Consider this . . .

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Monday, November 26, 2007

Garlic Benefits


cloves of garlicWhat makes garlic good for you? (Chris Ramirez for The New York Times)

Garlic has long been touted as a health booster, but it’s never been clear why the herb might be good for you. Now new research is beginning to unlock the secrets of the odoriferous bulb.

In a study published today in the Proceedings of the National Academy of Sciences, researchers show that eating garlic appears to boost our natural supply of hydrogen sulfide. Hydrogen sulfide is actually poisonous at high concentrations — it’s the same noxious byproduct of oil refining that smells like rotten eggs. But the body makes its own supply of the stuff, which acts as an antioxidant and transmits cellular signals that relax blood vessels and increase blood flow.

In the latest study, performed at the University of Alabama at Birmingham, researchers extracted juice from supermarket garlic and added small amounts to human red blood cells. The cells immediately began emitting hydrogen sulfide, the scientists found.

The power to boost hydrogen sulfide production may help explain why a garlic-rich diet appears to protect against various cancers, including breast, prostate and colon cancer, say the study authors. Higher hydrogen sulfide might also protect the heart, according to other experts. Although garlic has not consistently been shown to lower cholesterol levels, researchers at Albert Einstein College of Medicine earlier this year found that injecting hydrogen sulfide into mice almost completely prevented the damage to heart muscle caused by a heart attack.

“People have known garlic was important and has health benefits for centuries,'’ said Dr. David W. Kraus, associate professor of environmental science and biology at the University of Alabama. “Even the Greeks would feed garlic to their athletes before they competed in the Olympic games.'’

Now, the downside. The concentration of garlic extract used in the latest study was equivalent to an adult eating about two medium-sized cloves per day. In such countries as Italy, Korea and China, where a garlic-rich diet seems to be protective against disease, per capita consumption is as high as eight to 12 cloves per day.

While that may sound like a lot of garlic, Dr. Kraus noted that increasing your consumption to five or more cloves a day isn’t hard if you use it every time you cook. Dr. Kraus also makes a habit of snacking on garlicky dishes like hummus with vegetables.

Many home chefs mistakenly cook garlic immediately after crushing or chopping it, added Dr. Kraus. To maximize the health benefits, you should crush the garlic at room temperature and allow it to sit for about 15 minutes. That triggers an enzyme reaction that boosts the healthy compounds in garlic.

Garlic can cause indigestion, but for many, the bigger concern is that it can make your breath and sweat smell like…garlic. While individual reactions to garlic vary, eating fennel seeds like those served at Indian restaurants helps to neutralize the smell. Garlic-powder pills claim to solve the problem, but the data on these supplements has been mixed. It’s still not clear if the beneficial compounds found in garlic remain potent once it’s been processed into a pill.





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Sunday, November 25, 2007

Cost of Health Care

Editorial

The High Cost of Health Care

Published: November 25, 2007

The relentless, decades-long rise in the cost of health care has left many Americans struggling to pay their medical bills. Workers complain that they cannot afford high premiums for health insurance. Patients forgo recommended care rather than pay the out-of-pocket costs. Employers are cutting back or eliminating health benefits, forcing millions more people into the ranks of the uninsured. And state and federal governments strain to meet the expanding costs of public programs like Medicaid and Medicare.

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Health care costs are far higher in the United States than in any other advanced nation, whether measured in total dollars spent, as a percentage of the economy, or on a per capita basis. And health costs here have been rising significantly faster than the overall economy or personal incomes for more than 40 years, a trend that cannot continue forever.

It is the worst long-term fiscal crisis facing the nation, and it demands a solution, but finding one will not be easy or palatable.

The Causes

Varied and Deep-Rooted. Contrary to popular beliefs, this is not a problem driven mainly by the aging of the baby boom generation, or the high cost of prescription drugs, or medical malpractice litigation that spawns defensive medicine. Those issues often dominate political discourse, but they have played relatively minor roles in driving up medical spending in this country and abroad. The major causes are much more deep-seated and far harder to root out.

Almost all economists would agree that the main driver of high medical spending here is our wealth. We are richer than other countries and so willing to spend more. But authoritative analyses have found that we spend well above what mere wealth would predict.

This is mostly because we pay hospitals and doctors more than most other countries do. We rely more on costly specialists, who overuse advanced technologies, like CT scans and M.R.I. machines, and who resort to costly surgical or medical procedures a lot more than doctors in other countries do. Perverse insurance incentives entice doctors and patients to use expensive medical services more than is warranted. And our fragmented array of insurers and providers eats up a lot of money in administrative costs, marketing expenses and profits that do not afflict government-run systems abroad.

Does It Matter? If citizens of an extremely wealthy nation like the United States want to spend more on health care and less on a third car, a new computer or a vacation home, what’s wrong with that? By some measures, Americans are getting good value. Studies by reputable economists have concluded that spending on such advanced treatments as cardiac drugs, devices and surgery; neonatal care for low-birth-weight infants; and mental health drugs have more than paid for themselves by extending lives and improving their quality.

But if health care spending continues on its same trajectory, the United States will reach the point — probably several decades from now — where every penny of the annual increase in gross domestic product would have to go for health care. There would be less and less money for other things, like education, environmental protection, scientific research and national security, that may be equally or more important to the well-being of society.

Governmental budgets will face the crisis even sooner. States are already complaining that they have to crimp other vital activities, like education, to meet soaring Medicaid costs. And federal spending on Medicare and Medicaid is surging upward at rates that will cause the deficit to soar. That means politicians will have to raise taxes, severely cut a wide range of other governmental programs, or chop back the health programs themselves.

The question is: What can be done to lower both the high level of health care spending and its high rate of increase from year to year?

The Solutions

Geography. Pioneering studies by researchers at Dartmouth have shown enormous disparities in expenditures on health care from one region to another with no discernible difference in health outcomes. Doctors in high-cost areas use hospitals, costly technology and platoons of consulting physicians a lot more often than doctors in low-cost areas, yet their patients, on average, fare no better. There are hints that they may even do worse because they pick up infections in the hospital and because having a horde of doctors can mean no one is in charge.

If the entire nation could bring its costs down to match the lower-spending regions, the country could cut perhaps 20 to 30 percent off its health care bill, a tremendous saving. That would require changing the long- ingrained practices of the medical profession. Public and private insurers might need to refuse coverage for high-cost care that adds little value.

Stick to What Works. The sad truth is that less than half of all medical care in the United States is supported by good evidence that it works, according to estimates cited by the Congressional Budget Office. If doctors had better information on which treatments work best for which patients, and whether the benefits were commensurate with the costs, needless treatment could be junked, the savings could be substantial, and patient care would surely improve. It could take a decade, or several, to conduct comparative-effectiveness studies, modify relevant laws, and change doctors’ behavior.

Managed Care. For a brief period in the 1990s it looked as if health maintenance organizations competing for patients and carefully managing their care might bring down costs and improve quality at the same time. The H.M.O.’s did help restrain costs for a few years. The problem was, doctors and patients hated the system, management became much looser, and the upsurge in costs resumed. Managed care techniques are creeping back into some health plans, especially for services apt to be overused, but too heavy a hand would most likely produce another backlash.

Information Technologies. The American health care system lags well behind other sectors of the economy — and behind foreign medical systems — in adopting computers, electronic health records and information-sharing technologies that can greatly boost productivity. There is little doubt that widespread computerization could greatly reduce the paperwork burden on doctors and hospitals, head off medication errors, and reduce the costly repetition of diagnostic tests as patients move from one doctor to another. Without an infusion of capital, the transition from paper records is not apt to happen very quickly.

Prevention. Everyone seems to be hoping that preventive medicine — like weight control, exercise, better nutrition, smoking cessation, regular checkups, aggressive screening and judicious use of drugs to reduce risks — will not only improve health but also lower costs in the long run. Preventive medicine actually costs money — somebody has to spend time counseling patients and screening them for disease — and it is not clear how soon, or even whether, substantial savings will show up. Still, the effort has to be made. The Milken Institute recently estimated that the most common chronic diseases cost the economy more than $1 trillion annually, mostly from lost worker productivity, which could balloon to nearly $6 trillion by the middle of the century.

Disease Management. Virtually all policy experts want more careful coordination of the care of chronically ill patients, who account for the largest portion of the nation’s health care expenditures. Although that should improve the quality of the care they get, coordination may not cut costs as substantially as people expect. In some initial trials it has cut costs, in others not.

Drug Prices. Compared with the residents of other countries, Americans pay much more for brand-name prescription drugs, less for generic and over-the-counter drugs, and roughly the same prices for biologics. This page believes it would be beneficial to allow Medicare to negotiate with manufacturers for lower prescription drug prices and to allow cheaper drugs to be imported from abroad. The prospect for big savings is dubious.

Who Picks Up the Tab?

Pay Providers Less. With doctors dreadfully unhappy under the heavy hand of insurers, it would seem shortsighted to make them even unhappier by cutting their compensation to levels paid in other countries. But many experts believe it should be possible to tap into the vast flow of money sluicing through hospitals, nursing homes and other health care facilities to find savings.

Emphasize Primary Care. In a health system as uncoordinated as ours, many experts believe we could get better health results, possibly for less cost, if we changed reimbursement formulas and medical education programs to reward and produce more primary care doctors and fewer specialists inclined to proliferate high-cost services. It would be a long-term project.

Skin in the Game. The solution favored by many conservatives is to force consumers to shell out more money when they seek medical care so that they will think harder about whether it is really necessary. The “consumer-directed health care” movement calls for providing people with enough information about doctors and treatments so that they can make wise decisions.

There would most likely be some savings. A classic experiment by Rand researchers from 1974 to 1982 found that people who had to pay almost all of their own medical bills spent 30 percent less on health care than those whose insurance covered all their costs, with little or no difference in health outcomes. The one exception was low-income people in poor health, who went without care they needed. Any cost-sharing scheme would have to protect those unable to bear the burden.

And consumer-driven plans have limitations. Most health care spending is racked up by a small percentage of individuals whose bills are so high they are no longer subject to cost sharing; they will hardly be deterred from expensive care they desperately need. Moreover, few consumers have the competence or knowledge to second-guess a doctor’s recommendations.

Single Payer. Deep in their hearts, many liberals yearn for a single-payer system, sometimes called Medicare-for-all, that would have the federal government pay for all care and dictate prices. Such a system would let the government offset the price-setting strength of the medical and pharmaceutical industries, eliminate much of the waste due to a multiplicity of private insurance plans, and greatly cut administrative costs.

But a single-payer system is no panacea for the cost problem — witness Medicare’s own cost troubles — and the approach has limited political support. Private insurers could presumably eliminate some of the waste through uniform billing and payment procedures.

By now it should be clear that there is no silver bullet to restrain soaring health care costs. A wide range of contributing factors needs to be tackled simultaneously, with no guarantee they will have a substantial impact any time soon. In many cases we do not have enough solid information to know how to cut costs without impairing quality. So we need to get cracking on a range of solutions. The cascade of knowledge flowing from the human genome project, new nanotechnologies and the advent of treatments tailor-made for individual patients may well accelerate, not mitigate, the rise in medical spending. If we want the benefits, we will need to make them affordable.

Tips



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Sunday, November 18, 2007

Hiring Guidelines


Hire Great People: 10 Simple Rules

by Barbara Reinhold
Monster Contributing Writer

Rule number one is clear, but very counterintuitive: Don't ever, ever hire somebody just like yourself. Why not? Because from the beginning of time, executives have been unconsciously cloning themselves, stocking the shelves with vanilla young men from impressive schools. And what has happened to executives and companies that did that? As management guru Rosabeth Kanter observed, they often sink into the soft sand of irrelevance as the rough waters of current reality wash over them.

Here are the other nine:

2. Hire for Attitude Rather than Skill

Teaching skills is a snap compared with doing attitude transplants. Among the qualities you'll want most is a fierce sense of optimism.

3. Look for Renegades

In interviews, ask when the person has been in trouble. The obedient employee will be of limited use to you in this change-up environment.

4. Hold out for Results

Never hire someone with good potential but questionable habits, thinking you can change him or her. As in choosing mates, what you see now is what you get forever.

5. Go for a Sense of Humor

The potential hire who can't laugh easily, particularly at herself, is going to be a very dull and probably rigid employee.

6. Fill in the Blanks

Look carefully at the aggregate strengths and skill gaps of your teams in various work units, and go for the qualities and styles that are missing.

7. Test Drive

Don't be satisfied with references. Remember that many of the most glowing references are given for people others are eager to dump. Include day-long simulations as part of your interview process, or invite applicants to provide you with a portfolio of their best work.

8. Stock the Bullpen

Keep an eye out for prospects before the need arises. Don't wait until a vacancy occurs. Keep a pool of potential employees under the watchful eye of somebody who's responsible for hiring. Evaluate your recruiting team in terms of how well they keep the bullpen ready. And tell them never to turn away an interesting candidate with the line, "We don't have any positions open right now."

9. Push Harder for Diversity

Make certain you're spreading your net wide enough to find those high-potential, but different, fish who generally don't swim in the streams near you. Ask your HR group what contacts and periodicals they're using to interest potential hires. "We don't know where to find people different from us" is a costly excuse.

10. Listen

Most interviewers talk way too much. When a candidate finally gets to you, listen for the "story line" of his or her life, at home and at work. It's been said that being a leader is like practicing psychiatry without a license. That may be more true in hiring than in any other part of the job.

The job of recruiting is too serious to be handed off in its entirety to HR. Your legacy will be set, after all, by the teams you choose to accomplish your objectives.



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Monday, November 05, 2007

The Case of God v. Evil

In Book 10 of Milton’s “Paradise Lost,” Adam asks the question so many of his descendants have asked: why should the lives of billions be blighted because of a sin he, not they, committed? (“Ah, why should all mankind / For one man’s fault… be condemned?”) He answers himself immediately: “But from me what can proceed, / But all corrupt, both Mind and Will depraved?” Adam’s Original Sin is like an inherited virus. Although those who are born with it are technically innocent of the crime – they did not eat of the forbidden tree – its effects rage in their blood and disorder their actions.

God, of course, could have restored them to spiritual health, but instead, Paul tells us in Romans, he “gave them over” to their “reprobate minds” and to the urging of their depraved wills. Because they are naturally “filled with all unrighteousness,” unrighteous deeds are what they will perform: “fornication, wickedness, covetousness, maliciousness . . . envy, murder . . . deceit, malignity.” “There is none righteous,” Paul declares, “no, not one.”

It follows, then (at least from these assumptions), that the presence of evil in the world cannot be traced back to God, who opened up the possibility of its emergence by granting his creatures free will but is not responsible for what they, in the person of their progenitor Adam, freely chose to do.

What Milton and Paul offer (not as collaborators of course, but as participants in the same tradition) is a solution to the central problem of theodicy – the existence of suffering and evil in a world presided over by an all powerful and benevolent deity. The occurrence of catastrophes natural (hurricanes, droughts, disease) and unnatural (the Holocaust ) always revives the problem and provokes anguished discussion of it. The conviction, held by some, that the problem is intractable leads to the conclusion that there is no God, a conclusion reached gleefully by the authors of books like “The God Delusion,” “God Is Not Great” and “The End of Faith.” (See discussion here, here and here.)

Now two new books (to be published in the coming months) renew the debate. Their authors come from opposite directions – one from theism to agnosticism, the other from atheism to theism – but they meet, or rather cross paths, on the subject of suffering and evil.

Bart D. Ehrman is a professor of religious studies and his book is titled “God’s Problem: How the Bible Fails to Answer Our Most Important Question – Why We Suffer.” A graduate of Princeton Theological Seminary, Ehrman trained to be a scholar of New Testament Studies and a minister. Born-again as a teenager, devoted to the scriptures (he memorized entire books of the New Testament), strenuously devout, he nevertheless lost his faith because, he reports, “I could no longer reconcile the claims of faith with the fact of life . . . I came to the point where I simply could not believe that there is a good and kindly disposed Ruler who is in charge.” “The problem of suffering,” he recalls, “became for me the problem of faith.”

Much of the book is taken up with Ehrman’s examination of biblical passages that once gave him solace, but that now deliver only unanswerable questions: “Given [the] theology of selection – that God had chosen the people of Israel to be in a special relationship with him – what were Ancient Israelite thinkers to suppose when things did not go as planned or expected? . . . . How were they to explain the fact that the people of God suffered from famine, drought, and pestilence?”

Ehrman knows and surveys the standard answers to these questions – God is angry at a sinful, disobedient people; suffering is redemptive, as Christ demonstrated on the cross; evil and suffering exist so that God can make good out of them; suffering induces humility and is an antidote to pride; suffering is a test of faith – but he finds them unpersuasive and as horrible in their way as the events they fail to explain: “If God tortures, maims and murders people just to see how they will react – to see if they will not blame him, when in fact he is to blame – then this does not seem to me to be a God worthy of worship.”

And as for the argument (derived from God’s speech out of the whirlwind in the Book of Job) that God exists on a level far beyond the comprehension of those who complain about his ways, “Doesn’t this view mean that God can maim, torment, and murder at will and not be held accountable? . . . . Does might make right?”

These questions are as old as Epicurus, who gave them canonical form: “Is God willing to prevent evil but not able? Then he is impotent. Is he able but not willing? Then he is malevolent. Is he both able and willing? Whence, then, evil.”

Many books of theology and philosophy have been written in response to Epicurus’s conundrums, but Ehrman’s isn’t one of them. What impels him is not the fascination of intellectual puzzles, but the anguish produced by what he sees when he opens his eyes. “If he could do miracles for his people throughout the Bible, where is he today when your son is killed in a car accident, or your husband gets multiple sclerosis? . . . I just don’t see anything redemptive when Ethiopian babies die of malnutrition.”

The horror of the pain and suffering he instances leads Ehrman to be scornful of those who respond to it with cool abstract analyses: “What I find morally repugnant about such books is that they are so far removed from the actual pain and suffering that takes place in our world.”

He might have been talking about Antony Flew’s “There Is a God: How the World’s Most Notorious Atheist Changed His Mind.” Flew, a noted professor of philosophy, announced in 2004 that after decades of writing essays and books from the vantage point of atheism, he now believes in God. “Changed his mind” is not a casual formulation. Flew wouldn’t call what has happened to him a conversion, for that would suggest something unavailable to analysis. His journey, he tells us, is best viewed as “a pilgrimage of reason,” an extension of his life-long habit of “following the argument no matter where it leads.”

Where it led when he was a schoolboy was to the same place Ehrman arrived at after many years of devout Christian practice: “I was regularly arguing with fellow sixth formers that the idea of a God who is both omnipotent and perfectly good is incompatible with the manifest evils and imperfections of the world.” For much of his philosophical career, Flew continued the argument in debates with a distinguished list of philosophers, scientists, theologians and historians. And then, gradually and to his own great surprise, he found that his decades-long “exploration of the Divine ha[d] after all these years turned from denial to discovery.”

What exactly did he discover? That by interrogating atheism with the same rigor he had directed at theism, he could begin to shake the foundations of that dogmatism. He poses to his former fellow atheists the following question: “What would have to occur or have occurred to constitute for you a reason to at least consider the existence of a superior Mind.” He knows that a cornerstone of the atheist creed is an argument that he himself made many times – the sufficiency of the materialist natural world as an explanation of how things work. “I pointed out,” he recalls, that “even the most complex entities in the universe – human beings – are the products of unconscious physical and mechanical forces.”

But it is precisely the word “unconscious” that, in the end, sends Flew in another direction. How, he asks, do merely physical and mechanical forces – forces without mind, without consciousness – give rise to the world of purposes, thoughts and moral projects? “How can a universe of mindless matter produce beings with intrinsic ends [and] self-replication capabilities?” In short (this is the title of a chapter), “How Did Life Go Live?”

Flew does not deny the explanatory power of materialist thought when the question is how are we to understand the physical causes of this or that event or effect. He’s is just contending that what is explained by materialist thought – the intricate workings of nature – itself demands an explanation, and materialist thought cannot supply it. Scientists, he says, “are dealing with the interaction of chemicals, whereas our questions have to do with how something can be intrinsically purpose-driven and how matter can be managed by symbol processing?” These queries, Flew insists, exist on entirely different levels and the knowledge gained from the first can not be used to illuminate the second.

In an appendix to the book, Abraham Varghese makes Flew’s point with the aid of an everyday example: “To suggest that the computer ‘understands’ what it is doing is like saying that a power line can meditate on the question of free will and determinism or that the chemicals in a test tube can apply the principle of non-contradiction in solving a problem, or that a DVD player understands and enjoys the music it plays.”

How did purposive behavior of the kind we engage in all the time – understanding, meditating, enjoying without – ever emerge from electrons and chemical elements?

The usual origin-of-life theories, Flew observes, are caught in an infinite regress that can only be stopped by an arbitrary statement of the kind he himself used to make: “ . . . our knowledge of the universe must stop with the big bang, which is to be seen as the ultimate fact.” Or, “The laws of physics are ‘lawless laws’ that arise from the void – end of discussion.” He is now persuaded that such pronouncements beg the crucial question – why is there something rather than nothing? – a question to which he replies with the very proposition he argued against for most of his life: “The only satisfactory explanation for the origin of such ‘end-directed, self-replicating’ life as we see on earth is an infinitely intelligent Mind.”

Will Ehrman be moved to reconsider his present position and reconvert if he reads Flew’s book? Not likely, because Flew remains throughout in the intellectual posture Ehrman finds so arid. Flew assures his readers that he “has had no connection with any of the revealed religions,” and no “personal experience of God or any experience that may be called supernatural or religious.” Nor does he tells us in this book of any experience of the pain and suffering that haunts Ehrman’s every sentence.

Where Ehrman begins and ends with the problem of evil, Flew only says that it is a question that “must be faced,” but he is not going to face it in this book because he has been concerned with the prior “question of God’s existence.” Answering that question affirmatively leaves the other still open (one could always sever the Godly attributes of power and benevolence, and argue that the absence of the second does not tell against the reality of the first).

Flew is for the moment satisfied with the intellectual progress he has been able to make. Ehrman is satisfied with nothing, and the passion and indignation he feels at the manifest inequities of the world are not diminished in the slightest when he writes his last word.

Is there a conclusion to be drawn from these two books, at once so similar in their concerns and so different in their ways of addressing them? Does one or the other persuade?

Perhaps an individual reader of either will have his or her mind changed, but their chief value is that together they testify to the continuing vitality and significance of their shared subject. Both are serious inquiries into matters that have been discussed and debated by sincere and learned persons for many centuries. The project is an old one, but these authors pursue it with an energy and goodwill that invite further conversation with sympathetic and unsympathetic readers alike.

In short, these books neither trivialize their subject nor demonize those who have a different view of it, which is more than can be said for the efforts of those fashionable atheist writers whose major form of argument would seem to be ridicule.



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