Francophilia

Yesterday's post, and the time of year, mean that my mind is definitely wandering in the direction of two of my favorite things: cycling and France. My brother-in-law and sister-in-law are heading over to London for the start of Le Tour next week, and they will also be catching some of it live in the French Alps. I'm thrilled for them--a little jealous, but totally thrilled.

Along the sidebar to my blog you'll notice a link to Backroads. I have to give a shout out to Backroads, because last fall I got to go on a cycling trip with them in Provence. Of course we flew in and out of Paris, which is everything you ever heard it was, and then took the train to Avignon. I spent five days cycling around Mt. Ventoux (no, I did not climb it), St. Remy, Avignon, Pont-du-Gard, and lots of wonderful small villages. Backroads did it up right, the bikes were set up perfectly, the guides were great, the routes spectacular, the food was wonderful. If you love bikes, go. If you love France, you'll love it even more on a bike.

Forget everything you ever heard about the French not being friendly to Americans. If you are on a bike in France, truck drivers will hold up traffic to let you make a left turn on a busy road. At 5:00 pm I had to cross the Rhone River in Avignon on a narrow and busy bridge, but no one hassled me about the fact I was slowing down the traffic. And that is a long bridge. I can give many other examples, but cyclists in France hold a seemingly special place in the pecking order of the road.

I love the country, I love the people, and I love their grand Tour. I'm not crazy about their seeming anti-American feelings in the ranks of the Tour organizers, some of their press, and such, but I do love the event. I hope that the UCI and Tour officials can work through their posturing, and I wish all the riders and teams well. The event threatens to be a debacle this year, and it looks like many great riders won't be there.

Backroads offers many different cycling trips in France. If you have any desire at all to experience the greatest rides you will ever do, call them up. And no, I'm not paid to say that.

When the World Goes Mad

If you read my post on Floyd Landis, you know by now that I am a cyclist and I enjoy following the sport. Each July I look forward to watching the Tour de France, but I also follow the sport on line through various websites all season long. I was excited earlier this year when Team Discovery Channel got off to a great start with some early wins in the spring classics, and with a great showing at the Tour of Georgia here in the U.S.


But my sport is in a lot of trouble right now, and it is frustrating to us who love the sport in many ways. Cycling is first and foremost a blue collar sport. This is about gritty guys (and women) who are willing to punish their bodies in ways that are hard for most of us to imagine, and who ride amazingly well. But it takes a huge toll on the body to pedal a bike at high speeds (think, averaging more than 30 MPH) for anywhere from 65-120 miles every day during stage races. Plus all the training rides. It is not easy to do what these guys do. I got to ride once with pro riders in Austin, Texas in April of 2000, when I rode my first Ride for the Roses event to raise money for the Lance Armstrong Foundation.

I took off that morning with about 8,000 other cyclists. I was training for the MS 150, and the Ride for the Roses fell at a good time for me to go out for a 50 mile training ride. The pro riders got to start us off, and they went on a century ride (100 miles) that day. The route went east of Austin, and then south, and looped back to finish at a county fair location. There was a huge hill to climb to get back up to the start/finish line. As I was climbing that hill, I heard a lot of noise behind me and a guy with an Irish accent yelled for me to hold my line. That's cycling talk for "ride straight". The peloton of pro riders caught me in the last mile and totally blew past me up the hill I was climbing. They rode 100 miles in the time it took me to go 50. And I was in great shape at that time, at least so I thought.

The riders on this page, Matthias Kessler, Iban Mayo, Sirhiy Honchar, Alessandro Petacchi and Ivan Basso are some of the great riders of today. All of them are in trouble right now for failing doping tests. For Mayo and Petacchi, it is because their blood levels had too high concentrations of substances that are actually allowed (like asthma medication) within certain limits, but there is something a little off in their recent test results at the Giro d'Italia.

For other riders, it is more serious. Basso was handed a two year ban recently, and Kessler was fired yesterday from his team in Europe. The UCI (cycling's pro tour organization) has asked riders to sign an anti-doping charter before the Tour de France, and Le Tour is saying they intend not to allow anyone to ride who has not signed the document.

Cycling's zero-tolerance approach may at this point have reached the level of ridiculousness. Their testing program is completely messed up right now, and you are presumed guilty with virtually no way to clear your name if one of the WADA labs says you tested positive for something.

Meanwhile, in the U.S., we have baseball dancing around steroid abuse while high profile players attempt to break records that are, for baseball fans, sacred icons. The approach in that sport is broken too, but badly in the other direction. And a "pro wrestler" in Georgia may have been driven mad by his steroids. We may never know what role the drugs played, but a whole family has been killed in an episode that makes no sense, and "pro wrestling" isn't even a legitimate sport.

I don't know where this all leads, but it seems to me at times the world is just mad, and I'm not talking about useful anger here.

Freedom to Choose

John Stuart Mill, (1806-1873)

“That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant. He cannot rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because, in the opinion of others, to do so would be wise, or even right...The only part of the conduct of anyone, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute. Over himself, over his own body and mind, the individual is sovereign.”

From John Stuart Mill, On Liberty Ch. 1

This is going to be my last post on the issue of raw milk, at least for a while. I want to thank the many people who have been reading the website this week, and I invite any of you to check in as often as you like.

The most difficult argument to address in the whole issue of SB 948, before the legislature now in North Carolina, is the argument put forward by raw milk proponents that this is a matter of free choice. They ask, reasonably enough, “Why should this be illegal?” Why indeed? What social benefit is so great that it would require that society would prevent the free choice of these individuals to drink raw milk and eat raw milk based products?

There is almost no way to wrestle with or think through these issues without looking back to John Stuart Mill’s classic work on this subject, On Liberty. No matter what you or I may think about utilitarianism, of which Mill was a proponent, his writings on liberty are still among the best ever put forward. Mill argues convincingly that the only legitimate reason to limit another person’s liberty is when that liberty causes harm to another group or individual.

On its face, it would seem that I and everyone in the public health sphere would have to restrain ourselves in this matter, since it does me no harm if you choose to own a cow or a share of a cow, and even if I think you are taking an unnecessary risk, you drink that milk directly as you please. I admit that at first glance this seems the only logical conclusion. But unless several principles are agreed to on all sides, it is not true that your actions in this matter only affect you. There are at least two groups that are directly or indirectly impacted by your decisions, and only if there are strict limitations put in place can we agree that your actions only impact you as free individuals.

First, and Mill concurs on this point, children cannot be judged to have the capacity to freely choose. It is incumbent on society to limit the free choices of children because they are not able to make for themselves an informed choice. From a public health perspective, we would also be concerned on legitimate biological grounds that children should not be exposed to any products that pose unnecessary risks for them. The children are the future of society. The social benefit of extending life for as long as possible is best accomplished by keeping children alive until they become adults. Due to their small size, they are particularly vulnerable to dehydration from diarrhea, and should be protected to the best of our ability from pathogens that cause that set of symptoms.

Second, people in North Carolina (and elsewhere) who make their living from selling milk and other dairy products must not be harmed by someone’s choice to consume raw milk products from North Carolina. The potential risk here is that if a future outbreak occurs involving raw milk or milk products from North Carolina, all consumers may boycott all North Carolina dairy products, harming other producers. This is something we observed with the spinach outbreak last year. Thousands of dollars worth of spinach all over the country was plowed under because there was no market for spinach due to the contamination on one farm in California. Producers in the mainline dairy markets need to be protected from harm in order for raw milk consumers to exercise their free choice.

So, I would be forced to admit the legitimacy of your freedom if you were willing to commit to limiting the consumption of raw milk only to adults capable of making an informed choice, and you were willing to let the state set up regulatory mechanisms to test the product routinely, and establish other protections for the commercial dairy producers that the state Department of Agriculture deems appropriate. If the proponents of raw milk consumption agreed to these conditions, it would seem unreasonable to oppose them further.

That’s all I have to say on raw milk for now. It has been fun for me to think through my positions on this issue, and I appreciate Mr. Senkpiel and others for pushing me on it in the comment boxes. I only wrote anything about this because I felt my profession was maligned and unfairly represented in Ms. Nelson’s article, and because I thought the health claims being put forward were potentially dangerous. I hope I have at least helped you understand public health’s perspective better, even if in the end we cannot agree.

I wish you all health.

Why We Do What We Do

Did you ever wonder why the U.S. has a Surgeon General? Or why he or she wears a naval uniform? Because the first public health service in the United States were the navy doctors who took care of sick and injured seamen, and later inherited duties associated with quarantine stations established to keep out foreign diseases.


On each Wednesday, all over the U.S. Centers for Disease Control and Prevention campus, you will see men and women wearing naval uniforms. At the National Institutes of Health and in some state health departments you see the same thing. These are the Commissioned Corps of the U.S. Public Health Service, and they carry naval military rank. They have to meet annual physical requirements and wear their uniforms at least once per week.


The public health services of the United States were extremely limited for the first 150 years or so of our country's history. There wasn't even a list of nationally reportable diseases until Congress passed the first disease reporting law in 1878, which made Yellow Fever reportable. In subsequent years more diseases were made reportable, notably malaria, cholera, tuberculosis, polio, smallpox, measles, mumps, rubella, diphtheria, pertussis, and others. But many of the diseases we track today were not reportable until after the CDC was officially created in 1948, growing out of the Malaria Control Office Congress had previously established in Atlanta, Georgia.


What you may notice is that the list of diseases that were first made reportable are largely diseases that are under control today. But it was not always so. From the National Center for Health Statistics, we have records documenting life expectancy at birth dating back to 1850. In 1850, the average U.S. life expectancy at birth was only 39 years. By 1890, the average life expectancy at birth had risen to 43 years. In 1911, that number was still between 43-44 years. But today life expectancy at birth in the U.S. is 78 years. How did we add more than 30 years to average life expectancy at birth in less than 100 years time?


In 1900, the three leading causes of death in the United States were pneumonia & influenza (they were combined for reporting purposes back then), tuberculosis, and diarrhea. Today, our top three causes of mortality are heart disease, stroke and lung cancer. Researchers attribute 5 years of the added life expectancy since 1911 to advances in medicine. The remaining 25+ years of additional life expectancy that have been achieved are attributed to key public health interventions in three areas.


The majority of life expectancy added since 1911 in the U.S. is attributed to measures designed to prevent diarrheal diseases, particularly cholera and foodborne diseases; vaccination for childhood viral illnesses; and additives mandated to the U.S. food and water supply, notably fluoride in water, niacin in flour, and iodine to salt. Among the antidiarrheal interventions, the most important developments were sewage treatment plants, chlorination and chloramination of drinking water, and pasteurization of dairy products. These measures taken together were responsible for adding 25+ years to the average U.S. life expectancy at birth. This was accomplished by keeping children alive past age 5 years old, largely by preventing severe dehydration from diarrhea, and then to adulthood through vaccination.


The key to the most effective public health interventions devised to date is that they are designed to operate universally. The interventions are designed to affect everyone, and in so doing, improve the health of the entire population. And these interventions have proven wildly successful. The reason public health professionals worry about letting people opt out of the interventions is we risk returning to higher rates of disease in the very young, with increased mortality that we have learned how to prevent. None of us want to see the life expectancy gains we have worked so hard to achieve eroded.


In today's Independent, in the comments section many of you have read, I was amused to learn that we epidemiologists are being bought and paid for by agribusiness corporations, and we're only pawns in the game of denying people their freedoms and oppressing small farm producers. If that's true, I wonder why I get so much hate mail from oystermen, cattlemen, poultry producers, restaurant owners, and food distributors. And I wonder where my cash is stashed. The truth is, we make the policy recommendations we do to to keep people alive longer. It is the purpose of my profession. It has been our purpose for over 100 years. We may not have won many friends along the way, but we have been very successful in the past at correctly identifying interventions that work. If we weren't doing that, the 30 years of life expectancy that were added wouldn't be there. The numbers just don't lie.

Burden of Proof

Robert Koch (1843-1910), German physician and one of the first microbiologists

Last time I said I would attempt to lay out the difference between believing something was true, and being able to prove it. There is a huge difference. A useful framework for understanding that difference can be explored by looking at Koch's Postulates. Robert Koch was a German physician and one of the men who established the germ theory of disease in the 1800s-1900s as the preeminent explanation for many diseases. He also discovered Bacillus anthracis, the bacteria that causes anthrax, Mycobacterium tuberculosis, which causes TB, and other nasty pathogens.


Koch was working at a time when many people did not believe in germs, bacteria, viruses, etc., and when many early laboratorians were beginning to grow all kinds of bacterial cultures, but they did not know what they were growing, or which bacteria did what types of things. Koch put forward four classic postulates that could prove a connection between a particular disease and a particular bacterial pathogen. Since he was writing in German, the English translation of his postulate has been stated in various ways, but essentially these are what they say:

1 - The microorganism must be found in all organisms suffering from the disease, but not in healthy organisms.
2 - The microorganism must be isolated from a diseased organism and grown in pure culture
3 - The cultured microorganism should cause disease when introduced into a healthy organism.
4 - The microorganism must be re isolated from the inoculated, diseased experimental host and identified as being identical to the original specific causative agent.

Ok, so what do they mean in plain English? First, you have to always find the same organism in an animal or person suffering from the disease. You have to grow a pure culture (not mixed with other bacteria). Then, in experiments, inoculating a healthy test subject (usually an animal) with bacteria from the pure culture should reproduce the disease. And finally, you should be able to re-isolate the same bacteria from the diseased test subject. If a scientist could repeatedly do all of these things, he or she could claim to have established the linkage between the disease and the pathogen.


I bring this up to illustrate that there is in science a high burden of proof. In epidemiology there is also a high burden of proof. One of the accusations in the raw milk article that, frankly, set me off was the accusation that epidemiologists just jumped to the conclusion that raw milk caused disease and ignored other explanations. That isn't how we do our work. But what we do is not well known by many people, so I'd like to open the curtain to our methods, and our burden of proof. Forgive me if this turns into a long post.


There are many types of studies and different proof tests, so I will confine my remarks to outbreak epidemiology. This is the most relevant to the topic anyway, and it is the type of field epidemiology I do, so it is what I know the most about. When we are confronted with an outbreak of unknown etiology (an outbreak we recognize but do not know how it is spreading), we first want to interview the first reported cases to understand their recent exposures, and we want to determine what laboratory evidence there is, to help us focus on a cause. We test for bacteria, viruses, parasites, chemical exposures, toxins, nutrient imbalances, or other things depending on the symptoms the patients have. Once we know the pathogen we re-interview the cases to hone in on the exposures during known incubation periods. For example, salmonella has a usual 1-3 day incubation period, staph intoxications just 2-4 hours, norovirus 24-48 hours, E. coli 2-10 days, etc. So depending on the pathogen, we look at longer or shorter exposure periods.


If we determine that several cases share an exposure, for instance, eating Peter Pan peanut butter, then we have a hypothesis to test. We design a case-control study where we develop a systematic questionnaire asking about exposures, and make sure that the particular food item we are interested in is on the questionnaire, along with every other exposure we can identify that could explain the disease. In the case of salmonella, we would make sure that eating raw eggs, mayonnaise or ice cream made at home, raw milk, pet turtles, pet snakes, pet lizards, bird exposures, all kinds of things would be in the questionnaire that other people in previous outbreaks had implicated. We would also ask about restaurants, brand names of food items, grocery store chains they buy food at, etc. on the interview. Every investigation includes hundreds of potential exposures in the study design.


We would administer this lengthy questionnaire to all the case patients we knew about, plus another group of healthy people who were otherwise the same as our ill patients. We may choose the healthy controls in a variety of ways, but usually they are matched on key demographic and geographic variables to the ill persons, and we interview both the ill people and the control group systematically. Then we enter all of their responses into computers and run statistical tests on all the variables.


What we are calculating with these tests are called Odds Ratios. We want to see if there is any exposure in the study that ill people share overwhelmingly, but controls do not. Then we apply other statistical tests to our odds ratios to determine the probability that any association we derive could occur by random chance, and whether the association is toward causing disease, or protecting someone from getting the disease.


Once we have an exposure that is statistically associated with disease, we will try to, in the case of bacteria, culture the bacteria from some of the product we are implicating statistically. This is sometimes impossible, if all the food or beverage item has been consumed. But many times we can locate food samples to test. The goal is to grow the bacteria from both the patient and the implicated food item, if possible.


If we do implicate a food item, before we can publish that finding we typically have to satisfy at least two or three other groups of epidemiologists that our findings are valid. We would have to present our evidence to our peers and superiors inside our agency, and then usually to a similar group in another agency (like the CDC, FDA, Food Safety Inspection Service, USDA, or state health departments). Only if the evidence was found sufficiently strong by several different groups in diverse agencies would we be able to publish findings, initiate product testing, recalls, and trace back activities.


What I am saying here is that I do not believe the accusation by proponents of raw milk that epidemiologists implicating raw milk in particular outbreaks did so recklessly, or that they ignored other explanations. We face a high burden of proof, and there are many internal and external checks and balances in the system.


Similarly, proponents of raw milk are asserting that it has many health benefits over pasteurized milk. I think there is a high burden of proof they should meet before making those claims as a justification for relaxing the laws and regulations to open greater access to raw milk. To get there, we would need to agree on exactly what is the specific health benefit, and then we would need to design a study or studies to meet the burden of proof. At a minimum, proponents of raw milk would need to put forward a health benefit that all people would get from the product; it would need to be measurable; it would need to be reproducible; and benefit would have to be shown not to be caused by something else. Right now proponents of raw milk are asserting benefits that are vague or not measurable, are subjective, and diverse. They also seem to be challenging those of us who do this type of research to disprove their health claims or to verify them. But when someone is advancing a new claim or idea, it is on the claiming party to fund the studies, produce the research, publish the findings, and face peer review. That is how science is done.

The Foundational Science of Public Health

I am by profession and career an epidemiologist. Epidemiology is considered the foundational science of public health, because epidemiologists seek to understand the determinants and distribution of disease in human populations. In plain English, our main reason for existence is to figure out what causes disease and how disease patterns change over time, and in different populations or under different conditions.

Public health as a set of disciplines is relatively young. Sure, Greeks like Hippocrates had ideas about medicine, ancient Egyptians explored surgery, Chinese medicine practitioners devised frameworks for describing health and disease, and every culture had shamans, wise women and other healers who devoted their time and energies to promoting health. Their focus, however, was on the health of individuals.

Public health is different. Public health is concerned with the health of groups, of populations. Thinking about health in this way did not even start until the early 1800s, and the first people to think in these terms were brilliant physicians and theorists in Germany, France, and England.

One of the first to think about disease in terms of populations was a French physician named Louis Rene Villerme (1782-1863). In 1826 Villerme conducted a study that showed, conclusively and for the first time, that disease and death occurred at different rates and in different neighborhood and community patterns. Disease was neither random nor uniformly distributed. In fact, Villerme was the first to show that poor people suffered more disease and earlier deaths than the wealthy did.

Observing differences in disease patterns was a major breakthrough, but it did not explain why these patterns existed. In the 1800s, theories of disease causation included: miasma; contagion; personal behavior; and the supernatural. Miasma theory had strong political backing, driven by social reformers who advocated improved sanitation. Contagionists were not new, they had existed for a long time, but they did not know about germs. Contagionists were politically associated with the military and other authorities, who wanted to quarantine infected ships and goods. Capitalists felt threatened by contagion theories of disease -- they interfered with commerce. Personal behavior and the supernatural were closely intertwined. Moralists were inclined to think of disease in terms of divine punishment for misdeeds, and health as a sign of divine approval.

Arguably the most famous epidemiologist, ever, was a British physician in the 1850s named John Snow. John Snow was a London physician concerned with cholera epidemics in London in the 1850s. There were many theories trying to explain the cause of cholera at that time. Two of the most important were the miasma theory and the contagion theory. The miasma theory argued that noxious vapors or fumes existed in unsanitary areas, and these fumes were the cause of cholera. The contagion theory argued that there was some contagion, something that was passed directly to the individuals who contracted cholera. This debate was all occurring before the germ theory of disease had been developed.

Snow opposed the miasma theory of the spread of cholera. He believed that there was some sort of contagion involved. He documented a major rise in the epidemic of cholera in London's Broad St. area. He learned through extensive interviews that the people who were getting cholera were drinking water from the Broad St. pump. He also identified two anomalous groups who were very near the pump who suffered no effects of cholera: inmates at a prison; and workers at a brewery. The prison had its own well, and of course the inmates had no access to the public pump. The men at the brewery were not thought to drink water at all.

Snow also documented incidences of cholera in districts served by two competing water companies in London. Both companies used water from the River Thames, but one had a local water intake and the other had an intake upstream of London, away from the city's raw sewage. The Lambeth company, whose intake was upstream, suffered no incidences of cholera in areas it served. All the cholera occurred in households served by the company with the local water intake.

Snow's work was scientific. Many people before him had opinions about what caused disease. Snow designed experiments to try and prove what factors were and were not associated with disease. In his case, the disease of interest was cholera. The methods that Snow and Villerme demonstrated slowly began to permeate the thinking of physicians and influential policymakers, and the idea of a set of disciplines devoted to systematically improving the health of human populations was born.

The 1988 Institute of Medicine report defines public health as "what we as a society do collectively to assure the conditions in which people can be healthy." This endeavor involves [1] - assessment; what exactly is the state of health in the society? [2] - policy development; once the situation is understood and needs are identified, policies designed to address the problem areas need to be developed and implemented; and, [3] - assurance: the goal is that 1 & 2 will result in assuring the promotion and preservation of health in the society. Before policies can be developed and enforced, however, the determinants and distribution of disease must be understood. That is why epidemiology is the foundational science of public health.

The thing that triggered my alarm in the article promoting raw milk consumption as a positive health benefit is that in no way was it scientifically examined. The entire article quoted people's opinions and anecdotal descriptions. There was nothing rigorous in the thought process, although there were plenty of accusations, assumptions, and claims being thrown around as if they were facts. Next time I will attempt to describe the difference between believing something is so, and proving it.

The Assault on Science

"Science knows no country, because knowledge belongs to humanity, and is the torch which illuminates the world. Science is the highest personification of the nation because that nation will remain the first which carries the furthest the works of thought and intelligence."

Louis PasteurFrench biologist & bacteriologist (1822 - 1895)

I am about to start writing a series that may become boring to some of you, but is vitally important to me. In my blog caption, I said I would write about "everything that matters." Well, today my local Independent newspaper published a cover story on the raw milk movement, and there is a bill before the N.C. General Assembly to allow cow shares and human consumption of raw milk within certain limits.

In the story, pasteurization and homogenization are attacked in no uncertain terms as production steps that are alleged to destroy all that is good and true in milk, and raw milk is heralded as a panacea cure for everything from milk allergies to cancer. As an epidemiologist, thinking like that which produced this story leaves me feeling sad, concerned, and alarmed. Add to it a recent lawsuit against North Carolina alleging vaccines causing autism, along with the general degradation of science during the Bush administration and it is hard to remain optimistic about the future.

In the series I am about to write, I will focus only on the science of public health. There are too many things that I could write about. I will be trying to build the case that anti-science thinking and a basic failure to comprehend the history of disease control efforts in the United States are coalescing to support a radical fringe movement that threatens to undermine public health improvements that have taken 60 years to achieve. This case will take time to build, and I want to proceed in a way that illuminates the topic. If this is not your cup of tea, I can only beg your patience.

For the record, to tie this new series in with the one I did on food and food safety earlier, a few disclaimers. My grandparents had milking cows, and every morning and every evening my grandfather milked the cows. He brought fresh raw milk to the house and poured it through cheesecloth into milk cans, which he sold to a local dairy. But he also kept two gallons at the house each week, usually, one of fresh whole milk and one of fresh buttermilk. As a child I helped churn butter and I ate that butter. I was fed raw milk on my cereal. My grandmother cooked with raw milk. And I didn't die. None of that means it was safe. One of the points the author of the piece I read today made was basically built on interviews with people who drink raw milk, and say things like "And I'm fine. It's never made me sick."

The best analogy I can think of to respond to those points is that as a child in the 1960s I can remember my mom driving around Georgia at frightening speeds, with me, a small child sitting in the front seat, never wearing a seat belt. Meanwhile, everyone was driving 80 MPH (the then posted speed limit), no car had airbags, and most sign posts on the side of the road were solid bars that if hit could cut a car in half. And I didn't die. But that does not mean any of us were safe.

Louis Pasteur was a great man, a great scientist, and a true humanitarian. Pasteurization was one of the two or three major process inventions in the history of human kind. Along with vaccination, and a couple of food additive efforts, pasteurization has done more than almost anything else to add 30 years to the average life expectancy of most Americans. People who idolize a past before pasteurization and vaccination forget to mention that in that world, the average life expectancy in the U.S. was in the 50s, that thousands of children died from disease and want each year, and no one understood anything about the way diseases spread or how best to control them.

Judge me as you will, but let me make my case. For my part, I am grateful for the work Louis Pasteur and others have done before us.

Summer's Here

We have reached a transition of the seasons. The solstice occurs at 2:06 p.m. EDT. This is when the Sun is farthest north for the year in Earth's sky and begins its six-month return southward. Summer begins in the Northern Hemisphere, winter in the Southern Hemisphere.

Of course, that is just the dry scientific fact of what we are experiencing. For those of us in the Northern Hemisphere, tomorrow is officially the longest day of the year. Ancient Europeans marked this day with bonfire celebrations, and Shakespeare's "Midsummer Night's Dream" was inspired in part by the idea that solstice causes unusual behaviors in humans.

What does solstice mean to us today? In agrarian societies, this transition in the Northern hemisphere would signal the ripening of the crops, the fullness of the year, heading toward the bounty at harvest. Here on the Atlantic coast of the United States, summer solstice means we are heading into the teeth of hurricane season. From now until October, we will watch the tropics for signs of storms developing.

But for most people these days, I imagine that solstice will come and go with little thought or recognition. The weather anchors will inform us that it is now officially summer, but people have already been experiencing and acting like it was summer for several weeks.

I don't have any particular solstice memories or experiences to share, but I mark it every year, mentally. Along with the equinoxes it forms a mental signpost for me. 2007 is halfway done. We enter now the downhill slide of the year. Have you accomplished half of what you had hoped to this year? Does it matter to you? Well, remember that in six months we will be full in the clutches of our Winter solstice, and all the holiday season experiences.

Maybe that is why, figuratively, we get such a long day tomorrow. Time is about to start running out.

Hybridize

We are a Toyota family, and we are a Hybrid family. My wife primarily drives a 2002 Prius, and I usually drive a 2006 Highlander Hybrid. Today I found a nail embedded in one of the tires and took the SUV in to get the tire fixed. When the technician went to back out of the service bay, he at first wasn't sure that it was turned on. When he got out he looked at me with amazement and said "Wow, this thing sure is quiet!" He then went on to ask me how I liked it, and whether I had any issues with it.

Issues? What kind of issues could I have? It's an SUV that gives V-8 power from a V-6 engine, and gets 30 MPG. The Prius gets 50 MPG routinely. We are cutting down on greenhouse gas emissions, stretching our fuel budget, and we sacrifice nothing in terms of creature comforts to do it. We love our hybrids.

I know that car manufacturers are fighting Congress on new CAFE standards (the fuel efficiency requirements they have to meet to be able to sell cars) right now, and state governments are complaining that fuel efficiency is curtailing their tax revenues. It is a nasty secret that our own governments are in cahoots with the auto industry and big oil to keep fuel consumption up, so everyone makes money. Everyone but us consumers, that is. We get to pay and pay. And the environment is worse for it.

I just don't see why every car, truck, van and SUV in America can't average 30 MPG or better. There is absolutely no technological reason why any passenger vehicle on the road gets less than that on average. Toyota has shown that it can be done.

The only limiting factors, really, are backbone and imagination. Unfortunately, those seem to be two natural resources that are in critically short supply right now. I hope that someone finds a new set of reserves of them, and soon. For all our sakes.

Wonderful World of Wine

I have always been fascinated by wine. There is something magic and wonderful that can happen when grapes are fermented into wine by a master of the craft. I say something magic can happen, but it doesn’t always. Some bottles of wine I have drunk were truly awful, and some were sublime.


The wonderful and frustrating part of it all is that you cannot tell when you buy a bottle of wine whether it is worth the price, or even what you will think of it when you pull the cork. Some vineyards do have a greater likelihood of achieving consistency than others, but even among those, certain vintages rise above the rest as superb expressions of the soil, the climate, the grapes, and the skill of the winemaker.


While I love wine, and visiting vineyards, I find I do not love wine snobs. Once I was at dinner with a group of people and a wine was ordered. When the glasses and bottle were put together, this guy erupted in anger that the glasses were all wrong, and demanded to see the manager. The manager and the Maitre’ D came to our table to discuss the situation, and the chap went on and on about how we were about to drink a Bordeaux, and the glasses were for some other type of wine, and how it would be a disaster. To be honest, I found the whole thing embarrassing. The staff explained they were out of the other kind of glasses at the moment; this was all they had enough of to set our large table, etc. etc. He was having none of it, and all of the rest of us were left uncomfortably sitting there while the tempest raged on. And on.


When I read wine tasting notes, or look at the point values assigned to a wine by Wine Spectator or some other reviewer, I sometimes feel confused. Should I be able to discern the differences between currants, cherries, and plums in three different glasses? What about other tastes, like tobacco, tar, or one I read recently, oil? What on earth would I want to drink that for? Still, there are times when I do catch a sniff of apricot, or grass, or some other flavor, and understand what the reviewer was writing.


In the end, I find that I simply “know” what I like and what I don’t. Once I taste it. But it is still ephemeral. I remember in Texas buying a certain vintage of a rather cheap French table wine, and being completely blown away by it. I went back and bought a case of it. We drank it for several weeks, thoroughly enjoying each bottle. A couple of years later I saw the exact same vintage for sale in another store, and I eagerly bought a couple of bottles. When I poured it, it was past its prime and not very enjoyable at all. Some wines get better with age, others decline.


Sometimes, of course, it is also fun to play around with wine. This past weekend I made Sangria, and it was wonderful in every way. Here is the recipe I used; if you have others to suggest, I’d love to hear them.


I started with a bottle of Penfold’s Merlot, which cost me about $7.00 at the grocery store. I added to that ½ cup of sugar, ½ cup of cognac, ¼ cup Triple Sec, 1/8 cup of orange juice, and 1 lemon and 1 orange sliced thin. I stirred all of that together until the sugar was dissolved and chilled it for about 7 hours. Then I added 1 cup of orange flavored seltzer water and served it over ice. Everyone loved it.


If you have drunk something particularly fun, or memorable, please let the rest of us know.

More Tips from the Kitchen

Quick--you just find out that your kids have been invited to an impromptu sleepover, and you and your significant other suddenly have a date night you didn't know was coming. What are you going to do to make dinner special?

This was my meal dilemma last night, but stopping off at the local Whole Foods and walking through, I came up with a menu that turned out to be really good, and surprisingly easy. First, since I knew it would take a little while to fix the primary side dish, I grabbed some goat cheese spread and a loaf of sourdough rosemary bread. The goat cheese spread had garlic and basil in it, and with the bread made a wonderful snack to hold us over while I fixed the rest.

In the produce section I picked up some small sweet potatoes and heirloom tomatoes. I boiled the sweet potatoes whole for about 20-30 minutes or until soft. While that was going on, I diced up the heirloom tomatoes into two salad bowls, dusted them with an Herbs de Provence herb mix we picked up last fall in France, drizzled them with olive oil and balsamic vinegar, and tossed them to coat the tomatoes and moisten the herbs. Then I sprinkled crumbled feta cheese over the tomatoes to make a Mediterranean-inspired tomato and cheese salad. You could use any herbs you like, but thyme, basil, oregano, etc. would all work well.

As the potatoes neared being done, I fired up the grill. When the potatoes were soft, I drained them, removed the skins, and mashed them with 3 tablespoons of butter, some salt, ground ginger and cinnamon. Then I placed them in an oven on low heat to stay warm.

At Whole Foods in the seafood section I had picked up a skewer of peeled and deveined shrimp and some sea scallops wrapped in smoked salmon. I grilled these items for 3-5 minutes each side, seasoning them first with lemon and dill.

So, from start to finish, it took me a little over 40 minutes to make a fabulous meal. Salmon wrapped scallops and shrimp, grilled, with mashed ginger sweet potatoes and a tomato/feta side salad. We drank red wine with it, but a nice white wine would have worked equally well. The feta was a needed counterpoint to the sweet potatoes, but the grilled seafood had a smoky-lemony savor that was awesome. We chased all of this later in the evening with a turtle cheesecake dessert we split.

Not bad, for short notice, to make a special meal with limited clean up, little effort, and wonderful tastes. Try this menu sometime for someone you want to surprise, and let me know how you like it.

The Curious Case of the Missing Martian Oceans

Continuing the theme from last night, I took notice of two different things today. First, the computer glitches that happened on the International Space Station. The problem seems to be related to power surges and drops caused by installation of the new and improved solar panels. In hooking them up and retracting some of the old panels, there was some temporary glitch in the power supply that caused (apparently) a hiccup with the computers that run certain vital systems (like the oxygen supply).

The second was more evidence that Mars once had an ocean. The Northern portion of Mars has looked to many scientists like a dry ocean basin since the 1980s, but the evidence was inconclusive. And, no one wanted to repeat Lowell's infamous faux pas regarding Mars, reporting seeing canals on the planet when none are there. But the evidence for previous Martian oceans or at least an ocean continues to build.

Recent radar and satellite photographs of Mars strongly suggest that the south pole has enough water ice buried under the dust layers to fill a shallow sea over much of the planet. And findings by our probes Spirit and Opportunity have clarified some Martian chemistry issues sufficiently to at least permit the possibility that an acidic water ocean once covered a large chunk of the planet.

Mars is a fascinating object to study. There is evidence of volcanic activity, perhaps once an ocean. The planet used to have a molten core, but now it is quiet. In order to support an ocean, Mars would have once had to have a much denser atmosphere. Today it is very thin, and the gravity there is too week to hold on to one. Still, it does snow carbon dioxide there in the winter.

Saturn's moon Titan has recently been imaged to show what many scientists believe are giant lakes of liquid methane gas. Titan has a thick atmosphere, and it is brutally cold there. But it cycles methane the way our planet cycles water, although it does so much more slowly.

What these discoveries point out, however, is that other worlds are alien. They are not like Earth. We can find similarities out there, but the differences are truly real. While it is tempting to get very excited by the mounting evidence for even current water on Mars, getting there would be quite a human achievement. And as the ISS showed us today, little glitches could become real issues out there. So, before we go off half cocked and try to send someone to Mars to check things out, let's work out and work through the mundane tasks associated with keeping people alive out there.

It's The End of The World, As We Know It

Worried about global warming? Well, there's more than that out there in the future. This month's issue of Astronomy magazine explores what scientists think may happen, or certainly will happen eventually, to the Earth. Think: hot and dry. Really dry. As in, the oceans completely boil away.


Billions of years from now, the Sun will go into its Red Giant phase, and begin to expand. That much is pretty well certain. What is not clear is how rapidly this will happen. It may expand gradually. In that case, Earth may expand its orbit too, and wind up out there where Mars is today. Of course, it all may happen so fast, that we get caught close in, like Mercury is to our Sun right now. That would be bad. But, not as bad as if the Sun really got into mergers and acquisitions. Then our planet could actually wind up inside the sun.

Will anyone be here to worry about it? Odds are, probably not. As a species, we have only been around in our current evolutionary form some 30,000-50,000 years. The dinosaurs held dominion over the Earth for a few hundred million years, and look at them. Actually, you can look at them. What is left of the dinosaurs are the birds around us. They are the heirs of T. Rex and friends. At once sublime and irrelevant. They evolved the ultimate skill--flight--but their very continued existence is pretty much up to us and whether we decide to allow it.

Which brings me back to the end of the world. Right now, the International Space Station and Space Shuttle Atlantis are locked in orbit, with a few humans working up there. It costs us a lot of money to explore space, even to this limited degree that we do. The real science is done by probes and robots, like Spirit and Opportunity on Mars, or the New Horizons probe we sent to Pluto. It's probably a good thing that the IAU hadn't demoted Pluto from planet status before that project was pretty much ready to launch. Can you imagine the budget debates over whether or not to send a probe to an ice world that isn't even a planet anymore? (Officially)



For my part, I am supportive of continuing to fiddle around with sending humans into space. It may be very expensive, and some of the practicality of doing it may not be obvious. Lord knows we have plenty of problems right here on Earth that could use the money and effort. But in the long run, the really long run, if there are any humans still alive, they are going to have to leave here in order for our species to survive. Sooner or later, we have to try out living elsewhere. The early colonists may turn out like the Lost Colony did here in North Carolina--literally lost. But staying here, and nowhere else, is a long-term bad investment. Not that any of us really have to worry about it. I don't lose sleep over it.



I'm still glad to know that we keep working on it, and that the Exoplanet Hunters are checking out the real estate in other places. Someone may eventually need to go there, some way, some how. If only we can hang on long enough.

What's Wrong With This Picture?

I'll keep this short tonight, but this has been bothering me for a few months now. I realize that literally the whole world pretty much wants President Bush out of office by now, but I just cannot get into the idea that here, in the late Spring of 2007, we are already full blast into the Presidential election cycle for 2008.


I would have thought we could at least wait until, I don't know, Labor Day to get this level of frenzy around the issue. I'm not apolitical. And I'm not apathetic. But geez, this is ridiculous. For what it's worth, which isn't much at this point, I think Clinton is the candidate Republicans are desperately hoping the Democrats will run. She's the one they think they can get their base energized to defeat. Anyone else the Democrats could put forward would probably win going away.



So, of course, Clinton is who the Democrats will probably pick. As for the Republicans, does it really matter? They all pretty much look and sound the same. A little nuance here or there, but it's pretty much all the same. But, it's early. So on both sides, I would caution everyone to remember the old adage, "if you give 'em enough rope, he (or she) will probably hang himself." I think that is the risk they all face jumping out this fast with the campaign.



Too much rope.

Tips From the Kitchen

This has been a pretty good weekend for me in the kitchen, so I thought I would share a couple of recipes I created, in case you would like to try them also.

A little over a year ago I really got interested in making crepes. Last October we were in France and I got to watch the street vendors and other cooks, and I picked up a number of technique tips from them. I also learned from them that a basic crepe with Nutella spread and a fresh banana is to die for. Our whole family enjoys crepes with fresh fruit, and it has become a staple breakfast on the weekends. I have not been happy with the sauce I used, however, until this weekend. I used to just cook some of the fresh fruit in water with a little sugar, and while that did moisten the crepes, it was a little thin. Today I made a sauce that everyone agreed was the way to go.

This recipe makes enough fruit syrup sauce for three people, once with no leftovers. I used it on crepes, but it should also work well for pancakes. If you need more, just adjust the proportions accordingly. Start with 1/4 cup water, 3/4 cup fruit juice (I used Light Cran-Grape today, but I imagine any would work), 1/3 cup sugar, 1 Tablespoon corn starch, and some fresh strawberries. Combine everything in a small saucepan and bring to a slow boil while making the crepes or pancakes. When it reaches the desired thickness, just cut off the heat until you are ready to serve it up. I served it over crepes covered with fresh sliced strawberries and blueberries, then added the fruit syrup sauce, and my daughter topped it off with some powdered sugar. My wife and I didn't add the powdered sugar, but the sauce was plenty sweet without being cloyingly so. The point/counterpoint between fresh fruit and cooked fruit was very enjoyable.

This afternoon I made a roasted garlic vidalia onion salsa fresca that is very nice. If you want to try homemade salsa, this is an easy way to start out. I started with 8 fresh tomatoes, a vidalia onion, 1 jalapeno pepper with seeds, two cloves of garlic (roasted), 4 sun-dried tomatoes, some cilantro, and 1/2 Tablespoon each: salt, white vinegar, sugar, and corn starch. First I re-hydrated the sun-dried tomatoes and wrapped the garlic in foil, roasting it in a 350 degree oven for about 20 minutes. While the garlic roasted I put the tomatoes, jalapeno pepper, vidalia onion, and all the seasonings into a food processor and pulsed until I thought the chunks were the right size. Then I added the roasted garlic and pulsed a few more times to get that mixed in. The resulting salsa has a wonderful flavor, balancing the sweetness of the onion against the tartness of the vinegar and tomatoes, but with a smoky essence from the sun-dried tomatoes and roasted garlic. There is enough heat to make your lips tingle, but not so much that you don't keep wanting more. I was very happy with the results.

If you try either of these recipes, let me know how you liked them. If you have ideas for improving on them, let me know.

The Power of Promises

As I mentioned on my profile, I have a dog. Actually, I have a Golden Retriever/Chow mix dog that was rescued from an animal shelter about four years ago, by us. We got him as a puppy.


My dog's name is Austin, and he is what I refer to as a "special needs" dog. His mother's owners were not happy about the puppies, and they called the animal shelter to have them pick up the litter when they were one day old. There were three pups in the litter. One died, but two survived and were raised by hand by a foster family. Several veterinarians have commented on just how much work that must have been.


Since he was separated from his mother almost at birth, Austin never learned some things that puppies learn from their mothers. He is a very good dog, but he lacks confidence, and he can become nervous. Among the things that stress him out are the vacuum cleaner, the blender, the automatic garage door opener, and stray plastic bags that sometimes blow through the neighborhood.


Two years ago, a Rottweiler in our neighborhood got loose and attacked Austin while he was being walked. He was on lead, and in a vulnerable position. Plus, he was about 60 pounds lighter in weight than that dog, and it took two people to separate them. That incident was another major blow to his psyche. With his various deficits, he wound up on some doggie happy pills that he has to take every day. And, we learned that his anxiety after that made him react to stressful situations with fear based aggression, and we had to do some therapy for him with a special veterinarian, to help him overcome his fears, and help us learn how to help him handle these things better.


The vets we talked to and worked with were wonderful, but as we started the program, they gave us the other option. They pointed out things to us like Austin could never be adopted by another family, and that given all that he had been through, we wouldn't be considered bad pet owners if we put him down.


We never entertained that thought, and tonight as he lies here on the floor beside me, I am glad we stayed with the program and helped him deal with his problems. If someone pressed me to name why we have worked so hard with this dog, I suppose my answer would be that we made a promise to Austin to have him in our family and let him be our dog. We promised to take care of him, and not abandon him.


I read a quote once from a play, I think it might have been by Tennessee Williams, but I'm not sure. It had to do with marriages, and it went something along the lines that "Some number of years ago, we made a promise to each other. We didn't say we would meet each other's every need, and we didn't promise not to have our flaws. And in the end, when times got tough, it wasn't love that held us together, it wasn't our kids, it was that promise." I know that is not an exact quote, but it conveys the essence of what I remember. The other day on NPR I heard similar ideas being expressed by a contributor to the "This I Believe" series they are compiling. I liked what she said.


So, this is what I believe. I believe in the power of promises. Sometimes in life, we make a promise that we don't always know how it will turn out. It may be that we promise to take care of a dog with special needs, or we promise to love a person, even with their flaws. And then we will eventually have to confront the realities of the promise. I know that sometimes we may be tempted to take the other option in that moment, but for me, based on what I know from living, I'll hang on to the power of the promise more often than not.


And the reward we get for hanging in there, well, it's kind of like the reward I get each day when I come home. Austin may hate the garage door opener, but he loves us, and he gets excited when we walk through the door. Isn't that what love really boils down to in the end? Calming our fears enough to remember the excitement and joy we get from having our loved ones in our lives? If having Austin in my life never means more than this, giving me the chance to learn about the power of promises, then adopting him was worth it. Because life lessons like that one can only come through living. And a dog that can help us learn things like that is truly special.

Mind Your Ps and Qs

My, my, tuberculosis is getting a lot of airplay this week. Andrew Speaker has to be the most famous case of tuberculosis in the United States since Doc Holiday roamed the West with Wyatt Earp. Behind the hype and hysteria, of course, there are several real and important health stories going on here. I'm not sure those are getting the proper amount of attention, however.


Tuberculosis is not really the story here, I am afraid. I was a tuberculosis epidemiologist in Texas from 1994-1996, and have some familiarity with this disease. For all that has been said of Mr. Speaker, his particular case does not seem to have actually put anyone at major risk. Tuberculosis is not easy to spread unless one is aspirating lesions, or in the presence of a patient actively coughing up bugs, from holes in the lungs. His strain is a dangerous strain because it is drug resistant, but he does not seem to have been in a very active state of disease. It is serious because the case will be difficult to treat, but it is highly unlikely that anyone else has been infected.


The health stories here that do worry me, however, concern the sorry state of our public health laws regarding quarantine, and the violations of patient confidentiality that have occurred. None of us should know who this man is. He should not be a news story at all. That was part of what the Health Insurance Portability and Accountability Act of 1996 was all about, in particular, its Privacy Rule. From the summary document HHS has posted on their website about the Privacy Rule we read the following:

A major goal of the Privacy Rule is to assure that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public's health and well being.

Okay, so let me see a show of hands from everyone who thinks this rule was followed? And, let's see, he is a personal injury lawyer....hmm. I believe he will likely be filing a lawsuit in the future, once his lengthy course of treatment in the National Jewish Hospital in Denver is completed and he is cured of his tuberculosis.


It was not known, apparently, when he left for Europe that his strain of TB was extremely drug resistant. That does not excuse him for some of the decisions he made, but it is a pertinent fact. It is not clear that any health authority in the US had legal power to prevent his travel. Our quarantine laws are designed to keep people with infectious diseases out of the population, not in. Of course, it is also not clear that those laws, mostly based on 100 year old assumptions about people arriving in defined ports of entry on large ocean-going vessels, have any practical effectiveness today.


That actually is the other real story here, and we should be concerned about the quarantine problem. But not because of TB. We need to update our laws in this area due to the risks associated with Pandemic Influenza. In the future I'll probably write a bit about Pandemic Influenza, but for tonight I'll just point out that the flu is highly contagious, and part of our control strategies will require us to be able to quickly quarantine people who are infectious. The problem is, that it probably won't work. To be effective, we would have to know the first case or first few cases a) have the pandemic strain, and b) quarantine them a couple of days before they start showing symptoms. That would only be possible if a known outbreak was happening somewhere else in the world, we already knew it was a potentially pandemic strain, and we knew everyone who had been exposed. And their whereabouts at all times.


After the first few dozen patients developed pandemic flu and exposed their close contacts, quarantine would break down and the rest will become future history. Worst case scenario, we would be looking at over 100 million cases worldwide. Potentially half of those fatal. But today, I am afraid much ado is being made over something that was not nothing, but it also wasn't what everyone necessarily thinks, either.


Ps and qs. Pandemics and quarantines. Things to ponder. Along with, who violated Mr. Speaker's HIPAA rights, anyway? There is a story that needs to be examined a lot more closely.

My Life as an iPod Accessory

A friend of mine asked my opinion of mp3 players and the iPod last weekend, knowing that I had tried out a couple. I had the Nomad Jukebox when it first came out, before Apple released their Windows compatible version of iTunes. And, once the the Windows version of iTunes was out, I immediately purchased an iPod.

I absolutely love the iPod. In fact, I think it is the most perfect gadget ever invented in the history of the world. But since I got one, I sometimes feel my life is an iPod accessory. It started out simply enough. I transferred all my .Mp3 songs in my computer into the iTunes library. Then I went through all our CDs, uploading the songs that I had not already ripped. Of course, I learned how to buy songs from iTunes music store. But I started wanting to listen to my songs without needing to wear the headphones.

So I bought a cable at RadioShack to hook the iPod up to my house stereo. Then I bought a pair of Yamaha speakers that used the minijack interface, so I could play it in my office. But I wanted better audio quality, so I bought a pretty decent 3 piece speaker system (subwoofer with two satellites) to listen to it in my bedroom. But I wanted to also be able to charge it up while it played, and to have something a little more portable to move around the house. Enter the JBL On Stage.


When I travelled, as my job used to require, I wanted to listen to the iPod in my hotel room. So I bought the portable Altec Lansing speaker system, which packs very well and gives fairly good sound for such small speakers. But I didn't like the earbuds quite as much as I would prefer, and one day in the Hartsfield International Airport I bought the Shure earbuds (wow, that was an upgrade in sound performance).


Then I got to wanting to listen to it in the car, through the stereo speakers. I bought a new Alpine head unit that had an interface to connect to the iPod. It gives it power and it also has nifty technology that re-expands the music files on playback, yielding CD quality sound. When I traded cars I had to first have this head unit removed, the original one that came with the car put back in, and then have the Alpine unit immediately installed in my new SUV. Of course, I saved the one that came with the Highlander, so I can repeat the whole process in the future. My latest iPod accessory is a small pair of speakers on the handlbars of my Bianchi road bike. Now I can listen to the iPod while I cycle the back roads near Jordan Lake.


I have no idea how much money I have spent on these various and other accessories for the iPod. I don't even want to know. But I do know that my daughter and I have spent a lot of time listening to music and podcasts together, that road trips and work outs are wonderfully enjoyable, and that I can carry every song I ever loved around in my pocket. Podcasts let me TiVo the radio, and hear programs I wasn't able to catch when they were on the radio live.


And when my pre-teen asks if she can listen to Click and Clack on Car Talk as we drive to school in the morning, laughs her head off on the way there, and wishes me a good day as she is getting out of the car, what goes through my mind is: who knew the iPod was the key to domestic tranquility and connecting across the generations with this kid?


How cool is that? A gadget that serves as my alarm clock, travelling companion, workout partner, ultimate music player, and helps keep me cool enough in my daughter's eyes that she still wants to hang out with me, for now? Thank you, Apple, for dreaming something like this into existence.

Growth Matters

Okay, I'll give the food series a rest. I hope that some of you enjoyed it. I thought about several themes for tonight's blog post, but settled on the issue of suburban sprawl and growth matters here in North Carolina.

Today the Chatham County Commissioners took a courageous stance, and one that I want to applaud. Chatham County is the adjacent county to where I live in Apex, and in fact, the county line is less than two miles from my house. Today they voted a 12 month moratorium on new housing developments of more than 25 lots. They want that year respite from the onslaught of development to decide as a commission what kinds of updates they need to their various zoning ordinances, and to determine ways to pay the infrastructure costs of new development.

Here in North Carolina we are fighting an epic battle between pro-growth and pro-development forces, and those who favor a slower, more managed growth pattern that has a lot of citizen input, and that tries to make growth pay for itself. I guess by the way I phrased that you can tell where I fall on the spectrum.

The most recent estimates project that 4 million people will move to North Carolina between now and 2050. That would be like having everyone in South Carolina pick up and move here. There are over 50 bills that were filed this legislative session proposing to give new powers to city and county government to enact impact fees, land transfer taxes, sales taxes and other measures to raise money to pay for the costs of new roads, new water treatment facilities, new schools, sewer systems, and other utlility expansions. Most of these measures are being aggressivly fought by developers, low-tax interests, some members of the business community, and realtors. The tug of war is on between people who make their living from growth, and those who have to endure the consequences of a lower quality of life.

I remember a few years ago considering moving to Oregon. I learned pretty quick that the point of view of Oregonians seemed to be, "Oregon is a great place for you to visit and spend your vacation, but don't even think about moving here, thank you very much." I can relate to that. I have lived more of my life in North Carolina than anywhere else, but I'm not ready to advertise it as a place I want 4 million more people to come call home.

So, consider yourselves informed, if you are thinking about joining us here in the Tar Heel state. We have beautiful beaches, that is true. But we also have local infrastructures that are stressed to the max, and a population that is divided at the moment on whether we want many new neighbors right now. It's not your father's Mayberry anymore. And for my part, here's a toast to the Chatham County Commissioners. I hope they are starting a new political movement here in the Carolinas.

The Price of Convenience

Rich asked in a comment on the first post of this food series what my take was on the power of consumer preferences, in terms of what drives the portions and selections available in restaurants, and presumably, also in grocery stores. Some people have sued chain restaurants like McDonalds over the fat content of their food, and others have charged that the restaurants themselves need to be held more accountable for America's obesity epidemic.


I am not inclined to think that way. It doesn't make sense to me to blame industry or restaurants or grocery stores for America's weight problem. The food industry, in virtually all of its segments, is a very low-margin industry. Most high-end restaurants lose money on food, and have to sell (a lot) of wine (at incredible markups) to make money. On the low end of the scale, in fast food restaurants, where alcohol is not sold, the only way they can make money is by selling what people want. America's dirty secret is that we love our double cheeseburgers, our pizza buffets, our enormous portions, fried foods and sweets.


We do have a weight problem. When I was working an executive gig in the private sector, having lots of business lunches and dinners, working long hours, not working out consistently, and battling stress, gained over 30 pounds. My Body Mass Index hit 28, and I was officially overweight, heading for obesity.

In the past year I have lost 35 pounds, and am maintaining a healthy weight right now. In many ways, it wasn't hard to do, but for some people my methods would be really hard to stick with. The entire diet industry is the yang to the yin of poor choices and the ease of convenience foods. A recent interview on Marketplace that I heard said it was something like a $2 billion industry, when you add the books, the gyms, the supplements, the prepared food gimmicks, and home exercise equipment/DVDs/etc. all together. Jokes about losing the same ten pounds hundreds of times still circulate.

Losing weight and gaining weight is really easy, in some ways. The basic formula is still based on calories. Your body uses a certain amount of energy each day, and the food you eat provides that energy. If you eat fewer calories than than the body needs, you start losing weight. If you eat more calories than your body uses, you store the excess as fat, and start gaining weight.

The price we pay today for convenience is that it is really easy to consume more calories than you burn. When I decided to take control of my weight, I looked at where are the calories coming from? For me, there were two main problem areas.

The first was soft drinks. I was consuming 3-4 regular Mt. Dews every day. Each one had 170 calories in it. So I switched to Diet Mt. Dew, and limited myself to 1 a day. Then I added flavored water, like Fruit2O, to replace the other soft drinks. That increased my water consumption, but let me still get a caffeine boost in the middle of the day.

The other problem area was eating out, especially for lunch. I ate out 2-3 times a week. In July 2006 I stopped doing that. I made myself take my lunch, and we already hardly ever ate out for dinner, and never for breakfast. Not eating out puts me in total control of portions as well as the menu choices.

The third thing I did was get serious about exercise. I probably tripled the amount of exercise I got, from about 4-6 times per month to 3-5 times per week, with a good mix of activities. I use my Bowflex for 20 minutes every other day, walk the dog daily, and either hike, cycle or kayak at least 2 times a week for up to three hours at a time.

Now, is my life convenient? It depends on how you look at it. My overall health is much better and I've lost 35 pounds. I feel good. I look a lot better. My stress level is very low right now. I spend about 2 hours each weekend day cooking, and about 30-40 minutes each day during the week. I have to think about the week's menu and plan my shopping trips, but it really isn't hard for me to do.

I don't limit my food choices, or avoid foods I like. I eat whatever I want to. I do control portion sizes, and I avoid buying most snack foods and food-like items from the store. I made these changes because to me, the price of convenience was too high. But each person makes his or her own choices, and I won't judge anyone too harshly for that. I would challenge everyone to be honest with themselves and recognize that most of us do choose what we eat and drink. We also choose how active we will be. The results of our choices, therefore, for most of us, are our own.

Savoring It All

Okay, so my thesis basically is becoming that too many people are too out of touch with their food. Fewer and fewer people are actually involved in the production of food, yet we still produce tons of it. Maybe even more than we need. The real question is becoming, do we enjoy it? Is it good food? How can you even tell?

How many people have never tasted a homegrown tomato? If your only experience of a tomato is what you get in a grocery store, you have sadly missed out on one of life's purest pleasures. A lot of food is probably like that. Our experience of it is based purely on how we have encountered it in life. And a lot of people have not had many real and authentic food experiences.

So, from this point forward, I'm going to lay out a few ideas I have on how we can reconnect with our food. First let me say that I am not saying this is what anyone should do. The last thing in the world I want to be accused of is telling someone how they ought to live their life. I guess I'm still recovering from my traumatic upbringing in an evangelical protestant church--I'm not going to ask you whether you have a personal relationship with your asparagus, or your fried chicken. Neither will I be passing the plate or asking for a contribution.

What I will say is that if you agree that you would like to feel more connected with your food, I'll share a few ideas with you on how you might go about doing that. For me, there are three basic steps that I try to follow: start with real food, buy local food as often as possible, and grow whatever you can or want to for your own consumption.

Real food. When you buy groceries, look at your cart. How much of what is in there is real food? I mean, basic food items like apples, squash, meat, fish, poultry, eggs, grains, or dairy products? When I go shopping, I'm stunned at how much of the store, and how much of the contents of most people's carts, is filled with food-like items. Boxes and bags of snacks, meal starters like Hamburger Helper, pre-packaged complete meals that were made who knows when in a factory, meal bars, energy drinks, stuff like that. Stuff that when you read the label it takes you right back to freshman chemistry. Stuff that has corn sweetener as one of the first three ingredients, and lots of chemicals that you aren't really sure what they are or do.

If you want to connect with your food, start with real food. Make sure that most of what you buy is identifiable as food, and comes from one of the major food groups. Fruits, vegetables, grains like rice, oats or flour, fish, poultry, meat, dairy products like milk, yogurt and cheese. The basic building blocks of meals.

Buy local. Visit your local farmer's market, and meet the people who grew the food you buy. This does several things. It supports local farmers, it gets you closer to the production, and the food items were usually on the vine more recently. For some items, like locally produced honey, you get an added benefit in helping you adapt to the pollen from the area. That can help allergy sufferers, for instance. In our area, local strawberries, peaches and blueberries are available in season that completely blow away the stuff from California or Chile that is in the grocery store, when it comes to flavor. Another option is to visit pick-your-own farms and orchards. We did this the past three weeks for strawberries. We may not have grown it, but we picked it. Pies and margaritas made with berries that were on the vine just a few hours ago, and were picked only when ripe, are the best. Buying local also reduces the carbon footprint of your food, because it wasn't flown in from overseas or trucked in from the opposite side of the country. That helps fight global warming, at least to a small degree.

Now, for some food items, you don't want to buy local. That's okay. Just understand what you are doing and why. I love to make guacamole, but avocados don't grow in North Carolina. While we have a wine industry, California, France, Spain, Italy, Australia, and Chile all make superior wines. For a product like that, it makes sense to buy from wherever you want to. But for tomatoes, beans, sweet potatoes, seasonal fruits, etc., buying local like I suggested does get you more connected with what you are eating.

Grow your own. Everyone can grow or produce something that they eat. You can install a raised bed garden spot in many backyards, even very small ones. Container gardens can grow herbs like basil, and vegetables like tomatoes, peppers, and such. Some fruit trees make sense in a yard. When you grow your own food, even in limited quantities, you feel more connected to your food, and I think it is enjoyable to eat something you actually helped produce. Of course, if you have the space and inclination, putting in a whole garden really expands your options.

Cook. The final step in re-connecting with food is to actually cook what you eat. I don't mean warm it up in the microwave, I mean start with the basic elements of a meal and prepare it yourself. This part can be intimidating for some people. But it is so rewarding and enjoyable to actually bake and cook your own food. In our house, we bake our own bread, and we virtually never eat out. Since January 1, 2007, our family has only gone out to dinner four times. We cook almost all of the meals we eat, and we also take our lunches with us, the vast majority of the time. Doing this really does make you feel more connected with the food. It also has other health benefits, which I'll touch on tomorrow.

One food movement that I am really intrigued with right now is the Slow Food movement. You can follow the link on my website to learn more about Slow Food.

So, do you feel more at one with your food-ness? Do you feel that mystic bond with your carrots? Oh well, I don't either. Most of the time. But I at least would like to be closer to the food, and am working on doing that more days than not. Let me know what you think, and whether any of this resonates with you.