Vinod Khosla Thinks I’m Narrow-Minded

There’s a (tiny) bit of a discussion going on in Twitter about a post I wrote responding to Vinod Khosla’s statement that 80% of the work that doctors do will one day be replaced by computer algorithms.

(BTW, the title as cross-posted on the Health Care Blog -“The Day the Electronic Medical Record Tried to Kill Me“-  was not mine. My original post, if anyone is interested, was entitled “Will Doctors be Needed in the Future?” THCB’s new title made it look like my post was just another rant against the EMR. It was so much more than that.)

What I said

In my post, I talked a bit about the marketplace-driven IT innovations in healthcare, and medicine as seen through the eyes of the IT entrepeneurs. I questioned just how much of what doctors do today can really be replaced by algorithms, particularly the doctor-patient relationship.

I then asked if Khosla was right and answered myself – Maybe. I stated that we were in the midst of a huge disruption in healthcare, and reflected on how I was already seeing signs of that disruption in my current practice.  And while I still did not see anything changing too much just yet, as far as the future Khosla predicted? I wasn’t so sure.

I then stated that if there is a revolution in healthcare, we docs needed to make ourselves a part of it now. I urged my fellow physicians to become involved, in order to be sure that what happens in the IT-driven healthcare future actually improves our patients’ health beyond what we are doing today. 

It’s a completely legitimate concern, and, I believe, an extremely important one.  As an example, I cited the evolution of the EMR – a system that has created high hopes and caused huge disruption at enormous cost, even as we continue to struggle to find conclusive evidence that EMR use actually improves patient outcomes.

I then began to wonder what the future would look like if replacing 80% of doctor’s work with technology actually freed us up to do the real work of medicine. I imagined us then redistributing ourselves around the globe, virtually and actually, to take care of the entire planet. And called that the ultimate disruption in healthcare.

A pretty optimistic vision of the technological future if you ask me.

I thought my post was a thoughtful take on Khosla’s vision, not a takedown of it.

And yet, on Twitter, Khosla has called my post a “Usual muddy interpretation and narrow mindedness of what I said.”

How is my interpretation muddy or my take “narrow-minded”? As the end user whose work life has been radically impacted by technology, and a doctor who bears significant responsibility for the health outcomes of my patients, I think I have a right to discuss my thoughts about the healthcare technological revolution without being called “narrow-minded”.

What may be narrow-minded is Khosla’s representation of doctors as part of the problem and not the solution. I won’t get into his calling us “lazy”, or his implications that it is only the top 20% of docs – whoever they are – who are worth having around.

Maybe it’s simply that Khosla has decided that Steve Jobs was right when he said that  –  “A lot of times, people don’t know what they want until you show it to them.”

In which case, I guess we docs (and by extension, our patients) are just supposed to shut up and wait until Khosla and the rest of the IT gurus show us what we want.

Or risk being called “narrow-minded”.

Weill-Cornell Music & Medicine presents Mozart’s Requiem

NY1 News Story about us!

I’m so proud to be singing the Mozart Requiem with fellow faculty, students, residents and staff of Weill Cornell Medical College, New York Presbyterian Hospital, Memorial Sloan Kettering Cancer Center, Rockefeller University and Hospital for Special Surgery in our first collaborative choral concert. We’ll be performing under the direction of David Leibowitz, and will be joined by solists and several instrumentalists from the Julliard School.

It’s all part of Cornell’s Music & Medicine Initiative, a program that encourages medical students to continue their ongoing relationship with music by providing rehearsal space, performance venues and opportunities to collaborate with NYC’s many arts organizations. Concert proceeds will benefit the Weill-Cornell student-run free clinic for the uninsured of New York City.

The concert will be held next Sunday, October 7 at 6:30 pm at St Bart’s Church on Park Ave in NYC.  There will be a pre-concert lecture on Sunday at 5:30 pm at St Bart’s and on Thursday,October 4, at 5:30 pm, a free symposium at the Medical College on Music, Medicine and Mozart. (Concert and lecture details here)

The Requiem is one of the most beautiful and enigmatic works ever composed by Mozart, who was composing the Requiem at the time of his death and left it unfinished. The circumstances surrounding Mozart’s death, the writing of the Requiem and its ultimate completion have been the subject of centuries of scholarly debate and speculation, making it a most appropriate choice for this unique choral collaboration.

We had our first rehearsal with the orchestra yesterday, and from how it sounded I can say tell you it’s going to be a fabulous concert.  If you’re free next Sunday evening, do come !

How Many Miles is the Central Park Loop?

I finally mapped it so I could accurately track my exercise for My Fitness Pal, supporting my latest effort at getting into shape. (More on that in a later post)

  • The big loop is just about 6.1 miles.  
  • The shorter loop (the souther 2/3 of the loop, cutting across around 104th St to avoid the 84-foot climb at the top of the park) is 5.2 miles.
  • The shortest loop (The southern most loop, cutting across the 72nd street transverse, mostly done by tourists on rentals) is 1.7 miles. 

I usually do the big loop, adding in the milage to and from the park for an 8.7 mile ride that takes me a little under an hour. (That’s 585 calories if you’re interested.)

Of course, my time depends on how many times I stop to take pics – because there’s always something I want to capture. Here’s today’s pic –

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10 years later, WHI Still Being Debated

ACP Internist has a nice article on the continuing debate on HRT. (Disclosure – I’m quoted in the article.)

The article summarizes nicely the absolute risks of HRT use as described in the Women’s Heath Initiative (WHI), the landmark study from 2002, as well as the ongoing debate around the strengths and weaknesses of the design and findings from that study.

It’s good to get caught up on the issues in anticipation of the release of early results from new clinical trials of HRT prescribed the way we docs tend to use it – starting at menopause.

You may recall that the biggest criticisms leveled at the WHI were that the average age of that study’s participants was over 60 years old and that women with menopausal symptoms were actually excluded from the study. Later subgroup analyses of younger women in that study suggest an absence of adverse cardiac effects and possible markers of cardio-protection when HRT is started at menopause rather than 10 years later. (The  so-called Window Hypothesis –  ie, there is a window of opportunity during which HRT, if started, is actually good for the heart. Exceed that window and it’s bad for the heart.)

Researchers are now studying to see if that elusive heart disease benefit of HRT might still be found when HRT is started at menopause. Early results from the Kronos Early Estrogen Prevention Study (KEEPS) are expected to be presented at the Annual Meeting of the North American Menopause Society in October. If evidence is reported for cardio-protection, that would certainly be reassuring information for symptomatic women looking to use HRT to combat symptoms.

I would be surprised, however, if KEEPS finds a difference in breast cancer risks from HRT in this age group compared to those in the WHI. It is this risk, in this docs humble opinion, that leads many women to take HRT off the table at menopause and beyond, or to limit its use to just a few years around the time of worst symptoms.

So stay tuned – it’s going to be an interesting season of HRT news.

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Essential reading on the HRT and the WHI from TBTAM

Chicken Breasts with Tarragon – A great dish with an even better afterlife

I needed to use two leftover uncooked chicken breasts in the freezer and the tarragon crop was bursting out of its pot on the terrace. Enter this quick and delicious chicken preparation from Thomas Keller via the  NY Times. Serve it over noodles or rice, with a side of roast broccoli or sauteed kale.

Because the original recipe was meant for 6 breasts, we had a good bit of the amazing sauce leftover, as well as the rest of the can of chicken broth I had opened to make it. So, we mixed the sauce and the broth together and used it to make corn chowder the following night, using some leftover corn I had frozen away two nights previous. (The broth mixture substituted for water in the recipe – we added about 1/4 cup of water to make up the difference).

The  tarragon flavor and richness of that leftover broth added to an already wonderful soup, and it was the best corn chowder we’d ever made.

Living Till You Die

I just found out that one of my favorite patients has died.

She had metastatic cancer that presented some years after she had survived a previous and different cancer. Despite her diagnosis, she lived the final few years of her life in an ever-moving forward state of joy and self-satisfaction – working, exercising, developing new relationships, changing her hair style and color, buying great new clothes, traveling, even taking a lover. At her last visit, shortly after yet a new focus of cancer had been found, she was packing for a trip to Spain.

I think she packed more of life into those last years than many people do in a lifetime. This even more remarkable when I tell you that, at the time her metastatic cancer was diagnosed, she was already past the age at which most folks would have retired.

She was fortunate that she did not have significant pain or disability from her cancer. Also fortunate that her cancer was slow-growing, until it finally took her, at which point it was fast. Just a week or so from full steam ahead mode to the end, and only one of those days spent in the hospital.

She was also fortunate because she had a wonderful oncologist, who supported her desire not to be treated with with the kind of chemotherapy that could have destroyed the quality of any of her last days, even if there was some small chance it could lengthen those days. She also had a team of providers at the end who did not push for futile interventions, and family who were willing to let her go when it became clear that her time had come.

Of course, not every cancer lends itself to this kind of living or this kind of end. For some, the only treatments available, even those that are palliative, have tremendous side effects.  For others, things move too quickly, and the pain and disability overwhelm any chance of finding joy in one’s last days. And when the cancer strikes at a much younger age, when there are so many more years of life and love to lose, who can blame folks for being willing to suffer though agonizing treatments as long as there is even a tiny chance of a cure?

So this post is not meant to be a judgement on how others with cancer ultimately face their diagnosis or their death.

It’s just me being happy for one that was able to find so much joy in facing hers.

And being inspired to live the days of my life, however long, with that same sense of joy and self-satisfaction that she lived hers.
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Image created using Caption.it with a screenshot

Beautiful Caterpillar

I found this little guy on the terrace in the parsley pot when I went out to snip some herbs for dinner this evening. Now I know why our parsley crop is so measly –  it’s being eaten!

This black swallowtail (also known as a parsley worm) will be a gorgeous Monarch butterfly very soon if the birds don’t get him. I think I”ll leave him alone for now. The season is almost over, and he’s too pretty to squash.

EMR Use May Interfere with Depression Screening – Why Face Time is Important

Awhile back, I wrote about how a simple change in office workflow (and a smart office layout) allowed me to get back some of the face time with my patients that I had lost when we transitioned to an  electronic medical record (EMR). As a result, I am happier, my patients are happier and I like to think I am providing better care.

Now, a new study shows that my instincts were right on – face time with patients is important. Researchers found that providers using an EMR detected and treated less depression in their patients than those still using paper, although the differences were only found in patients with three or more chronic conditions. The authors theorized that EMR using providers are spending more time looking at the computer screen than at their patients, and missing cues in facial expression and body language that in the past tipped them off to depression in their patients.

…EMRs have been observed to have a negative impact on psychosocial exchange, with screen gaze being inversely related to physician engagement in psychosocial questioning and emotional responsiveness. It is possible that the clinical work flows embedded in EMRs inadvertently encourage physicians to focus on these multiple physical problems and push depression treatment “off the radar screen” even after physicians diagnosed the condition…

…it has shown that physicians often find that EMR interfaces create additional work by forcing them to click through many screens and options as well as imposing tasks previously handled by others, especially when placing orders. Similar effects in primary care may take away significant visit time and reduce physician’s cognitive performance in terms of ability to provide comprehensive care. Such effects are also likely to be significantly greater during visits by patients with multiple chronic conditions than patients with few chronic conditions.

Even with my new work flow, I find that I still frequently have to consciously pull my eyes away from the screen and force myself to stop typing and look at my patients while they talk. This research study has me thinking that I meed to keep tweaking my work flows to see if I can improve face time even more than I already have.

Yellow Squash & Almond Saute

Remember what I said once about great recipes being infectious? Well, here’s another one.

Looking for a good way to prepare two gorgeous yellow squash we picked up at the 79th St Greenmarket on Sunday, I came across a recipe for quick zucchini and almond saute on Deb Perelman’s blog Smitten Kitchen. And then the same recipe on Adam Robert’s blog The Amateur Gourmet. And then on Confessions of a Picky Eater. And then on about another million and a half other food and mommy blog sites, all inspired by Deb’s recipe.

Deb herself was inspired by Jimmy Bradley, the chef at The Red Cat – a restaurant I’d passed by on Tenth Ave in Chelsea, but have never thought to try. Of course now that I’ve made this recipe, the Red Cat is at the top of my list of must-eat places. Jimmy  has been sharing his recipe for Quick Sauté of Zucchini with Toasted Almonds and Pecorino all over the internet, TV and radio since The Red Cat Cookbook came out in 2006. So if you google Jim’s name and zucchini, you’ll see a whole ‘nother spate of food bloggers who’ve made this dish.

Now, this recipe had mutated a bit from its source. While Bradley makes his preparation with 1/4  cup of oil and two separate fry pans, Deb uses only 2 tbsp of oil and makes it all in one pan, mentioning Bradley’s tent of pecorino as more of an afterthought.  Hmm…easier to make and lower calories and fat. I knew which version I was making.

But wait – Mine would have yellow summer squash instead of zucchini. Another mutation!

Let’s see how far this one spreads….

[amd-recipeseo-recipe:4]

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How to Julienne a zucchini – great video comparing a knife to mandoline. Wish I’d found it before I cut up my squash!

Ovarian Cancer Screening Not Effective in Women at Average Risk

The United States Preventive Services Task Force has recommended against routine screening with ultrasounds or blood tests for ovarian cancer in asymptomatic women at average risk for the disease.

The reason is simple – these tests are not effective screening.

“There is no existing method of screening for ovarian cancer that is effective in reducing deaths,” Dr. Virginia Moyer, the chairwoman of the expert panel, said in a statement from the group, the United States Preventive Services Task Force. “In fact, a high percentage of women who undergo screening experience false-positive test results and consequently may be subjected to unnecessary harms, such as major surgery.”Yes, there is ultrasound and CA125. But doing these tests in healthy women without symptoms and at average risk causes more problems than it prevents, and most importantly, it does not prevent deaths from ovarian cancer.

Screening is recommended for women who carry genetic mutations that increase their risk of ovarian cancer (such as BRCA or MLH1 mutations), although its impact is still not entirely certain even in this group. More effective in this group is prevention by prophylactically removing the ovaries and fallopian tubes, which will prevent 95% of the ovarian cancers that occur  in these women.

While ultrasound has no role in routine screening for ovarian cancer, it remains an important diagnostic tool when women present with symptoms that could be signs of ovarian cancer – bloating, abdominal pain, decreased appetite or early fullness after eating and new onset urgency and frequency of urination not due to other causes such as a UTI. Of course, almost all of the time these symptoms will not be due to ovarian cancer, but it’s important to rule it out.

We May Not Have Effective Screening, But We Do Have Effective Prevention for Ovarian Cancer

What does prevent ovarian cancer is birth control pills. Women who use the pill for as little as 1-2 years will see a 22% reduction in risk, and in long term users get a 60% reduction in risk.  Although protection wanes with time, it persists as long as 30 years after stopping the pill. It is estimated that birth control pills have prevented over 100,000 deaths from ovarian cancer to date. (Not to mention pregnancy prevention and other health benefits.)

Users of Depo-Provera may get a similar reduction in  risk as pill users do. In addition, tubal ligation may also reduce ovarian cancer risks. Studies are underway in high risk women to see if removal of all or part of the fallopian tube is effective as removal of the ovaries.

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More Posts on Ovarian Cancer from The Blog that Ate Manhattan

Will Doctors Be Needed in the Future?

There’s a big discussion going on in the health tech community about a controversial keynote speech given by Vinod Khosla at the Health Innovation Summit (HIS), in which he stated that 80% of what doctors do could be replaced by machines.

If you’re a doc like me who has no idea who the heck Vinod Khosisa is (he’s a venture capitalist and co-founder of Sun Microsysstems), why he’d be a keynote speaker at a healthcare event and what the heck HIS is, well, that’s the point of this post.

You see, there are a whole lot of folks like Khosia out there – investors, entrepreneurs, tech types – who are attempting to redefine healthcare according to their own personal vision.  Where we see a healthcare system in crisis, they see opportunity – just another problem with a technological solution.  Computer-driven algorithms are the answer to mis-diagnosis and medical error, IPhone apps can replace physician visits, video connectivity can increase access.

Where we see illness and distress, they see a market.

And what business folks like to call disruption in the marketplace. Think about what happened to downtown small town USA after the first shopping mall opened. Or what happened to movie houses when Netflix started offering DVD rentals online. Or where all the independent bookstores went when the first Borders opened up, and what happened to Borders when the Kindle hit the market.

Out with the old, in with the new.

If  Khosla is right, the we docs in our offices and hospitals are the old downtown department stores, the bookstores and the bricks and mortar businesses in an online revolution.

We’re replaceable. At least most of us.

Is Khosla right?

Maybe.

The therapeutic relationship between a doctor and a patient can never be replicated by an IPhone app. Not when so many of my patients leave my office on a daily basis telling me how much better they feel just having spoken to me. It’s a powerful and sacred relationship that is irreplaceable.

These days, however, almost all of my patients have googled their symptoms, and many have done a over the counter diagnostic test or treatment  before coming in to see me. I’ll never see the ones who got their questions answered online or their symptoms cured by that over the counter med – I see what’s left after self-diagnosis and self-treatment has failed, or google told them to see me.

That’s disruption, isn’t it?

One day very soon, women will be able to screen themselves for cervical cancer and std’s using a self-administered vaginal swab. No need to see me unless the test is abnormal, or there are symptoms.

Disruption.

Of course, computer driven diagnostic algorithms, apps and programs can create a whole new set of problems in over-diagnosis, since “there’s nothing seriously wrong with you” is rarely an output.  In my office, that’s a very frequent clinical assessment. Functional ovarian pain.  The occasional errant menstrual cycle or missed period. Anxiety. Stress. Depression. Lack of sleep. Over-eating, over-drinking, over-medicating.  What computer is going to pick that up?

Not to mention trauma care, surgery, childbirth, respiratory distress and any one of thousands of health emergencies that you can’t treat with an IPad.  I don’t see any of that work going away for docs anytime soon, do you? Some of it, of course, is being shared with trained non-physicians, and even robots. But docs are still an indispensable part of the healthcare mix.

So while the mix is changing, we docs are still in it. And I don’t see that changing. At least for here and for now. But the future?

I don’t know.

Docs need to be part of the digital revolution

I do know that if this is the new revolution in healthcare, we docs better get in on it.

Take the EMR as an example of what happens when docs let non-docs innovate in healthcare without significant physician input. We become typists, not physicians. Clerical work that used to be done by lower paid staff – entering lab and radiology orders – becomes ours to do. We spend the majority of a patient visit looking at a computer screen and not the patient. Retrieving relevant clinical information is like searching for a needle in the haystack of required fields of entry, most of which are not necessary to provide care.

Indeed, we have not yet shown definitively that EMR’s improve outcomes.

And yet we’re all using them, aren’t we?

If we are not part of the digital revolution and leave it to the venture capitalists and entrepreneurs, they will develop products that may sell, but if they don’t improve outcomes, all that will have been accomplished is a disruption in a marketplace.

Wouldn’t it be so much better if we could disrupt disease?

The real opportunity in Healthcare Innovation

There are millions upon millions of folks – some in American, but most in the undeveloped world – who have never had, and will never have the opportunity for a patient-physician therapeutic relationship such as that I’ve described above. They have no one to call when Google tells them to “talk to your doctor”.

But the overwhelming majority of the do have cell phones. Amazing, really. We can’t get indoor plumbing modern contraception or malaria tents to those in need, but 80% of folks in the developing word have cellphones. If that’s not an opportunity and a potential market for healthcare innovation, then nothing is. If we can get any healthcare into the hands of these folks, even if it’s healthcare delivered by a mobile app, we have the potential to improve their lives.

Now, imagine that we docs were able to free ourselves from the 80% of our work that can be replaced by technology, and then redistributed ourselves (virtually and personally) across the globe where we were truly needed, so that we could provide needed healthcare to the entire planet?

Now that’s disprution.

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Recommended reading

 

Poached Nectarines

Poached fruit is one of my favorite desserts, especially in September when the cooler evenings beckon us to eat outdoors on picnic tables covered in cotton tablecloths, a sweater at hand for when the sun sets. And that moment, when the crickets start and the fireflies come out, is the perfect time to ladle warm, sweet  fruit atop cold vanilla ice cream, top it with a sprig of fresh mint and bring it out to the porch. If you haven’t finished that bottle of wine you opened at dinner, now is the time.

[amd-recipeseo-recipe:2]

Black Bean Cakes

This is a new favorite quick evening meal in our household, straight from the pages of Cooking Light Magazine.  All we added were a few grape tomatoes.

I love having eggs for dinner – there is something so homey about it. I also like that this meal uses ingredients we usually have in stock – all we need to pick up at the store on the way home is fresh cilantro and maybe a lime – though if we have a lemon at home I’d use it instead. If you don’t keep Panko around the house (we usually have a bag in the freezer), use some old bread to make your own breadcrumbs instead.

Stanford Analysis of Organic vs Conventional Foods – Well Done, Poorly Spun

A  Stanford University meta-analysis  comparing the health effects of organic to non-organic food has concluded that organic meat and produce, while not necessarily more nutritious than conventionally raised food, does harbor less antibiotic resistant bacteria and less pesticide residue. Pesticide levels are also lower in children consuming food from organic vs conventional sources.

[The researchers reviewed]7 studies in humans and 223 studies of nutrient and contaminant levels in foods met inclusion criteria. Only 3 of the human studies examined clinical outcomes, finding no significant differences between populations by food type for allergic outcomes (eczema, wheeze, atopic sensitization) or symptomatic Campylobacter infection.

Two studies reported significantly lower urinary pesticide levels among children consuming organic versus conventional diets, but studies of biomarker and nutrient levels in serum, urine, breast milk, and semen in adults did not identify clinically meaningful differences.

All estimates of differences in nutrient and contaminant levels in foods were highly heterogeneous except for the estimate for phosphorus; phosphorus levels were significantly higher than in conventional produce, although this difference is not clinically significant.

The risk for contamination with detectable pesticide residues was lower among organic than conventional produce (risk difference, 30% [CI, −37% to −23%]), but differences in risk for exceeding maximum allowed limits were small.

Escherichia coli contamination risk did not differ between organic and conventional produce. Bacterial contamination of retail chicken and pork was common but unrelated to farming method. However, the risk for isolating bacteria resistant to 3 or more antibiotics was higher in conventional than in organic chicken and pork (risk difference, 33% [CI, 21% to 45%].]

The researchers also found less fungal toxin contamination in organics and higher levels of Omega 3 fatty acids in organic dairy.

This is all  important information for consumers who want to lessen their family’s exposure to pesticides, some of which can be endocrine disruptors and have been linked to cancer.  It also supports organic claims as to the superior fatty acid content of milk and poultry.

Poorly Spun

And yet, here’s the way Stanford themselves pitched their research to the media –

Little evidence of health benefits from organic foods, Stanford study finds
BY MICHELLE BRANDT

Crystal Smith-Spangler and her colleagues reviewed many of the studies comparing organic and conventionally grown food, and found little evidence that organic foods are more nutritious.

You’re in the supermarket eyeing a basket of sweet, juicy plums. You reach for the conventionally grown stone fruit, then decide to spring the extra $1/pound for its organic cousin. You figure you’ve just made the healthier decision by choosing the organic product — but new findings from Stanford University cast some doubt on your thinking.

“There isn’t much difference between organic and conventional foods, if you’re an adult and making a decision based solely on your health,” said Dena Bravata, MD, MS, the senior author of a paper comparing the nutrition of organic and non-organic foods, published in the Sept. 4 issue of Annals of Internal Medicine.

Huh? Exposure to pesticides and antibiotic resistant bacteria is not a factor to be considered in making buying choices based on your health? Omega 3 fatty acids are not important?  Says who?

The researchers  pointed out that they found only 17 human studies, too little to really base any long term recommendations, hence the “little evidence”. But there is “little evidence” because a hypothesis has been disputed, and “little evidence” because the volume of data is too small on which to base conclusions. The latter is clearly the case here, but the headline makes it appear to be the former.

The authors also point out that despite differences in pesticide exposure, most exposure, even in conventionally grown produce, was below government limits. But that’s not the point, is it? Organic proponents think government limits are too high in the first place, so this is not reassuring to them, or informative to the public.

And note also that Bravata was careful to say “If you’re an adult” – I would assume that means if you’re feeding a child, you may want to think differently.

My conclusions on the study

I’d say this study pretty much supports the claims that organic producers are making when it comes to the issues most important to consumers who choose organic food sources.

The media is all over this one

Headlines range from ” Stanford Scientists Cast Doubt on Advantages of Organic Meat and Produce” (NY Times) to” Organic Food Has Little Health Impact”   (Fox News ) and “Organic Food is not healther than conventional produce” (Huff Post).  Reuters actually had a more accurate headline “Organic food no more nutritious than conventionally non-organic” , which still is misleading in that it ignores the pesticide data, which is actually the reason most folks prefer organic.

I say ignore the headlines and read the study yourself. See what conclusions you come to, and buy accordingly.

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Essential Reading

Hash Brown Waffles

A big shout out to Tara at Tea & Cookies for this wonderful recipe for making hash browns using a waffle iron. It’s really a quite healthy and low-fat preparation. I’m not posting a recipe here – Tara’s recipe is complete with fabulous prep photos. My only addition was a generous grating of black pepper.

The only downside of this recipe is the length of time it takes to cook – 20 minutes in my two-waffle iron. If you need to make more than two waffles, you can hold the finished waffles in the oven at 200 degrees fahrenheit without losing crispness.

My husband, the king of hash browns, wanted me to try adding onion – so I added some grated and drained onion. The taste was great, but they were too wet and burnt a bit. I think I’ll stick with Tara’s simpler version.

If you want prefer traditional hash browns, here’s the best recipe I know.