). Dallas surpassed Chicago, Denver, Seattle, Atlanta, Los Angeles, Portland, Charlotte, Washington, DC, and Phoenix. Most of these millennials are coming to Dallas for jobs. Since Dallas–Fort Worth is one of the top employment growth markets in the country—with more than 100,000 jobs created in the last 12 months—it makes sense that young workers would come to North Texas. Almost 80,000 people move to the Dallas–Fort Worth area each year.

DALLAS APARTMENT BUILDING

More apartments are being built in Dallas–Fort Worth than any other market in the country, and rents are at an all-time high (23). The number of units under construction in the first quarter of 2016 in Dallas–Fort Worth was just over 43,000. In contrast, Houston has nearly 31,000 under construction; Los Angeles, 24,000; Washington, DC, 21,000; Seattle, 20,400; Denver, 19,000; Atlanta, 16,000; Austin, 14,000; and Chicago, 14,000.

PROPERTY TAXES IN TEXAS

Texas ranks as the state with the fifth highest property tax burden in the country, with a median property tax rate of 2.17% (24). The average property tax rate in Texas is about 70% higher than the nationwide average of 1.31%. Across the country, a homeowner with a property valued at $200,000 would pay $2620 a year in property taxes; in Texas, the bill would be over $4300. The four states with higher property taxes are Illinois, New York, New Hampshire, and New Jersey. The lowest property tax rates in the US are in Hawaii, the Rocky Mountain region, and southeastern states. Although the higher property taxes are offset by the lack of a state income tax, a recent study showed that Texas was among the two dozen states with the highest overall tax burden. Texas residents' total state and local tax burden is more than 11%.

HANDWRITING VERSUS COMPUTER TYPING

Some recent studies show that handwriting appears to focus classroom attention and boost learning more effectively than typing notes on a keyboard (25). College students write about 22 words a minute and type an average of 33 words a minute. The feature that makes laptop notetaking so appealing—the ability to take notes more quickly—was what undermined learning, according to a professor at the University of Nebraska. Taking notes with a lead pencil, first mass produced in the 17th century, is not so different than using a fountain pen, patented in 1827; a ballpoint pen, patented in 1885; or a felt-tip marker, patented in 1910. Today, however, virtually all college students have portable computers, lectures are the main vehicle for instruction, and the keyboard clatter of notetaking is a sound track of higher education. Generally, students who take class notes on a laptop take more notes and can more easily keep up with the pace of a lecture than students scribbling with a pen or pencil. Researchers at Washington University in St. Louis in 2012 found that laptop notetakers tested immediately after a class could recall more of the lecture and perform slightly better than their pen-pushing classmates when tested on facts presented in class. Any advantage, though, was temporary. After just 24 hours, the computer notetakers typically forgot material they had transcribed. Nor were their copious notes much help in refreshing their memory. In contrast, those who took notes by hand could remember the lecture material longer and had a better grip on concepts presented in class, even a week later. The process of taking it down encoded the information more deeply in memory. Longhand notes were better for reviewing later points.

SINGLE LADIES

In 1877, nearly 50 years before American women were granted the right to vote, Susan B. Anthony predicted a coming “epoch of single women” (26). According to Rebecca Traister, that epoch has finally arrived. For the first time in American history, the majority of the female electorate is now composed of single women. That is the theme of Rebecca Traister's All the Single Ladies. The book is both a sweeping history of the “invention of female adulthood” and a defense of this “new category of citizen,” whose “expanded power,” she claims, “signals a social and political rupture as profound as the invention of birth control, as the sexual revolution, as the abolition of slavery, as women's suffrage and the feminist, civil rights, gay rights, and labor movements.”

CEO HOURLY PAY VERSUS RANK-AND-FILE HOURLY PAY

Some states presently are moving to boost the minimum wage to $15.00 an hour. The minimum wage increase will affect a large pool of workers that include store clerks, cooks, and waiters. The 76 restaurant and retail CEOs who have 2015 pay reported so far earned a median of $2700 an hour, about $5.6 million annually (27). The CEO of McDonald's earned $3800 an hour last fiscal year, or $7.9 million. That ranked him only 25th among the 76 companies analyzed. The highest-paid CEOs in these industries had hourly pay as follows: CVS Health, $13,900; L Brands, $13,000; Starbucks, $9700; and Wal-Mart, $9300. The average CEO in the Standard & Poor's 500 earned 204 times more than the median employee at the same companies in 2014. The Securities and Exchange Commission will soon require companies to disclose the gap between CEO and average worker pay starting in 2017.

A piece in USA Today in April 2016 (28) listed the 11 current CEOs of companies in the Standard and Poor's 500 who in 2016 were paid at least $30 million a year. The huge amount paid to the CEOs was not proportional to how the stock of their companies did. For example, Philippe Dauman, CEO of Viacom, was paid $54.2 million in 2015 and the stock price of his company fell 44%. Mark V. Hurd and Safra Ada Catz of Oracle were each paid over $50 million in 2015 and the stock rose only 3%. Physicians are worker bees in comparison.

UNIVERSITY ENDOWMENTS

According to a piece in The Wall Street Journal, endowment assets for all US institutions in 2016 now total $529 billion (29)! The endowments in billions of the nation's richest universities as of 2016 are the following: Harvard, $36; Yale, $26; University of Texas system, $24; Princeton, $23; and Stanford, $22. The enrollments in these five universities are as follows: Harvard, 21,000; Yale, 12,000; University of Texas system, 217,000; Princeton, 8000; and Stanford, 16,000 (dollars and numbers are rounded off). State and federal policymakers now appear to want to tax these endowments or force the wealthiest schools to spend down their endowments to defray soaring student bills and refill depleted higher education budgets.

PROLIFERATION OF ONLINE MEDICAL JOURNALS

Note: This editorial originally appeared in The American Journal of Cardiology (30) and is reprinted here with permission.

Almost daily on my emails there is a new open access (online) medical journal requesting a manuscript from me, or asking that I review a manuscript received by them. During a recent 2-month period, I counted at least 26 heart-related journals and at least 75 non–heart-related journals (Table). Most do not have a physician as editor, and few are included on PubMed. Medicine went from having a physician editor of international distinction to a nonphysician editor of unknown qualifications. Most of the online journals charge authors to publish their manuscripts and not the readers for reading them, the reverse of hundreds of years of publishing. Some of these online journals not only request reviews from physicians of the submitted manuscripts but also request that physicians recommend names of appropriate reviewers, and some request that physicians actually manage groups of manuscripts as visiting editors. A young investigator might be tempted to submit his/her manuscript to one of the open-access journals after receiving a gracious invitation to do so rather than submit the manuscript to an established journal. I realize that online publishing without print publishing will probably be the future for most present-day print journals, but that change has not occurred yet, so I recommend staying with the print journals as long as they use that medium. Academic careers will not be built by publishing in the open access journals with nonphysician editors.

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