Surrealism in DC

This little post on Josh Marshall's site really made me take notice. The confirmation hearings for Chuck Hagel have been all about how he's a traitor for opposing the ultimately futile and failed "surge" in Iraq, which allowed the U.S. to get the hell out under a fragile fiction of stability so that all hell could break lose last year -- not that anybody in the U.S. has been paying attention. Trust me, Iraq is now coming apart at the seams. Also too how he is an insufficiently mad dog Zionist.

So far nobody has asked about, say, Syria, but the key point of the linked piece, and what has me quaking in my boots, is that nobody has asked him about the sequester, which it increasingly appears is going to happen because Paul Ryan evidently wants it. Or so he says. I personally don't think an 8% cut in the military budget would be a national security disaster, in fact I think it would be good for both national and global security; but I'm worried about everything else that will get trashed, including funding for my own research of course, but more than that, Great Depression II which will very likely ensue.

Of course nobody who brought this disaster on us will ever be held accountable.

Or as RL Borosage puts it  (more or less as I put it myself a few days ago:

We need a return to sensible governance. Repeal the sequester -- sudden and deep across the board cuts are idiotic. Promise to pay the debts already incurred and stop threatening a default that would shake global finances. Fund the government while working on a budget reflecting new priorities.
Commit to growing our way out of the hole we are in. Invest in areas vital to our economy and to our people. Pay for those commitments in ways that makes sense. Put people back to work and watch the deficits and debt burden come down.
That means launching a major five-year initiative to Rebuild America -- modernizing our decrepit infrastructure to make it a competitive advantage while creating jobs. Make the investments needed to provide every child with a world-class education -- from universal pre-school to skilled teachers to affordable college. Invest in research and development and sustain America as the global hotbed of innovation.
Pay for these and other vital priorities by ending the war in Afghanistan and reducing our empire of bases. Crack down on overseas tax dodges. Raise taxes on millionaires and tax the income of investors at the same rate as that of workers. End the obscene subsidies to big oil, big Pharma and big Agra.
This isn't rocket science. It is common sense. Yet, at this point, it can't be heard in the bedlam of a Washington afflicted with deficit delusions and austerity hysteria.

Why bother to offer any specifics?

What with the Republicans in Congress demanding drastic cuts in federal spending and "entitlement reform," but refusing to say what exactly the heck they are talking about, and president Obama saying that Medicare can save money without hurting beneficiaries but not bothering to say exactly how, it's obvious that all you have to do to be a successful politicians is spout empty rhetoric.

Here, the Center for American Progress proposes what it says are $385 billion in Medicare savings over 10 years without taking one single benefit away from seniors. I can't vouch for the arithmetic, but it's true that most of these reforms would definitely save some money. However . . .

They mostly save money by making suppliers -- drug companies, medical device manufacturers, hospitals, specialist physicians -- compete for their business or outright cutting payments. There is some other waste they want to wring out of the system but that's also somebody's income. That's our problem -- it isn't really Medicare beneficiaries who politicians are worried about, they don't have any money, don't contribute billions to political campaigns or superPACs or for that matter work for the news media. It's all those people who are profiting from Medicare spending. CAP can say "Hey, let's shut off the gravy train and take care of people cost-effectively," but where is the organized, financed, effective constituency for that?

Evidence based medicine

Sounds like a good idea, it's the right way to go but, it ain't easy.

Here's a problem I've been working on. Suppose you wanted to search all the relevant scientific literature and do a systematic review and metanalysis to figure out the best way to diagnose acute appendicitis. (I'll leave the definitions of unfamiliar terms in the preceding sentence for later; suffice it to say we'll be applying the best available methods for combing information from all of the good quality studies that have been done on the subject.) Then you can write a report and tell doctors how to do this. Fewer people get sent home only to have their appendix rupture; fewer people get surgery unnecessarily. Yeah!

Oh my gosh is it not nearly that easy. First of all, why are we trying to diagnose acute appendicitis in the first place? There are a lot of different tests you can use, but before you use any of them, you have to decide who to use them on. The facile answer is, people who show up at the ER with pain in the lower right quadrant of the abdomen. Then there are various other more specific clinical indicators that will raise or lower your suspicion that this really is acute appendicitis. But are we trying to diagnose appendicitis, or figure out whatever the reason might be that they have this symptom? If we go straight to question 1, maybe we're missing something else we ought to be thinking about.

And is this person a child, a woman (or for that matter a 14 year old girl) of reproductive age not known to be pregnant, a woman known to be pregnant, an adult male of [insert age category], or a very old person? How long have they had the pain? Every one of these variables means you're looking at a whole different kettle of fish.

Does the person have insurance that will pay for a CT scan or will they have to pay out of pocket -- or maybe the hospital will have to eat the cost. This is a medical emergency, potentially, so they have to treat you whether or not you can pay, but what does "treating" you mean? If you do have appendicitis, the cheapest thing to do (in hindsight), and the best from your point of view as well, is to go straight to surgery. On the other hand the totally cheapest thing to do, and the best from your point of view if you don't have appendicitis, is to send you home with advice to come back if it doesn't get better. But in either case, the wrong decision is likely to cost more and result in a much worse outcome.

You can always diagnose appendicitis, with almost perfect sensitivity and specificity, by opening up the abdomen and removing the appendix and having a pathologist look at it. But that's not really the question after all, is it? The question is, should I open the abdomen of this person with lower right quadrant pain. Maybe I'll find out they don't have appendicitis but there is some very good reason why I should have opened their abdomen. On the other hand, maybe they have an ectopic pregnancy or an ovarian tumor or colon cancer, and the wrong kind of surgeon is looking at it, who doesn't know what to do.

You can start with ultrasound, which has essentially no risk, but it's often equivocal. Then you can go to a CT scan, which does irradiate you with potentially some small long term risk, unless you're in early pregnancy in which case there may be greater risk to the fetus; you might also be less inclined to do a CT scan on a young child. If your hospital has an MRI scanner, there's no ionizing radiation but it's more expensive. And the hospital might not have one.

I could go on but you get the idea. You might be particularly averse to post-surgical pain, or you might not care so much. You might have known someone who died of a ruptured appendix so you're really anxious about it, or you might be happier to go home and wait. Whatever.

So . . . Doctors don't generally "know" what they're doing. They're just muddling through, hopefully for the best. As are we all.

Plugola

Not really, they didn't have to pay me. The Laborer's Union wants you to sign a petition asking the White House to end the delay in promulgating standards to protect workers from silica dust. Silicosis is a serious, often fatal lung disease caused by this exposure. Here's the background:

OSHA began working on new silica rules in 1997. A proposal was drafted and sent to the Office of Management and Budget (OMB) for review in February 2011. Normally, OMB has 90 days to review proposals before they are made public. However, publication has been delayed for nearly two years. Releasing the proposal for publication is just the first step in a lengthy review process. OSHA rulemaking requires public hearings and extensive opportunities for public input.

I've known about this for several years because some of my former colleagues at Tufts studied the problem. This has been crippling and killing American workers literally for centuries. There's no excuse for it to continue.

The doctor is out . . .

. . . but it's okay. Many have been viewing with alarm the current shortage of primary care physicians, and predicting that it's just going to get a lot worse. This is one argument advanced against the affordable care act. What's the use of giving everyone insurance if there aren't enough doctors for them all?

Green, Savin and Lu in Health Affairs (at least you can read the abstract) aren't so worried. Although insuring timely access to care -- it can take months to book a routine appointment nowadays -- would seem to make the problem even worse, it turns out that most analyses have been based on an overly simplistic assumption: that the supply of medical services is equivalent to X number of physicians per Y number of people. (1 per 2,500 is the popular choice.)

Actually, physicians nowadays are less and less likely to come as indivisible units; they more and more practice in teams, which makes it easier to match day-to-day demand with an available provider. Yeah, it might not be your regular doc but you don't necessarily need her for an urgent care visit. Even better, you don't need a doctor at all -- Nurse Practitioners and Physician Assistants can do 90% of the visits. It takes much less time and money to produce one than it does to put a doctor through 4 years of medical school and 3 years of residency; and even yet better, their salaries are lower, which is not entirely unjust since they don't need to repay $250,000 in loans or give up 7 years of their lives.

This is just one of many ways we can make health care better and cheaper in this country, while making it accessible to everyone. If we have the will, and if the people get it through their heads that nobody in his or her right mind would ever vote for a Republican.

The Speech

Okay, I'll drop the cynicism for a moment and give the prez some props for delivering the straightforward ideological manifesto he should have provided a long time ago. He's finally stopped believing his own bullshit about bipartisanship and One America yadda yadda, and apparently (although it has yet to be demonstrated) abandoned the strategy of negotiating with himself and pre-caving on every confrontation with the Republiwackos.

Strong words on climate change; direct debunking of libertarianism; repudiation of militarism (rhetorically anyway -- see below); historically correct representation of civil rights and justice as a historically unfinished process, not an inherent feature of American society and -- to many people's surprise -- making the struggle for lesbian and gay equality part of a triumvirate with  the women's movement and the Civil Rights movement of the 1960s; promising to protect the vulnerable and needy; promising to invest in public goods and regulate commerce for the common welfare; some talk about gun safety; immigration reform.

Not everyone on the portside is completely happy, however. No mention of the horrifically destructive and pointless war on drugs and the prison-industrial complex. In fact, he has shown every sign of continuing it and ramping it up. As for the military-industrial complex, he spoke of peace but not of a peace dividend; did not even mention the vast archipelago of overseas military bases; did not mention the undeclared drone war in Pakistan and Yemen and the extrajudicial executions done on his sole authority. No mention of the surveillance state and the absurdly bloated, largely secret national security establishment.

Talk of saving money on health care was vague. The true debate right now is whether we do it by hurting Medicare and Medicaid beneficiaries, or by making health care more efficient and effective by hurting drug and medical device companies, hospital and nursing home chains, and wealthy sub-specialist physicians, all of which are fattening on our own flesh. The entire argument about deficits and entitlements is actually between these two entirely different definitions of the problem, but he failed to clarify that.

Talk of inequality was also vague. We need to tax the wealthy even more, not necessarily by further raising marginal tax rates but by taxing investment income the way we tax wages. We need to insure a full employment economy through our public investments, a goal he did not state. We need universal access to affordable higher education, also not specified. We need to break up the big financial institutions, tax financial transactions, insure workers' right to organize, and strengthen shareholders' rights and create executive accountability. All unmentioned. Corporations are legal fictions, chartered by government; government can take their charters away, after all, but that power is never exercised.

So it's better than what we've been hearing, but not quite there yet. So sez me.

Ignoring the moment

Yeah, it's MLK day, and the inaugural ceremony/speech. I should probably say something profound. But . . .

Call me old fashioned, but back in my day the definition of "girlfriend" included physical connnnnnntact. Let me tell you, it's something you really miss when they aren't around.

Why do we call that thing in the basement the "hot water heater"? That's redundant and repetitive. It's just a water heater, okay?

Okay, I won't ignore the day entirely.

I believe I have previously mentioned my friend who thought Lance Armstrong was being persecuted. Sports heroes are not generally the kinds of people I look to for inspiration -- their accomplishments are essentially arbitrary, the mastery of invented feats. When they turn out to be personally flawed, there's nothing left. (Armstrong of course is more than just flawed - he turns out to be one of the ugliest narcissists ever.) Dr. King was a deeply flawed person in some ways, but it doesn't matter -- his personal life was irrelevant to his greatness. I'm not sure everybody totally gets that distinction.

People is puzzling

The news is dominated today by the chemically enhanced cyclist and the linebacker with the imaginarily dead imaginary girlfriend. Both stories have a certain amount of intrinsic weirdness but it got me to thinking that all the world over, people are obsessed with sports. The popularity of particular games is as definitive of cultures as religion and cuisine; and the civic unity of cities and nations is as much about sporting teams and iconic athletes as it is about political institutions and nationalist mythology.

I don't have any deep explanation of this. It's like music -- nobody really knows why we like it so much or what it really means. I'm as much a fan as anybody, looking forward to the AFC championship game on Sunday even knowing the awful truth about what it's doing to my heroes' cerebrums. Oh well.

American Exceptionalism

All this is old, old news to readers of this blog, but we might as well keep chopping away. The National Academies of Science commissioned yet another panel on the health of the U.S. population compared to civilized countries, and they reach the same depressing conclusion: we're not the Greatest Country on Earth; God doesn't bless America; we aren't a Shining City on the Hill; we aren't Number One. We are the uttermost piece of crap. E.g.

• For many years, Americans have had a shorter life expectancy than people in almost all of the peer countries. For example, as of 2007, U.S. males lived 3.7 fewer years than Swiss males and U.S. females lived 5.2 fewer years than Japanese females.

• For the past three decades, this difference in life expectancy has been growing, especially among women.

• The health disadvantage is pervasive—it affects all age groups up to age 75 and is observed for multiple diseases, biological and behavioral risk factors, and injuries.

  
  The wise people don't know exactly why, or they kind of do but they're coy about it. We have much more gun violence, we die more in car crashes mostly because we drive more, we have more people who are depressed and addicted and oh yeah -- lots of people don't have access to health care and the health care they do get isn't as good even though it costs 2 or 3 times as much.
  
  A funny thing happens when we turn 65 though -- the life expectancy gap stars to shrink and it goes away by age 75. What else happens at age 65? Oh yeah -- you get, for the first time, universal, comprehensive, single payer national health care.
  
  By the way -- it's also a lot cheaper. Even though it's better.

Aaron Swartz

I've written before about open access, perhaps to a degree obsessively, and I try not to repeat myself too much here (which is getting difficult as the years go on, to be sure). But I do have to take this occasion to once again say how very important is this issue, how very fundamental to what ought to be the ethic of science.

Some readers may be fully involved in this issue, may completely understand what was at stake for this young man who took his own life this weekend, and why he did the deed that had MIT and the U.S. attorney pursuing him like the furies, trying to destroy his life and career by imprisoning him for 35 years. Here's his manifesto.

In my own words, subscriptions to scientific journals cost hundreds of dollars a year -- or more. In fact, the library at my own elite Ivy League university has cancelled many of them recently because we can't afford it. Nevertheless, we still have thousands of journal subscriptions and I get to read them all because I have the magical powers of a college professor in a wealthy country at a wealthy university. You, however -- be you the common rabble in our wealthy country, or an academic department chair in Kenya or the Dominican Republic, do not get to read them. Most of the research that they publish was paid for by taxpayers, but it does not belong to the taxpayers. It belongs to people who own for-profit academic publishing companies, that in turn sell it -- for their own profit -- only to those institutions that can afford the exorbitant prices their monopoly power enables them to charge.

This is wrong. Scientific knowledge is the common property of humanity. The right way to do this is to include the cost of publication in the original grant that funds the research. That's how the Public Library of Science, BMJ Open Access, Dove Press, Biomed Central, and other completely legitimate open access scientific publishers work. Yes, we pay them to publish our stuff, but they still have rigorous peer review and high editorial standards -- higher, in fact, than the subscription model publishers in many cases. The reason for that is obvious: they have to spend the money on editorial costs instead of lining their owners' pockets; they have to compete for the best research because the people who do that excellent research are paying for publication; and they have to prove their quality and integrity every day. Best of all, everybody in the world with an Internet connection can read the work.

Mr. Swartz downloaded thousands of copyrighted academic publications from an archive called JStor. But he didn't try to sell them, he just tried to make a point. Knowledge belongs to humanity. For this, the U.S. Attorney and the Massachusetts Institute of Technology hounded him to death. Rapists and murderers don't get 35 years.

Update:  In response to an anonymous commenter, I should also add that I, like almost all researchers, freely share my own work with anyone who asks for it. You can go to my academic web page, see my publications, and if you send me an e-mail, you'll get the PDF. That's just one more thing that's ridiculous about this entire issue.

What Bernie Says

Right here. It's been hard for me to post lately because it feels like biting granite. Our political debates are all completely phony, and the corporate media are making us all live in that phony world. For whatever reason (and I'm not going to get into the Obama mental telepathy game that so many people like to play) the president is not puncturing the fake scenery, he's playing right along.

Yes, we have a spending problem. Specifically, the more than $700 billion a year we're spending on the military, which is more than we spend on Medicare.

Yes, we have a tax problem. Specifically, as Bernie says, federal revenue is a lower percentage of GDP today than it was 60 years ago, and it's somewhere around half of what the rest of the wealthy countries raise -- you know, totalitarian dungeons like Canada and Sweden. We have the most unequal distribution of wealth and income of any developed country, and in fact we're back to where we were in the Gilded Age, just before the Great Depression.

No, privatizing everything and turning it over to profit-making corporations doesn't make it efficient, competition doesn't make the consumer sovereign, and it doesn't make us freer. As Eduardo Porter convincingly demonstrates, in the case of health care it leaves us ripped off, ill served, and unhealthy. You know what does work really well? Universal, comprehensive, single payer national health care. Ask any country where they spend half of what we do, and have healthier people.

Right now, we don't have a deficit problem, we have a problem of insufficient aggregate demand, which means we have a lot of unemployed people. We need to spend money to put them to work. Then, if we want to eliminate the federal deficit long term (not that we particularly need to do that), all we need to do pay taxes the way we did under Ronald Reagan, eliminate the cap on social security taxes, and create a Medicare for All system that is funded by the money people are paying in health insurance premiums now, that pays for results, and not for doing unnecessary, useless and harmful procedures.

If we want to be affluent in 2025, we need to spend money on good quality education and universal access to vocational training and higher education, for everybody; renewable energy, mass transit, a smart electrical grid, and energy efficiency and conservation; and scientific research and development; and less money on the military.

Who the hell is talking about this -- what we absolutely must do. Not Barack Obama, that's for sure.

Money money money

I presume y'all have encountered the tidal wave of blather about the trillion dollar platinum coin. Paul Krugman is for it, in case you need an intro, so it can't be all bad. Most people are having a very hard time grasping this concept, and it I guess it does seem kind of ridiculous. But that's because most people don't know what money is.

It's fairy dust. It's fiction. It's purely symbolic. And that is true, by the way, whether it's made out of gold, or paper, or nothing. The proof? There's a society that already uses money which, like the trillion dollar platinum coin, never leaves the vault. The people of Yap, a real fantasy island, have two-ton rocks, mined from a distant island, which are money. But they never move. They just change ownership. One of them, in fact, lies at the bottom of the ocean, due to a transportation accident, but it still counts. Somebody owns it, and they are accordingly affluent.

The little pieces of paper with dead presidents are just an accounting convenience, as you have learned since you started paying for everything with a credit card. In fact, if you didn't have your wallet on you, or you were between paychecks, in the old days you might write an IOU to your friend or your grocer. Guess what? You printed money, just as surely as the government does. That's all money is -- a symbol.

One of the enduring, and mysterious quirks of conservative ideology is that they just can't grasp this idea. It offends something deep in their psyche, that money isn't actually worth anything but a promise. They somehow believe that gold and silver have "real" value and therefore should be money. But think about it for a second: the value of all the stuff that people buy and sell, all the debt they owe, is far more than the ostensible value of all the gold and silver in the world. All money is backed by real assets, it just doesn't happen to be gold. If I can buy a car or a house or lunch with a sum of money, the sum of money is worth that much, identically as it's worth whatever amount of gold it can buy. There is no difference.

Once Ron Paul gets his tiny brain around that idea, the rest of his nonsensical worldview will melt away like the snows of March.

Ozymandias

That is the famous poem by Shelley, of course. I thought of it when I read this essay by Bill McKibben, which has been reposted just about everywhere in a coordinated cyber-bomb. So if you haven't come across it yet, go check it out.

Now you're back. Let me tell you why neither Barack Obama or anybody else in power is doing anything meaningful about the existential threat facing our civilization. I have a writer friend who got an assignment from Harper's to write about climate change as a kind of eschatology. He kept asking me what it was like to live in the End Times and he got a little bit miffed when I wouldn't buy into the concept. It's not the end times. Civilizations come and go. The world goes on. So far, as a matter of fact, so has Homo sapiens. The collapse of classical Greece, the Roman Empire, feudal Europe and the Kingdom of Ouagadougou haven't even slowed us down.

Industrial civilization is built on fossil fuel, just as Mesopotamia was built on its irrigation system and the Holy Roman Empire on the Catholic religion and steel swords, spears and armor. If some scientist had come along and told them those bases for their civilizations were doomed, and they just had to try something else, what do you think would have happened? I don't know about Mesopotamia, but in Europe, you got burned at the stake.

To say that we have to give up fossil fuel is to say that our civilization must go the way of Ozymandias. It's just not clear to me that it can happen until it all comes crashing down. We are Homo petroleus. Eventually, we won't be any more. The times will be very trying, filled with catastrophe and pain. Then we'll be something else.

Another of those competing liberty things . . .

For what are to me quite mysterious reasons, every year we have these whoop dee doos about health care workers refusing to get flu shots. This particular nurse -- who got fired from a long-time hospital job -- claims it's for "religious" reasons but apparently, at least from what her lawyer seems to be saying, the only religion in question is that it's her religion not to get the flu vaccine. Beyond that, she offers no explanation for her refusal.

Okay. I may get some pushback on this but here's the whole story as far as I'm concerned. Yes, the flu pandemic hoax of three years ago had me foaming at the mouth, and particularly got me up in the face of Daily Kos's Greg Dworkin. Influenza is not, in fact, all that big of a public health issue. Most of the 36,000 people or so in the U.S. who are are officially tagged as dying of flu are already debilitated and it just finishes them off. There is a much smaller number of unlucky folks whose lives are definitely cut short by it, including some children, but it's a far smaller number than are killed from car crashes, or even homicide. Most of the so-called Flu Like Illnesses (FLIs) that people get aren't flu at all, they're other viruses. Also, the flu vaccine isn't as effective as it's been touted to be, maybe about 60% effective, i.e. you can still get the flu even if you've been vaccinated.

All true. On the other hand . . .

The risk of any serious complications from flu vaccine is as close to zero as it can possibly be. It may even be zero. Possibly there is a 1 in a million risk of Guillan-Barre syndrome, or possibly there isn't. Virus for flu vaccines is grown in eggs, so people with allergies used to have a problem, but now there is egg free vaccine. So the worst you can get is a sore arm. Getting the vaccine benefits you personally, because it might let you avoid a case of the flu or have a more mild one if you do get it. That's not all . . .

It benefits everybody else, particularly people who are immunocompromised, pregnant women, and old folks, who are at high risk for flu complications, because by weakening the chain of transmission, it helps prevent other people from being exposed. (That's called "herd immunity," and maybe you don't like that term as applied to people but it's accurate.) So . . .

Obviously there's a basic interest in not forcing people to do what they want, in general, but if you work for a hospital you are obliged to act in the interest of the patients. You aren't allowed to smoke in the workplace, you aren't allowed to come to work while you're sick and know you are contagious, you aren't allowed to slack off and not pay attention to your duties, you may be required to do regular tests to establish that you retain the skills to do your job, you may have to get certain physical examinations -- as pilots and school bus drivers, for example, must do. Flu may not be the biggest problem in the world but it's a big problem for somebody who is already sick and in the hospital. So, if the administrators of the hospital require you to get a flu shot, they are well within their rights. Refusal is irrational, irresponsible, and nonsensical.

I feel no sympathy for this woman whatsoever. Zip. Zilch. Zero. Fire away.

Pleasingly Plump

Sorry for the long hiatus, I was distracted by a (very wonderful) personal matter. It turns out blogging isn't necessarily the most important thing in the world after all.

Anyway, despite the new year and all the ongoing political sturm und drang, I'm going to re-enter the blogosphere with a conventional Stayin' Alive post. Flegal and colleagues in the new JAMA present a very careful meta-analysis of studies linking body mass index with mortality. Their findings confirm what has been the general trend in observations over recent years: the categories of overweight and obesity set by NIH consensus panels may define healthy weight a little too stringently. People in the current "overweight" category (BMI between 25 and 29) actually seem to have slightly lower all-cause mortality than people of ostensibly "normal" weight, and people in the lowest category of "obesity" (BMI 30-34) do not appear to have higher mortality rates. Above that, however, obesity is most definitely associated with sharply higher risk of mortality.

But . . .

It's complicated. Underweight individuals have elevated mortality, probably mostly because the reason they are underweight is that they are already sick. Mildly overweight people may have good cardiovascular fitness and good muscle mass, or not: being both overweight and unfit is probably bad. Also, staying svelte in youth is probably a good omen for your later years. People tend to gain weight with age, but very few young people die, so when we're talking about mortality risk, we're talking about older folks who are naturally a little bit more zaftig than their younger selves.

Anyway, the point of all this is, if I were a real doctor, I'd tell you to pay more attention to being physically active and fit, and eating a well-balanced diet, than whether you're five pounds overweight by the standard measure. However, if you're much more overweight than that, you should try to trim down. And how can you do that?

Well, this one is abstract only for the rabble, but: the high fructose corn syrup and table sugar thing is probably real. It turns out that fructose -- of which there are similar amounts in both of the above-named products -- is the worst form of calories. Not only does it have a high glycemic index, it doesn't satisfy hunger, in fact it appears to make you hungrier. That's the crap in soda and supermarket sweets and the sugar bowl on your table. It's increasing prevalence in the American diet may have a lot to do with the obesity epidemic. Do not eat it! Have a piece of fruit.

Back to a normal schedule now, I hope.