UK health IT 'glitch': Hundreds of thousands of patients have potentially been given an incorrect cardiovascular risk estimation after a major IT system error

This in the UK.

What is euphemistically referred to as an "IT system error" is, in reality, the mass delivery of a grossly defective medical device adversely affecting hundreds of thousands of patients.  I'm surprised not to see that other kindly euphemism, "glitch" (http://hcrenewal.blogspot.com/search/label/glitch):

http://www.pulsetoday.co.uk/your-practice/practice-topics/it/gps-told-to-review-patients-at-risk-as-it-error-miscalculates-cv-score-in-thousands/20031807.article

11 May 2016  

By Alex Matthews-King

Hundreds of thousands of patients have potentially been given an incorrect cardiovascular risk estimation after a major IT system error, Pulse can reveal.

The MHRA has told GPs they will have to contact patients who have been affected by a bug in the SystmOne clinical IT software since 2009.

Of course, this refrain appeared, a corollary of "Patient care has not been compromised" (http://hcrenewal.blogspot.com/search/label/Patient%20care%20has%20not%20been%20compromised) when health IT crashes and outages occur:

The regulator says that means that ‘a limited number’ of patients may be affected, and the risk to patients is ‘low’.

At best, it's good that only a "limited number" of patients were "affected."  I guess they feel they can justify a "limited number" of patient harms for the glory of a medical Cybernetic Utopia.

At worst, how do "the regulators" know exactly who was affected?  Answer: they don't and this is boilerplate BS meant to CYA.

But Pulse has learnt that the 2,500 practices using SystmOne are having lists sent to them of around 20 patients per partner who may need to be taken off statins, or be put on them, after their risk is recalculated.

Statins are not an innocuous medication.  From WebMD at http://www.webmd.com/cholesterol-management/side-effects-of-statin-drugs?page=2#1:

The most common statin side effects include:

• Headache
• Difficulty sleeping
• Flushing of the skin
• Muscle aches, tenderness, or weakness (myalgia)
• Drowsiness
• Dizziness
• Nausea or vomiting
• Abdominal cramping or pain
• Bloating or gas
• Diarrhea
• Constipation
• Rash

Statins also carry warnings that memory loss, mental confusion, high blood sugar, and type 2 diabetes are possible side effects. It's important to remember that statins may also interact with other medications you take.

Not to mention the risks of not being on a statin if you truly need one.

And this number could increase if a practice provides NHS Health Checks routinely. In addition, the lists being sent to practices only go back to October 2015, but practices will be sent further lists potentially dating back to 2009 over the next few weeks.

Wait!  The "regulators" said that ‘a limited number’ of patients may be affected.  They are clairvoyant, I would imagine.  Maybe one of them is Harry Potter?

The "regulators", who have the same powers as the man-wizard above, know through clairvoyance that only a limited number of people were affected, and risk to them low.

A statement from MHRA to Pulse said: 'An investigation has been launched into a digital calculator used by some GPs to assess the potential risk of cardiovascular disease (CVD) in patients.

'We are working closely with the company responsible for the software to establish the problem and address any issues identified.

The problem is incompetence and negligence.  One wonders what testing was performed before this was unleashed on the public in the UK.

TPP told Pulse they were working to address the ‘Clinical Safety Incident’ and that the QRISK calculator was provided as an advisory tool to support decision making. They added they were working to ensure the issues were addressed and GPs are informed of affected patients ‘as soon as possible’.

‘Clinical Safety Incident’ - what a wonderful euphemism for "healthcare IT debacle."

Deputy chair of the GPC’s IT subcommittee Dr Grant Ingrams told Pulse it would be ’loads of work’ to sort out.

He said: ‘It affects everyone who has had a QRISK, and SystmOne are sending out messages to say “look at these patients”. But then you have to see if the change is significant, and whether you would have made a different decision at the time, or put them on a different treatment’

It will probably be more work than if such a system had never been constructed.

Dr Ingrams said: ‘There’s potential harm both ways…What happens when a patient who had been of a high risk and this hadn’t been identified and they’ve now had a stroke or heart attack?  ‘Similarly if someone had a low risk and they’ve been put on a statin and had a side-effect who’s responsible? That’s the clinical risk.’

Answer: the company that produced this grossly defective software, and those "regulators" who allowed it on the market without independent and thorough testing, are responsible.

Dr William Beeby deputy chair of the GPC’s clinical and prescribing subcommittee, said the bug ‘certainly had the potential to impact on patient confidence’ and this could create even more work  ... ‘It’s the tool we’ve been told to use. So if the tool is inaccurate, then you start to lose confidence and the doctors will then lose confidence as well.’

Patient confidence (let alone physician confidence) in cybernetics already took a big hit in the UK several years back, as at my Sept. 2011 post "NPfIT Programme goes PfffT" at http://hcrenewal.blogspot.com/2011/09/npfit-programme-going-pffft.html.

However, it seems, hyper-enthusiast overconfidence in health IT, including that of the "regulators", would not be injured even if bad health IT caused more casualties than the bombings and V2 attacks suffered by the UK in WW2.

After the health IT debacles involving billions of wasted pounds in the UK, perhaps the UK's "regulators" need to look upon health IT as fondly as this piece of technological wizardry.

A TPP spokesperson told Pulse: 'TPP is dealing with the Clinical Safety Incident involving the QRISK2 Calculator in SystmOne. The tool is intended to support GPs in assessing patients at risk of developing cardiovascular disease and in developing treatment plans. The QRISK2 Calculator is presented within SystmOne as an advisory tool.

"Advisory tool"?  That the doctors can safely ignore?  Hogwash.

’We are actively working to ensure the issues identified are addressed and to ensure that clinicians are informed of any patients that may have been affected as soon as possible.’ 

Until the next health IT "bug" arises, that is.

-- SS

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HIT Mayhem, Canadian Style: Nanaimo doctors say electronic health record system unsafe, should be shut down, non-medical PR hacks say it's perfectly safe

Some candid honesty:

To hell with doctors and nurses and their concerns about horrible health IT.  

That seems the international standard in 2016 regarding their concerns.  There's just too much money to be made in this business to worry about such piddling annoyances as maimed and dead patients.

Doctors, after all, don't know anything about computers, and cybernetic medical experiments on unconsenting human subjects are just good fun.

This new example from Canada:

http://www.theprovince.com/health/local-health/nanaimo+doctors+electronic+health+record+system/11947563/story.html

Nanaimo doctors say electronic health record system unsafe, should be shut down

By Cindy E. Harnett
Victoria Times Colonist
May 27, 2016

Implementation of a $174-million Vancouver Island-wide electronic health record system in Nanaimo Regional General Hospital — set to expand to Victoria by late 2017 — is a huge failure, say senior physicians.

Who cares what they say?  They're just doctors, so sayeth the imperial hospital executives.. 

After a year of testing, the new paperless iHealth system rolled out in Nanaimo on March 19. Island Health heralds the system as the first in the province to connect all acute-care and diagnostic services through one electronic patient medical record, the first fully integrated electronic chart in the province.

EHR pioneer Dr. Donald Lindberg, retired head of the U.S. National Library of Medicine, called such total command-and-control systems "grotesque", and that was in 1969 (See http://hcrenewal.blogspot.com/2014/06/masters-of-obvious-aat-athens-regional.html).  He observed back then:

But he's a doctor too, so what does he know, sayeth the hospital executives.

But nine weeks after startup, physicians in the Nanaimo hospital’s intensive-care and emergency departments reverted to pen and paper this week “out of concern for patient safety.”

Who cares what they say?  apparently not the executives, per Toni O'Keeffe, Vice President and Chief, Communications and Public Relations, http://www.viha.ca/about_viha/executive_team/toni_okeeffe.htm, as below.  The system's perfectly safe!

Doctors said the system is flawed — generating wrong dosages for the most dangerous of drugs, diminishing time for patient consultation, and losing critical information and orders.

“The whole thing is a mess,” said a senior physician. “What you type into the computer is not what comes out the other end.

“It’s unusable and it’s unsafe. I’m surprised they haven’t pulled it. I’ve never seen errors of the kind we are now seeing.”

Doctors are so concerned, they want Island Health to suspend the implementation.

“Take it away and fix it and test it before you bring it back — stop testing it on our people,” said one doctor. “Why wasn’t this introduced in Victoria first? If they went live in Victoria first, they would have a riot.”

(Is there anything unclear there, I ask?)

SHUT UP DOCTORS.  IT''S PERFECTLY SAFE, sayeth the administration.

The doctors, who fear reprisals, spoke to the Times Colonist on condition of anonymity.

If doctors did not fear reprisals I'd have a full time job writing on EHR debacles.  I could almost have one now.

The $174-million system started with a 10-year, $50-million deal for software and professional services signed in 2013 with Cerner Corporation, a health information technology company headquartered in Kansas City. Thus far, the company has been paid close to $12 million. The remaining $124 million is to be spent by Island Health for hardware, training and operating the system.

I wonder just how much graft there may be, driving what seems an international phenomenon of bad health IT with doctors and nurses complaining (e.g., examples of mayhem at http://hcrenewal.blogspot.com/2013/07/rns-say-sutters-new-electronic-system.html), patients being harmed and dying (e.g., ECRI Deep Dive study at http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html), yet hospital execs and government officials gleefully moving full steam ahead.

The system is being used in Nanaimo’s hospital, Dufferin Place residential care centre (also in Nanaimo), and Oceanside Health Centre in Parksville.

Since March 19, mobile touch-screen computer console carts have been rolling around hospital hallways. Voice-recognition dictation software immediately transcribes a doctor’s verbal notes into a patient’s electronic record, and scanners track each bar-coded patient bracelet around the hospital. But doctors complain the new technology is slow, overly complicated and inefficient.

Today's clinical IT is needlessly and blindingly complex.  But hospital executives are, in my increasing view, too ignorant to recognize the necessity of simplicity in critical functions such as clinical medicine.  Their jobs are child's play in comparison.  (I should know; I once was a health IT  executive after having practiced medicine for a number of years.)

“The iHealth computer interface for ordering medications and tests is so poorly designed that not only does it take doctors more than twice as long to enter orders, even with that extra effort, serious errors are occurring on multiple patients every single day,” wrote one physician at the Nanaimo hospital.

In view of current warnings and that which is known, and has been known for many years from the literature about bad health IT, each and every adverse outcome of injury that occurs represents hospital executive gross negligence:

Gross negligence is a conscious and voluntary disregard of the need to use reasonable care, which is likely to cause foreseeable grave injury or harm to persons, property, or both. It is conduct that is extreme when compared with ordinary Negligence, which is a mere failure to exercise reasonable care.  http://legal-dictionary.thefreedictionary.com/gross+negligence

I leave it to the reader to classify patient deaths.

“Tests are being delayed. Medications are being missed or accidentally discontinued.”

My mother and other patients in whose litigation I have provided informatics expertise were injured and/or died from precisely that type of mistake.

Doctors can’t easily find information entered by nurses, the physician wrote.

There are also complaints about the pharmacy module of Cerner’s integrated system — the only joint build between Island Health and Cerner.

iHealth implementation staff brought in to input orders for physicians this week entered eight drug mistakes on one day and 10 on another, while there were no mistakes in the paper orders, doctors said. “If the experts can’t enter it correctly, what is the average Joe going to do?” one doctor said.

Suffer, and take on all the liability, of course.

Another problem, they said, is patients’ drug orders disappearing from the system.

Australian informatics expert Jon Patrick wrote of such issues in 2011 as at this link: http://hcrenewal.blogspot.com/2011/03/on-emr-forensic-evaluation-from-down.html.  His technical paper was ignored, and pushback for having written it draconian.

Here's the administration's view:

... But Island Health spokeswoman Antoniette O’Keeffe said the system is safe and doing what it’s intended to do.

To hell with the doctors concerns and with the patients.

“We are not going back to paper,” she said. “We can’t go back to paper. We don’t have the mechanics to go back to paper.”

I'll be generous about the stupidity represented by that statement.  What she means is, we've jsut blown tens of millions of dollars on computers.  We'd get out asses kicked by the Board if we admitted we blew it and went back to paper.

Island Health acknowledges that documentation for staff doing emergency-department patient intake was a challenge, noting Nanaimo is the busiest emergency department on the Island.

A mere "challenge."  How about "was not possible in a 24 hour day?"

Nanaimo has some of the top physicians in the country and “we respect the feedback they are giving us, and so we are listening to them and we are tweaking and modifying the system,” O’Keeffe said.

We respect their feedback.  They say it should be shut down, but "the system is safe and doing what it’s intended to do."

Challenges include getting medication orders into the system, getting clinical staff trained, work flow and documentation, O’Keeffe said.

More staff have been added to speed up admissions and others are working around the clock in the intensive-care and emergency departments to input handwritten physician orders into the system, O’Keeffe said.

Cerner is working with Island Health staff, “and they’ll be here until we get this fully implemented,” O’Keeffe said.

Ms. O'Keefe. bad health IT is never "fully implemented."  (e.g., http://hcrenewal.blogspot.com/2013/11/weve-resolved-6036-issues-and-have-3517.html) Instead, clinicians learn to work around bad health IT, except when the risk of doing so slips through and patients get maimed or killed.

Island Health credits the system’s electronic warnings for catching about 400 human-caused medication errors and conflicts at three sites, saying it’s a sign that the system is working. It will produce a warning, for example, if the dosage is too high for a patient’s weight, if the drug is not appropriate for a particular disease or if there’s a drug conflict.

Across the country, thousands of medication mistakes are made daily due to human error, “and this system is designed to catch them,” O’Keeffe said.

Doctors respond that so many irrelevant flags pop up, it creates confusion, while the computer loses or duplicates drug orders.

Ms. O'Keefe and her administration are obviously blissfully unaware of how health IT can cause medication errors en masse impossible with paper, e.g., "Lifespan (Rhode Island): Yet another health IT 'glitch' affecting thousands", http://hcrenewal.blogspot.com/2011/11/lifespan-rhode-island-yet-another.html.  Of course, many hospital executives are ill-informed, lacking the curiosity of  the average scientist or physician.

The system was a decade in the making for Island Health. Twenty-three clinical teams were involved in developing various components and there was user-group testing, modifications and feedback, O’Keeffe said. Training has gone on for the last year, she said. “You can only bring a system so far and then you have to put it in a real environment to test it.”

At best - test it - yes, on unsuspecting human subjects known as patients, doctors and nurses.  The ones who are harmed and the ones who die are worthy human sacrifice for the glory of computing, eh, Ms. O'Keefe?

At worst - what is wrong with this industry that each and every installation of this technology is an experiment?

Is it that the technology has exceeded the intellectual horsepower of available personnel?  In my experience that has seemed to be the case.

By the end of the implementation, it’s expected family doctors will also be able to access patient files started in acute-care settings. Island Health is working on that component now, O’Keeffe said. Once the system is working smoothly in Nanaimo, it will be installed in the north Island and then Victoria hospitals in 12 to 18 months, O’Keeffe said.

Runaway trains cannot be stopped.

Canadian lawyers, take note.

-- SS

Addendum: An Op-Ed on this matter is here:

http://www.timescolonist.com/opinion/op-ed/comment-new-computer-system-a-detriment-to-health-care-1.2264274  

It is grim, written by a doctor under a pseudonym (Dr. Winston Smith is the pseudonym for a doctor in Nanaimo - that says much about fear of retaliation):

One health record. Making care delivery easier for health-care providers. Safer health care. These are the claims Island Health has made publicly for its new electronic health-record system iHealth, introduced initially at Nanaimo Regional General Hospital in March and intended to roll out across Vancouver Island in the coming months.
These are goals physicians share — many of whom enthusiastically use electronic records in their clinics. Despite “bumps in the road,” Island Health claims the implementation of the system is going well.
But these claims are untrue. iHealth does not provide a single health record: It offers no less disjointed and poorly accessible a collection of patient information in differing programs and sites than the previous system.
The system is cumbersome, inefficient, not intuitive — and not simply because it is a new system, but because of its very nature. It’s like trying to make a DOS-based computer work like an Apple or Windows-based system: You can perform many of the same functions, but it is slow, takes multiple steps and is inefficient.
Even the youngest generation, who have grown up with computers, and those with computing science degrees can’t make it work effectively.
The system’s ordering function is faulty and requires multiple separate steps and choices to order a simple medication: A processing issue safety experts know is highly likely to cause error.
And the system sometimes makes default changes in medication orders without the knowledge of the ordering physician. Single orders for medications disappear from the record, so that duplicate orders are initiated by unknowing doctors.
The consequence of these problems is that hospital-based care delivery is slower, more inefficient, more prone to error. Health-care providers are found interacting with their mobile computer monitors in already overcrowded hallways rather than providing direct patient care.
Nurses and doctors have less of a holistic appreciation of their patients and their illnesses because of the disjointed complexity of the electronic record rather than the simple navigability of the previous paper record and charting.
And communication with the computer system has supplanted direct discussion between health-care team members: Like trying to manage complex illnesses through text messages.
Health-care delivery is slower, so surgical operations are cancelled or delayed and patients leave the emergency department without being assessed; patients are not seen in a timely fashion or at all by specialists; medication errors are regular, so patients are medicated inappropriately or even overdosed; and some of our most experienced and valued health-care providers opt for early retirement or leave rather than continue the frustration and moral distress that this system has generated.
And the effect of iHealth is not restricted to the hospital, as some specialists have reduced their outpatient service because of the increased workload iHealth has caused.
In short, health care is not easier or better. The quality of care is worse and access is reduced. Improvements can be made and have been, but the system is fundamentally flawed. The impact on work efficiency and quality will never return to previous levels — a fact even the Island Health iHealth “champions” acknowledge.
Worse, iHealth is unsafe and dangerous. Medicine strives to be evidence-based, but there’s no evidence electronic record systems improve quality of care, and plenty of evidence they do the opposite — particularly this one.
Doctors have expressed their concerns to Island Health. Rather than suspending the system, the health authority’s response has been simply to delay its rollout beyond Nanaimo. It’s OK to let our community suffer while they tinker.
Dr. Brendan Carr, the CEO of Island Health, tells us he’ll “do whatever it takes to make this work,” even while continuing to risk worsening quality of care and expending more of our taxpayer dollars — $200 million so far, a fraction of which applied to delivery of health-care services could provide inordinately better health-care outcomes than any electronic record can do.
The medical community has finally taken matters into our own hands in the interests of patient safety, quality of care and access. A number of departments are refusing to continue using the system and instead returning to the previous one.
Why does Island Health not withdraw this system? In sum, they’ve spent a lot of taxpayers’ dollars on iHealth, a product of Cerner, which has been sued by hospital systems in the United States.
And as with many such systems, the objective has not been better patient care, but has been more Orwellian: Improved administrative data and control — no wonder Island Health is loath to give it up.
Well, Dr. Carr, the patient should be paramount. I and my family and my community are not expendable. No electronic record system should be introduced that will not explicitly improve health care, patient safety and access.
Any deterioration in health care is not an acceptable outcome. Suspend the iHealth experiment. Stop wasting taxpayer dollars. Sue for our money back for having been sold a lemon (as other jurisdictions have done).
Spend our tax dollars on services, infrastructure and equipment that will improve health care, not make it worse.
Dr. Winston Smith is the pseudonym for a doctor in Nanaimo.
- See more at: http://www.timescolonist.com/opinion/op-ed/comment-new-computer-system-a-detriment-to-health-care-1.2264274#sthash.rWwQcJZA.dpuf

... The system is cumbersome, inefficient, not intuitive — and not simply because it is a new system, but because of its very nature. It’s like trying to make a DOS-based computer work like an Apple or Windows-based system: You can perform many of the same functions, but it is slow, takes multiple steps and is inefficient.

Even the youngest generation, who have grown up with computers, and those with computing science degrees can’t make it work effectively.

The system’s ordering function is faulty and requires multiple separate steps and choices to order a simple medication: A processing issue safety experts know is highly likely to cause error.

And the system sometimes makes default changes in medication orders without the knowledge of the ordering physician. Single orders for medications disappear from the record, so that duplicate orders are initiated by unknowing doctors.

Deadly.

The consequence of these problems is that hospital-based care delivery is slower, more inefficient, more prone to error. Health-care providers are found interacting with their mobile computer monitors in already overcrowded hallways rather than providing direct patient care.

This was not what the pioneers intended.

Nurses and doctors have less of a holistic appreciation of their patients and their illnesses because of the disjointed complexity of the electronic record rather than the simple navigability of the previous paper record and charting.

That sums up a major problem with today's health IT well.

The medical community has finally taken matters into our own hands in the interests of patient safety, quality of care and access. A number of departments are refusing to continue using the system and instead returning to the previous one.

This type of revolt, showing who really owns the hospital, needs to become commonplace.

Why does Island Health not withdraw this system? In sum, they’ve spent a lot of taxpayers’ dollars on iHealth, a product of Cerner, which has been sued by hospital systems in the United States.

And as with many such systems, the objective has not been better patient care, but has been more Orwellian: Improved administrative data and control — no wonder Island Health is loath to give it up.

Indeed.

The CEO is himself a physician:

Well, Dr. Carr, the patient should be paramount. I and my family and my community are not expendable. No electronic record system should be introduced that will not explicitly improve health care, patient safety and access.

This anonymous doctor needs to speak to my mother, who I visited yesterday along with my father, on U.S. Memorial Day - at the cemetery after her encounter with bad health IT.

Read the whole Op Ed at the link above.

-- SS

New computer system a detriment to health care

New computer system a detriment to health care

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Are You Ready for Some (Political) Football? - the NFL, Concussion Research, the NIH, and the Revolving Door

Probably because it involved the favorite American sport, the controversy about the risk of concussions to professional National Football League (NFL) players, and how the NFL has handled the issue is very well known.  A recent article in Stat, however, suggested that one less well known aspect of the story overlaps some issues to concern to Health Care Renewal.

Allegations that a Prominent Physician and NFL Official Tried to Influence the NIH Grant Review Process

The article began,

Dr. Elizabeth Nabel, president of Boston’s Brigham and Women’s Hospital [BWH] and one of the nation’s most prominent medical executives, was part of a National Football League effort to 'steer funding' for a landmark concussion study away from a group of respected brain researchers, according to a congressional committee report that was sharply critical of the league.

The report found that the NFL 'inappropriately attempted to influence' the National Institutes of Health’s [NIH] grant selection process.

Dr Nabel, in fact, not only runs the BWH, a renowned teaching hospital and major component of Partners Healthcare, but also serves as the "chief health and medical advisor" to the NFL. Anyone who has followed even a bit of the media coverage about the NFL and concussions affecting football players knows that the NFL could be negatively affected by any more research that associates playing professional football, concussions, and the adverse effects of concussions. 

The Stat article chronicled the intricate communications between Dr Nabel and the NIH as documented by a report from the Democratic staff of the House Committee on Energy and Commerce.

 It cited a series of communications between NFL representatives, including Nabel, and officials of the NIH, and a foundation that accepts gifts from private donors to support NIH research. The discussions began after the NIH decided last year to award a $16 million grant to a research team led by Dr. Robert Stern of Boston University — but before the award was publicly announced.

The money for the grant was to come from a donation pledged by the NFL to the Foundation for the National Institutes of Health, and league officials say they were concerned about aspects of Stern’s group and the proposed study.

Research by Stern’s team and BU colleagues has helped establish a link between football and chronic traumatic encephalopathy, long-term brain damage that’s been observed in a growing number of athletes, including former NFL players, who suffered repeated head injuries.

The implication seems to be that this research group might be counted on to fearlessly pursue research even if the outcomes suggested that playing football might lead to adverse medical effects, which might not be so good for the NFL's interests.  So,

Nabel, who knows the NIH well from her 10 years working as a high-level manager in the agency, sent two emails to Dr. Walter Koroshetz, director of the National Institute of Neurological Disorders and Stroke [NINDS], according to the report. That’s the NIH branch that was awarding the grant.

In one email on June 23, 2015, she wrote, 'I am taking a neutral stance here,' while noting a concern about a potential conflict of interest: members of the NIH grant review panel had coauthored papers with two researchers that she had heard might be receiving the grant — Dr. Ann McKee and Dr. Robert Cantu of BU.

Later that day, she wrote Koroshetz that 'a Dr. Stern, who may also be with this group, has filed independent testimony in the NFL/Players Association settlement.'

Indeed, Stern was critical of how the settlement would be administered, pointing out flaws with the neuropsychological tests that the league proposed using to determine how to compensate injured players.

 Notwithstanding that Dr Nabel had an obvious conflict of interest herself: she worked for the NFL.  In any case,  

'I hope this group is able to approach their research in an unbiased manner,' Nabel’s email continued, the report says.

Nabel sent Stern’s testimony to Koroshetz, according to the report.

'My sole objective,' Nabel said in her statement, was to ask her former NIH colleagues to 'ensure there were no conflicts of interest among grant applicants.'

The NIH found no conflicts involving the grant review panel and stuck with its decision to award the grant to the Stern group. It ended up using internal funds, not the NFL money, to pay for the grant.

The NIH told STAT it agrees with the 'characterization of events in the report.'

An Affront to the Sanctity of the Grant Review Process?

Although Dr Nabel and the NFL asserted that they acted appropriately at all times, neither the committee staff nor one very prominent ethicist agreed,

The committee report said that Koroshetz disagreed ..., and said he was aware of no other instance where a donor raised objections to a grantee prior to the issuance of a notice of grant award.'

'The NFL’s characterization of the appropriateness of its actions suggests a lack of understanding of the importance of the NIH’s independent peer review process,' the committee report states.

Nabel’s spokeswoman said Koroshetz never told Nabel her actions were inappropriate. 'In fact, all of their interactions were very collegial and cordial,' she said.

I will interject that the question was not whether Dr Nabel was hostile or bullying, but was whether she tried to inappropriately influence the grant review process.  So also,

Arthur Caplan, a professor of bioethics at New York University, said Nabel’s actions, as described in the report, risk harming Nabel’s reputation and that of the Brigham. 'When she did anything to try to shape the selection of investigators or challenge the objectivity' of the grant selection process, he said, 'she had to know that that was 100 percent inappropriate, 100 percent unacceptable.'

Having served on numerous NIH and Agency for Healthcare Research and Quality (AHRQ) review committees (known as "study sections"),  let me add some context at this point.  Study section members must meet rigorous standards for freedom from conflicts of interest.  They also fiercely guard their independence.  The grant reviews they construct are supposed to be entirely about the scientific, clinical and public health merit of the proposals, and the scores they give proposals are the most important determinants of whether it gets funding.  Funding decisions are actually made by agency staff and advisory boards, but are supposed to depend only on the reviews and the general priority of the proposals' topics.  Nobody - I repeat, nobody - outside of this process is supposed to influence the funding decisions.

So the notion that big wigs from big outside organizations with vested interests in how a particular research project might turn out were communicating with top NIH officials about grant proposals, and that the officials allowed them to continue to communicate, and allowed even the chance they would be influenced by their communication strikes this old reviewer, to quote Dr Caplan, as "100 inappropriate, 100 percent unacceptable."

Did the Revolving Door Enable the Attempt to Influence NIH Grant Review?

Not directly discussed in the Stat article, however, was why Dr Koroshetz, director of NINDS, was willing to accept, if not agree with Dr Nabel's communications.  The article did note that Dr Nabel was a former "high-level manager" at the NIH.  In fact, according to her official Brigham and Womens' Hospital biography, Dr Nabel was director of the US National Heart, Lung and Blood Institute from 2005-2009.  She became CEO of the BWH in 2010.  Thus, she was a former top NIH leader who once held a rank commensurate with that held by Dr Koroshetz.

But wait, there is more.  Also according to her official BWH biography, Dr Nabel's husband is one  Gary Nabel, now the chief scientific officer at Sanofi.  Dr Gary Nabel, in turn, was Director of the Vaccine Research Center at the National Institute for Allergy and Infectious Diseases (NIAID), another NIH institute, through 2012, but then according to Science, became chief scientific officer at Sanofi. So Dr Nabel's husband was also a high-ranking NIH leader, although apparently not as high-ranking as his spouse and the NINDS director with whom she communicated. 

Thus it appears that maybe Dr Nabel had outsized influence at the NIH and on the NINDS director because she was a former NHLBI director, and the spouse of a former high-ranking NIAID leader.  Her attempts to influence the NIH grant application process therefore appear to be a possible manifestation, albeit delayed, and partially at one spousal remove, of the revolving door pheonomenon.

We have noted that the revolving door is a species of conflict of interest. Worse, some experts have suggested that the revolving door is in fact corruption.  As we noted here, the experts from the distinguished European anti-corruption group U4 wrote,

The literature makes clear that the revolving door process is a source of valuable political connections for private firms. But it generates corruption risks and has strong distortionary effects on the economy, especially when this power is concentrated within a few firms.

  This case suggests how the revolving door may enable certain of those with private vested interests to have excess influence, way beyond that of ordinary citizens, on how the government works.

Worse, this case also suggests how it seems that the country is increasingly run by a cozy group of insiders with ties to both government and industry.  In fact, just a little more digging reveals that a key player in this case has even more ties to big private health care organizations.  According to ProPublica, in the last three months of 2014, Dr Elizabeth Nabel received $26,070 from Medtronic, mainly for food, travel and lodging, but which included $8572 for "promotional speaking/ other."  In 2015, she was appointed to the board of directors of Medtronic, despite not having previously owned any Medtronic stock, according to the company's 2015 proxy statement.  Also in 2015, she was appointed to the board of directors of Moderna Therapeutics.    Her husband, as noted above, now works as chief scientific officer for Sanofi.

So, as we have said before.... The continuing egregiousness of the revolving door in health care shows how health care leadership can play mutually beneficial games, regardless of the their effects on patients' and the public's health.  Once again, true health care reform would cut the ties between government and corporate leaders and their cronies that have lead to government of, for and by corporate executives rather than the people at large.

Video addendum: the beginning of "League of Denial" from PBS Frontline



ADDENDUM (29 May, 2016) - This post was republished on the Naked Capitalism blog.

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Travel Tips To Pack Light With Ease Every Time

I despise packing for a trip.  To be precise, I despise it immensely.  I loathe every last detail so much I am ashamed to admit, a few times, I considered canceling my trip just because I didn't want to pack for it. And if you knew how much I enjoy seeing new places and how I feel it is part of living a healthy lifestyle, you would understand it's an issue!

And, to make it even more tragic, I think I passed my "hate packing gene" to one of my daughters. One time before we left for a trip when we had an early flight to catch, I opened her bedroom door to remind her of the time. There, I found her throwing her entire closet in a suitcase just because - you guessed it - she hates to pack and had procrastinated and left the packing task to the very last possible moment!

So, if you are in the "despise packing camp" like me and my daughter, I have a packing strategy to make it a little more bearable. Come see how I lessen the pain with a few travel multitaskers, a bag I always have packed ready-to-go as well as lots of packing hints from other travel masters that could help you, too! And, of course, I do hope you will add your packing and travel ideas in the comments as well!

5 Health And Beauty Multitaskers To Travel Light

Despite my shuddering at the thought of packing, I know travel is necessary to connect with those I care about, learn new things and to stimulate my mind (all part of creating that healthy lifestyle!).

One trick I implement is creating travel size containers (see my favorites in the next section) of items that can multi-task and save room in my bag. And I always refill them each time upon my return from my trip so that they are ready for the next dreaded packing task. (Check! One less thing to pack!) And, believe it or not and as strange as it sounds, five of them are food items that can be used for some effective home remedies, too. Here they are and how and why I use them:


1.  Baking soda

It is inexpensive, and I can use it as a facial skin exfoliator, toothpaste, bee sting remedy and more. I am not the only one that uses it a lot as here are 31 other uses for baking soda as well!


2.  Coconut oil

I use it as a body moisturizer, eye makeup remover, hair conditioner (on the tips if needed on the beach), and lip moisturizer before bed. I use this on my carry-on for long flights, too;

Don't miss this:  What to pack in that carry-on to make your time in the air feel just like home!

3.  Raw honey

Raw honey is best over the processed variety and here's why. You can sweeten your tea and wash your face. This is the method I have used.


4.  Lemon

I throw a few lemons in my bag to make my morning lemon water, and if I am going to the beach, sometimes my daughters and I rub it in our hair to lighten.

Don't miss this: You won't believe all the great things you can do with those citrus peels!


5.  Pink salt

I wrote about how this is the hands down, much healthier salt to use for cooking but I can also use it as a body scrub (mixed in with a bit of my coconut oil) and a scratchy throat elixir for me, my family or anyone I am traveling with at the time.

Create A Ready-To-Go Travel Bag

Having a makeup/toiletries bag ready to go at a moments notice really lessens my stress load in packing!  Taking the time to set it up once and never again, with the exception of a few updates and refills here and there, makes me a whole lot more excited for my next travel adventure knowing part of my packing is already done! 

Here are a few items that are really useful to create your ready-to-go makeup/toiletries bag in a snap:

1.  I have tried a lot of make-up/toiletries travel bags and have learned you need one that you don't have to dig through or even half empty out to find things to save a whole lot of time getting dressed. This drawstring functional travel makeup bag can easily keep you organized!  It is roomy, easy to find things in and I love all the sections and the extra pockets. You can throw it in the washer after each trip, too! Great price and cute colors.

2.  There are never enough mirrors when traveling (especially with daughters!), so a light-weight, travel make-up mirror is a life-saver.  If I am not using it, my daughters are!

3.  All those beauty multitaskers I talked about in the above section as well as your shampoo, soap, etc. fit so well in these leak-proof, BPA-free and TSA approved bottles.  They have a lot of extra features, are well-rated and they can be labeled, too, which I really appreciate.  (Before I had labeled bottles, I used conditioner on my hair as shampoo more times than I'd like to admit! ) 

Stress-saving tip: Just make sure to refill your bottles soon after your return home so your travel bottles are ready for next time!

4.  I purchased an inexpensive, well-rated extra make-up brush set like this one to keep in my travel bag leaving my other nicer set at home.  That way I never forget a brush and never leave my better ones in a hotel bathroom! Plus, these are smaller and take up much less space.

5.  This plug adapter takes up so little room, that I just keep it in my bag for international trips if I am lucky enough to plan one.  It is well-rated and works great!


6.  Another task I am not particularly fond of is ironing.  I rarely iron anything before I pack it anymore because it is just so wrinkled by the time I arrive. But, this travel steamer is great to quickly make you look presentable and wrinkle-free.

8 Other Expert Packing Hints, Travel Links & Travel Tips

There are some real pros out there with some amazing packing hints I don't want you to miss! Tap here for major ideas as well as a few other words I have about travel mixed in below:

1.  Oh my! This guy is a packing ninja and takes only 15 minutes to do it.

2.  International traveling takes a bit more thought. Here are important things to consider.

3.  Make your travel dreams a reality with this step-by-step plan to get you there . . . even if it seems impossible financially or logistically!

4.  Squeeze the most out of your travel adventure with these methods.

5.  You can't miss this fun and really helpful video on packing tips!

6.  How and why traveling can enhance your health!

7.  I don't think I could manage this, but I sure do admire those that do: pack for a month in a carry-on.

8.  Get every last detail here on packing lightly.

For Even More On The Topic . . .

• Consider throwing in your suitcase these other natural skin treatments!  

• While you are packing, best do a quick look-over in your bathroom and see if there are some things you could easily replace with healthier options. 

Please share any packing suggestions, tips or let us in on your secret on how you psyche yourself to prepare for your travel adventures! After all, I need all the help I can get!

This post previously appeared at THM but has been greatly expanded and updated.

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No Questions Asked - Journalist Parrots the Talking Points in Support of Hospital Executive Compensation

The problem of ever rising, amazingly generous pay for top health care managers is a frequent topic for Health Care Renewal.  We have suggested that the ability of top managers to command ever increasing pay uncorrelated with their organizations' contributions to patients' or the public's health, and often despite major organizational shortcomings indicates fundamental structural problems with US health, and provides perverse incentives for these managers to defend the current system, no matter how bad its dysfunction.

In particular, we have written a series of posts about the lack of logical justification for huge executive  compensation by non-profit hospitals and hospital systems.  When journalists inquire why the pay of a particular leader is so high, the leader, his or her public relations spokespeople, or hospital trustees can be relied on to cite the same now hackneyed talking points.

As I wrote last year,  and last week,

It seems nearly every attempt made to defend the outsize compensation given hospital and health system executives involves the same arguments, thus suggesting they are talking points, possibly crafted as a public relations ploy. We first listed the talking points here, and then provided additional examples of their use. here, here here, here, here, and here, here and here. 

They are:
- We have to pay competitive rates
- We have to pay enough to retain at least competent executives, given how hard it is to be an executive
- Our executives are not merely competitive, but brilliant (and have to be to do such a difficult job).

Yet as we discussed recently, these talking points are easily debunked.  Additionally, rarely do those who mouth the talking points in support of a particular leader provide any evidence to support their applicability to that leader.

Bit at least most journalists who inquire into hospital executive compensation make an attempt to be "fair and balanced" by also quoting experts who question the talking points.

Hospital Executive Compensation in Central Pennsylvania

However, we just found an ostensibly journalistic survey of local hospital executive compensation in the Reading (PA) Eagle which seemed designed to encourage the public to welcome their ever more highly paid corporate health overlords.  This started with its title:

Nonprofit health care organizations pay for the best executives

And its opening paragraph

At first blush, the leaders of area hospitals are handsomely compensated. But a Reading Eagle analysis finds that their compensation is in line with hospital administrators in other areas.

The author was not shy about documenting the munificent pay of local hospital executives, seven of whom received more than $1 million as documented by their organizations' most recent financial reports.

 Harold Paz, CEO of Hershey Medical Center (Penn State University) topped the list in 2014, at $1.57 million.
+++
Second was Thomas E. Beeman, former president and CEO of Lancaster General Health, at $1.5 million.
+++
Third was Clint Matthews, president and CEO of Reading Health System, at $1.44 million in 2014, the most recent year information was available.

Then,

Fourth place in total compensation went to Ronald W. Swinfard, trustee and CEO of the Lehigh Valley Health Network, at $1.32 million in 2014.

Fifth place in total compensation was Kevin Mosser, director and CEO, WellSpan Health at Ephrata Community Hospital, at $1.29 million.

Sixth place was Rod Erickson, former president, Hershey Medical Center, Penn State, $1.28 million.

Seventh place was Richard Seim, president, WellSpan Specialty Services, WellSpan Health, $1.01 million.

In eighth place was Michael F. O'Connor, CFO. WellSpan, Ephrata Community Hospital, $993.618.

Ninth was Charles Chodroff, president, South Central Preferred, WellSpan Health, $906,582.

Tenth was Rodney Kirsch, senior VP, development, Hershey Medical Center Penn State, $860,445.

Eleventh was John Morahan, chair, president and CEO, Bornemann Health Corp. and St. Joseph Regional Health, at $841, 246. Bornemann is an affiliate of St. Joseph Regional Health, and compensation came from Catholic Health Initiatives.

Parroting the Talking Points

But the public should fear not, because, as the talking points say....

We have to pay competitive rates

This was invoked early in the article.

The Reading Eagle review also found that leaders of hospitals in Berks County are compensated in line with their counterparts at other medical centers in Pennsylvania.

Also,

Overall, the compensation of medical nonprofit leaders in Berks County is on par with leaders of similar locations elsewhere, said Chester Mosteller, founder and president of Mosteller and Associates, a human resource professional services firm in Reading.

We have to pay enough to retain at least competitive executives

To support both the first and this talking point, the article cited a local expert,

 Nonetheless, people are sometimes surprised at high compensation levels at nonprofit hospitals, said Tish Mogan, standards for excellence director at the Pennsylvania Association of Nonprofit Organizations in Harrisburg. But, Mogan noted, if the leaders of nonprofit hospitals were not well compensated, they could be poached by for-profit medical centers.

'They have to be competitive,...

Doubling down, the article also cited  "Anna Valuch, director of marketing for Reading Health System," whose CEO, her boss, pulled down $1.44 million. She said

the system's board of directors takes seriously its responsibilities in terms of creating an executive compensation plan that is fair, competitive and consistent with the system's mission to provide the highest quality health care.

Later, the reporter quoted Ms "Cindy Bergvall, co-owner of accounting firm Bee Bergvall and Co in Bucks County and its affiliate, the Catalyst Center for Nonprofit Management," as saying

nonprofit health care organizations are competing with for-profit organizations for talent, so they must offer competitive wages.

Our executives are brilliant

Ms Morgan immediately segued into a claim that executives

have to make sure that somebody's in charge that has the capability to make sure that, if I'm on that procedure table, things are in place to take care of me,

Mr Mosteller had a different version of the brilliance argument.

'It's been extremely challenging with the Affordable Care Act and Medicare, and that all results in some very big challenges within the health care arena,' he said. 'It is by no means an easy nonprofit to run and manage. It's become increasingly complex to operate and fulfill your mission in those environments.'

Similarly, "J Andrew Weidman, chairman of the board of directors for Penn State Health St. Joseph," put all three talking points into one sentence,

'To be in the best position to recruit and retain vital and talented employees, we must pay competitive wages,' Weidman said.

So did "Brian Downs, director of media relations for Lehigh Valley Health Network," who worked for CEO Ronald W Swinfard, who pulled down $1.32 million,

'To attract and retain the highest caliber health care professionals needed to sustain the quality of care LVHN provides to our community, and to oversee the operation of a nearly $2 billion organization, we must offer compensation that is competitive with organizations we compete with for talent in the job market,' Downs said.

Note that several of these experts/ commenators worked directly for the very well compensated hospital system CEOs of interest, and the others apparently worked for firms that got financial support from these CEOs' hospital systems. 

No Questions Asked

While the Eagle quoted multiple proponents of high executive pay repeating all the talking points, the reporter apparently did not challenge any of them to justify any of the talking points in the context of interest.  In particular, no one provided any evidence that any of the particular executives are so brilliant, or as the article implies, why ALL local executives are brilliant.  How can there not be a single average one in the bunch?

In fact, a quick Google search reveals reasons to questions the brilliance of at least some of them.  For example, Hershey Medical Center, whose CEO was the highest paid of the group, has proposed a controversial merger which is the subject of strong opposition by the US Federal Trade Commission (FTC).  (See articles in Modern Healthcare and PennLive.  Per Modern Healthcare, the FTC is claiming that the merger would lead to "higher prices and diminished quality [of care]." Especially given that the FTC seemingly has a high threshold to challenge a hospital system merger, its opposition certainly suggests questions about current hospital management.  Also, Lancaster General Health, whose CEO was the second best paid of the group, had to pause a big expansion project because of cost overruns (see this article in Lancaster Online), and suffered a major outage of its electronic health record (EHR) system (see this article in Lancaster Online).  

Yet the Reading Eagle reporter did not raise these incidents, nor question anyone about the supposed brilliance of the leaders at the institutions that suffered them.

Furthermore, many of the points made on behalf of high executive pay raised obvious questions that were not asked.  For example,  Ms Morgan was not asked whether any executives actually have been recently "poached."  Ms Bergvall was not asked to name the for-profit organizations with which the hospital systems was competing for talent.   Strikingly, Ms Bergvall also was not asked to justify the assertion that it is the responsibility of hospital managers, not physicians, to make sure that "when I am on the procedure table, things are in place to take care of me."

Even more strikingly, Ms Bergvall was apparently not questioned further after she suggested that CEOs may command more pay simply because  they may feel entitled to a big dollop of all the money flowing throught he health care system

when nonprofit organizations bill for services, like hospitals do, they usually have the financial resources to compensate people well.  

'In the health care industry, you have an income stream that allows you to pay better,' Bergvall said.

Of course, many of the media reports on high executive compensation in health care do not report any cross-examination of its supporters.  Perhaps these advocates refused to respond to such questions, or the reporters felt too intimidated to challenge them.

But nearly all articles that try to delve into executive compensation at all at least quote some experts who are skeptical of current practices.  And there are real reasons to be skeptical.  As we discussed here, there is a strong argument that huge executive compensation is more a function of executives' political influence within the organization than their brilliance or the likelihood they are likely to be fickle and jump ship even bigger 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. 

This article included no such attempts at balance.  So it ended up more like propaganda for managers' current privileged position in health care than journalistic inquiry.  It is sad to see reporting about important health policy issues devolve into propaganda to support the status quo, and those who personally profit the most from it.  But perhaps those who work at the Reading Eagle hesitate to offend those who are making the most from the current system.  It appears that the newspaer is owned by the Reading Eagle Company, and this, in turn is owned by the Barbey family, which according to Politico also

controls the publicly-traded lifestyle clothier VF Corporation (Nautica, Jansport, Wrangler, Timberland, Lee, Vans, etc.) and is ranked no. 48 on Forbes' list of America's richest families.

Discussion

We will not make any progress reducing current health care dysfunction if we cannot have an honest conversation about what causes it and who profits from it.  In a democracy, we depend on journalists and the news media to provide the information needed to inform such a discussion.  When the news media becomes an outlet for  propaganda in support of the status quo, the anechoic effect is magnified, honest discussion is inhibited, and out democracy is further damaged.

True health care reform requires ending the anechoic effect, exposing the web of conflicts of interest that entangle health care, publicizing who benefits most from the current dysfunction, and how and why.  But it is painfully obvious that the people who have gotten so rich from the current status quo will use every tool at their disposal, paying for them with the money they have extracted from patients and taxpayers, to defend their position.  It will take grit, persistence, and courage to persevere in the cause of better health for patients and the public. 

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Secrets To Create Great Abs and Amazing Health

Stressing over the number on the weight scale? Well, get this! That number actually may not be as important to your health than the size of your tummy! Yes, studies say even skinny people with a BMI (body mass index) in the normal range could still be in the red zone, depending on the shape of their mid-section.

You see, the fat that lies just below your skin (not that we want to, but the kind you can grab with your hands) is called subcutaneous fat. In your belly, it’s called visceral fat because it builds up in the spaces between and around your viscera -- internal organs like your stomach and intestines. And, fat build up there -- not a good thing!  Keep reading to find out why that is so and find some exact steps to take to get rid of it that don't just involve exercise and diet.

Why Belly Fat Is Especially Dangerous To Our Health

Here are some reasons why we really need to pay attention to that spare tire that could be forming:

• This visceral fat is a different animal as the fat in your middle makes toxins that affect the way your body works.  Those toxins include chemicals called cytokines that doctors say boost your chances of heart disease and make your body less sensitive to insulin, which can bring on diabetes.

• Cytokines also cause long-term inflammation, our bodily enemy as this can lead to certain cancers of the colon, esophagus, and pancreas.

• Scientists think cancer is caused by cell mutations as they divide. Fat in your abdomen may spur on hormones that prompt cell division.  More cell division means more opportunities for cell mutations, which means more cancer risk.

3 Ways Creating Strong Abs Can Make Your Everyday Life Much Better

Besides not wanting to be a toxin-making machine creating possible disease and looking good in your clothes, here are some other reasons creating a strong core can make a big difference in your everyday life:

1.  Strong core. Stronger back. Less pain. Better mood.

Back pain can really get in the way of living life and make us cranky! And, a lot of back pain is related to weak muscles in your trunk. Thus, working on strengthening that midsection can help resolve many back issues. The muscles in your core weave throughout your torso and attach to your spine. Consequently, when ab muscles are weak, it creates some strain on the spine.

Don't miss this:  A list of other tips to keep your back strong and nimble.


2.  Trim tummy. Better sleep. More energy.

Belly fat can bring on chronic, loud snoring and maybe even sleep apnea. People who have sleep apnea literally stop breathing for a few seconds to even more than a minute sometimes all night long greatly disrupting sleep. Who wouldn't feel exhausted after a night like that? But, losing weight can often help remedy the problem so you can get a better night's sleep and, of course, more air!

Don't miss this:  Why and how cherries can be a smart snack for better sleep.



3.  Flat stomach. Protection from injury. More free time.

Who wants to spend their time on crutches with a sprain, at doctors' offices or worse on the operating table for a repair.  No one. A flat, strong, stomach can help protect you from injury.  Unlike any other muscles in your body, a strong core affects the functioning of the entire body and how it moves. Whether you garden, hike, run marathons or chase kids all day, the stronger the abs, the better protected you are from injuring yourself.

How To Successfully Create A Flatter Stomach and Much Healthier Body

Regular exercise and healthy food choices are fundamental to create a flat and strong core (as well as optimal health overall!), but here are some essential tweaks to creating success with that critical goal in mind:

1.  Eat well and don't starve yourself!

Going around hungry all the time isn't fun! And, if you think it helps lessen belly fat, scientists would tell you are wrong.  Eating enough food (yes, of course, healthy whole food choices!) keeps your body from experiencing hormone imbalances.  Eating too few calories reduces the amount of the fat-burning hormone leptin in your body, which will slow down weight loss.

Don't miss this:  None of these nutrient-dense foods will add inches to your waistline!

2. Stand tall and ready.

I am the Mom always on my daughters to watch their posture and I must say, they get compliments on their good posture! Not only do you appear more confident and positive, having good posture takes 5 pounds off! And carrying yourself all day strong and tall without slumping is much better for your back and keeps your abs strong, too.

3.  Create smart exercise routines that don't hog your day!

Don't get me wrong, that ab routine can help define muscles, but cardio for overall weight loss is important too, to show the definition.  Shorter cardio workouts that use high-intensity interval training is showing more effective for fighting belly fat, too.

Don't miss this:  Check out this 25-minute interval training routine I have been doing lately at home that doesn't hurt my knees!


4. Take time to unwind.

A constant high level of stress can lead to higher levels of the stress hormone cortisol in your body, which can increase the amount of tummy fat.  For a flatter stomach and so many other reasons, find a few ways that lessen your stress today.

Don't miss this:  For many, it is hard to know how to unwind.  I have 25 ways that may help you destress successfully right here.


5.  Don't drink your calories.

Opt out of the sugary drink habit. There are many better options than choosing drinks that have calories and that can cause weight gain around the middle.  Clean water is always a great way to hydrate and support your body, but if you don't like the taste of water much, add citrus or a sprig of fresh herbs to liven it up.  Your taste buds will adjust to the lack of sweetness! My husband, an avid tea drinker, slowly learned to delete the sugar he adds to his tea and now he adds none and hates the taste of sugary tea. If he can do it, you can!

Don't miss this:  Here are some of my family's favorite toxin-free water bottles we use to stay well hydrated on the go.

For Even More On The Topic . . .

• Here is how I created an effective home gym that fits under my couch!

• Lots and lots of ab exercise routines can be found right here.

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Host Your Best Barbecue . . . the Healthy Way!

Fire up the grill, get those coals glowing. gather around the Barbie.  It is a favorite summer activity for many cultures -- grilling with friends and family!  There are endless cookbooks and even numerous TV competitions dedicated to this method of cooking.  But the TV hosts don’t mention that many studies have discovered cancer-causing compounds can be created when grilling those foods.

I certainly do not want to throw water on a favorite social past time and I don't plan to! Instead,  I have for you a few small measures you can take to counteract what science has been telling us about the bad effects of grilling our foods. Come take a look and get on with hosting your best barbecue -- the healthy way!

Why Grilling Can Be Bad For Your Health

Here is a bit more about what the studies about grilling are telling us:

• Grilling and pan frying can cause the harmful cancer-causing chemicals heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) to form when meats like beef, pork, fish or poultry are cooked using high-temperature methods.

• These compounds are the same as those found in cigarette smoke.  And we already know how unhealthy that is.

• The formation of HCAs and PAHs varies by meat type, cooking method, and how long the food has been grilled or cooked.  Meats cooked at high temperatures, especially above 300ºF (as in grilling or pan frying), or that are cooked for a long time tend to form more HCAs. 

8 Easy Tips To Grill The Healthy Way

So, that was the bad news.  Here is the good news! There are remedies that can interfere or derail this HCA and PAH formation.  And here are some simple ways to do just that:

1.  Give it a soak.

Adding several antioxidant-rich foods to marinades counteracts those DNA damaging compounds nicely.  Reach for foods like these when grilling:

• Add spices to your dishes such as turmeric, garlic and sage when creating a marinade.  

• Fresh herbs like rosemary and parsley are strong counterparts.  

• Yogurt and olive oil make great bases for effective marinades as well as wine and especially beer and stout ale.   

• Fresh fruit such as grapes, cherries, prunes, blackberries and blueberries are great antioxidants to add as well.

Don't miss this: Tap here for a great tip on how to use that antioxidant, inflammation-fighting spice, turmeric, the right way to get all those amazing health benefits!


2.  Add Vitamin E.

Some studies have shown 400 I.U. from a vitamin E capsule rubbed in the meat can counteract HCA and PHA formation.

3. Turn down the flame.

Grilling low and slow is the best method to create lower levels of char.

4.  Flip often.  

Turn the meat over often to avoid too much charring.


5. Include lots of fruits and vegetables!

Those wonderful colorful veggies offer a free pass. There is no HCA and PHA formation when grilling vegetables. Serving some fruits like apples or pineapple alongside the grilled items can counterbalance the harmful compounds, too. 

Don't miss this:  You should try some of these healthy vegetable recipes.


6.  Choose foods wisely.

Skinless chicken creates 50 percent less risk of HCA and PHA formation. Fish and seafood tend to form much lower levels of cancerous compounds as well.


7.  What you drink can help, too.

Go ahead and tip your glass for a few suds as stout ale has been shown to be a most effective neutralizer of HCAs in red meat.  Green tea is the non-alcoholic beverage of choice with grilled items as well. They both make great marinades as well for taste and to reduce the dangerous compounds from forming.

Don't miss this:  Lots of ideas for hundreds of healthy drink ideas at your fingertips!

8.  Choose natural charcoal.

Avoid self-lighting charcoal and lighter fluid as they contain harmful petroleum products which can be absorbed into what you are grilling.

Don't miss this:  Follow my Pinterest board completely dedicated to healthy grilling!

Top Tools To Create Your Perfectly Healthy Barbecue

Create that perfectly healthy barbecue for your family and friends with tools like these that I have round-up for you.  See if any of these items I have linked to can set the scene for your best outdoor time:

1.  Mini Lantern Set: Can't have a party without festive lighting.  These strands are adorable and great for an outdoor barbecue to liven things up!

2.  Silicone Grill Brush:  Gotta use one of these to baste those tasty and healthy marinades on your foods!

3.  Quilted Hammock:  Your friends and family will love you for setting up a comfortable hammock like this one. It screams summer outdoors and fun times!

4.  Natural Charcoal:  No chemicals here to add toxicity to your beautiful healthy meals!

5.  Drink Dispenser:  Let everyone serve themselves with a great drink dispenser for that tasty green tea sangria (recipe below!).

6.  Grill pan:  Throw those critical veggies in here to keep it easy and not let them fall through the grates!

Two Healthy Barbecue Recipes

Here are a two favorite simple healthy recipes that you could serve at your next barbecue with a lot less worry over those unwelcome toxic, cancer-causing guests forming on your platter:

1.  Green Tea Sangria (Non-Alcoholic)

Gather

• 7 green tea bags
• 7 cups filtered water
• 2 cups blackberries, blueberries and pitted cherries combined
• 1 green apple sliced
• optional:  2 tablespoons or so of maple syrup or raw honey 
• fresh mint

Now Do This

• Place tea bags in pitcher or container that can tolerate almost boiling water.
• Boil the water just under the boil and pour over tea bags to steep for 5 - 10 minutes.
• While tea is steeping, slice apple and rinse berries and cherry pieces.
• Remove tea bags after the tea is reached desired strength.
• Add fruit and maple syrup or honey, if using.
• Stir and allow to cool and for flavors to mesh.
• Serve over ice and garnish with sprigs of mint.

2.  Grilled Chicken with Spiced Yogurt

Gather

• 1 pound boneless, skinless organic chicken thighs
• 1.5 cups organic plain Greek yogurt
• 1 teaspoon turmeric
• 1 teaspoon cumin
• 2 small cloves garlic minced
• 1 teaspoon oregano
• 1 teaspoon minced rosemary
• 1.5 tablespoons fresh lemon juice
• few bits of lemon peel grated
• 1/4 cup minced, fresh parsley

Now Do This

• Combine yogurt with turmeric, cumin, garlic, oregano, rosemary, lemon juice and lemon peel.
• Stir well to make the marinade.
• Set aside half of mixture for sauce and refrigerate in a glass container.
• Cover chicken pieces well with remaining marinade and refrigerate for at least a few hours but overnight is better.
• Grill chicken until internal temperature reaches 165 degrees.
• Cover and let it rest for five minutes.
• Sprinkle with minced parsley.
• Serve with extra set-aside marinade as dipping sauce.

Serve with steamed rice of choice and some grilled tomatoes and zucchini.

For Even More On The Topic . . . 

• Brush up on which healthy cooking oils you should use in your kitchen and on the grill.

• Here is why I choose maple syrup as a sweetener like I do in the Green Tea Sangria above.

Jump in! Do you have a favorite healthy grilling recipe to share? Please do and provide a link in the comments!

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