Dr. David Ludwig, MD, recently published a response to my critique of the carbohydrate-insulin-obesity hypothesis. This is good because he defends the idea in more detail than I've encountered in other written works. In fact, his piece is the most scientifically persuasive defense of the idea I can recall.
Before we dig in, I want to emphasize that this is science, not tribal warfare. The goal is to arrive at the best answer, rather than to win an argument. I'm proceeding in good faith, based on my belief that Ludwig and I are both serious people who care about science and human health, and I hope my audience will do the same. That said, let's get to it.
Now there is another reason for Americans who aspire to medical careers to be concerned about applying to offshore medical schools.
Introduction
Admission to US medical schools is increasingly difficult. So many who seek medical careers may be tempted to apply to schools outside the US. In the last 30 years, American entrepreneurs have opened offshore medical schools, mostly in the Caribbean, that cater to US students. They teach in English, and do not require immersion in an unfamiliar culture, so may be more attractive than medical schools in other countries whose mission is to educate physicians to practice in those countries. In 2010, Eckhert documented that the number of offshore medical schools, "for-profit institutions whose purpose is to train U.S. and Canadian students who intend to return home to practice," but not to train physicians to practice in the countries in which these schools are located, was rapidly growing.(1) By 2010, there were 33 such schools, 20 of which were new since 2000.
Such offshore medical schools exist in a grey area. The small countries or colonies in which they are located usually do not seek to regulate them, since the physicians they produce are going to practice elsewhere. There is no requirement that these offshore medical schools be accredited in the US. Such accreditation is currently not required for individual graduates of such schools to be admitted to US house-staff programs or for US licensure. So perhaps it is not surprising that little is known about these schools.
How they choose students, the qualifications or even names of their faculty, their curriculum, how they supervise clinical training (which is mostly done by affiliated North American hospitals), and what happens to their graduates are obscure. Eckhert attempted to describe what is known, but noted "variability exists in the availability of information on faculty; where data exists, it is noted that most of the permanent on-site basic science faculty are internationally trained, many have no documented medical education experience in the United States, and it is not uncommon for them to be OMS [offshore medical school] alumni."
Such information as is available about these schools comes from the schools themselves.
DeVry Accused of Deception
Yet now there is reason to be more suspicious about the information the schools choose to reveal. This week, media reports documented that the US Federal Trade Commission (FTC) is suing DeVry University for allegedly "deceptive" recruiting practices. DeVry University is a subsidiary of DeVry Education Group. DeVry has two offshore medical schools as subsidiaries, the American University of the Caribbean School of Medicine, and Ross University School of Medicine.
On Wednesday, the Federal Trade Commission sued DeVry, which operates three Florida campuses, including one in Miramar, for 'deceptive' recruiting practices. The company is one of the nation’s largest for-profit colleges, with 50-plus U.S. campuses, and more than 41,000 students. In addition to the disputed 90 percent number [of graduates who found work in their chosen field], the FTC alleges DeVry also falsely advertised that its graduates 'earn 15% more than graduates from other colleges and universities.'
The allegations were that DeVry rigged the statistics:
The FTC suit alleges that DeVry fudged the numbers on its 90 percent job placement rate by leaving out some out students who weren’t finding jobs. This was done by classifying the students as not actively seeking employment, even though that wasn’t the case, the FTC says.
According to the FTC, DeVry also boosted its job placement numbers by counting students as placed in their field even when that clearly wasn’t accurate. Examples of DeVry’s 'in field' placements cited in the lawsuit include:
▪ A graduate from the technical management degree program working as a mail carrier. ▪ A business administration graduate working as a waiter at the Cheesecake factory. ▪ A business administration graduate working as a secretary at a prison. ▪ A technical management graduate working as a sales associate at Macy’s.
The Miami Herald reporter found at least one more example,
One former student at DeVry’s Miramar campus told the Herald that the school’s recruiter made it seem like his project management degree would lead to guaranteed employment. But after graduating in 2011, the student, who asked to be identified only by his first name, Luis, said he never got a callback from the more than 50 job postings he applied for.
Luis said he has $30,000 in student loans, and is working the same type of job he had before enrolling at DeVry, as a medical device technician.
A blog post on the Republic Report included two more examples,
graduates who majored in technical management working as unpaid volunteer positions at medical centers;
a business administration graduate with a health care management specialization working as a car salesman.
Not surprising, the corporate leadership of DeVry University denied the claims, and dismissed the evidence as "anecdotal examples that exaggerate the allegations but do not prove them." They focused on the overall numbers, claiming that "there is no national standard for calculating employment statistics...."
Yet they did not challenge the particular anecdoes, all of which seemed to be examples of unsuccessful placements claimed by the University to be the opposite.
Adding to Previous Concerns about DeVry Owned Offshore Medical Schools
In 2013, we posted about a Bloomberg investigative article about the two DeVry owned medical schools, at the American University of the Caribbean and Ross University. The article focused on multiple issues: - high attrition rates of students compared to those in US based schools - inability of many students to complete clinical training in the customary two years - low rates of students matching to US residencies compared to US graduates - high costs for students, presumably a cause of their high levels of debt
Keep in mind that some of these concerns were based on statistics supplied by DeVry. Yet now there is a new reason to be doubtful about their statistics. Furthermore, while Eckhert wrote in 2010 that the increasing presence of offshore medical graduates in the US "obligates U.S. medicine to take a closer look at these educational programs," no such scrutiny has occurred since then.
Summary
Outsourcing US medical education to offshore schools that largely escape regulation in the US, and in the countries in which they are located is another outstanding example of how the US has applied hyper market based solutions to health care. While more US students are attending such schools, and often paying a high price and incurring high indebtedness for the privileges of doing so, there are many reasons to be doubtful about the quality of the education they may receive, and the likelihood of their long-term success as physicians.
Yet health care, and particularly the quality of education received by those who practice medicine in the US, could be viewed as a public good. Dubious training of US doctors affect not only the doctors themselves, but their patients' and the public's health. Outsourcing this education could put a lot of people at risk.
However, it does provide an attractice opportunity for the managers of the outsourced system to make money. Per the DeVry Education Group 2015 proxy statement, CEO received $5,343,407 in total compensation that year, and owned over one million shares of stock (currently valued at just under $20 million). Four other named officers each received at least $1 million.
So, we see another aspect of the US health care system in which money seems to trump mission, facilitated by an unseemly alliance between wealthy corporate executives and bad US government policy. We need to reexamine our fascination for "market based" approaches to health care, when almost nothing about any part of health care resembles, or could resemble a free market. We need to make health care more transparent, and shine more sunshine on the nooks and crannies, like off-shore but US corporate owned medical schools. We need to facilitate health care leadership and governance that puts patients' and the public's health first, way ahead of the personal enrichment of the participants.
As long as the US continues its light touch regulation of the outsourced offshore system which now educates increasing numbers of US doctors(2), Americans who want to become doctors ought to be very skeptical about the futures they may face if they choose to go to such offshore schools.
References
1. Eckhert NL. Private schools of the Caribbean: outsourcing medical education. Acad Med 1010; 85: 622-630. Link here. 2. Eckhert NL, van Zanten M. U.S.-citizen international medical graduates - a boon for the workforce? N Engl J Med 2015; 372: 1686-7. Link here.
We spend a lot of time considering what we choose to put inside our body to improve out health, which I applaud! But, what about what we put on the outside to show it some love? How about we think about that a bit, too. And, I promise, my suggestion won't cost you a lot of money or take a lot of time.
Let's consider supporting that outside with this special "recipe" to do all this: improve your health, increase your mineral levels, induce deep relaxation, detoxify your body and bring on a great night's sleep - all at the same time! It is some "recipe," and, I really think you are going to find it very easy to follow!
Your liver and kidneys play key roles for removing toxins and do so every day, but your skin has a star role, too, filtering and detoxifying, right along with them. To gently push that detoxification process along, following the "recipe" for a special bath that I describe below and regularly scheduling one for yourself can do wonders and be a great health-promoting tool. Besides, the time in the tub for some serious day-dreaming can't be beat!
The Health Benefits of a Detox Bath
Besides the warmth of the hot water a bath can provide, a hot soak can create a great time of relaxation and rejuvenation. But, while you are there, why not step it up a bit with the addition of a few ingredients to create a healthy habit of regularly detoxing (primarily through sweating) at the same time. But before I get to the recipe, here are some other considerations regarding detoxing baths to keep you motivated:
1. Detox baths may help you clear toxins.
The full research on this is not firm, but many report the ingredients you place in the detox bath water can push the sweating process further along as well as simultaneously replenish minerals and soften skin. Let me assure you, this bath warms you head to toe! And, then some!
2. Bath time can make for better sleep time.
The warmth of the water, the solitude and time to let your mind wander as well as the magnesium in the Epsom salts all can bring on deep relaxation. And, insomniacs take note: many say this bath can induce a wonderful slumber after. Thus, it is best to take this bath at nighttime.
3. Mothers-to-be should choose another means of detoxing.
This is not a process for mothers-to-be! Women who are pregnant or may even think they are pregnant, stay away. Also check with your doctor first if you are diabetic, have high blood pressure or heart issues.
4. The Epsom salts in a detox bath may benefit those with autism.
Most people with autism conditions have a deficiency in a key detoxification pathway. The Epsom salts can help restore magnesium and sulfate absorption into the body through the skin benefiting all but especially helping those with autism. Here is more information on that. And, more here as well.
Epsom salts have been a long time remedy for stiffness and muscle soreness, as well. It is a great one to bring on a ski trip or bike trip or race of any kind.
5. Detox baths can help the many deficient in magnesium.
Epsom salts in a detox bath can supply in a highly available form of magnesium that can be absorbed readily through our skin. Epsom salts left on the skin after a bath can continue to be absorbed providing continuous ‘timed-released’ benefits much like a skin patch.
Don't miss this: Check this out to make sure you are not choosing the wrong kind of salt to cook with? It's an easy swap if you are not.
How to Create A Detox Bath To Improve Your Health
Follow this simple recipe to fortify your bath time with health benefits and deep relaxation to be on your way to sweet slumber. Below is an explanation of the specific benefit to each ingredient listed. I included links to the products I use, if you are interested. As always, I only link to products I use and find to be of excellent value. Gather Before Your Bath
Pitcher of purified water with some lemon, lime, cucumber or fresh mint for you to sip while soaking. Make it a big pitcher, too! Dehydration is a common result of this bath. Drink a glass before the bath, sip while soaking and you may want a glass after, as well. Do not skip this step! You will thank me later for this suggestion.
1 - 2 cups of Epsom salt. This reduces inflammation, relieves stiffness or soreness, induces sweating and the magnesium in the salt allows your skin to absorb this vital mineral.
1 cupbaking soda. It is alkaline in nature and it may help balance an acidic system. It softens the skin as well.
1,000 mg of Vitamin C. Studies show this is an effective chlorine eliminator. You can crush a tablet before adding it to the tub. If you have a water filter for your bath that eliminates chlorine, then no need!
1 cup apple cider vinegar. Optional. It softens your skin and is also good for those with acne.
3-4 drops of essential oil of choice. Optional. Some good choices would be lavender for relaxation or geranium or sandalwood. One of my favorites is rose essential oil as it smells wonderful, too.
Now do this
Place dry ingredients in tub and begin to fill the bath with hot water, setting the temperature to what you like. Keep in mind the hotter, the more sweating; the more sweating, the more detoxing.
Add vinegar while the water fills up the tub. Ensure the ingredients are mixing well in the water. Depending on what you add to the tub, the water may turn orange or yellow due to the ginger and vinegar.
Soak yourself in the bath for a minimum of 20 minutes but longer is better.
After your bath
Get out of the tub slowly and gently holding on to firm surfaces. This bath can make you a little woozy. Go slowly.
Briefly showering now is optional, as you may want to allow the Epsom salts to stay on your body for better absorption.
Drink another glass or two of purified water.
For future detox baths, you may want to make a pre-measured "dry mix" of the Epsom salt, baking soda and ginger and store it in a jar for future use. Shake well to distribute evenly. All you will need when you want to have a detox bath is two cups of dry mix, one crushed Vitamin C tablet and one cup of vinegar if you are using that. And, that large pitcher of water, of course!
Tell me, do you turn to hot baths to relax and rejuvenate? Did you know it could do so much? What do you add to your tub for good health?
Medical journals are supposed to promote professional values – scientific, social, and ethical. Quality matters, in each of these domains. Lately, however, highly ranked journals are failing in respect of ethics commentaries. Some editors seem happy to publicize or even to co-author commentaries that are dismissive of current ethics initiatives – like transparency of data reporting and disclosure of conflicts of interest (COI). That’s one way for journals to jump the shark in the race for ratings. They surely get attention and applause in some quarters – but those stunts are net negatives for the journals. Here is one example.
Last fall, JAMA went splashy with a sappy Viewpoint articleon conflict of interest by Anne R. Cappola and Garret A. FitzGerald. Anne Cappola is also an associate editor of JAMA– what a coincidence! The article was a Pollyanna piece by these two professors at Penn, promoting pushback on perceived pharmascolds, but really just papering over the problem of COI. The sappy formula? They declared conflict of interest to be a pejorative term that should be replaced by confluence of interest. This casuistry was backed up by wishful thinking and hortatory hand waving, weakly argued. Mostly, it gave the impression that the authors, presuming to speak for investigators generally, were offended by the increasing regulations for managing COI. Those developments have occurred at the Federal, institutional, and publication levels. Worse, the authors ignored the reality of recent corruption that led to those new regulations. That uncomfortable fact was airbrushed out of their discussion. In response, one critic of confluence of interest, writing on the COI blog, aptly raised a comparison to Wall Street: “The phrase also reminds me of a statement by then king-of-the-hill securities analyst Jack Grubman: “What used to be a conflict is now a synergy.” (Three years later Grubman was fined $15 million dollars and barred from the industry for life for what were apparently still considered COIs.)”
The Viewpoint article appeared on-line September 24, 2015, and four days later I sent a critical reply to JAMA. The printed version of the Viewpoint article appeared November 3, 2015, and on 4 December, 2015 I was notified that JAMA chose not to publish my letter to the editor. During the following six weeks, now nearly five months since it appeared, JAMA published no replies whatsoever to the Viewpoint article. Could it be that JAMA has deep sixed all the responses? That’s one way to manage bad publicity, but it is inconsistent with the standards we expect of a journal like JAMA. Here is the text of my letter to the editor of JAMA. Keep in mind that there is only so much one can say within a limit of 400 words and 5 references.
LETTER TO EDITOR, JAMA 09-28-2015 Text word count 389
5 references
TITLE: CONFLICT OF INTEREST
In their recent Viewpoint (1), Anne Cappola and Garret FitzGerald recommended replacing the term conflict of interest (COI) with confluence of interest, declaring a pejorative connotation of the term conflict. A better suggestion would have been competing interest, which already is in wide use (2) and which does not paper over the problem. The authors did not frankly acknowledge the gravity of recent COI scandals that led to the situation they decry. Sadly, there are real, common, serious, and unacceptable conflicts of interest. Boundaries are needed, and the authors’ effort to weaken the boundaries is misguided.
Their case for re-framing COI more benignly as a confluence of interests is weakly argued. For instance, they warned of concern that current policies on COI “… might restrain innovation and delay translation of basic discoveries to clinical benefit.” (1) They produced no evidence for that speculative assertion, though they said it was a key reason for their endeavor. Moreover, COI policies do not demonize collaboration with industry. We once had an honorable tradition of interacting with industry while retaining our integrity as clinical scientists. That tradition broke down when academic investigators in many specialties were coöpted as key opinion leaders (KOLs) by the marketing departments of corporations. There followed an era of corruption in corporate-funded and KOL-managed continuing medical education and journal supplements; of experimercials disguised as KOL-initiated clinical trials (3); of rampant, biased ghostwriting, commissioned by corporations and often with cynical honorary KOL authorship; and of selective analyses of clinical trials data designed to exaggerate benefits, minimize harms, and maximize markets (4). We can readily agree with the Viewpoint authors that these practices had the effect of “biasing the interpretation of results, exposing patients to harm, and damaging the reputation of an institution and investigator” (1). Inevitably, those practices and individuals were exposed, which led to Congressional action and to staggering legal penalties (over $3 billion in the case of GlaxoSmithKline) (5). In response, COI policies were strengthened at the Federal and institutional levels and, of course, they now inconvenience everybody. Such is the way of bureaucracies. As we survey the aftermath, we should direct our annoyance to the many opportunistic investigators who entered into those compromised relationships with industry. It makes no sense now to shoot the messengers or to use sophistry in an attempt to define the problem away.
ACKNOWLEDGEMENTS
The author declares no competing financial interest or other conflict of interest.
REFERENCES
(1)Cappola AR, FitzGerald GA. Confluence, not conflict of interest: Name change necessary. JAMA.Published online September 24, 2015. doi:10.1001/jama.2015.12020.
(2)James A, Horton R, Collingridge D, McConnell J, Butcher J. The Lancet's policy on conflicts of interest––2004. Lancet. 2004; 363 (9402):2-3.
(3)Carroll BJ. Sertraline and the Cheshire cat in geriatric depression. American Journal of Psychiatry. 2004; 161(6): 1145-1146.
(4)LeNoury J, Nardo JM, Healy D, Jureidini J, Raven M, Tufanaru C, Abi-Jaoude E. Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ. 2015;351:h4320.
So, yes, Virginia, there is real COI and there is real corruption in medical science. You cannot make them go away by wishing them away. And, JAMA, if you allow your editors to promote divisive, weak, and problematic ethics positions, at least have the decency to allow debate.
The ever increasing compensation of top managers of health care organizations provides incentives to continue business as usual. We have frequently discussed executive compensation for top health care leaders that seems wildly disproportionate to their contribution to their organizations' health care mission.
Furthermore, not only does executive compensation seem to have anti-gravity properties, rising even at institutions facing financial challenges, or while other employees face salary cuts and job loss, but it continues even after the lack of justification for it has been called out.
Herein we discuss two examples of continuing anti-gravity compensation that occurred at institutions we have previously cited for similar problems. These are discussed in the order of their appearance in the media.
Novant Health
In 2011, we first noted that executives of Novant Health, headquarted in Winston-Salem, NC, were getting raises while they were laying off more lowly employees. Then in 2014, we posted about more raises going to Novant executives, again while more lowly employees had their pay cut.
Recently, in December, 2015, Richard Craver, writing for the Winston-Salem Journal, discussed the latest (2014) compensation figures from Novant Health.
Carl Armato, chief executive and president of Novant Health Inc., received a 14.4 percent jump in salary during fiscal 2014 to $1.19 million.
In addition,
Armato is in his fourth year as the system’s top executive. His salary has risen 70.9 percent since he took over as the top executive Jan. 1, 2012, following the retirement of Paul Wiles.
Armato’s incentive compensation increased less than 1 percent to $919,738. Altogether, Armato’s core compensation was $2.59 million.
Other top executives also did very well,
Jeff Lindsay, chief operating officer, received $709,856 in salary, $382,813 in bonus and incentive pay and overall core compensation of $1.23 million. Lindsay, former president of Forsyth Medical Center, was not listed among Novant’s top executives in fiscal 2013.
For the 27 listed current executives, as of Dec. 31, 2014, on Novant’s Form 990 filing with the Internal Revenue Service, the system spent $12.17 million on salaries and $8.73 million on bonuses and incentive pay.
Specifically,
Seven other listed Novant Health Inc. executives received at least $442,000 in salary and core compensation of at least $517,000 for fiscal 2014.
* Fred Hargett, chief financial officer, received a 15.9 percent raise in salary to $708,924, bonus and incentive pay of $565,120 and overall core compensation of $1.54 million.
* Jesse Cureton, chief consumer officer, received a 14.2 percent raise in salary to $573,683, bonus and incentive pay of $472,173 and overall core compensation of $1.07 million.
* Jacqueline Daniels, chief administrative officer, received a 3.9 percent raise in salary to $565,283, bonus and incentive pay of $518,631 and overall core compensation of $1.13 million.
* Sallye Liner, former chief clinical officer, received a 2.9 percent raise in salary to $516,171, bonus and incentive pay of $474,991 and overall core compensation of $1.05 million.
* Dr. Thomas Zweng, chief medical officer, received $470,217 in salary, bonus and incentive pay of $282,014 and overall core compensation of $790,191.
* John Phipps, president of Novant Medical Group, received $459,024 in salary, bonus and incentive pay of $377,219 and overall core compensation of $873,015.
* Peter Brunstetter, chief legal officer, received $442,116 in salary, bonus and incentive pay of $45,000 and overall core compensation of $517,765.
The hospital system trotted out some of the usual talking points used to justify very high pay for top executives.
Novant, like most health care systmes serving North Caroling, says high compensation levels are necessary to recruit and retain executives to run 'a very complex organization.'
Novant, as do most not-for-profit health-care systems serving North Carolina, stresses high compensation levels are necessary to attract executives to run 'a very complex organization.'
Furthermore, the system's board of trustees say
bonuses and incentives are based on annual and three-year goals that 'focus on the quality and safety of health care, improving the patient experience, transforming to an electronic health record, financial stewardship and providing community benefit.'
To put that in perspective, the 27 top executives are about 0.1% of the system's total workforce of "about 25,000." The $20.9 million used for their salaries, bonuses, and incentive pay (but apparently not retirement benefits and other perks) amounted to 0.55% of the system's total revenue (of about $3.79 billion) and approximately 1% of the approximately $2 billion the system spent on all employee salaries and benefits (according to the Novant 2014 financial statement).
However, just a month before, the Triad Business Journal and Mr Craver again in the Winston-Salem Journal covered a case that certainly questioned the "financial stewardship" of Novant top management, but did seem like some sort of parody of the "community benefit" they provided. Per the former,
Novant Health has reached a preliminary settlement with a group of current and former employees over handling of their retirement plans, with the health system agreeing to pay $32 million and make changes going forward.
The proposed settlement has been agreed to by Novant and the seven plaintiffs, which include a variety of doctors, nurses and other health care workers,...
The point of the litigation was
what plaintiffs claim are excessive fees associated with the system's retirement plan along with 'kick-backs' to a Triad businessman with a long-standing relationship with the health system.
The complaint alleged that during a three-year period starting in 2009, the plan paid excessive compensation of close to $18 million to Colorado-based Great-West Life & Annuity Insurance Co. and brokerage firm D.L. Davis & Co., based in Winston-Salem and operated by CEO and President Derrick Davis.
Along with the allegations of excessive fees, the plaintiffs claimed that entities owned or controlled by Davis benefited from real estate and development deals with Novant Health.
Also,
The agreement would also bar Davis and his companies from being involved in the management of Novant Health retirement plans and would prohibit Novant from entering into any new real estate deals or business relationships with Davis and his companies for at least four years.
As is customary in such cases, a Novant statement said its leadership "do not agree with the claims in the lawsuit," but agreed to the large settlement and other stipulations apparently to avoid "a long and costly legal battle." But if the complaint was unfounded, how would it be good stewardship not to contest it? Of course, were it to be true, then there would be even more evidence of poor stewardship.
In fact, for full disclosure, I got to add my skepticism about how Novant recompenses its managers in the text of Mr Craver's December, 2015, article,
'Each organization seems to have their own set of metrics, often frequently adjusted, and that somehow always make their own executives seem good,' Poses said.
'Every organization thinks their executives are above average,' Poses said. 'There are no overseers willing to question executive pay, since boards are mainly executives of other organizations; and executives are always compared only with other executives.'
Somehow, I doubt that any Novant executives or board members would care about what I said, or that Novant executive pay will not continue to climb, unless push comes to shove.
Cape Cod Healthcare
In January, 2015, we blogged about how the former CEO of Cape Cod Healthcare had been collecting severance pay for 3 years, totaling more than $3 million, after he abruptly left his and after being sanctioned by the state medical board for faulty prescribing abusable psychoactive drugs (which he allegedly took himself) ; and it was revealed that there were concerns about financial mismanagement at the health care system which he formerly ran. While CEO of Cape Cod he also presided over multiple layoffs, some of which were of clinical personnel. At that time, of course, the system board of trustees defended his leadership because they said it improving system finances.
No, on January 14, 2016 the Cape Cod Times reported,
For the fourth year since abruptly leaving Cape Cod Healthcare, former CEO Dr. Richard Salluzzo pulled in a hefty paycheck, according to new financial reports filed with the state attorney general’s office.
Since parting ways with the nonprofit corporation in November 2010, Salluzzo has taken in about $3.5 million, including $407,371 for the most recent year on file, fiscal 2014.
In many ways, this report doubled down on the previous 2015 version. Dr Salluzzo did not merely preside over layoffs, but
During his tenure Salluzzo presided over what he called the largest job cut in Cape Cod Healthcare’s history, a layoff of about 200 employees, in addition to bringing about improvements such as better billing.
The chairman of the system's board of trustees did not merely defend Salluzzo's financial results, but
'The actual performance was just phenomenal,' [Chairman William] Zammer said. 'We have a healthy, vibrant health care system.'
The Cape Cod Times suggested that observers outside the hospital system begged to differ,
But a professor of business ethics at Bentley University in Waltham questioned the extent of Salluzzo’s 'golden parachute,' while the spokesman for a nurses union called it 'outrageous.'
'These post-employment payouts must have been in his initial contract,' said W. Michael Hoffman, executive director of the center for business ethics at Bentley.
'It does sound crazy and wrong given the amount of his golden parachute,' Hoffman said in an email.
'It’s unconscionable we’re still paying someone who left under questionable circumstances,' said David Schildmeier, spokesman for the Massachusetts Nurses Association.
Schildmeier said the money would be better spent on patient care, especially since Cape Cod Healthcare draws a large percentage of its patient revenue from taxpayer-funded Medicare and MassHealth programs.
Dr Salluzzo is gone, but I doubt that the board of trustees is listening to these critics, and again unless push comes to shove, I suspect the new CEO will find his position to be very remunerative.
Summary
As I said in 2015,...
As health care organizations have become increasingly big and influential, their leadership has been increasingly in the hands of generic professional managers, not health care professionals. These hired managers have commanded generous and ever increasing pay, which has been justified by the common talking points: managers have extremely hard jobs and are brilliant, and high pay is necessary in a competitive market to attract and maintain top leaders.
Yet none of the boosters of high pay for health care managers, who mainly seem to consist of the legal, marketing, and public relations personnel who answer to them, and occasionally the board members who also are hired manager, answer the obvious questions: What is the evidence that managers are brilliant and their jobs are so hard, especially when compared to the highly-trained health care professionals at their own institutions? Is their really a free market in hired managers, and why is it so isolated from the market for health care professionals and other people employed by health care organizations?
These justifications seem particularly ridiculous when managers whose results are obviously not brilliant, e.g., marked by deficits, losses, and lay-offs, are getting huge and increasing pay. They also seem ridiculous when the "market" apparently dictates salary cuts and lay-offs for all employees other than the managers of a particular organization.
Instead, it seems likely that hired health care managers make more and more because of the influence they have on their own pay. This influence is partially generated by their control over their institutions' marketers, public relations flacks, and lawyers. It is partially generated by their control over the make up of the boards of trustees who are supposed to exert governance, especially when these boards are subject to conflicts of interest and are stacked with hired managers of other organizations. Furthermore, per the dogma of pay for performance, their pay may be heavily tied to short-term financial results, rather than fulfillment of the patient care or academic mission.
Thus, as in the larger economy, non-profit hospital managers have become "value extractors." The opportunity to extract value has become a major driver of managerial decision making. And this decision making is probably the major reason our health care system is so expensive and inaccessible, and why it provides such mediocre care for so much money.
So to repeat, true health care reform would put in place leadership that understands the health care context, upholds health care professionals' values, and puts patients' and the public's health ahead of extraneous, particularly short-term financial concerns. We need health care governance that holds health care leaders accountable, and ensures their transparency, integrity and honesty.
So push needs to come to shove. I just posted that generic management/ "managerialism" just drove physicians who are corporate employees of one big health care system to unionize and contest their working conditions and other outcomes of generic management. I submit that to get true health care reform, physicians, health care professionals, and members of the public concerned about our ever more expensive, yet constantly declining health care system need to do more than just read angry blog posts.
But until they do, I guess I will have an infinite number of follow-up posts, like this one, to write.
I have a new brush you may want to consider to add to your beauty bag! And, it is not for your teeth, to apply your make-up or for your head of hair either! Let me explain.
You probably use several brushes in your daily health and beauty routine, but, there is another brush that may help, too! Exfoliation is a critical part of a great skin care routine as it creates a wonderfully smooth complexion. But, a technique using a special brush for your body - a dry brush - and regularly dry brushing your body is exfoliation amplified. Some consider it part of their beauty routine, but dry brushing? It does so much more than just bring on that beauty glow.
Roll down to learn more why you should consider dry brushing a regular beauty and health habit and why it is one of the easiest, cheapest and most effective routines to promote healthy skin and body.
10 Health & Beauty Benefits to Dry Brushing Your Skin
First, the beautification benefits: 1. Dull, dead skin is buffed away in seconds.
The act of brushing sloughs off dry skin exposing a new, youthful layer. And, after you dry brush your legs, you can get the closest shave ever!
2. Your complexion takes on a beautiful glow.
The blood flow it creates gives a rosy complexion and tighter skin.
Don't miss this: Want more tips for a healthy glow? Check out this for lots of skin care tips.
3. Acne is diminished.
Dry brushing opens and clears the pores of dirt and grime that could contribute to acne.
4. Dry brushing is a great first step to your skin routine.
Serums or moisturizers you use after dry brushing can be readily absorbed because of the pore-opening results of the technique.
5. Some say it can help banish cellulite.
No scientific proof on this one, but many claim it helps diminish that stubborn combination of fat and connective tissue.
As if that isn't impressive enough, read on to the health benefits:
6. Circulation is enhanced.
Dry brushing wakes up the circulatory and lymphatic systems bringing blood to your organs as well as filtering waste. Find out more here about how our circulatory and lymphatic systems work and why they are so crucial. 7. Dry brushing can help detoxify your body.
It helps move the lymphatic system along, therefore, drainage of fluids.
8. Your kidneys and colon will thank you.
The heightened circulatory and lymphatic system aids in digestion and kidney function.
9. Dry brushing regularly keeps you aware of your body and any changes.
Dry brushing is a great time to do skin exams. It keeps you aware of any changes you may notice over time to moles or texture, etc.
10. The act can energize you!
Dry brushing enhances your level of alertness as it is invigorating. Dry skin brushing also rejuvenates the nervous system by stimulating nerve endings in the skin. It really wakes you up!
3 Steps to Dry Brush Your Skin The Right Way
The dry brush method really takes only minutes, but keep in mind these tips and 3-step process to get it right.
Here are 5 tips to remember:
Always brush towards the heart with long, graceful, upward sweeps.
Avoid harsh movements or back and forth sweeps.
Do not brush too hard. Your skin may be pink from increased blood flow but this should not hurt.
Do not brush sensitive area like your face or injured or bruised skin or scrapes, cuts, etc.
Many find the ideal time to dry brush is before showering or bathing for the day. It can be energizing so you may want to think about this as part of your morning routine - every day or even a few times a week depending on your skin sensitivity. Place the brush near your towel so you won't forget!
Here is a 3 step method to dry brush:
Start brushing your skin at your feet and work up your legs (front and back) and hips one at a time.
Next, start brushing up your torso, your sides and your back. On your stomach, direct the brush counterclockwise.
Then, work the brush from your hands up the arms, both sides, toward your chest. Sweep over your shoulders onto your chest as well. On your neck, brush down towards your heart.
The Best Type of Dry Brushes
Search for a dry brush that meets these requirements:
Your dry brush should contain bristles that are natural, not synthetic.
The bristles should be somewhat stiff, but not too hard.
Look for one that is comfortable in your hand and that has an attachable handle for hard-to-reach spots, too.
I, personally, own this Merben Jute Body Brushwith short handle and love it. But, I hear this long handled dry brush is great too! Both are at Amazon. I only link to products I actually use and find to be of excellent value.
But, no matter what kind you buy, make sure to regularly wash your dry brush with hot, soapy water and air dry to keep bacteria away that could cause breakouts or infections.
So, tell me. Are you a dry brusher? Please do share with the readers your experience with this technique or if there are any dry brushes that are your favorite.
This post appeared previously at THM but has been updated.
We have posted about the plight of the corporate physician. In the US, home of the most commercialized health care system among developed countries, physicians increasingly practice as employees of large organizations, usually hospitals and hospital systems, sometimes for-profit. The leaders of such systems meanwhile are now often generic managers, people trained as managers without specific training or experience in medicine or health care, and "managerialists" who apply generic management theory and dogma to medicine and health care just as it might be applied to building widgets or selling soap.
We have also frequently posted about what we have called generic management, the manager's coup d'etat, and mission-hostile management. Managerialism wraps these concepts up into a single package. The idea is that all organizations, including health care organizations, ought to be run people with generic management training and background, not necessarily by people with specific backgrounds or training in the organizations' areas of operation. Thus, for example, hospitals ought to be run by MBAs, not doctors, nurses, or public health experts. Furthermore, all organizations ought to be run according to the same basic principles of business management. These principles in turn ought to be based on current neoliberal dogma, with the prime directive that short-term revenue is the primary goal.
Now there are a few signs that the physicians are getting fed up with having to answer to generic management and managerialism.
I found two stories, perhaps somewhat related, about physicians unionizing to stand up to their new often managerialist overseers. The most prominent was in the New York Times on January 9, 2016, provocatively titled "Doctors Unionize to Resist the Medical Machine." It tells the story of how the hospitalists at PeaceHealth Sacred Heart Medical Center in Springfield, Oregon, formed a union de novo. The second started with a brief article in the Seattle Times on December 27, 2015, about how housestaff at the University of Washington (UW) revived a housestaff association and turned it into a union.
Managerialism as the Stimulus at PeaceHealth
The long article about PeaceHealth showed that managerialist leadership of the hospital system was the chief stimulus for unionization.
Managerialist Tactics: Outsourcing
The NYT article opened with
in the spring of 2014, when the administration announced it would seek bids to outsource its 36 hospitalists, the hospital doctors who supervise patients’ care, to a management company that would become their employer.
The outsourcing of hospitalists became relatively common in the last decade, driven by a combination of factors. There is the obvious hunger for efficiency gains. But there is also growing pressure on hospitals to measure quality and keep people healthy after they are discharged. This can be a complicated data collection and management challenge that many hospitals, especially smaller ones, are not set up for and that some outsourcing companies excel in.
Outsourcing is a now familiar entry in the managerialists' playbook. It is seen more in manufacturing than in health care. Although touted as improving economic "efficiency," it also may reduce the accountability of the managers of the organization that does the outsourcing.
Pursuit of Economic Efficiency
In this case,
Outsourced hospitalists tend to make as much or more money than those that hospitals employ directly, typically in excess of $200,000 a year. But the catch is that their compensation is often tied more directly to the number of patients they see in a day — which the hospitalists at Sacred Heart worried could be as many as 18 or 20, versus the 15 that they and many other hospitalists contend should be the maximum.
It was the idea that they could end up seeing more patients that prompted outrage among the hospitalists at Sacred Heart, which has two facilities in the area, with a total of nearly 450 beds. 'We’re doctors, we’re professionals,' Dr. [Rajeev] Alexander said. 'Giving me a bonus for seeing two more patients — I’m not sure I should be doing that. It’s not safe.' (A hospital representative said patient safety was 'inviolate.')
A constant theme of managerialism, and the neoliberalism that underlies it, is economic efficiency. The usual narrative is that efficiency means providing better goods and services at lower costs. Instead, managerialism and neliberalism may mean decontenting goods and services so as to lower costs to the organizations providing them, but not necessarily providing more value to consumers. In health care terms, managerialism and neliberalism may lead to less accessible, more mediocre health care that increase revenue to the organizations providing it, as implied by the physicians' comments above. Making the US the most commercialized, managerialist run, and arguably neoliberal health care system among the developed countries has not led to lower costs, better access, or better health care quality.
The backstory for the outsourcing emphasizes that managerialism, and the resulting economic efficiency was indeed the goal of PeaceHealth...
In 2012, Sacred Heart’s parent, PeaceHealth, a nonprofit health care system, installed an executive named John Hill to adapt its Oregon hospitals to the latest trends in health care. Mr. Hill, in an effort to rein in the budget and improve the efficiency of a hospital that administrators said was lagging in key respects, including how long the typical patient stayed, eventually concluded that the hospitalists at Sacred Heart should be outsourced.
Centralization of Control
Furthermore,
The hospitalists also chafe at the way the administration has tried to centralize decisions they used to make for themselves. This might include hiring fellow doctors or the order in which they see patients on any day. They also complain of being loaded down with administrative tasks.
'We’re trained to be leaders, but they treat us like assembly line workers,' said Dr. Brittany Ellison, a hospitalist in the group. 'You need that time with the patient,...'
A major feature of managerialism is the concentration of power within (generic) management. To quote Komesaroff(1),
In the workplace, the authority of management is intensified, and behaviour that previously might have been regarded as bullying becomes accepted good practice. The autonomous discretion of the professional is undermined, and cuts in staff and increases in caseload occur without democratic consultation of staff. Loyal long-term staff are dismissed and often humiliated, and rigorous monitoring of the performance of the remaining employees focuses on narrowly defined criteria relating to attainment of financial targets, efficiency and effectiveness.
We're Only In It for the Money
Also, the negotiations that started once the PeaceHealth physicians formed their union demonstrated a central tenet of managerialism
Even starker than the divide over these questions are the differences in worldview represented on opposite sides of the table. During a bargaining session last fall, the administration proposed increasing the number of shifts a year. Hospitalists now earn about $223,000 a year for 173 shifts and are paid extra for working more. The hospital offered $260,000 for a mandatory 182 shifts, and up to $20,000 in bonus pay for hitting certain medical performance targets. The hospitalists work seven days on and seven days off, so this would have effectively eliminated any time off for sick days or vacation.
When the doctors pointed this out, the administration responded that if they missed a few days, it would make sure they got extra days to hit the required number of shifts for full pay.
The hospitalists assured the administration negotiators that their concern had nothing to do with money — that none of this had ever been about money. They preferred to work less and make less to avoid burnout, which was bad for them and worse for patients. At which point the administration responded that money was always the issue, according to several people in the room. (The hospital declined to comment.)
Suddenly it dawned on the doctors why they had failed to break through, Dr. Alexander said. 'Imagine Mr. Burns,' the cartoonishly evil capitalist from 'The Simpsons,' 'sitting across the table,' he said. 'There’s no way we can say, 'This isn’t what we’re talking about. We’re not trying to get the bonus.''
Again, managerialism is based on neoliberalism, and neoliberal view is that the market rules. The market is the arbiter of success, and money is the only outcome that matters. As Komesaroff put it(1),
The particular system of beliefs and practices defining the roles and powers of managers in our present context is what is referred to as managerialism. This is defined by two basic tenets: (i) that all social organisations must conform to a single structure; and (ii) that the sole regulatory principle is the market.
We carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way.
Ostensibly, this is accompanied by core values, such as,
Stewardship We choose to serve the community and hold ourselves accountable to exercise ethical and responsible stewardship in the allocation and utilization of human, financial, and environmental resources. and,
Social Justice We build and evaluate the structures of our organization and those of society to promote the just distribution of health care resources.
We have frequently discussed how leadership of contemporary health care organizations often seem to act contrary to the organizations' stated mission, that is, mission-hostile management.
Value Extraction
Finally, while managerialism is ostensibly concerned with economic efficiency, whose efficiency matters. When managers address physicians' efficiency, they seem to look at amount of work done divided by the cost to the hospital of paying physicians. However, they never seem to look at their own costs, the costs of management, as being a negative.
The PeaceHealth 2014 form 990, the latest available, states that the then CEO, Mr Alan Yordy (whose highest academic degree was an MBA, according to his LinkedIn page) had total compensation in 2013 of $1,366,742, and 11 other managers had total compensation greater than $250,000, with 9 having total compensation greater than $500,000. Those figures should be compared to the highest compensation offered the hospitalists, a maximum of $280,000 for 182 shifts a year, eliminating all vacation and sick leave. So if it is all about the money, the managers are making the most of it.
We have discussed ad nauseum the ridiculous compensation of the leaders of health care organization, even non-profit organizations. Value extraction by top management has become a central feature of the US and global economy (look here).
The NYT article did not discuss whether the upset hospitalists knew about their bosses' compensation. I suspect they did.
Forming a Functioning Union at the University of Washington
The media coverage of the UW housestaff unionization was less detailed. It does appear, though, that a stimulus was the pursuit of economic efficiency by UW management through squeezing the pay of housestaff, as described in the December article in the Seattle Times. In it the house staff said,
they account for about one-fifth of King County’s doctors and they want higher pay, new child-care benefits and free parking. Some UW residents and fellows earn so little that they qualify for welfare programs like Temporary Assistance for Needy Families and the Seattle City Light Utility Discount Program, according to the UWHA [University of Washington Housestaff Association.]
The association has proposed that residents and fellows earn at least the same salary as the UW’s lowest-paid physician assistants. Because the doctors in training work very long hours, they sometimes earn less than Seattle’s minimum hourly wage, the UWHA has said.
The council members, in their letter to Cauce, called the situation shocking. And based on information from the UWHA, they wrote that some residents and fellows qualify for welfare programs like Temporary Assistance for Needy Families (TANF).
The Seattle articles noted that the UW housestaff may earn from just over $53,000 to just under $70,000 a year. Keep in mind, however, that under current rules, house staff may work up to 80 hours a week. So $53,000 for someone working those hours translates into $13.25/ hour, under what many people now claim is the living wage. That could be considered exploitation of workers with doctoral degrees working in often highly stressful situations where lives may be on the line. Whether there were issues other than money (and the respect it implies) involved at UW was not apparent based on the minimal press coverage.
So it appeared that the hospitalist physicians working for PeaceHealth, and most likely the housestaff of the University of Washington were pushed to unionize to counteract the managerialism of their hospital leaders.
The Results of Unionization So Far
In my humble opinion, similar stories to those at the PeaceHealth hospital about managers pushing physicians to increase productivity and efficiency, seemingly with little regard for the effect that might have on patient care and physicians' professionalism can be found at many hospitals and health systems. Housestaff may be paid at little more than minimum wage rates at many training institutions. However, employed physicians have rarely effectively resisted up to now. Perhaps one reason is that at many institutions, each employed physician has his or her own contract, and may feel little power to negotiate his or her working conditions independently. Housestaff physicians obviously might feel they have even less leverage. But at PeaceHealth Sacred Heart, the physicians had other ideas:
Amid the groaning, a relatively new member of the group named Dr. David Schwartz observed, 'They can’t fire all of us — there are unions.' This was a bit of a stretch: While there are hospitals around the country whose doctors are unionized, there did not appear to be a union anywhere composed of a single group of specialists. But Dr. Schwartz, a barrel-chested man with close-cropped hair and a bushy beard who would not look out of place at a graduate English seminar, thought unionizing might be worth a try.
At the time, it was only one of several options the doctors considered. They talked of forming an independent hospitalists group, of forming an alliance with an outsourcing firm of their choosing. But the alternatives gradually fell away for a variety of practical reasons, and the doctors were growing increasingly bitter.
Dr. Littell developed a riff, which the other hospitalists appropriated, about how the situation was like having your spouse of several decades announce he or she was going to play the field. 'You’ve been great, you’ve always been there,' he would joke. 'I just heard there could be better spouses out there.' The kicker: 'The good news is, you’re in the running, too!'
Amazingly, the unionization at PeaceHealth Sacred Heart was at least partially successful,
By March 2015, the PeaceHealth leadership, whatever its interest in efficiency gains, was apparently not pleased that one of its hospitals had a white-collar labor insurrection on its hands. The company announced that it would not outsource the hospitalists, a move it later said was always a possibility. Mr. Hill, who declined to comment, left in May.
The union did defeat the outsourcing tactic. But otherwise results have not been so quick to appear,
Noting that the negotiations with the hospital administration have dragged on for roughly a year, Dr. Schwartz said, 'It’s pretty obvious that they don’t want to get a contract done.' He says the administration worries that if it essentially rewards the hospitalists with a contract, it encourages other hospital workers to unionize too.
The housestaff at UW used a slightly different set of tactics, but still managed to form a real union. Per the earlier Seattle Times article,
Established in 1964, the UWHA was mostly dormant during the 1980s and 1990s, according to the association’s website. It became active again starting in 1999. In 2013, members proposed making it a state-recognized collective-bargaining unit.
The UW petitioned the state Public Employment Relations Commissionto block the move, arguing that the residents and fellows were students paid stipends rather than employees paid salaries. But the commission sided with the residents and fellows, who last year voted to unionize.
The housestaff association has succeeded in negotiating. But as did the PeaceHealth doctors, they have not yet been able to secure their positions, per the later article.
University of Washington brass say they’re committed to providing the UW’s medical residents and fellows with decent compensation and benefits, but they insist the newly unionized doctors in training are asking too much in contract negotiations.
So,
Talks have been stalled for some time but are set to resume this month with a mediator assigned by the state Public Employment Relations Commission.
The two sides 'remain far apart in the area of compensation,' Joyner wrote in his letter.
Parenthetically, unexplored in any of the press coverage is whether the parallels between what is going on at PeaceHealth and the University of Washington have to do with explicit ties between the organizations. In 2013, per Beckers' Hospital Review, the news broke that the two institutions signed a letter of intent to create a "strategic alliance." In 2014, an article in the Seattle Times noted the ongoing concerns of housestaff and students at UW that the alliance could be diminishing their educational opportunities.
Summary
In one sense, it is amazing that physicians are now starting to unionize as a response to the managerialism of their leaders. It was not all that long ago when the majority of physicians worked as solo practitioners or in small group practices, and fiercely defended their autonomy. The last thing they would have thought about was unionization. Since physicians were their own bosses, with whom could their unions have negotiated? In addition, in the US, independent physicians and physician practices could not legally unionize. Practices that discussed such issues as fees were liable to anti-trust prosecution. And with what bosses could they have conceivably negotiated.
Yet now physicians are increasingly corporate employees, hence corporate physicians. At the moment, unionizing may be one of the few effective tactics health care professionals can use to halt the march of managerialism/ generic management and partially relieve the plight of the corporate physician (and health care professional.) However, in the long run, as long as people who care more about money than about patients' and the public's health run health care, even unions will not be able to make that much progress, and not without adverse effects.
It would take true health care reform to address the larger problems with health care and society that is now leading to physicians unionizing. In my humble opinion, hospitals, health care systems, and other "provider organizations" should seek better patient care, not growth. Should they not voluntarily downsize (an almost comical idea in the current context), anti-trust enforcement, and probably new legislation would be needed to stop their pursuit of market dominance and return them to responsible community organizations. The now much smaller hospitals, and provider organizations should not be run for profit, and the commercial practice of medicine should again be illegal. Most physicians should go back to being private practitioners as individuals or within small groups. Leaders of hospitals and provider organizations should be accountable for putting patients' and the public's health first, upholding professional values, and should not expect to get rich doing so. But I dream on....
Musical Interlude
To lighten things up, if only a little, here is the YouTube video version of the full third album by the Mothers of Invention, led by the incomparable Frank Zappa, "We're Only In It for the Money."
ADDENDUM (21 January, 2016) - This post was republished on the Naked Capitalism blog.
Reference
1. Komesaroff PA, Kerridge IH, Isaacs D, Brooks PM. The scourge of managerialism and the Royal Australasian College of Physicians. Med J Aust 2015; 202: 519- 521. Link here.
Like many others, I have only praise for a book I read recently brilliantly sharing the secrets of some of the healthiest people from around the world. The book, The Blue Zones Solution, by Dan Buettner, is full of practical advice and recipes from various regions (referred to as blue zones) that I have been trying lately.
Some of the "secrets" from these regional " blue zones," I was already aware of as two of the areas it depicts are some parts of Italy and Greece in the Mediterranean, where I have shared some amazing meals and I have written about as well - specifically, the amazing health benefits of a Mediterranean Diet.But, I learned a lot of new things, too, from the book, and it certainly reinforced a lot as well. I plan to write a post a bit later on the book, but I thought I would highlight what a whole day of eating like a person lucky enough to live near those breathtaking Mediterranean shores to get your started - just in case you want to mimic the healthy lifestyle, too!
But, before we talk about the good eats, first, allow me to make a few key points about the way of life for those who inhabit that glorious area of our world because it is definitely not just about what you eat. Living the healthy Mediterranean lifestyle really encompasses much more. And, you can easily adopt the lifestyle, no matter where you live. Come see!
8 Important Points to Remember to Keep to A Mediterranean Diet and Lifestyle
Here are some things to keep in mind when adopting the Mediterranean way of eating and living:
1. The beauty is in the simplicity.
This way of eating is all about the ingredients prepared in simple ways that bring out the flavor of the food. The food is fresh as possible, wholesome and unprocessed. For the most part, it does not take long to prepare, either, leaving more free-time.
2. Clear away the processed stuff.
Rid yourself of those foods with ingredients you cannot pronounce. No chemical-laden food. Keep it whole and fresh.
3. Get creative.
No boredom here. The Mediterranean diet allows plenty of variety and experimentation. All those healthy ingredients can be combined in hundreds of ways. Vegetarian, dairy or gluten-free diets can easily be considered a variation of the Mediterranean diet, too.
4. Shop smartly to save time.
Keep pantry staples like olive oil, jarred tomatoes, whole grains, pasta, and olives on hand. Pick up the fresh ingredients a few times a week. This saves time, too!
Not the salt shaker. Lots of basil, oregano, rosemary, thyme, garlic, mint, lemon and many other additions make the Mediterranean dishes taste so good and add loads and layers of flavor.
The emphasis is on whole foods with plenty of fiber that fills you up. Fewer amounts of a great tasting, fresh off-the-vine or perfectly ripe food is needed to satisfy. This helps keep the weight down, too.
7. Move your feet. A life of exercise and movement is part of the lifestyle. It does not have to be strenuous or over-the-top - just lots of natural ways to keep the blood pumping a good part of your day.
Don't miss this: Loads ofexercise options that you can fit in your day easily.
8. Don't go it alone. Share your meals, share your life! Invite someone for dinner. Gather your friends and family and create a meal together, like those that live the Mediterranean lifestyle. I promise, it will taste a lot better.
Cooking the Mediterranean way is really a dream for those who like to cook simply and quickly most of the time. That would be me! Possibilities of meals are endless but with "quick" on the mind, I offer two options for a day of meals: Quick and Quicker. I have given some loose directions on some of the meals as well as some links to some specific recipes.
How: Boil the water for the egg while preparing the toppings for the polenta. Start boiling the water for the polenta. Finish polenta and top with yogurt and fruit mixture. Drizzle a bit of honey on top. Toast a slice of multi-grain to dip in the egg.
Quicker: Espresso, Some fresh fig jam swirled in plain Greek yogurt, sprinkled with some sliced almonds or walnuts; a large handful of grapes
Don't miss this: Don't get confused over all those egg labels. There are differences and here is what they mean and advice on making sure you arebuying the healthiest eggs for you!
Lunch
Quick: whole grain orzo with diced zucchini, cucumber. white beans, mint and lemon with olive oil infused with garlic and red pepper, a sprinkle of Parmesan cheese; seasonal fruit.
How: Simmer on low flame garlic and red pepper flakes in olive oil to infuse while the water is boiling for orzo, Cut up vegetables. Cook orzo and drain. Add vegetables and beans, toss with infused olive oil. Sprinkle with fresh mint and lemon juice. Sprinkle with Parmesan cheese . Quicker: Large salad of tomatoes, red pepper, avocado, fresh mozzarella drizzled with olive oil, balsamic vinegar and lots of basil; a large slice of whole grain bread. lightly toasted, with a smear of hummus
Snack
Quick: 1/2 avocado with lemon juice, salt and pepper, red pepper flakes; small portion of marinated olives
Quicker: Two clementines; a handful of raw almonds
Quicker: Grilled marinated tofu or shrimp with olive oil, lemon, oregano, and garlic; steamed basmatti rice; spinach salad with olives, crusty bread
Need More Inspiration?
Naturally, I turn to fellow bloggers and writers all the time to get inspiration. Here are some links to Mediterranean diet gurus for endless ideas on how to reap the benefits of this delicious and healthy way of eating:
The Blue Zones Solution, by Dan Buettner: an award-winning book with lots of very clear and simple healthy Mediterranean recipes
Mediterrasian Kitchen: a blog that takes a creative and smart approach of merging Asian and Mediterranean cuisines. Such fantastic flavors!
Have your visited the Mediterranean or do you live there? Do you have a quick and easy recipe for a Mediterranean dish you and your family love? Please add a link in the comments!
Note: I only link to products I actually use and find to be of excellent value. This post contains an affiliate link but does not affect the price for the item at all. Note: This post appeared previously on THM but has been updated with latest links. tomato: photo credit: <a href="http://www.flickr.com/photos/spisharam/2742433355/">spisharam</a> via <a href="http://photopin.com">photopin</a> <a href="http://creativecommons.org/licenses/by-sa/2.0/">cc</a> rosemary: photo credit: <a href="http://www.flickr.com/photos/thedepartment/134527398/">Here's Kate</a> via <a href="http://photopin.com">photopin</a> <a href="http://creativecommons.org/licenses/by-nc-sa/2.0/">cc</a> garlic: photo credit: <a href="http://www.flickr.com/photos/calliope/7472855/">Muffet</a> via <a href="http://photopin.com">photopin</a> <a href="http://creativecommons.org/licenses/by/2.0/">cc</a> Featured on Jill Conuers.Urban Naturale
