Mr. President, I challenge you to a nudge-off

Courtesy: WhiteHouse.gov

Below is an op-ed I wrote for the Baltimore Sun in the form of a letter to President Obama.

A challenge to the ex-smoker in chief
July 25, 2009

Dear Mr. President,

 I feel your pain. It is no fun being judged by others for a personal habit, regardless of whether it’s bad for your health or not. I cringed the other week when, under the guise of wondering whether your new anti-smoking law will be effective, McClatchy reporter Margaret Talev rattled off a series of nosy questions about your own smoking habits during your first afternoon news conference. 

As a person who battled a serious weight problem and exhibited horrendous eating behaviors for decades, I totally understand why you needled Ms. Talev for prying into your private life. Despite the fact that I lost about 180 pounds six years ago, I still struggle to stay on that proverbial wagon that you claim to fall off of “once every month or so.” Which leads me to the reason for my correspondence today.

Following the teachings of your trusted advisor, Cass Sunstein (co-author of Nudge), I’d like to challenge you to a mutually beneficial nudge-off. 

I couldn’t help but notice that you made a concerted effort to make it clear that you are “a former smoker,” rather than a smoker who just can’t seem to stay quit. No doubt, Mr. Sunstein taught you the important lesson of changing your default self-image. If you ever “fall off the wagon” again and smoke a cigarette, instead of feeling like you’ve failed and that you’re a smoker again, the moment you take that last drag you’ll return to your default nonsmoker position. It’s a subtle change of thought, but it can be quite empowering. Now you won’t have to struggle with the pangs of quitting again because you’ve already decided that you’re a nonsmoker. However, the difficulty of making sure you don’t stray again remains. That’s where our nudge-off will come into play.



Through simple diet and exercise I was able to lose almost half my body weight in less than a year, but I couldn’t have done it without significantly altering my self-defeating eating habits. The experience has given me keen insight into behavior change, and played no small role in drawing me to my current position at the Johns Hopkins Bloomberg School of Public Health, where I am directing several projects designed to positively influence health and eating behaviors. The projects are based on the national Healthy Monday campaign’s communications model, which incorporates weekly reminders and nudges every Monday in hopes that the intended behavior change will not only take place that day but will carry on through the week.



After reading Mr. Sunstein’s and Richard Thaler’s book, Nudge, I realized the Monday model is a perfect complement to their theory on how to improve “decisions about health, wealth and happiness,” or in other words, nudging people to make the right decisions. In your case, Mr. President, if you fall off the wagon again, using periodic messaging each Monday will offer you 52 nudges a year to get right back on, reinforcing your new nonsmoker default self-image. The model can be implemented in countless ways. Currently, with the leadership of several obesity experts at Johns Hopkins, I am directing a caloric awareness research project based on the Monday model. I’ve also reached out to Baltimore City Public Schools in hopes of incorporating a cooking program for kids each Monday. In an effort to save money, help the environment, and improve students’ health, the school system’s top chef has already decided to offer Meatless Monday menu options during the next school year.

So, here’s my proposal: I challenge you to fight any urge to smoke each Monday for the next year; in return, since I need to lose about 50 pounds, on the same day I promise to consume less than 2,000 calories worth of food and drink. Should I falter, I will donate $100 dollars to the charity of your choice or, should you like, I could take over your dog walking duties for a month – your call. If you falter, well, you are the president of the United States, so perhaps the most I could hope for is a phone call.



Sincerely,
Ralph Loglisci, Baltimore



The writer is project director for the Johns Hopkins Healthy Monday Project.
Link to story in the Sun. Saturday, July 25, 2009

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Will Big Ag try to redefine what’s considered preventive care now that the White House signaled it supports banning the use of antibiotics for growth promotion in food animals?

Courtesy: USDA

Chalk one up for public health advocates fighting to keep antibiotics an effective treatment for fighting disease in people after the FDA’s principal deputy commissioner of food and drugs, Dr. Joshua Sharfstein, revealed that the Obama Administration, “supports ending the use of antibiotics for growth and feed efficiency” in food animals. Dr. Sharfstein made the statement during a House Rules Committee hearing Monday afternoon, which was called by the committee chair, Congresswoman Louise Slaughter (D, NY), to discuss her proposed Preservation of Antibiotics for Medical Treatment Act. (PAMTA)

For public health advocates, the fact that the FDA is officially linking antimicrobial resistance to animal agriculture is worthy of celebration, considering industry lobbyists successfully bullied the FDA under the Bush Administration to look the other way and tried to sweep the unsavory facts under the rug for years. Not surprisingly, Dave Warner a spokesperson for the National Pork Producers Council told the New York Times:

There are no good studies that show that some of these antibiotic-resistant diseases… have any link to antibiotic use in food-animal production.

What surprises me is that the NYT didn’t call Warner out on this claim. Maybe both the NYT and Warner could learn a great deal from Dr. Frederick Angulo over at the Center for Disease Control and Prevention. Dr. Angulo knows a little bit about infectious diseases. He’s a medical epidemiologist trained in veterinary medicine and human public health. Angulo serves as the CDC’s Deputy Chief of the Enteric Diseases Epidemiology Branch in Atlanta. He’s considered to be a world-renowned expert in foodborne and waterborne diseases. Just recently the Journal of the American Veterinary Medical Association quoted him as saying:

There is scientific consensus that antibiotic use in food animals contributes to resistance in humans,” Dr. Angulo said. “And there’s increasing evidence that such resistance results in adverse human health consequences at the population level. Antibiotics are a finite and precious resource, and we need to promote prudent and judicious antibiotic use.

Antibiotic resistance may sound like a new issue to many Americans, but believe it or not it’s been a concern almost since Dr. Alexander Fleming discovered penicillin in 1928. During his 1945 Nobel Prize lecture, Fleming warned about the dangers of resistance:

It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.

The Union of Concerned Scientists estimates that as much as 70% of all the antimicrobials produced in the U.S. are given to food animals. Millions of pounds of antimicrobials are administered each year at low doses to these animals, usually in their feed. So it’s not surprising that we’re finding antimicrobial resistant bugs like MRSA, better known as the flesh-eating bacteria, or resistant forms of Campylobacter, E. coli and Salmonella on the meats that we buy in the grocery store and floating around in the environment. Big Ag advocates claim that the proposed ban is going to backfire and we’ll end up with even more sick food animals and force farmers to treat them with antibiotics anyway. Many, like Congressman Leonard Boswell (D-IA) point to examples in Denmark, where a ban enacted more than a decade ago initially increased the mortality of piglets and the need to treat them with antibiotics. But as Robert Martin, former executive director for the Pew Commission on Industrial Farm Animal Production, testified, what the industry seems to ignore (or doesn’t want the public to know) is that once Danish hog farmers improved their production practices, “including better ventilation in the barns, more space provided for the animals, and more frequent cleaning of the barns,” the mortality rates quickly declined to pre-ban numbers.

Two Danish scientists, Dr. Frank Møller Aarestrup and Dr. Henrik Wegener, from the National Food Institute at the Technical University of Denmark submitted written testimony to the Rules Committee in effort to “set the record straight.” Drs. Aarstrup and Henrick said “representatives of organizations funded by U.S. agri-business have criticized and mis-represented the facts on the Danish ban of antibiotics since its inception.” In fact, according to their soon to be published study on the “Danish experience,” over the long-term, significantly reducing the use of antimicrobials actually increased swine productivity.

Lawmakers, like Senator Ted Kennedy (D-MA) and Congresswoman Slaughter have been introducing forms of PAMTA for almost a decade now. From the beginning, organizations like the American Public Health Association, American Medical Association, Consumers Union and the Center for Science in the Public Interest recognized the need to restrict the constant low dosage use of antibiotics in agriculture. Each year, provisions in the legislation varied, but each version proposed banning the use of antibiotics important to human health from being used in food animals and to restrict the use of other antibiotics.

While many health advocates applaud lawmakers for introducing PAMTA, there are some who believe the legislation should be stronger. Martin was invited to Monday’s hearing to present the Pew Commission’s findings and recommendations on how to tackle the antibiotic resistance threat posed by animal agriculture. The Commission goes a few steps further than PAMTA. Rather than limiting the ban to the 7 classes of antibiotics important to human health, the Commission recommended a ban on the non-therapeutic use of all antibiotics and other antimicrobials, like ionophores, that have the potential to lead to the increase of antimicrobial resistant bacteria in the environment. Ionophores are made up of organic compounds that have antibiotic properties. Instead of using fungus based antibiotics, ionophores are commonly added to feed to kill single-cell parasites that infest the intestinal tracts of animals. You might remember Tyson Foods got into a little hot water a few years ago for labeling itschicken antibiotic-free despite the fact it was still treating its birds with ionophores. While the use of ionophores continues to add to the ever-increasing “reservoir of antimicrobial resistance,” the USDA says the use of the compounds, “…does not necessarily lead to other types of antibiotic resistance.” What led scientists to couch their conclusion was that they did find that the use could lead to resistance in bacitracin, which is commonly found in antibiotic ointments, like Neosporin, used to treat skin and eye infections.

Robert Martin says, “PAMTA is a good first step, but as it’s currently written, I think it’s only a beginning in reducing the threat of antibiotic resistance in animal agriculture.” The proposed legislation could even be less effective if industry lobbyists are successful in redefining what the proposed law should consider therapeutic uses of antibiotics. Martin warns that the industry is trying to argue that producers no longer use antibiotics as growth promoters; rather they’re primarily using the drugs to keep the animals from getting sick. Martin quipped, “it’s the crowded, unhealthy, putrid conditions these animals are forced to live in that’s making them sick, and that is not a reasonable excuse to threaten the effectiveness of antibiotics in human medicine.”