Protein 101: Dispelling the Myth Surrounding Meatless Meals

Courtesy: Flickr - McCall Magazine, 1939 George Eastman

Courtesy: Flickr – McCall Magazine, 1939 George Eastman

It is disappointing to see members of the media spread misinformation due to their own ignorance, gullibility, or, worse, disinterest in digging for the truth — especially when it has to do with the health of children. Case in point, a reporter from a South Dakota talk radio show apparently believes that Baltimore City Public Schools’ Meatless Monday meals are lacking in protein. Last Friday, Tom Riter asked U.S. Agriculture Secretary Tom Vilsack a rather leading question (notice how many times he said “bother”) during a USDA news conference to preview the Obama administration’s priorities for the Child Nutrition Act Reauthorization:

Mr. Secretary, I was wondering if it bothered you… that… you were talking about the importance of the nutrition for the school children… and I was wondering if it bothered you that school districts like Baltimore, Maryland institute Meatless Mondays… not letting the children have protein in the diet by doing that. Does that bother you?

Seriously? He thinks Baltimore City Schools are denying kids their recommended daily allowance of protein? I hate to break it to you Mr. Riter, but meat isn’t the only food that contains protein. The United States is among the very few wealthy nations in the world where people derive the majority of their dietary protein from animal sources. The global average is 30% of dietary protein from animal sources, including dairy and eggs, and 70% from grains, vegetables, and fruit.

If Mr. Riter had bothered to contact the Baltimore City Schools he would have found that each meat-free meal contains more than the amount of protein required by the USDA. My guess is that Mr. Riter jumped to his mistaken conclusion after reading misleading quotes from a meat lobby organization, or he really needs to brush up on his basic biochemistry.

Not being a biochemist myself, I wanted to confirm with an expert that eating a meat-free diet one day a week in no way denies a child of a well-balanced nutritious meal. So I emailed Dr. Marion Nestle, a nationally renowned food expert and professor of nutrition, food studies and public health at New York University. Dr. Nestle responded:

 Consider it confirmed.

But what about the claims that we need to eat animal proteins because they contain certain “necessary” amino acids that vegetable proteins don’t? Professor Nestle replied:

Prepare for a biochemistry lecture: all proteins are made of the same amino acids. ALL. No exceptions. The difference between animal and vegetable proteins is in the content of certain amino acids. If vegetable proteins are mixed, the differences get made up. Even if they are not mixed, all you have to do to get the right amount of the low amino acids is to eat more of that food. There is no ‘need’ for animal proteins at all.

However, Dr. Nestle did say:

Meat makes a huge difference in the diets of deprived kids in developing countries not only because of its protein, but also because its nutrients are sometimes more absorbable than those from vegetables. For American kids, who eat plenty of calories, it’s far less important.

By the way, if Mr. Riter had actually tried to find out what the kids were being served, he would have found animal proteins are still on the menu. Below is a sample of the meals Baltimore kids are eating on Mondays. You might notice that the meals contain dairy products.

Meatless Monday Menu 1

Veggie Lasagna or Grilled Cheese w/ Tomato

Mixed Vegetables, Steamed Broccoli, Pineapple Tidbits & Fresh Fruit

1%, Chocolate, Straw- berry, Non-fat milk

Meatless Monday Menu 2 

Pasta Primavera with mozzarella sticks or Grilled Cheese w/ Tomato

Romaine Salad, Garlic Bread, Steamed Broccoli & Fresh Fruit

1%, Chocolate, Straw- berry, Non-fat milk

Meatless Monday Menu 3

Veggie Quesadilla on a Whole Wheat Tortilla or Grilled Cheese w/ Tomato

Black beans and rice, Refried beans, Corn, & Fresh Fruit

1%, Chocolate, Straw- berry, Non-fat milk

Regarding Mr. Riter’s leading question, Secretary Vilsack didn’t bite. Instead he made it clear that all of our schools are feeding students foods that are packed with too much saturated fats and salt:

It’s fairly clear from the [recently released] Institute of Medicine study and other additional studies that we’ve got far too much sodium, far too much saturated fat in the diets of children, and far too many discretionary calories. The result is that youngsters are not getting the nutrition they need and we need to do a better job.

I’d be remiss if I didn’t point out that Feedstuffs, a popular agribusiness newspaper, recently took the time to get most of the story straight regarding the Meatless Monday program at Baltimore City Public Schools. Here’s an excerpt for an article published today:

Interestingly… Anthony Geraci, director of food and nutrition services for BCPS, doesn’t see Meatless Monday as having anything to do with denying kids meat. In his opinion, Meatless Monday is simply a marketing ploy he has adopted to expose kids to more plant-based proteins.

Feedstuffs’ Trent Loos, a rancher and radio show host, traveled to Baltimore and posted a video of his interview with Geraci. Geraci is a very persuasive person. He obviously won Loos over with his ambitious plan to change the way Baltimore students think about food.

ABC World News with Charles Gibson aired acomprehensive piece last week on Baltimore City Schools school lunch revolution as well. You might recognize the reporter, Dr. Richard Besser, former acting director of the Centers for Disease Control and Prevention.

Like Tony Geraci often says, we can’t lose sight of the fact that the campaign to improve the foods served in public schools isn’t about politics or corporate profits, it’s about the health and well-being of children.

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School Lunch Revolution Blossoms in Baltimore

Baltimore City Public Schools' Great Kids Farm

Baltimore City Public Schools’ Great Kids Farm

Sometimes change happens in the most unexpected places. When I learned that Baltimore City Public Schools was on a mission to change the way its more than 80,000 students thought about food, I have to admit, I was surprised. The cash strapped school system has long faced difficult challenges and the last place I expected to see noticeable reform was with its food services department. To top that off, you could have bowled me over, when I heard that the City Schools’ new chef/dietitian, Mellissa Mahoney, convinced her boss, Tony Geraci, to let her develop her own Meatless Mondaylunch menus. To be honest, I doubt that Mahoney needed to do a lot of convincing. When it comes to dreaming up innovative and cost effective ways to feed kids healthy, tasty, whole foods, Geraci isn’t shy about pushing the envelope. It’s Geraci’s bold and sometimes brash entrepreneur spirit that has captured the attention of food policy experts across the country, including the White House.

Last week Geraci, hired a little over a year ago to reform Baltimore City Public Schools’ food services program, wasinvited to testify before a congressional sub-committee that is looking for innovative practices to improve child nutrition. Geraci touted what the Baltimore school system has already achieved:

We now provide fresh fruit with every lunch we serve. All over Baltimore, students are learning what an actual, locally grown peach tastes like instead of some synthesized peach flavoring. And as of this school year all of the peaches, lettuce, tomatoes, cucumbers—all of our fruits and vegetables—come from Maryland farms.

While many credit Geraci’s tenacious leadership abilities for what has been accomplished in Baltimore, Geraci will be the first to tell you that much of the groundwork was laid by a strong group of volunteers and innovative community organizers dedicated to changing the way people and children think about food in the Baltimore region. In 2006, a study by the Baltimore Efficiency and Economy Foundation highlighted reasons why school lunch reform in City Schools was sorely needed, and even listed Geraci as a potential consultant. Geraci says, however, that if it were not for a small group of students, whom he calls school lunch revolutionists, he would not be in Baltimore today. One of those young revolutionists, Alice Sheehan, was invited to share her story at the same congressional hearing with Geraci. Sheehan is currently an 8th grader in the Baltimore City Public Schools system, and she wasn’t shy about telling members of the House Committee on Education and Labor what spurred her and her fellow school lunch revolutionists to stand up and demand that school leaders “get rid of the overcooked, tasteless and just plain disgusting food.” She went on:

[more than 3 years ago] Our story started with the endless grumbling about lunches at school. Tired of the complaints and ready for action, our student council and others together took samples of our prepackaged lunch down to the Baltimore City School Board to demonstrate what it would be like to eat this every day. If that is what they feed us, we said, they should have to eat it too. The Board turned up its nose: no thanks! But the deed was done: we had started acting and not just complaining.

With the help of their Social Studies teacher, Peter French, Sheehan and a handful of her fellow classmates, who were studying the U.S. Constitution at the time, came up with a Cafeteria Bill of Rights.

The Cafeteria Bill of Rights include:

o The right to nutritious and delicious food for breakfast and lunch

o The right to fresh fruit and fresh vegetables each day

o The right to choose-more than one main selection each day

o The right to give feedback and have input on the quality and selections made and have our input be given serious consideration

Following an impressive grassroots campaign and a Baltimore Sun article critical of the food quality and taste disparities between City Schools and nearby better funded schools, the young school lunch reformers scheduled a meeting to talk with the newly hired Baltimore City Public Schools CEO Dr. Andrés Alonso. Sheehan described the meeting:

And we gave him our Cafeteria Bill of Rights, and told him of our expectations for a better and healthier school lunch system. He was sympathetic with our cause, and admitted how much he disliked the pre-packaged food at his own cafeteria. He said he would do something about it. And he did. The NEW director of food and nutrition, Mr. Geraci, has been working hard to improve our lunches ever since.

Last month White House Assistant Chef and Food Initiative Coordinator Sam Kass along with officials from the U.S. Departments of Education and Agriculture met up with Geraci, an accomplished chef himself, at the City Schools’ new Great Kids Farm. The 33-acre organic teaching farm – complete with a variety of vegetables and fruits, not to mention goats, chickens and bees – is Geraci’s pride and joy. Geraci says the farm serves as a powerful tool to teach children about food by reconnecting them to how it’s grown and raised and teaching them that food doesn’t come from the grocery store. He proudly told his guests that the farm is virtually self-sufficient thanks to: the hard work of its farm manager, Greg Strella, dozens of volunteers, donations from non-profits, revenue from its community supported agriculture shares and sales to local restaurants.

It may take longer than he hopes, but Geraci is trying to wean the school system from the pre-packaged meals that many of the schools serve and replace them before the end of this school year with cooked meals prepared right on school property. For the majority of the system’s schools, which no longer have kitchens, Geraci is already working on plans to convert an old warehouse into a central kitchen, from which fresh cooked meals can quickly be delivered. Currently the school system is serving kids regional fruits, veggies and dairy after brokering deals with local suppliers and acquiring a fleet of refrigerated trucks and milk coolers.

Mathew Yale, Deputy Chief of Staff for the Secretary of Education, told Geraci he’s most interested in learning about how the school system made so many changes without a significant increase in federal or state funding. Geraci says it takes a lot of hard work, ingenuity, and luck. Much of the equipment he’s received came through grants or donations. The trucks and milk coolers were a $1.3 million gift from the Mid-Atlantic Dairy Association. But Geraci says if the feds gave the school system more freedom to spend federal dollars to purchase produce, his office would be able to buy a great deal more local fruits and veggies. His favorite example of typical waste inherent in the system is comparing the cost of locally grown apples to apples trucked from states as far away as Washington, almost 3,000 miles from Baltimore. A case of Maryland apples costs the Baltimore City Public Schools about $6, while a case of government-approved apples costs them about $56. Geraci says, “it’s outrageous! Why would we spend almost ten times as much money for food that we can grow in our own backyard?” He says, “it not only saves the City Schools money, it puts cash back into the local economy.”

Incorporating Meatless Monday into this year’s lunch menu plans, Geraci says, was another innovative cost cutting measure. The move not only saves the district money but it serves as an educational tool as well. Meatless Monday gives the school system an opportunity to expose students to different cultures, Geraci says, through various meat-free recipes and meals from around the world. U.S. meat industry lobbyists quickly grumbled about Baltimore’s lack of meat options on Mondays, inferring that the meals may lack proper nutrition and claiming menu decisions should be left to the experts not administrators. If the lobbyists had bothered to talk to the person who came up with the idea, Mellissa Mahoney, they would have learned that she is a dietitian and that she ensured each meal surpassed all USDA required nutrition standards. Jokingly, Geraci testified in front of House Education and Labor committee members that he had “an unholy love of pork,” but he insisted that, “[Meatless Monday] is not about denying people meat. This is about beginning a conversation about alternatives… beginning a conversation about change.”

2009 CLF Award presentation at Great Kids Farm

2009 CLF Award presentation at Great Kids Farm

The Johns Hopkins Center for a Livable Future recognized the Baltimore City Public Schools last month with the 2009 CLF Award for “Visionary Leadership in Local Food Procurement and Food Education” in hopes of encouraging school districts across the nation to initiate their own school lunch reforms. Timing is also important, as lawmakers consider the reauthorization of the federal Child Nutrition Programs. While Geraci didn’t have time to complete his prepared testimony on the Hill last week, his written testimony finished with a request for Congress to implement the six recommendations of the National Farm to School Network:

1. Guarantee funding for competitive, one-time grants that will help schools develop their own farm to cafeteria projects—menus, procurement, and educational and promotional materials that get local produce into schools.

2. Increase the reimbursement rate for all child nutrition programs in line with actual costs.

3. Apply the same high nutritional standards to all foods and beverages sold within schools, even those not covered by the United States Department of Agriculture’s school meals program.

4. Encourage purchasing of local fruits and vegetables through the Fresh Fruit and Vegetable Program.

5. Incorporate language changes in existing Child Nutrition Reauthorization feeding programs to promote increased local food purchasing.

6. Provide mandatory and consistent funding for the Team Nutrition Network to enable a consistent and coordinated nutrition education approach

Public Health & Industrial Farm Animal Production: Setting the Record Straight

PCIFAP public meeting in North Carolina, 4/10/07

PCIFAP public meeting in North Carolina, 4/10/07

The American Veterinary Medical Association’s recent “response” to the Pew Commission on Industrial Farm Animal Production’s final report on the state of industrial animal agriculture is disconcerting. It appears that leadership of the veterinary professional organization is attempting to misuse science to obfuscate and delay critically needed changes in the food animal production system rather than tackling very real public health and environmental threats head on.

For years a groundswell had been building from a widespread group of experts and advocates in the areas of public health, environment, social justice, and animal welfare sounding the alarms about the serious problems industrial food animal production poses. But until the Pew Commission on Industrial Farm Animal Production (PCIFAP) decided to take on the politically controversial issue, there had never been a comprehensive examination of industry’s practices by such a respected and diverse panel of experts. Following a grueling 2½ -year discovery process, and despite several overt attempts by industry to discredit it, the Commission concluded that the scientific evidence was too strong and the public health risk too great to ignore and offered a series of consensus recommendations on how to repair our unsafe food animal production system.

The tone and timing of the AVMA’s 38-page response to the PCIFAP final report, 15 months after it was released, is quite telling. The document’s executive summary starts out by suggesting that the PCIFAP’s technical reports (published separately) were “biased,” and that, “the Pew report contains significant flaws and major deviations from both science and reality.” Another telling facet is that the “response” contains very little scientific citation to backup its rebuttal. It’s not a coincidence that this response coincides with the recent revelation that the Obama Administration supports the idea of banning the use of key antibiotics as growth promoters in food animals, which happens to be one of the PCIFAP’s key recommendations. Not to mention, this year’s version of the Preservation of Antibiotics for Medical Treatment Act (PAMTA) appears to have a much better chance of passing than in any prior year.

The AVMA depends heavily on its relationships with the animal agriculture, pharmaceutical and other industries. The AVMA’s attack on the PCIFAP final report smacks of being more like an industry-choreographed campaign to defeat PAMTA than a conscientious review of a hugely important document.

Dr. Michael Blackwell, PCIFAP Vice Chair, attending PCIFAP public meeting in Arkansas, 2/13/07

Dr. Michael Blackwell, PCIFAP Vice Chair, attending PCIFAP public meeting in Arkansas, 2/13/07

Two prominent veterinarians trained in public health are dismayed over the AVMA’s PCIFAP final report response. One of those veterinarians is the PCIFAP’s vice chairman, Dr. Michael Blackwell. As the former dean of University of Tennessee’s College of Veterinary Medicine, a retired assistant U.S. surgeon general, and a former chief of staff of at the Office of the U.S. Surgeon General, Dr. Blackwell’s expertise in both veterinary medicine and public health is undeniable. Dr.Blackwell says he’s, “shocked over the fact that the AVMA did not try to learn the truth about the Commission’s work, even from one of its own members,” and “instead chose to write a response from the perspective of the industry.”

Dr. Christine Hoang, assistant director for the AVMA’s scientific activities, confirmed that the writing group, selected by AVMA leadership, never reached out to Dr. Blackwell or even attempted to poll other members of the PCIFAP to clear up any questions they may have had with the final report recommendations. Dr. Blackwell pressed the AVMA to allow him to discuss the Commission and its report. However, he says the writing group only allowed him 20 minutes via phone to speak to six committees. Dr. Blackwell concluded that the AVMA was not interested in what he had to say. When asked why the AVMA writing group did not reach out to PCIFAP members, the AVMA’s CEO, Dr. Ron DeHaven, said that the writers felt discussions would not be productive, because they had reviewed the same data and came up with different conclusions. Dr. DeHaven added that a few of the AVMA writing group members, who had been contacted by the PCIFAP during its discovery process, felt that the PCIFAP final recommendations did not reflect information that they had provided the PCIFAP commissioners and believed that further discussion with PCIFAP members was not warranted.

In a letter to his Texas congressional representatives, another AVMA member, Dr. Raymond Tarpley, shared his disappointment with the organization’s stance on PAMTA:

I am dismayed that my professional organization (the AVMA of which I am a member) has chosen to pursue a reckless policy that favors the misuse of critical antibiotic compounds for reasons other than medical necessity. Microbial resistance to loose and repeated antibiotic exposure for non-therapeutic reasons has been proven, and while the AVMA has apparently buckled to pressures from industrial animal agriculture, it is without doubt an unwise investment in the health of our animals and human population to continue to use these valuable compounds to promote industry profits at the expense of societal risk

In a letter to the White House earlier this month, Big Food representatives tried to defend the use of antibiotics in food animals as growth promoters, using similar arguments that the AVMA laid out in its PCIFAP final report response. Industry continues to point to European data, collected by countries that banned the use of antibiotics for growth promotion in food animals several years ago, to bolster its claim that a ban in the U.S. would backfire and increase the number of sick animals. In its PCIFAP final report response, the AVMA claimed animal deaths and disease in Denmark rose following its ban, “requiring more therapeutic antibiotic use to treat the resultant diseases.

Dr. Tarpley dismisses the AVMA’s interpretation of the Danish data:

Contrary to statements by the AVMA, the ban on antibiotics in Denmark has been shown to have positive benefits for human and animal welfare, while not harming the industry. Their interpretation of the Danish data reflects the bias of the AVMA in the spin of data favorable to industry.

Setting the Record Straight

It’s not just Dr. Tarpley who dismisses the AVMA’s findings on antibiotic bans. Last month, two Danish researchers from the National Food Institute at the Technical University of Denmark, Drs. Frank Møller Aarestrup and Henrik Wegener, submitted written testimony for a U.S. House Committees Rules hearing on PAMTA to, “set the record straight.”

As you may be aware, 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.

They explained that over the long-term, the ban on antibiotics for growth promotion in Danish pigs not only reduced antibiotic use by more than 50 percent but overall pork production has increased by 43 percent.

Despite its recognition that veterinarians should increase their coordination among physicians and public health professionals, the AVMA’s stance on public health prevention appears to be out of sync with the rest of the world. In video and audio recordings posted on the AVMA’s website, Dr. DeHaven kept using the the term “theoretical risk.”

…the Pew Commission recommends the elimination of the use of certain antibiotics in animals based on a purely theoretical risk to human health.

Recent statements from Dr. Frederick Angulo, a veterinarian himself and the Center for Disease Control and Prevention’s Deputy Chief of the Enteric Diseases Epidemiology Branch, appear to contradict Dr. DeHaven’s claim.

There is scientific consensus that antibiotic use in food animals contributes to resistance in humans. And there’s increasing evidence that such resistance results in adverse human health consequences at the population level.

There is overwhelming evidence documented not only in the PCIFAP’s technical report, Industrial Farm Animal Production, Antimicrobial Resistance and Human Health, which was conducted by experts at the Johns Hopkins Bloomberg School of Public Health, but in other peer-reviewed research conducted all over the world, that proves the use of antibiotics in food animals contributes to the growing pool of antibiotic resistance in nature. It is undeniable that low-dose use of antibiotics, (i.e., using it as a growth promoter in animals) leads to the selection of bacteria with resistance to many of the antibiotics doctors depend on to treat people for serious infections.

Dr. Blackwell didn’t hold back his disappointment in a letter that he recently sent to Dr. DeHaven regarding the AVMA’s refusal to recognize that animal agriculture is a major contributor to antibiotic resistance.

To my knowledge, the AVMA remains the only major medical or public health organization not recommending changes in agriculture practices to help ensure sustainability where the use of antimicrobials is concerned. As a public health veterinarian I find this disconcerting and embarrassing.

Public Health vs. Cost Effectiveness

So why is the AVMA clinging to this term “theoretical risk?” Here lies one of public health’s biggest conundrums. The goal of public health professionals is to take all reasonable efforts to protect people from preventable diseases. Often times reasonable can be defined as cost effective. The big question, especially now as the health care reform debate rages on across the country, is whether preventative health care measures are cost effective? If you’re only focusing on quarterly returns and immediately measurable public health benefits, the answer most likely is no. This is especially true in the eyes of Big Ag, because it’s going to cost money upfront to retrofit all of those industrial farms that are dependent on antibiotics to make up for the unhealthy conditions in which the animals we eat are produced. Not to mention, you can’t measure in a short period time how much money was saved due to public health disease prevention measures.

How do you measure the cost savings or return on investment in cases where an antibiotics ban prevented people from getting sick and going to the doctor or the hospital? We know a great deal about the costs of drug resistant infections in the United States in terms of health care costs, increased morbidity, and increased risk of death. Over longer periods of time we can measure whether doctor visits or reported illnesses are decreasing among certain populations or regions touched by industrial animal agriculture. Dr. Ellen Silbergeld, a nationally renowned expert in antimicrobial resistance and its relations to agriculture, and the lead author of the PCIFAP’s antimicrobial resistance technical report, says there is no question that removing antibiotics and other antimicrobials from animal feed will save money through reduced human medical costs. Dr. Silbergeld says based on multinational studies (ex. Austrian study) in Europe following the ban on antimicrobials in animal feeds, “there is clear evidence that this ban was associated with reduced prevalence of drug resistant pathogens in people in hospitals in the E.U.”

It doesn’t surprise me that researchers in Denmark found that Danish farmers initially saw increases in animal disease when the antibiotic ban went into effect. However, after farmers improved ventilation systems and gave the animals more space, within a relatively short period of time they found production actually increased while at the same time they greatly reduced the need for antibiotics.

When it comes to cost savings, particularly when you’re looking at environmental health cost savings, the PCIFAP argues that you have to take into account the externalized costs of industrial animal production. Right now Big Ag is very happy to let the public pick up the tab. Those externalized costs, among a host of other things, include increased environmental health risks from the introduction of antibiotic resistant bacteria like MRSA or novel viruses like the current H1N1 swine flu, particulate matter known to exacerbate asthma, the emissions of countless toxic gasses from enclosed barns and environmental pollution from excess nutrients (animal feces & urine) contributing to the dead zones in the Gulf of Mexico and choking the Chesapeake Bay. Don’t forget about the contamination concerns of nitrates and other pollutants in well water from all that liquid animal waste sprayed onto or pumped into the ground that is not agronomically absorbed.

The PCIFAP’s technical report entitled An Economic Analysis of the Social Costs of the Industrialized Production of Pork in the United States can be applicable in almost any public health prevention cost analysis. This particular analysis determined that when you consider several “external” costs of industrial hog production and subsidies, using the alternative and more sustainable hoop barn system costs about 25 percent less than the use of conventional concentrated animal feeding operations (CAFOs). (Ironically, without including externalities, CAFOs only have a 26-cents per hundredweight advantage over hoop barns.) Using the same equation that researchers devised for the PCIFAP economics report and inputting the externalized costs, we could get a glimpse at the potential cost effectiveness of an antibiotics ban for growth promotion in industrial food animal production in the U.S. The tough part is agreeing on what those externalized costs are and whether they can be attributed to animal agriculture — hence the reason for all of this industry obfuscation and attempts to misuse science to muddy the issues. The longer Big Ag can hold off on paying for upgrades and changes to the system the longer it can continue to make money at the public’s expense.

Dr. Ron DeHaven taking part in PCIFAP discussion panel, 9/11/2006

Dr. Ron DeHaven taking part in PCIFAP discussion panel, 9/11/2006

It’s interesting to note that Dr. DeHaven himself played a role in the PCIFAP’s early discovery process. During a 2006 meeting in Washington, DC Dr. DeHaven took part in a discussion panel consisting of several members of the USDA invited to discuss their role in regulating animal agriculture. At the time, Dr. DeHaven was the head of the USDA’s Animal and Plant Health Inspections Service.

I sincerely hope that the 78,000 veterinarians, whom AVMA leadership say they represent, view the AVMA’s response to the PCIFAP final report with the same scrutiny as Drs. Blackwell and Tarpley. It’s a black eye on an incredibly important profession filled with some of the most brilliant people I know.

(Note: I served as the Communications Director for the Pew Commission on Industrial Farm Animal Production)

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

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

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.”

Obama vs McCain: Health Care Reform

McCain’s Health Care Reform Plan Could Almost Double My Insurance Costs

I’m not an economist, but I just can’t see how Senator McCain’s health care reform plan will do anything to save the average taxpayer money let alone solve our health care crisis.

We all know both presidential candidates’ plans are based on fundamentally different views. Senator Obama believes the government and the private sector must together ensure that everyone in the country has health insurance, while McCain believes that each individual is responsible for his or her own health care. Those issues aside, I see at least two huge cracks in McCain’s plan.

First is his $5,000 tax credit proposal for families and $2,500 for individuals. It seems to me, the credits are not nearly enough to help most Americans save money. My jaw dropped when I heard McCain say during last Wednesday’s final 2008 presidential debate, that the average health care insurance plan in America costs a family only $5,800 annually. I have no idea where he got that number, unless he was looking at data from almost a decade ago. According to the latest Kaiser Family Foundation annual Employer Health Benefits Survey the average health insurance premium costs more than $12,700 for a family and $4,704 for individuals. Kaiser Family Foundation’s news release for the 2008 survey even points out “premiums more than doubled since 1999 when total family premiums stood at $5,791 (of which workers paid $1,543).” Even the non-profit and non-partisan National Coalition on Health Care cites the Kaiser Family Foundations’ 2007 Survey which found the average family premium averaged nearly $12,100. By the way, according to its website, the Coalition’s honorary Co-Chairmen are Presidents George H. W. Bush and Jimmy Carter

So, I’m wondering how could McCain’s health care reform plan save me money? Right off the bat, McCain’s plan could actually increase costs for many Americans because the money their employer spends on their health care benefits would be considered taxable income to them. However, those costs could be offset by his proposed tax credits. So, I suppose there is a chance I’d save money there.

Considering the state of the economy right now, and the fact that medical benefits consume the largest share of employer benefit costs, most companies would jump at the chance of dropping them. And don’t count on your employers to give the money they save back to you. I doubt most companies will say, “Since we’ve decided to drop all of your health care benefits, we thought the nice thing to do was to give the cost savings back to you.” My guess is, most companies will say, “Due to the shaky economy you’re lucky your take-home pay is remaining the same.”

I wondered how I’d fair if my employer decided to drop my health benefits? So I did a little internet researching. I’m married, and my wife is covered on my company plan. So, I checked out some quotes at Maryland’s CareFirst BlueCross BlueShield. According to CareFirst a somewhat comparable insurance plan to the PPO we have now would cost us $7,236 a year. Now that doesn’t sound too bad, but I still need to find dental and vision coverage. I’m having a difficult time finding an accurate quote. I did find that that average dental care plan costs between $15-25 a month. Since we had a good dental plan, I’ll guess for the two of us it would cost $40 a month or $480 a year. I found less information on average vision insurance. Some numbers I found averaged around $10 a month. So let’s say for the two of us it would be $15 a month or $180 annually.

Added up, a somewhat comparable health insurance plan would cost me and my wife about $7,896 annually. With McCain’s plan, from what I understand, our $5,000 tax credit would go directly to our insurance companies. So we would be responsible for $2,896 a year or $241 a month. I have a feeling my numbers are lower than what they would be if I really was forced to purchase my own plans. However, the cost to me is still significantly more than what I pay now, which is $75 a month. That means under McCain’s plan I’d pay at the very least $166 a month ($1,992 annually) more than I do now. That’s a 45% increase.

The other massive fissure I see in McCain’s plan is the suggestion that increased competition, stricter controls on medical costs (like drugs), and limiting malpractice suits will somehow cut health care costs enough to help the uninsured and unemployed gain health care coverage. While their literature acknowledges the large number of uninsured, if you listen to at least one of McCain’s health advisers, there are very few uninsured people to worry about anyway. The Dallas Morning News reported John Goodman, “who helped craft Sen. John McCain’s health care policy, said anyone with access to an emergency room effectively has insurance.”

McCain’s plan to ask states to create a federally-supported Guaranteed Access Plan or “high-risk” pool for people with pre-existing conditions sounds more like a plan to protect insurance companies than to help the sick or the poor.

So what about Obama’s plan? I certainly don’t think it’s perfect, but I believe it’s leagues above McCain’s. Obama’s plan to create a new public health care program is going to be complicated and most likely bogged down with bureaucracy. But it will achieve the goal of ensuring every American has access to health care insurance.

The fact that Obama wants to require all children to have health insurance seems like a no-brainer, and I’m shocked it’s not already a law. While I have no problem with Obama’s plan to require every employer to offer employees health benefits or contribute to the cost of a new public insurance program, I can see why some people would. The proposed mandate could be considered to many small business owners, who claim they can’t afford health care benefits, a burdensome new tax. However, Obama’s plan to give small businesses a refundable tax credit of up to 50% of premiums paid on behalf of their employees could help ease those business owners’ pain.

Take this layperson’s view with a grain of salt. I am by far not an expert in any of these areas and I’m sure I’ve missed some important provisions contained in each candidate’s plan. I hope this just gives you something to think about and that you do your own investigating.

Saturday, October 18, 2008