The past was bad

It’s looking tonight like the GOP will manage to pass some version of the AHCA, a bill repealing the Affordable Care Act and creating some kind of return to the pre-ACA status quo; hard to know exactly what, since the vote will be taken without the bill being publicly released, and the House has decided not to wait for the Congressional Budget Office to estimate just how much this bill will cost Americans.

GOP fans will say: “How can this be such a big disaster, crying liberals?  Ten years ago there was no Obamacare, and people did fine.”

Some people did fine!  Some people didn’t do fine.

You’ll hear people say, in the same sad snappish tone of voice, “Parents today are obsessed with safety, in my day kids rode in the way back of the station wagon, they didn’t wear seatbelts, they crossed the street by themselves, and they were fine.”

Some kids were fine!  But just so you know:  in 1975, about 1600 kids 13 and under were killed by cars as pedestrians, and another 1400 were killed in crashes while riding in cars.  In 2015, those numbers were 186 and 663.  Throw in teenagers and that’s another 8700 dead passengers in 1975; down to 2715 in 2015.

People did fine, except for the thousands of kids who got killed back then who wouldn’t get killed now.

A while ago I was reading the reunion book for the Harvard class of 1893, the people who graduated exactly 100 years before me.  You know what you notice in their bios?  A lot of people’s children died.  In 1920, about 8% of American babies died before the age of 1.  It’s now 0.6%.

People were fine!  They had a baby, the baby died, they got on with their life.

But I like it better when babies hardly ever die, when thousands of children don’t get killed in car crashes, and when Americans have access to affordable health insurance even if they’ve been sick before.  The past was fine.  But it was also bad.

 

 

Olive oil and nuts beat a low-fat diet that’s not low-fat

Great-looking results from a big randomized diet study reported today in the New York Times:

About 30 percent of heart attacks, strokes and deaths from heart disease can be prevented in people at high risk if they switch to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables, and even drink wine with meals, a large and rigorous new study has found….

Scientists randomly assigned 7,447 people in Spain who were overweight, were smokers, or had diabetes or other risk factors for heart disease to follow the Mediterranean diet or a low-fat one.

Low-fat diets have not been shown in any rigorous way to be helpful, and they are also very hard for patients to maintain — a reality borne out in the new study, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation.

Now, I am not a low-fat dude.  Long ago I dated somebody who was into Dean Ornish and every time she “sauteed” onions in water a little piece of me died.  I pour a lot of olive oil on things, because I like it (especially Frantoia, which the guys at the Italian grocery in the Trenton Farmer’s Market turned me on to when I lived in Princeton) and because mainstream nutritional wisdom has been promoting monounsaturated fats for a long time now.  But I do think low-fat gets kind of a bad rap from the NYT piece.  Even more so in some of the other coverage, like the LA Times, which headlines their story “Mediterranean diet, with olive oil and nuts, beats low-fat diet.”  The Times, at least, points out far down in the piece that the “low-fat” group, while counseled to reduce fat, didn’t actually do so.  To get numbers, you have to go to the supplemental material of the original paper.  There, you find that the Mediterranean eaters were getting 41% of their calories from fat, while the “low-fat” arm got 37%.  A low-fat diet is 22%.  Random googling suggests that most vegans are getting 20%-30% of their calories from fat.

In other words, the study doesn’t really show that the Mediterranean diet is better for you than eating low-fat; it shows that hardly anybody is capable of eating low-fat, which is a different thing entirely.

Menopause Matters

It’s a little outside the usual stomping grounds of this blog, but I thought I’d mention that my cousin-in-law the doctor, Julia Edelman, has a new book out, Menopause Matters. Julia is the mom of this cousin-in-law, by the way.