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For many of us, the extent of learning how healthy we’re eating amounts to glancing at the back of our food’s packaging, but FatSecret aims to provide a more complete picture.

The New York-based start-up recently launched a tool for food companies and restaurants to upload the nutritional information of their products, along with an interface for programmers to mash up that data. FatSecret’s Web site is currently a hub for diets, recipes and general nutritional information. These new additions will effectively allow FatSecret manipulate and port this system elsewhere, complete with official data from food brands.

As far as online dieting diaries go, FatSecret already has healthy competition from About.com’s Calorie Count Web site and LiveStrong.com’s Daily Plate tool. Lenny Moses, FatSecret’s chief operating officer, says his site will be able to get the best information by verifying nutritional values directly with brands, but I see little reason to question the data provided by the existing two sites. LiveStrong, for instance, has a verification process that involves “independent sources,” though the verification method for Calorie Count isn’t as clear. Both sites allow users to suggest foods, along with their nutritional value, to administrators.

I think the potential with FatSecret lies more with FatSecret’s programming interface, or API. At the very least, it points to a future where dietary information could be ubiquitous, if developers begin stuffing nutritional information into Web sites and mobile apps that deal with food.

As an example, Moses said a site like MarthaStewart.com could tap FatSecret’s database for the calorie or fat content of the site’s recipes, or a

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food health

A health plan linchpin commands respect

By Lisa Wangsness, Globe Staff | August 18, 2009

BANGOR - For many Washington lawmakers, it’s been an angry August: returning home for the summer recess, they have faced put-downs, shout-downs, and worse at the hands of some constituents seething about the proposed health care overhauls before Congress.

But Senator Olympia Snowe, a pivotal player in the health care drama, has seen nothing of the kind since she came home to Maine last week.

Mainers are treating their popular senior senator with characteristic Yankee restraint. Public meetings are respectful, protesters virtually absent. Special-interest groups on the right and the left that have helped organize mass protests elsewhere are treating Snowe gingerly. Even President Obama mentioned how much he likes her at a town hall meeting he held in Portsmouth, N.H. - just close enough to Maine to get her attention without seeming too aggressive.

No one, it seems, wants to risk offending the slight, genial senator who is one of the most influential voices in the Senate in deciding whether a health overhaul bill passes.

Snowe is one of three Republicans on the powerful Senate Finance Committee trying to work out a bipartisan deal. And based on her voting record, she is the most likely of the trio to break from the GOP and vote with Senate Democrats - who may need at least one Republican to get a bill passed, especially if Massachusetts Senator Edward M. Kennedy, who is battling brain cancer, is unable to travel to Washington and cast a vote in the fall.

Snowe met with Obama twice the week before the August recess, and she has plans for several major conference calls on health care with the other Finance Committee negotiators. She also shares a state with Senator Susan Collins, another moderate Republican who could be a crucial vote on any compromise that emerges.

“Maine is ground zero for health care,’’ said Dennis Rivera, chairman of health care for one of country’s most powerful unions, the SEIU, who flew to Maine

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politics health

New NIH chief: Turn science into better care, fast
By Associated Press | Monday, August 17, 2009 | http://www.bostonherald.com | Healthcare
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WASHINGTON — An influential geneticist who wears his faith on his sleeve says that as the new director of the National Institutes of Health he won’t inject his religious convictions into medical research while pushing cutting-edge science into better bedside care.

"The NIH director needs to focus on science," Dr. Francis Collins told The Associated Press on Monday. "I have no religious agenda for the NIH."

In taking the reins of the NIH, Collins — best known for unraveling the human genetic code — said he wants a practical focus for the nation’s premier research agency, that new discoveries may even help save precious health care dollars.

"We should be completely bold about pushing that agenda," Collins said — not just for U.S. health, but for global health, too.

"Here we are at a circumstance where I think our country is seeking maybe to redefine our image a bit in the world, from being the soldier to the world to being perhaps the doctor to the world. I’d like to see that happen," he said, in his first interview before greeting employees of the $30 billion agency.

The Bush administration drew criticism for allowing religious ideology to guide some decision-making, such as curbs on the NIH’s funding of research involving embryonic stem cells.

Collins is well-known for finding common ground between belief in God and science, without letting his evangelical Christian beliefs influence his 15 years of research at the NIH. He led the Human Genome Project that, along with a competing private company, mapped the genetic code that he famously called "the book of human life." Remarkably for Washington, Collins’ team was ahead of schedule and under budget.

The folksy Collins, who explains the complexities of DNA in language the average person can understand, at the time called it "awe-inspiring to realize that we have caught the first glimpse of our o

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science health spirituality

BMC chief will retire as contract ends in ’10
Ullian says long-planned departure is not linked to hospital’s fiscal woes
Ullian’s contract is up in January. Ullian’s contract is up in January.
By Liz Kowalczyk
Globe Staff / July 29, 2009
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Elaine Ullian, who transformed Boston Medical Center into a hugely successful teaching hospital, announced yesterday that she will retire, amid what could be the hospital’s worst financial crisis in years.
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Her decision to leave in January is not related to the current troubles at the hospital - the state’s largest provider of medical care to the poor - Ullian said in an interview.

Earlier this month, Boston Medical Center sued Massachusetts officials, accusing them of illegally cutting payments for treating thousands of poor patients and plunging the hospital into fiscal uncertainty. The hospital estimates that it will lose $175 million in the fiscal year starting Oct. 1 and $38 million by the end of this fiscal year - its first loss in five years.

Ullian said she had intended all along to retire when she turns 62. Her five-year contract expires on Jan. 3, her 62d birthday. Though the hospital faces unprecedented challenges, Ullian, who works punishing hours, said she could not break a promise to her family, and particularly to her husband of 35 years, that she would retire next year.

As the crisis with the state unfolded this summer, Ullian said she did not have second thoughts about retiring because she has “an incredibly talented team. The hospital is not Elaine Ullian,’’ she said. “It’s been here 160 years. It’s been through two world wars. This hospital will certainly survive all of us. This was very much a personal decision I made years ago.’’

Still, many people in Boston’s healthcare community did not

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health

July 25, 2009, 5:07 pm
Why markets can’t cure healthcare

Judging both from comments on this blog and from some of my mail, a significant number of Americans believe that the answer to our health care problems — indeed, the only answer — is to rely on the free market. Quite a few seem to believe that this view reflects the lessons of economic theory.

Not so. One of the most influential economic papers of the postwar era was Kenneth Arrow’s Uncertainty and the welfare economics of health care, which demonstrated — decisively, I and many others believe — that health care can’t be marketed like bread or TVs. Let me offer my own version of Arrow’s argument.

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either — they’re not in business for their health, or yours.

This problem is made worse by the fact that actually paying for your health care is a loss from an insurers’ point of view — they actually refer to it as “medical costs.” This means both that insurers try to deny as many claims as possible, and that they try to avoid covering people who are actually likely to need care. Both of these strategies use a lot of resources, which is why private insurance has much higher administrative costs than single-payer systems. And since there’s a widespread sense that our fellow citizens should get the care we need — not everyone agrees, but most do — this means that private insurance basically spends

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health

July 21, 2009, 9:30 pm
Microbes ‘R’ Us
hand microbes Agence France-Presse/Getty Images
There are 150 species right at your fingertips.

This week, the 40th anniversary of the first moon landing, there’s much talk of exploring other worlds. Which is exciting and grand; such is the stuff that dreams are made on. Yet we don’t need to go abroad to find amazing new life forms. We just need to look at the palms of our hands, the tips of our fingers, the contents of our guts.

The typical human is home to a vast array of microbes. If you were to count them, you’d find that microbial cells outnumber your own by a factor of 10. On a cell-by-cell basis, then, you are only 10 percent human. For the rest, you are microbial. (Why don’t you see this when you look in the mirror? Because most of the microbes are bacteria, and bacterial cells are generally much smaller than animal cells. They may make up 90 percent of the cells, but they’re not 90 percent of your bulk.)

This much has been known for a long time. Yet it’s only now, with the revolution in biotechnology, that we’re able to do detailed studies of which microbes are there, which genes they have, and what they’re doing. We’re just at the start, and there are far more questions than answers. But already, the results are astonishing, and the implications profound.

Even on your skin, the diversity of bacteria is prodigious. If you were to have your hands sampled, you’d probably find that each fingertip has a distinct set of residents; your palms probably also differ markedly from each other, each home to more than 150 species, but with fewer than 20 percent of the species the same. And if you’re a woman, odds are you’ll have more species than the man next to you. Why should this be? So far, no one knows.

But it’s the bacteria in the digestive tract, especially the gut, that intrigue me most. Many of these appear to be true symbionts: they have evolved to live in guts and (as far as we know) are not found elsewhere. In providing their habitat — a constant temperature, so

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health

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Childrens, Public Health
Can closing schools stop the flu?
Email|Link|Comments (0) Posted by Elizabeth Cooney July 20, 2009 08:53 PM

As they prepare for a fall flu season that could bring two nasty strains, Boston health officials are studying whether school closings helped to stop the spread of swine flu during the spring.

Dr. Anita Barry, director of the infectious disease bureau at the Boston Public Health Commission, said the agency is still analyzing case reports from private and public schools that closed after abseentism rates soared. They expect to have answers in a month that will tell them if closing schools broke the chain of transmission of swine flu, known by its scientific name H1N1.

The Boston review continues even as an article appearing today in a special issue of the British medical journal The Lancet Infectious Diseases concludes that closing schools early in a pandemic can reduce the number of cases at its peak, but cases might rise later when they reopened, leading to the same totals had schools not been shuttered. This flattening in the number of cases was observed in epidemics dating from 1918 through 2008.

The social and economic costs of prolonged closing may be high, measured in lost income for parents who must miss work as well as in disruptions in the healthcare system when its workers also have to stay home, Simon Cauchemez of Imperial College London and co-authors wrote.

"The H1N1 pandemic could become more severe, and so the current cautious approach of not necessarily recommending school closure in Europe and North America might need reappraisal in the autumn," the authors said. But "there are still many uncertainties about the health, economic, and social implications of closing schools to mitigate an influenza pandemic."

The novel flu strain has disproportionately sickened young people since it emerged in April. In Massachusetts, almost two-thirds of confirmed cases were found in people under age 18, reflecting similar figures worldwide.

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health

Using Scientific Tools in an International War on Fake Drugs
By THOMAS FULLER

“Let’s use some Atlanta drug money,” said Facundo M. Fernández, a chemistry professor, as he picked out a limp, ratty dollar bill from his wallet and handed it to one of his graduate students.

Minutes later, after running the bill through the laboratory’s high-tech machinery, the chemists had found what they were looking for: traces of cocaine.

Dr. Fernández, a professor at the Georgia Institute of Technology, said that the demonstration, which he repeated with other bills provided by a reporter, showed both how pervasive cocaine was in the United States and how sensitive his machines were.

They can instantly identify the chemical makeup of food, drugs and just about anything placed in front of their stainless-steel aperture. The uses of the machines, known as mass spectrometers, are manifold — the federal Department of Homeland Security has commissioned Dr. Fernández to study whether the technology can help sniff for explosives at airports.

But Dr. Fernández’s main focus is counterfeit pharmaceutical drugs, especially in poorer countries, where government regulation is weak. He is part of an informal group of researchers and government officials spanning Africa, Asia and the United States who have teamed up with Interpol, the international police agency, to use cutting-edge technology in tracking fake drugs that claim to treat malaria. Counterfeit malaria drugs are of particular concern because of the scale and severity of the disease — it kills more than 2,000 children a day in Africa alone — and fears that fake or substandard malaria drugs are aggravating a growing problem of drug resistance.

For years, scientists have been able to analyze the ingredients of a pill or capsule using mass spectrometers, which identify chemicals by measuring molecular weights. But the overall process was time-consuming, taking about an hour per sample.

A scientific breakthrough in 2005 added an “ion gun” to the machines and allowed Dr. Fernández

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health

8 and Under
When Weight Is the Issue, Doctors Struggle Too
Michael Klein

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By PERRI KLASS, M.D.
Published: July 20, 2009

The mother came out of the exam room to intercept me: she knew I would probably have to talk to her daughter about how she was gaining weight, she said, but please don’t use the word “fat,” or even “overweight.” Don’t make her feel bad about herself.
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The girl was about 8, and when I plotted her growth chart, it was clear some balance had shifted over the past year, and her weight was increasing much too fast relative to her height. It was worth talking about.

But I was as conscious of my own body as I was of hers. How on earth, I was thinking, am I supposed to give sound nutritional advice when all they have to do is look at me to see that I don’t follow it very well myself? How to reconcile that with her mother’s reasonable request: Don’t make her feel bad about herself? And taking it all together, how am I supposed to help stem the so-called epidemic of childhood obesity when not a week goes by that I don’t break my own resolutions? What price the not-skinny doctor?

“The advice we’re supposed to give in pediatric clinic, it boils down to ‘Eat less, exercise more,’ ” said Dr. Julie C. Lumeng, an assistant professor of pediatrics at the University of Michigan Medical School and an expert in childhood obesity. “This is such blasphemy, but when I deliver this advice to families, my heart’s not in it, because I just feel like so often the families are just glazing over, and when that advice is delivered to me, I glaze over, too.”

What does it mean when the doctor clearly can

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parenting health

Let the handshake meet an end
In today's world, why cling to this surefire germ spreader?
handshake illustration
By Neil Swidey
July 19, 2009

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A few weeks ago, I met a construction worker who was immersed in a big sewer project. His hands, like his coveralls, were dark with grime. But he was a friendly guy, and we had just been introduced, and I didn’t want to be rude. So I did what we’ve all been conditioned to do since childhood: I thrust my right hand out to meet his for a good shake.
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After looking at his filthy hands, he shot me a quizzical look, as if to say, “You can’t be serious.” Then he extended his comparatively clean right forearm. I grabbed onto it and shook, and we both smiled.

A couple of days earlier, my wife and I had been sitting around our kitchen table with some friends who all have kids the same ages. The talk naturally drifted to the fears swirling around swine flu and how common cases of sniffles and scratchy throats were automatically subjecting schoolchildren to seven-day sentences at home, a practice sure to continue now that we’re in summer-camp season. While some of the parents complained about over-reaction, one of the dads took a different tack. Isn’t it time, he asked, to retire the handshake?

My mind flashed back to that comment the moment my hand clutched the construction worker’s forearm. This worker clearly recognized the absurdity of putting politeness over common sense. Why didn’t I? With everything we now know about germs, about the ferocity with which trouble travels via hand-to-hand contact, why do we feel obligated to soldier on with this centuries-old tradition?

It’s not clear exactly why and when the handshake became our default in-person greeting. The most common explanation is that it was how a man, upon meeting another, could establish that neither was carrying a weapon. The practice dates at

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health

At the Frost Valley Y.M.C.A. camp last week, counselors and staff were laying out swim lines, whitewashing a fence around the horse paddock and mowing the meadow in the shadow of Wild Cat Mountain.
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Times Topics: Swine Flu (AH1N1 Virus)
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Jenn Ackerman/The New York Times

Campers can wash up in sinks in the dining hall entrances.

But there were a few more things on the checklist before this year’s campers arrived.

Housekeepers were wiping down doorknobs with bleach solution. The medical staff was adding new questions about fevers and coughs to the opening-day health screenings, which traditionally target head lice. Three negative-pressure isolation rooms were ready to accommodate sick campers. Hand sanitizer was everywhere.

Here and across the country, summer camps have been busy trying to erect a firewall against swine flu.

“We think we’re ahead of the curve, but who knows?” said Jerry Huncosky, chief executive officer of Frost Valley, a 6,000-acre camp in the Catskill Mountains. “I think it’s the ‘who knows?’ that we’re preparing for.”

Sleep-away camp, of course, is a time of rustic simplicity and extremely close contact: 8 to 10 campers in a snug cabin is the norm. With swine flu’s potential for rapid transmission, camp poses unusual challenges for the adults charged with the campers’ care. It is perhaps no wonder that camp directors have been deluged in recent weeks with e-mail messages about swine flu protocols from the Centers for Disease Control and Prevention, the American Camp Association and local health departments.

Swine flu has already surfaced at summer camps in the South and the West, where the camp season begins early, closing camps in Missouri and California and prompting the Muscular Dystrophy Association to cancel the rest of its annual summer camp program.

Outbreaks of swine flu have also been reported at camps in Georgia and North Carolina, but campers there were being treated on site.

The first task is simply to keep out the H1N1 virus,

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health

Jerri Nielsen; found new life escaping death at S. Pole

By Bryan Marquard, Globe Staff | June 25, 2009

Fresh from a painful divorce and ready for a new chapter in her life, Dr. Jerri Nielsen spotted a want ad for a physician to work at the Amundsen-Scott South Pole Research Station. In Antarctica, she found a peace that had eluded her as an emergency room doctor in her native Ohio.

“Life sang out, and every small breath was a triumph against nothingness,’’ she wrote in “Ice Bound,’’ a 2001 book recounting the experience. “The route to the pole was, after all, an inner journey. Antarctica was a blank slate on which you could write your soul.’’

In March 1999, a couple of weeks after the last plane left before the Antarctic winter settled in, she found a lump in her breast that turned out to be an aggressive cancer. Dr. Nielsen performed a biopsy, then treated herself with supplies dropped from a plane that could not land because of the harsh weather. Finally, as word of her plight spread and the world watched anxiously, she was plucked from the polar ice sheet in a daring rescue flight.

Dr. Nielsen, who had remarried and lived in Southwick in recent years, died in her house Tuesday of complications from cancer that recurred five years after she left Antarctica. She was 57 and had achieved a measure of tranquility, even in the face of death.

Being “on the ice,’’ she told Psychology Today magazine in 2006, after her cancer returned, “created a much greater clarity for me about what was essential in life.’’

“I’m not afraid of death,’’ she said. “I’ve come to accept it as being part of life, and I think I’ve come to accept it earlier than my years because of what’s happened to me.’’

Dr. Nielsen’s brother, Eric Cahill, who was her agent after she returned from Antarctica, said that her health had declined rapidly in the past month. Her husband, Tom Fitzgerald, was with her when she died, her brother said.

“She loved life, and she lived it to the fullest,’’ Cahill said. “Even though she died sooner than we wou

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health

Memphis Hospital Says It Did Jobs’s Liver Surgery

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Article Tools Sponsored By
By BARRY MEIER
Published: June 23, 2009

Methodist University Hospital in Memphis acknowledged Tuesday that it had performed a liver transplant on Steven P. Jobs, the chief executive of Apple.
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Apple’s chief, Steve Jobs, is said to be recovering well.
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Times Topics: Steve Jobs

In a statement posted on its Web site, the hospital said Mr. Jobs had received the organ because he had the most urgent need for a new liver when one became available.

“Mr. Jobs is now recovering well and has an excellent prognosis,” Dr. James D. Eason, the hospital’s chief of transplantation, said in the statement.

Methodist’s statement follows an apparent turnabout on Mr. Jobs’s part on whether to disclose where he received his transplant amid intense media and public speculation on the issue.

As recently as Monday, a spokeswoman for Methodist said the hospital did not have any records to indicate that a patient named Steve Jobs had received any kind of treatment there. In its statement Tuesday, the hospital said it was making the disclosure with Mr. Jobs’s permission.

Methodist has one of the shortest waiting times of any liver transplant center in the country, according to a transplant registry operated by the Arbor Research Collaborative for Health and the University of Michigan.

Once registered, patients must normally wait in line until the seriousness of their condition and time on the waiting list pushes them to the top.

A scoring system, known as a MELD score, determines where a patient ranks on a transplant waiting list. The higher the score, the sicker a patient is and the higher the ranking. Any ties are decided by who has had that

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health

How Did Steve Jobs Get a Liver Transplant?
By Tara Parker-Pope
DESCRIPTIONThor Swift For The New York Times Steve Jobs.

Given the scarcity of donor organs, how did Apple co-founder Steve Jobs get to the head of the line on the liver transplant list?

In today’s New York Times, reporters Denise Grady and Barry Meier attempt to provide answers.

Whenever someone rich and famous receives a transplant, suspicions inevitably arise about whether that person managed to jump to the head of the waiting list and take an organ that might have saved the life of somebody just as desperate but less glamorous. The dark theories are a holdover from the case of Mickey Mantle, who waited all of one day for a liver in 1995, and then died from liver cancer anyway, just two months later.

In Mr. Jobs’s case, doctors say there was no need, and little opportunity, to cheat the system. Under current procedures, any transplant center ranks potential liver recipients on its waiting list, with the highest rankings based on how sick the patients are and how long they have been that sick. Jumping ahead of a sicker patient is not allowed.

And yet, there are ways to work the system to one’s advantage. Waiting times for a liver vary in different parts of the country, and people who can afford to travel are free to go to a city or state with the shortest wait and bide their time until they have reached the top of the list, a donor dies and an organ becomes available. Indeed, some patients rent apartments or stay in hotels near a hospital and wait for the phone to ring. It may not seem fair, but it is not illegal.

To learn more, read the full story, “A Transplant That Is Raising Many Questions,” and then please join the discussion below.

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Healthy Consumer, organ donation, pancreatic cancer, Steve Jo

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health

Bill Rodgers and the Perfect Running Shoe
By Tara Parker-Pope
DESCRIPTIONLisa Poole/Associated Press Bill Rodgers at the 2009 Boston Marathon.

For weeks now, I have been struggling to find the right running shoe. I chose one for its pink swoosh, but it never felt right. I tried two other pairs but still struggled with blisters and foot pain. Then I finally checked out my local specialty running store, where the salesman (shout out to Matt at Princeton Running Co.) watched me walk, suggested a few different shoes and let me try them out on a treadmill. Sure enough, I found a shoe that felt great, and several runs later, my feet couldn’t be happier.

I recently spoke to marathon great Bill Rodgers, four-time winner of both the New York City and Boston marathons who now owns a specialty running store in Boston. I asked him why it’s so tough to find the perfect running shoe. Here’s our conversation.
Question

What makes the perfect running shoe?
Answer

Some people run in almost anything, others are on a never-ending search. I think finding the right fit is important. You really want to be comfortable in your shoes. It’s about how it feels. You’ll find out on the road. There’s never quite the perfect shoe. It’s a quest. In 1976 I did have a pair of running shoes from Asics, I wish they still made them, the Asics Montreal. They were phenomenal shoes. They were light, they didn’t wear down fast, great shoe, fit perfect. They were the best shoes I ever wore.
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Question

You own a running store. Why do you think it makes such a difference to shop at a specialty store rather than a larger sporting goods store?
Answer

I don’t think it’s that unusual to have a pair of shoes you just don’t like, and they end up being your gardening or walking-the-dog shoes. I always tell people to go to a specialty store in t

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health

June 22, 2009, 9:00 pm
A Push for the Wired Patient’s Bill of Rights
By Steve Lohr

Starting with a few dozen supporters, including health bloggers, individual physicians, startups and Microsoft, a group is seeking to firmly inject the rights of patients into the Obama administration’s multibillion-dollar drive to computerize medical records.

The group’s effort begins with a Web site, HealthDataRights.org, which goes live on Monday night. And it is a bottom-up endeavor to harness the power of social media to influence policy and practice as personal medical information begins a years-long journey from paper records into the Internet age.

The early supporters all share the view that informed, motivated patients must play a much greater role in managing their own health if the policy goals of improving the quality of care and curbing costs are to be achieved. And, they add, health information technology, when used wisely, can help a lot. The endorsers include Web sites and personal health startups geared to advancing consumer-driven health care and helping patients learn about and manage their own health, including PatientsLikeMe.com, DiabetesMine.com and 23AndMe.

The new Web-based push comes a week after the Obama administration published a “preamble” document outlining the goals for electronic health records and the broad criteria for their “meaningful use” to qualify for incentive payments to doctors and hospitals. The administration document declared that its “ultimate vision” is one in which “all patients are fully engaged in their health care,” while physicians and clinics have real-time access to all the medical information they need to ensure the quality and safety of care.

The administration’s statement of goals is encouraging, but more needs to be done, said Adam Bosworth, the former head of Google’s health unit and founder of an online health startup, Keas, which has not yet begun operating. He is one of the people who helped orchestrate the patients rights initiative.

The group’s declaration of “he

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health

How the Food Makers Captured Our Brains
By TARA PARKER-POPE

As head of the Food and Drug Administration, Dr. David A. Kessler served two presidents and battled Congress and Big Tobacco. But the Harvard-educated pediatrician discovered he was helpless against the forces of a chocolate chip cookie.

In an experiment of one, Dr. Kessler tested his willpower by buying two gooey chocolate chip cookies that he didn’t plan to eat. At home, he found himself staring at the cookies, and even distracted by memories of the chocolate chunks and doughy peaks as he left the room. He left the house, and the cookies remained uneaten. Feeling triumphant, he stopped for coffee, saw cookies on the counter and gobbled one down.

“Why does that chocolate chip cookie have such power over me?” Dr. Kessler asked in an interview. “Is it the cookie, the representation of the cookie in my brain? I spent seven years trying to figure out the answer.”

The result of Dr. Kessler’s quest is a fascinating new book, “The End of Overeating: Taking Control of the Insatiable American Appetite” (Rodale).

During his time at the Food and Drug Administration, Dr. Kessler maintained a high profile, streamlining the agency, pushing for faster approval of drugs and overseeing the creation of the standardized nutrition label on food packaging. But Dr. Kessler is perhaps best known for his efforts to investigate and regulate the tobacco industry, and his accusation that cigarette makers intentionally manipulated nicotine content to make their products more addictive.

In “The End of Overeating,” Dr. Kessler finds some similarities in the food industry, which has combined and created foods in a way that taps into our brain circuitry and stimulates our desire for more.

When it comes to stimulating our brains, Dr. Kessler noted, individual ingredients aren’t particularly potent. But by combining fats, sugar and salt in innumerable ways, food makers have essentially tapped into the brain’s reward system, creating a feedback loop that stimulates our desire to e

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Something’s Got to Give in Medicare Spending
By TYLER COWEN

MEDICARE expenditures threaten to crush the federal budget, yet the Obama administration is proposing that we start by spending more now so we can spend less later.

This runs the risk of becoming the new voodoo economics. If we can’t realize significant savings in health care costs now, don’t expect savings in the future, either.

It’s not the profits of the drug companies or the overhead of the insurance companies that make American health care so expensive, but the financial incentives for doctors and medical institutions to recommend more procedures, whether or not they are effective. So far, the American people have been unwilling to say no.

Drawing upon the ideas of the Harvard economist David Cutler, the Obama administration talks of empowering an independent board of experts to judge the comparative effectiveness of health care expenditures; the goal is to limit or withdraw Medicare support for ineffective ones. This idea is long overdue, and the critics who contend that it amounts to “rationing” or “the government telling you which medical treatments you can have” are missing the point. The motivating idea is the old conservative chestnut that not every private-sector expenditure deserves a government subsidy.

Nonetheless, this principle is radical in its implications and has met with resistance. In particular, Congress has not been willing to give up its power over what is perhaps the government’s single most important program, nor should we expect such a surrender of power in the future. There is already a Medicare Advisory Payment Commission, but it isn’t allowed to actually cut costs.

Scholars have been applying comparative-effectiveness research to Medicare for years, and the verdict is not altogether pretty. It turns out that some regions spend more on Medicare than others — sometimes two or three times as much, as documented by the Dartmouth Atlas Project. Yet the higher-spending regions often fail to produce superior health care resu

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Medical Problems Could Include Identity Theft
By WALECIA KONRAD

Brandon Sharp, a 37-year-old manager at an oil and gas company in Houston, has never had any real health problems and, luckily, he has never stepped foot in an emergency room. So imagine his surprise a few years ago when he learned he owed thousands of dollars worth of emergency-service medical bills.

Mr. Sharp, as it turned out, was a victim of a fast-growing crime known as medical identity theft.

At the time, Mr. Sharp was about to get married and buy his first home. Before applying for a mortgage he requested a copy of his credit report. That is when he found he had several collection notices under his name for emergency room visits throughout the country.

“There was even a $19,000 bill for a Life Flight air ambulance service in some remote location I’d never heard of,” said Mr. Sharp, who made this unhappy discovery in 2003. “I had emergency room bills from places like Bowling Green, Kan., where I’ve never even visited. I’m still cleaning up the mess.”

The last time federal data on the crime was collected, for a 2007 report, more than 250,000 Americans a year were victims of medical identity theft. That number has almost certainly increased since then, because of the increased use of electronic medical records systems built without extensive safeguards, said Pam Dixon, executive director of the nonprofit World Privacy Forum and author of a report on medical identity theft.

And uncountable, Ms. Dixon said, are the people who do not yet know they are victims. They may not know that their medical information has been tampered with for months or even years until, as in Mr. Sharp’s case, it shows up in collections on a credit report.

Medical identity theft takes many guises. In Mr. Sharp’s case, someone got hold of his name and Social Security number and used them to receive emergency medical services, which many hospitals are obliged to provide whether or not a person has insurance. Mr. Sharp still does not know whether he fell victim to one c

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