February 22, 2011, 8:30 pm By MARK BITTMAN
How to Make Oatmeal . . . Wrong
Another Article from the New York Times - please see writing in bold below which pointed out the ease simple food can be made.
There’s a feeling of inevitability in writing about McDonald’s latest offering, their “bowl full of wholesome” — also known as oatmeal. The leading fast-food multinational, with sales over $16.5 billion a year (just under the G.D.P. of Afghanistan), represents a great deal of what is wrong with American food today. From a marketing perspective, they can do almost nothing wrong; from a nutritional perspective, they can do almost nothing right, as the oatmeal fiasco demonstrates.
One “positive” often raised about McDonald’s is that it sells calories cheap. But since many of these calories are in forms detrimental rather than beneficial to our health and to the environment, they’re actually quite expensive — the costs aren’t seen at the cash register but in the form of high health care bills and environmental degradation.
Oatmeal is on the other end of the food spectrum. Real oatmeal contains no ingredients; rather, it is an ingredient. As such, it’s a promising lifesaver: oats are easy to grow in almost any non-extreme climate and, minimally processed, they’re profoundly nourishing, inexpensive and ridiculously easy to cook. They can even be eaten raw, but more on that in a moment.
Like so many other venerable foods, oatmeal has been roundly abused by food marketers for more than 40 years. Take, for example, Quaker Strawberries and Cream Instant Oatmeal, which contains no strawberries, no cream, 12 times the sugars of Quaker Old Fashioned Oats and only half of the fiber. At least it’s inexpensive, less than 50 cents a packet on average. (A serving of cooked rolled oats will set you back half that at most, plus the cost of condiments; of course, it’ll be much better in every respect.)
The oatmeal and McDonald’s story broke late last year, when Mickey D’s, in its ongoing effort to tell us that it’s offering “a selection of balanced choices” (and to keep in step with arch-rival Starbucks) began to sell the cereal. Yet in typical McDonald’s fashion, the company is doing everything it can to turn oatmeal into yet another bad choice. (Not only that, they’ve made it more expensive than a double-cheeseburger: $2.38 per serving in New York.) “Cream” (which contains seven ingredients, two of them actual dairy) is automatically added; brown sugar is ostensibly optional, but it’s also added routinely unless a customer specifically requests otherwise. There are also diced apples, dried cranberries and raisins, the least processed of the ingredients (even the oatmeal contains seven ingredients, including “natural flavor”).
A more accurate description than “100 percent natural whole-grain oats,” “plump raisins,” “sweet cranberries” and “crisp fresh apples” would be “oats, sugar, sweetened dried fruit, cream and 11 weird ingredients you would never keep in your kitchen.”
Since we know there are barely any rules governing promotion of foods, one might wonder how this compares to real oatmeal, besides being 10 times as expensive. Some will say that it tastes better, but that’s because they’re addicted to sickly sweet foods, which is what this bowlful of wholesome is.
Others will argue that the McDonald’s version is more “convenient.” This is nonsense; in the time it takes to go into a McDonald’s, stand in line, order, wait, pay and leave, you could make oatmeal for four while taking your vitamins, brushing your teeth and half-unloading the dishwasher. (If you’re too busy to eat it before you leave the house, you could throw it in a container and microwave it at work. If you prefer so-called instant, flavored oatmeal, see this link, which will describe how to make your own).
If you don’t want to bother with the stove at all, you could put some rolled oats (instant not necessary) in a glass or bowl, along with a teeny pinch of salt, sugar or maple syrup or honey, maybe some dried fruit. Add milk and let stand for a minute (or 10). Eat. Eat while you’re walking around getting dressed. And then talk to me about convenience.
The aspect one cannot argue is nutrition: Incredibly, the McDonald’s product contains more sugar than a Snickers bar and only 10 fewer calories than a McDonald’s cheeseburger or Egg McMuffin. (Even without the brown sugar it has more calories than a McDonald’s hamburger.)
The bottom-line question is, “Why?” Why would McDonald’s, which appears every now and then to try to persuade us that it is adding “healthier” foods to its menu, take a venerable ingredient like oatmeal and turn it into expensive junk food? Why create a hideous concoction of 21 ingredients, many of them chemical and/or unnecessary? Why not try, for once, to keep it honest?
I asked them this, via e-mail: “Why could you not make oatmeal with nothing more than real oats and plain water, and offer customers a sweetener or two (honey, the only food on earth that doesn’t spoil, would seem a natural fit for this purpose), a packet of mixed dried fruit, and half-and-half or — even better — skim milk?”
Their answer, via e-mail and through a spokesperson (FMO is “fruit and maple oatmeal”): “Customers can order FMO with or without the light cream, brown sugar and the fruit. Our menu is entirely customizable by request with our ‘Made for You’ platform that has been in place since the late 90s.”
Oh, please. Here’s the thing: McDonald’s wants to get people in the store. Once a day, once a week, once a month, the more the better, of course, but routinely. And if you buy oatmeal, they’re O.K. with that. But they know that, once inside, you’ll probably opt for a sausage biscuit anyway.
And you won’t be much worse off
Sunday, February 27, 2011
Thoughtful article
Some interesting points are made here. The importance of the practical side of medicine, picking up physical signs, not focussing on the 'iPatient' rather than the patient. I don't agree with the performance aspect.
From the New York Times: Treat the Patient, Not the CT Scan
By ABRAHAM VERGHESE
Published: February 26, 2011
Palo Alto, Calif.
THE other day as I walked through a wing of my hospital, it occurred to me that Watson, I.B.M.’s supercomputer, would be more at home here than he was on “Jeopardy!” Perhaps it’s good, I thought, that his next challenge, with the aid of the Columbia University Medical Center and the University of Maryland School of Medicine, will be to learn to diagnose illnesses and treat patients.
On our rounds of the wards, Watson would see lots of other computers with humans glued to them like piglets at a sow’s teats. We might visit a patient with a complex illness — one whose second liver transplant has failed, who has a fungal meningitis and now also has kidney failure and bleeding and is on a score of medications.
Watson might help me digest the sheer volume of data that is in the electronic medical record and might see trends in the data that speak of an impending disaster. And since Watson is constantly trolling the Web, he would perhaps bring to my attention a case report published the previous night in a Swedish journal describing a new interaction between two of the drugs my patient is taking.
Better still, if Watson could harness data from all the patients in our hospital and in every other hospital in America, we might be alerted to mini-epidemics taking shape. For example, Watson might recognize that the kidney failure in our patient is linked to kidney failure in a patient in Buffalo and another in San Antonio; all three patients, he might inform me, were taking a “natural” weight loss supplement that contained a Chinese herb, aristolochia, that has been associated with more than 100 cases of kidney failure.
In short, Watson would be a potent and clever companion as we made our rounds.
But the complaints I hear from patients, family and friends are never about the dearth of technology but about its excesses. My own experience as a patient in an emergency room in another city helped me see this. My nurse would come in periodically to visit the computer work station in my cubicle, her back to me while she clicked and scrolled away. Over her shoulder she said, “On a scale of one to five how is your ...?”
The electronic record of my three-hour stay would have looked perfect, showing close monitoring, even though to me as a patient it lacked a human dimension. I don’t fault the nurse, because in my hospital, despite my best intentions, I too am spending too much time in front of the computer: the story of my patient’s many past admissions, the details of surgeries undergone, every consultant’s opinion, every drug given over every encounter, thousands of blood tests and so many CT scans, M.R.I.’s and ultrasound images reside in there.
This computer record creates what I call an “iPatient” — and this iPatient threatens to become the real focus of our attention, while the real patient in the bed often feels neglected, a mere placeholder for the virtual record.
Imaging the body has become so easy (and profitable, too, if you own the machine). When I was an intern some 30 years ago, about three million CT scans were performed annually in the United States; now the number is more like 80 million. Imaging tests are now responsible for half of the overall radiation Americans are exposed to, compared with about 15 percent in 1980.
With that radiation exposure comes increasing risk for cancer, but what worries me even more is that this ease of ordering a scan has caused doctors’ most basic skills in examining the body to atrophy. This loss is palpable when American medical trainees go to hospitals and clinics abroad with few resources: it can be quite humbling to see doctors in Africa and South America detect fluid around patients’ lungs not with X-rays but by percussing the chest with their fingers and listening with their stethoscopes.
Of course, we still teach medical students how to properly examine the body. In dedicated physical diagnosis courses in their first and second years, students learn on trained actors, who give them appropriate stories and responses, how to do a complete exam of the body’s systems (circulatory, respiratory, musculoskeletal and the rest). Faculty members stand by to assess that the required maneuvers are performed correctly.
But all that training can be undone the moment the students hit their clinical years. Then, they discover that the currency on the ward seems to be “throughput” — getting tests ordered and getting results, having procedures like colonoscopies done expeditiously, calling in specialists, arranging discharge. And the engine for all of that, indeed the place where the dialogue between doctors and nurses takes place, is the computer.
The consequence of losing both faith and skill in examining the body is that we miss simple things, and we order more tests and subject people to the dangers of radiation unnecessarily. Just a few weeks ago, I heard of a patient who arrived in an E.R. in extremis with seizures and breathing difficulties. After being stabilized and put on a breathing machine, she was taken for a CT scan of the chest, to rule out blood clots to the lung; but when the radiologist looked at the results, she turned out to have In retrospect, though, her cancer should have been discovered long before the radiologist found it; before the emergency, the patient had been seen several times and at different places, for symptoms that were probably related to the cancer. I got to see the CT scan: the tumor masses in each breast were likely visible to the naked eye — and certainly to the hand. Yet they had never been noted.
Too frequently, I hear of (and in a study we are conducting, I am collecting) stories like that from all across the country. They represent a type of error that stems from not making use of basic bedside skills, not asking the patient to fully disrobe. It is a more subtle kind of error than operating on the wrong limb; indeed, this sort of mistake is not always recognized, and yet the consequences can be grave.
IN my experience, being skilled at examining the body has a salutary effect beyond finding important clues that lead to an early diagnosis. It is a ritual that remains important to the patient. Recently my ward team admitted an elderly woman who had been transferred from her nursing home in the night because of a change in her mental status. A CT of the head and all other tests were determined to be normal; the problem had been dehydration, and she was better, ready to go back. But as our team was about to enter the room, my intern warned me that the patient’s lawyer daughter was unhappy with the plan to return her mother to the nursing home, and was waiting impatiently to see me and contest the transfer.
After introducing myself to the patient and to her daughter, I did a thorough but quick neurologic exam. I put the patient through her paces: mental status, cranial nerves, motor and sensory function, used my reflex hammer and pointed out interesting things along the way to my interns and students. I then said to the daughter that her mother seemed back to normal. To our surprise, the daughter seemed comforted, and now had no objection to her mother’s return to the nursing home.
Later, our team discussed what had just happened. We all felt that the daughter witnessing the examination of the patient, that ritual, was the key to earning both their trusts.
I find that patients from almost any culture have deep expectations of a ritual when a doctor sees them, and they are quick to perceive when he or she gives those procedures short shrift by, say, placing the stethoscope on top of the gown instead of the skin, doing a cursory prod of the belly and wrapping up in 30 seconds. Rituals are about transformation, the crossing of a threshold, and in the case of the bedside exam, the transformation is the cementing of the doctor-patient relationship, a way of saying: “I will see you though this illness. I will be with you through thick and thin.” It is paramount that doctors not forget the importance of this ritual.
An answer that might have been posed on “Jeopardy!” is, “An emergency treatment that is administered by ear.” I wonder if Watson would have known the question (though he will now, cybertroller that he is), which is, “What are words of comfort?”
From the New York Times: Treat the Patient, Not the CT Scan
By ABRAHAM VERGHESE
Published: February 26, 2011
Palo Alto, Calif.
THE other day as I walked through a wing of my hospital, it occurred to me that Watson, I.B.M.’s supercomputer, would be more at home here than he was on “Jeopardy!” Perhaps it’s good, I thought, that his next challenge, with the aid of the Columbia University Medical Center and the University of Maryland School of Medicine, will be to learn to diagnose illnesses and treat patients.
On our rounds of the wards, Watson would see lots of other computers with humans glued to them like piglets at a sow’s teats. We might visit a patient with a complex illness — one whose second liver transplant has failed, who has a fungal meningitis and now also has kidney failure and bleeding and is on a score of medications.
Watson might help me digest the sheer volume of data that is in the electronic medical record and might see trends in the data that speak of an impending disaster. And since Watson is constantly trolling the Web, he would perhaps bring to my attention a case report published the previous night in a Swedish journal describing a new interaction between two of the drugs my patient is taking.
Better still, if Watson could harness data from all the patients in our hospital and in every other hospital in America, we might be alerted to mini-epidemics taking shape. For example, Watson might recognize that the kidney failure in our patient is linked to kidney failure in a patient in Buffalo and another in San Antonio; all three patients, he might inform me, were taking a “natural” weight loss supplement that contained a Chinese herb, aristolochia, that has been associated with more than 100 cases of kidney failure.
In short, Watson would be a potent and clever companion as we made our rounds.
But the complaints I hear from patients, family and friends are never about the dearth of technology but about its excesses. My own experience as a patient in an emergency room in another city helped me see this. My nurse would come in periodically to visit the computer work station in my cubicle, her back to me while she clicked and scrolled away. Over her shoulder she said, “On a scale of one to five how is your ...?”
The electronic record of my three-hour stay would have looked perfect, showing close monitoring, even though to me as a patient it lacked a human dimension. I don’t fault the nurse, because in my hospital, despite my best intentions, I too am spending too much time in front of the computer: the story of my patient’s many past admissions, the details of surgeries undergone, every consultant’s opinion, every drug given over every encounter, thousands of blood tests and so many CT scans, M.R.I.’s and ultrasound images reside in there.
This computer record creates what I call an “iPatient” — and this iPatient threatens to become the real focus of our attention, while the real patient in the bed often feels neglected, a mere placeholder for the virtual record.
Imaging the body has become so easy (and profitable, too, if you own the machine). When I was an intern some 30 years ago, about three million CT scans were performed annually in the United States; now the number is more like 80 million. Imaging tests are now responsible for half of the overall radiation Americans are exposed to, compared with about 15 percent in 1980.
With that radiation exposure comes increasing risk for cancer, but what worries me even more is that this ease of ordering a scan has caused doctors’ most basic skills in examining the body to atrophy. This loss is palpable when American medical trainees go to hospitals and clinics abroad with few resources: it can be quite humbling to see doctors in Africa and South America detect fluid around patients’ lungs not with X-rays but by percussing the chest with their fingers and listening with their stethoscopes.
Of course, we still teach medical students how to properly examine the body. In dedicated physical diagnosis courses in their first and second years, students learn on trained actors, who give them appropriate stories and responses, how to do a complete exam of the body’s systems (circulatory, respiratory, musculoskeletal and the rest). Faculty members stand by to assess that the required maneuvers are performed correctly.
But all that training can be undone the moment the students hit their clinical years. Then, they discover that the currency on the ward seems to be “throughput” — getting tests ordered and getting results, having procedures like colonoscopies done expeditiously, calling in specialists, arranging discharge. And the engine for all of that, indeed the place where the dialogue between doctors and nurses takes place, is the computer.
The consequence of losing both faith and skill in examining the body is that we miss simple things, and we order more tests and subject people to the dangers of radiation unnecessarily. Just a few weeks ago, I heard of a patient who arrived in an E.R. in extremis with seizures and breathing difficulties. After being stabilized and put on a breathing machine, she was taken for a CT scan of the chest, to rule out blood clots to the lung; but when the radiologist looked at the results, she turned out to have In retrospect, though, her cancer should have been discovered long before the radiologist found it; before the emergency, the patient had been seen several times and at different places, for symptoms that were probably related to the cancer. I got to see the CT scan: the tumor masses in each breast were likely visible to the naked eye — and certainly to the hand. Yet they had never been noted.
Too frequently, I hear of (and in a study we are conducting, I am collecting) stories like that from all across the country. They represent a type of error that stems from not making use of basic bedside skills, not asking the patient to fully disrobe. It is a more subtle kind of error than operating on the wrong limb; indeed, this sort of mistake is not always recognized, and yet the consequences can be grave.
IN my experience, being skilled at examining the body has a salutary effect beyond finding important clues that lead to an early diagnosis. It is a ritual that remains important to the patient. Recently my ward team admitted an elderly woman who had been transferred from her nursing home in the night because of a change in her mental status. A CT of the head and all other tests were determined to be normal; the problem had been dehydration, and she was better, ready to go back. But as our team was about to enter the room, my intern warned me that the patient’s lawyer daughter was unhappy with the plan to return her mother to the nursing home, and was waiting impatiently to see me and contest the transfer.
After introducing myself to the patient and to her daughter, I did a thorough but quick neurologic exam. I put the patient through her paces: mental status, cranial nerves, motor and sensory function, used my reflex hammer and pointed out interesting things along the way to my interns and students. I then said to the daughter that her mother seemed back to normal. To our surprise, the daughter seemed comforted, and now had no objection to her mother’s return to the nursing home.
Later, our team discussed what had just happened. We all felt that the daughter witnessing the examination of the patient, that ritual, was the key to earning both their trusts.
I find that patients from almost any culture have deep expectations of a ritual when a doctor sees them, and they are quick to perceive when he or she gives those procedures short shrift by, say, placing the stethoscope on top of the gown instead of the skin, doing a cursory prod of the belly and wrapping up in 30 seconds. Rituals are about transformation, the crossing of a threshold, and in the case of the bedside exam, the transformation is the cementing of the doctor-patient relationship, a way of saying: “I will see you though this illness. I will be with you through thick and thin.” It is paramount that doctors not forget the importance of this ritual.
An answer that might have been posed on “Jeopardy!” is, “An emergency treatment that is administered by ear.” I wonder if Watson would have known the question (though he will now, cybertroller that he is), which is, “What are words of comfort?”
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