Check out this new blog

I've been working for a few months with Dan Callahan, Shep Nuland, and Mary Crowley of the Hastings Center to develop a new blog. It's called Over65. Our aim is to foster a voice for progressive-minded folks over 65 who will comment thoughtfully on health care, social security, and other aging-related issues. We felt that there's a lot talk about  the Medicare generation, but not enough talk from that group. We think of the blog as the first step in what we hope will become a series of linked projects, aiming to build a foundation for more thoughtful policy discussion of issues involving aging and intergenerational equity than has happened to date.

I'll be travelling for two weeks, and will look forward to returning to both blogs when I'm back

Cattle "Emissions"

Ancestral Health Symposium 2012 is now history. The symposium took place at the Harvard Law School August 9^th-11^th. Not a bad gig for a forage agronomist! The title of my presentation was The Reality of Ruminants and Liebeg’s Barrel: Examining the New ‘Conventional Wisdom'. All of the presentations were video taped, and will be freely available.

My title slide. Cattle mob grazing a pasture under center pivot irrigation.
Photograph by Dawn Gerrish.

One of the themes of this year’s symposium was sustainability. I don’t see that term in the simplistic way many do, in part because I remember being told by leaders of the sustainable agriculture movement that “animals have no place in sustainable ag!”

The truth is that the production of animal products from perennial forages is the sustainable agricultural system. Many, however, are concerned about the carbon dioxide and methane “emissions” from livestock in general, and cattle in particular. Some folks don’t seem to understand that a cow grazing grass can only emit carbon that was originally in grass, and that the carbon in grass has to have come from the atmosphere. So it’s a cycle not an “enrichment.” But there’s more to it than that!

Under the following assumptions:

Carbon:Nitrogen ratio = 17 and 3.4% N, giving 57.8 % C
3% of body weight daily dry matter (DM) intake; 1,000 lb cow = 30 lb DM per day
70% utilization - 30 lb DM eaten / 0.70 = 42.8 lb DM offered
Equal above and below ground DM distribution
90% of C consumed is “emitted” 

We’d see:

42.8 lb DM above ground, 42.8 lb DM below ground – 85.6 lb DM total
57.8% C in DM – 49.5 lb C total
17.3 lb C consumed
15.6 lb C emitted

Thus, for every pound of carbon “emitted” by a cow on grass, 3.2 pounds of carbon are fixed in plant roots, uneaten plant debris, or the cow herself or her calf. Even if we say that 100% of carbon she ingested is emitted (a biological impossibility!), there’d be 2.9 pounds of carbon fixed for every pound emitted! Beef cattle are carbon negative!

Someone (perhaps Todd Becker?) asked me what happens to methane in the atmosphere. A good question, and one I wasn't completely sure about. So I went looking and found the following at this site:

"In the lower part of the atmosphere, below about 10-12 km (the troposphere), the key cycles are mediated above all by the presence of what are called OH radicals — colloquially known as the atmospheric detergent. All hydrocarbon chemical species that are emitted can be eventually broken down (or oxidized) by these radicals to CO₂ and H₂O, and methane is no exception. An average molecule of CH₄ lasts around eight to nine years before it gets oxidized. This is a long time compared to most atmospheric chemicals but is fast enough so that there can be significant year-to-year variability."

Penn Dermatology Practice Opens at Penn Presbyterian Medical Center

Penn Dermatology has opened a new practice at Penn Presbyterian Medical Center. The recently renovated office is located in the Medical Arts Building, Suite 106.

Marie Urberti-Benz, MD and Douglas J. Pugliese, MD see patients at this new location. Dr. Urberti-Benz has provided dermatologic care to patients at Penn Presbyterian Medical Center for several years. Dr. Pugliese is new to the practice and has a clinical focus in general dermatology and wound care. He is currently accepting new patients.

Penn Dermatology physicians are experts in the diagnosis and treatment of skin, hair and nail disorders as well as cosmetic and aesthetic services. The dermatologists, dermatologic surgeons and dermatopathologists diagnose and treat patients with a full spectrum of dermatologic conditions as well as rare skin conditions.

Learn more:
Dermatology services at Penn Medicine
Dr. Pugliese 

Penn Cardiology Now in Somers Point

World-class heart care is now available in a new South Jersey location. Penn Medicine’s new cardiology practice in Somers Point Brings some of the region’s most renowned heart specialists to the residents of southeastern Atlantic and northern Cape May counties. The physicians at Penn Cardiology Somers Point offer the highest level of cardiac care with access to the expertise, resources and research available only from Penn Medicine.

The full range of cardiovascular services available at Penn Cardiology Somers Point includes:

• Consultative cardiology
• Echocardiography
• Long-term electrocardiographic monitoring
• MUGA scans (heart function assessment)
• Stress echocardiography
• Stress and pharmacologic nuclear stress testing
• Vascular testing

Practicing cardiologists at Penn Cardiology Somers Point:

• David Arluck,  MD
• Katherine Dowd, MD
• Steven E. Kornberg, MD
• Jacob L. Levin, MD, FAAC
• Beth Wolfson, APNC

See a full list of Penn Cardiology community locations

For more information or to schedule an appointment with a Penn cardiac physician, please call 800-789-PENN.

Now at Penn: Gamma Knife® Perfexion™

Gamma Knife® Perfexion™ is the latest form of precision radiation therapy for treating cancer. This non-surgical treatment uses 192 sources of radiation to precisely target tumors, lesions and other intracranial structures.
Radiation therapy damages cancer cells and tumors, preventing them from multiplying. The Gamma Knife was developed in 1968 and primarily used to treat intractable pain and movement disorders. Compared with earlier Gamma Knife versions, Perfexion offers an expanded reach for treating metastasis anywhere in the brain and can also treat multiple locations in a single session.
Gamma Knife® Perfexion™ is one of a full range of treatment options for benign, malignant and metastatic cancer that Penn Medicine offers patients in the Philadelphia region. Currently, Penn Neurosurgery treats as many as 300 patients in the Penn Gamma Knife Center—the most of any hospital in the Philadelphia region.

Learn more:

• Gamma Knife® Perfexion™
• Penn Neuro Surgery

Old against young in Japan

If you read about a country with economic problems where "already indecisive leaders [are] loath to upset retirees from the baby boom who make up more than a quarter of the population and tend to vote in high numbers," you might guess that the article was about the U.S. and Medicare. It's not.

It's about Japan and the value of the yen.

In 2007 the Japanese yen was trading at 123 to the dollar. In the post-2008 economic crisis the yen was seen as a safe haven currency. Its value went up. It now trades for about 78 to the dollar.

So what does the exchange value of the yen have to do with intergenerational conflict? An article in today's New York Times explains why the old and the young are fighting about currency.

The strong yen makes imports cheaper. Cheaper imports drive down domestic prices as well. Older people on fixed incomes can buy more. What cost them 123 yen in 2007 costs them only 78 yen now. But a strong yen makes exports more expensive, and Japanese industry - very export dependent - is suffering. This hurts the young.

Japanese political scientists say the government has tolerated the strong yen out of fear of the elderly. Shigeru Ono, a 62 year old retired oil company manager who lives on a monthly pension of 130,000 yen (approximtely $1,660), understands the intergenerational conflict:

The strong yen and deflation have been a boon for us baby boomers. But I also know that they cannot be good for my son’s generation.

The U.S. is struggling to contain the cost of Medicare. Japan is struggling with the impact of a strong yen. In families, grandparents cherish children and grandchildren. But in wider society the relationship between generations is playing out differently.

The future well being of both countries depends in large measure on the balance of competition and cooperation between old and young.

Massachusetts nibbles at the cost bullet

On the last day of the legislative session, the Massachusetts Senate unanimously approved a 350 page health reform bill. The House approved it by 132-20. Governor Patrick has said that he will sign it. (The bill itself is not yet available on line - I've read about it but not yet seen it.)

Like the Affordable Care Act, the Massachsetts bill includes a wide range of policy steps - creating an oversight agency, promoting transparency about costs, supporting wellness programs, encouraging global budgets and an end to fee-for-service, and more. But the key component is the line in the sand about overall health care costs: between 2013 - 2017 cost increases should not exceed the growth of the state economy. For 2018 - 2022 cost increases should be at least 0.5% below the state economy growth.

So what happens if costs exceed the target?

Since total health care cost is the sum of thousands of independent charges (by hospitals, medical offices, equipment vendors, and more) and payments (by insurers, patients, government, and more), there's no one to hold accountable and no real enforcement mechanism.

Representative Steven Levy's twitter comment on the cost containment commitment was (1) "lol" and (2) "only concrete thing in it is more bureaucracy and fees." He's not right, but he's not completely wrong.

Even without a true accountability structure or enforcement mechanism, the cost commitment matters. The situation reminds me of all the times my wife and I said to our sons some form of - "we expect you to do XYZ." By the time they were teen agers they were smart enough to ask - "what happens if I don't do XYZ?" We tried to avoid too much sabre rattling and generally said something like "we expect XYZ to happen - if it doesn't we'll deal with it then..."

Of course XYZ didn't always happen. Sometimes there were consequences. Sometimes there were apologies and resolutions to do better. Occasionally our sons would persuade us that XYZ was the wrong expecation - it should have been ABC. But we always took it seriously if XYZ didn't happen.

Managing a state with 6.5 million residents and $80 billion in health expenditures is rather more complex than managing a four person family, but I expect the same process I experienced as a parent to happen in Massachusetts.

Until now we've not had explicit expectations for health costs. Now we do. Measuring how we're doing in relation to a commitment is different than wringing hands over "unsupportable cost increases." Our legislators and Governor have made a promise. It's not clear how they, and we the citizens, will accomplish it. But we can't avoid paying attention to it, working on it, learning from what happens, and taking next steps.

The law sets a process in motion. It's not a silver bullet. It's more like tying a string around  a finger to ensure vigilant attention. But that's more than our state, or any state in the U.S. has done before.