A Blessing for Some, A Curse for Others

Important, Frequently Asked Questions About How the Health Care Reform Bill Will Affect You

March 14, 2010

(Ed's Note: This article by Chris Haines originally appeared in the AARP Bulletin on March 12, 2010. For those of us that have lived at least 6 decades, it is likely that we have had a family member, or know of someone, who has contracted Alzheimer's disease.)

By Chris Haines

As a cure for Alzheimer's disease continues to elude scientists, non-drug treatments—including mental and physical exercise and even caregiver support—are emerging as the best proven medicine for the disease, according to many of the latest studies presented at the recent 25th Conference of the Alzheimer's Disease International.

Although the impact of these approaches has been understood anecdotally for years, the arc of Alzheimer's disease research has finally reached a point where non-drug treatment studies have continued long enough to constitute evidence-based research. That means these approaches are proven tools for those working to help people with the debilitating illness, which affects 5.3 million people in the United States, and 26 million people worldwide.

An irreversible brain disorder, Alzheimer's robs people of their memory and eventually impairs most of their mental and physical functions.

The proof that these therapies really work may also be good economic news: Non-drug therapies can save money, for individual families as well as state and local governments, by delaying entrance into nursing homes for those suffering from dementia, experts say.

Sharing and Remembering

"Psychological therapies have been used with people with dementia for at least 50 years," says Robert Woods, a professor at Bangor University in Wales, whose presentation highlighted the fact that behavioral approaches have fewer side effects than drug therapies.

Two of the common therapies are known as "cognitive stimulation" and "reminiscence therapy." Cognitive stimulation involves a small group of people with dementia meeting a couple of times a week with a care worker, to take part in a range of activities—from word games to a group baking session.

The sessions are intended to involve those with Alzheimer's in activities that are mentally stimulating and enjoyable.

Woods cites studies that found cognitive stimulation groups can actually improve a person's scores on tests of memory, language and thinking-similar to the changes seen with the currently available medications for Alzheimer's disease.

"More importantly," Woods says, "participants also reported improved quality of life. Behavioral approaches have been shown to be effective in a number of domains including improved mood."

Reminiscence therapy groups are similar, but focus on activities and discussions of personal events and experiences. Carefully selected pictures, objects, sound and video recordings are used to evoke old memories.

Caregivers reported improved behavior in those with Alzheimer's, without the use of drugs. And the patients reported a better quality of life. Both these results help keep men and women at home with their families, rather than in a nursing home.

"Dementia is a complex set of conditions," he adds. "Building on the person's life history is always a good starting point, as a guide to their values, interests and preferences. Engaging the person in a positive, constructive approach may be more effective than tackling problem behavior head-on."

Thinking and Walking

Identifying the presence of dementia early appears to be the best weapon in delaying its severity. Even without expensive medical exams, there are markers that might indicate a problem.

"We all forget where we left the keys or remote control from time to time," says Michael Valenzuela of the University of New South Wales in Sydney, Australia, and author of It's Never too Late to Change Your Mind. "If, however, we were to forget what the remote control is for, then this is a more serious type of memory issue that would require follow-up investigation."

In his presentation, Valenzuela cited two studies that demonstrated that brain training using computer programs and physical exercise can delay—and even improve—cognitive decline.

In a study conducted in Italy, researchers found that four weeks of computer brain training helped improve the overall cognitive abilities of those with Alzheimer's disease. Significantly, these improvements in a group that was at high risk for dementia continued for three months after the training stopped.

The second study found that six months of simple, self-directed physical exercise resulted in a modest, but persistent, improvement in mental abilities as long as one year later.

"The potential preventative effects of brain training and physical exercise are much stronger before a person is diagnosed with dementia," Valenzuela cautions. "After diagnosis, these strategies may have some value, but are qualitatively different and lead to less consistent outcomes."

Caring for the Caregiver

Shifting the focus from patient to caregiver, Mary Mittelman of the Center for Excellence on Brain Aging at New York University's Langone Medical Center reported on a 20-year study of how giving caregivers support helped delay a patient's entry into a nursing home.

Mittelman's team monitored Alzheimer's caregivers (usually family members) who were given counseling and training on how to deal with their patients—and compared them to caregivers who received no such support.

The results were encouraging, and showed that support had a significant effect on the caregivers' emotional and physical health, and even their reactions to their patient's behavior, which could be distressing and trying. That helped translate to the patients remaining at home about a year and a half longer.

Caregivers, Mittelman says, need ongoing support and help. "Alzheimer's disease doesn't remain static," she says. "It changes over time. What you learn to deal with today is not what you're going to confront a year from now."

February 22, 2010

We Deceive Ourselves

We Look at Other People Who Are Morbidly Obese and Think, "I'm in Great Shape Compared to Them"

(Ed's Note: Ann Pietrangelo is a freelance writer and multiple sclerosis patient advocate. Her staunch belief in affordable and accessible health care for all fuels her passion for health care reform.)

February 15, 2010

(Ed's Note: This WebMD feature examines the health dangers and benefits of eating red meat.)

By Elizabeth Lee

Does eating red meat increase the risk of dying from heart disease or cancer?

It is a question that keeps coming up, fueled by research and high-profile campaigns by advocacy groups on both sides of the debate.

WebMD asked the experts, looking for answers about disease risk, health benefits, and what role red meat should play in the diet.

Here is what they had to say.

1) Does eating red meat increase the risk of cancer and heart disease?

For heart disease, the answer is pretty clear. Some red meats are high in saturated fat, which raises blood cholesterol. High levels of LDL cholesterol increase the risk of heart disease.

When it comes to cancer, the answer is not so clear. Many researchers say the effect of eating red meat does raise the risk, especially for colorectal cancer.

A recent National Institutes of Health-AARP study of more than a half-million older Americans concluded that people who ate the most red meat and processed meat over a 10-year-period were likely to die sooner than those who ate smaller amounts. Those who ate about 4 ounces of red meat a day were more likely to die of cancer or heart disease than those who ate the least, about a half-ounce a day. Epidemiologists classified the increased risk as "modest" in the study.

The meat industry contends there is no link between red meat, processed meats, and cancer, and says that lean red meat fits into a heart-healthy diet. A meat industry spokeswoman criticized the design of the NIH-AARP study, saying that studies that rely on participants to recall what foods they eat cannot prove cause and effect. "Many of these suggestions could be nothing more than statistical noise," says Janet Riley, a senior vice president of the American Meat Institute, a trade group.

But many studies have found similar links. Another one that followed more than 72,000 women for 18 years found that those who ate a Western-style diet high in red and processed meats, desserts, refined grains, and French fries had an increased risk of heart disease, cancer, and death from other causes.

"The association between consumption of red and processed meats and cancer, particularly colorectal cancer, is very consistent," says Marji McCullough, PhD, a nutritional epidemiologist with the American Cancer Society.

After a systemic review of scientific studies, an expert panel of the World Cancer Research Fund and the American Institute for Cancer Research concluded in 2007 that "red or processed meats are convincing or probable sources of some cancers." Their report says evidence is convincing for a link between red meat, processed meat, and limited but suggestive for links to lung, esophageal, stomach, pancreatic, and endometrial cancers.

Rashmi Sinha, PhD, the lead author of the National Cancer Institute study, points to a large number of studies that link red meat consumption with chronic diseases.

"The level of evidence is what people look at," Sinha says. "If there are 20 studies that say one thing and two studies that say the other thing, you believe the 20 studies."

2) If eating red meat does increase the risk of cancer, what is the cause?

That is not clear, but there are several areas that researchers are studying, including:

Saturated fat, which has been linked to cancers of the colon and breast as well as to heart disease.

Carcinogens formed when meat is cooked.

Heme iron, the type of iron found in meat, may produce compounds that can damage cells, leading to cancer.

3) Are there nutritional benefits from eating red meat?

Red meat is high in iron, something many teenage girls and women in their childbearing years are lacking. The heme iron in red meat is easily absorbed by the body. Red meat also supplies vitamin B12, which helps make DNA and keeps nerve and red blood cells healthy, and zinc, which keeps the immune system working properly.

Red meat provides protein, which helps build bones and muscles.

"Calorie for calorie, beef is one of the most nutrient-rich foods," says Shalene McNeil, PhD, executive director of nutrition research for the National Cattlemen's Beef Association. "One 3-ounce serving of lean beef contributes only 180 calories, but you get 10 essential nutrients."

4) Is pork a red meat or a white meat?

It is a red meat, according to the U.S. Department of Agriculture. The amount of myoglobin, a protein in meat that holds oxygen in the muscle, determines the color of meat. Pork is considered a red meat because it contains more myoglobin than chicken or fish.

5) How much red meat should I eat?

Opinions differ here, too. Most of the nutritionists that WebMD contacted suggested focusing on sensible portion sizes and lean red meat cuts, for those who choose to eat it.

Ask yourself these two questions, recommends Alice Lichtenstein, DSc, professor of nutrition at the Human Nutrition Research Center on Aging at Tufts University.

1) Are you taking in more calories than you're burning off?

2) Is red meat crowding out foods such as fruits, vegetables, and whole grains?

"People don't need to give up red meat," says Christine Rosenbloom, PhD, RD, a nutrition professor at Georgia State University. "They need to make better selections in the type of meat they eat and the portions."

Government guidelines in MyPyramid suggest 5 to 6 1/2 ounces daily of protein from a variety of sources, including lean meats, nuts, and seafood. So if you are planning on eating a burger for dinner, it should be a 3-ounce hamburger patty, about the size of a standard McDonald's burger.

The American Institute for Cancer Research, a nonprofit that focuses on cancer prevention through diet and physical activity, advises no more than 18 ounces of cooked red meat a week. The group recommends avoiding all processed meats, such as sausage, deli meats, ham, bacon, hot dogs, and sausages, citing research that shows an increased risk of colon cancer.

6) What are some of the leanest cuts of red meat?

For the best red meat cuts, look for those with "loin" in the name: Sirloin tip steak, top sirloin, pork tenderloin, lamb loin chops.

Beef: Also look for round steaks and roasts, such as eye round and bottom round; chuck shoulder steaks; filet mignon; flank steak; and arm roasts. Choose ground beef labeled at least 95% lean. Frozen burger patties may contain as much as 50% fat; check the nutrition facts box. Some grilling favorites are high in fat: hot dogs, rib eyes, flat iron steaks, and some parts of the brisket (the flat half is considered lean).

Pork: Lean cuts include loin roasts, loin chops, and bone-in rib chops.

7) What are the criteria for a lean cut of red meat?

Meats can be labeled as lean if a 3-ounce serving contains less than 10 grams of total fat, 4.5 grams or less of saturated fat, and less than 95 milligrams of cholesterol.

If you are buying beef, check the U.S. Department of Agriculture grading, too. Beef labeled "prime" is the top grade but is also highest in fat, with marbling, tiny bits of fat within the muscle, adding flavor and tenderness. Most supermarkets sell beef that is graded as "choice" or "select." For the leanest red meat, look for a select grade.

8) Is grass-fed beef a leaner red meat choice than grain-fed?

Grass-fed beef is leaner than grain-fed, which makes it lower in total fat and saturated fat. Grass-fed beef also contains more omega-3 fatty acids. But the total amount of omega-3s in both types of beef is relatively small, says Shalene McNeil of the National Cattlemen's Beef Association. Fish, vegetable oil, nuts, and seeds are better sources of omega-3s.

9) Can grilling red meat cause cancer?

High-temperature cooking of any muscle meat, including red meat, poultry, and fish, can generate compounds in food that may increase cancer risk. They are called heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs).

10) How can you reduce potential cancer-causing compounds when grilling?

Several steps help prevent these compounds from forming or reduce your exposure to them.

Choose lean red meat cuts when grilling to reduce the chance of flare-ups or heavy smoke, which can leave carcinogens on the meat.

If grilling, cook over medium heat or indirect heat, rather than over high heat, which can cause flare-ups and overcook or char meat. Limit frying and broiling, which also subject meat to high temperatures.

Do not overcook meat. Well-done meat contains more of the cancer-causing compounds. But make sure that meat is cooked to a safe internal temperature to kill bacteria that can cause food-borne illnesses. For steaks, cook to 145 to 160 degrees Fahrenheit; for burgers, cook to 160 degrees.

Marinate. Marinades may reduce the formation of HCAs. Choose one without sugar, which can cause flare-ups and char the meat's surface.

Turn meat frequently. Use tongs or a spatula rather than a fork to avoid releasing juices that can drip and cause flare-ups. Do not press burgers with a spatula to release juices.

Do not grill as much meat. Instead of a steak, try a kabob that mixes meat, fruit and vegetables. Plant-based foods have not been linked to HCAs.

Trim fat from meat before cooking, and remove any charred pieces before eating.

Consider partially cooking meats and fish in the oven or microwave before finishing on the grill.

February 9, 2010

The Truth About Fat

Everything You Need to Know About the 5 Different Kinds of Fat, and Why It Matters That You Do Know the Difference

For most of us, body fat has a bad reputation. From the dimply stuff that plagues women's thighs to the beer bellies that can pop out in middle-aged men, fat is typically something we agonize over, scorn, and try to exercise away.

But for scientists, fat is intriguing—and becoming more so every day. "Fat is one of the most fascinating organs out there," says Aaron Cypess, MD, PhD, an instructor of medicine at Harvard Medical School and a research associate at the Joslin Diabetes Center in Boston. "We are only now beginning to understand fat."

"Fat has more functions in the body than we thought," agrees Rachel Whitmer, PhD, research scientist at the Kaiser Permanente Division of Research in Oakland (CA), who has studied the links between fat and brain health.

To get the skinny on fat, WebMD asked four experts on fat—who, not surprisingly, prefer not to be called fat experts—to fill us in.

Fat is known to have two main purposes, says Susan Fried, PhD, director of the Boston Obesity and Nutrition Research Center at Boston University and a long-time researcher in the field.

1) Fat stores excess calories in a safe way so you can mobilize the fat stores when you are hungry.

2) Fat releases hormones that control your metabolism.

But that is the broad brushstroke picture. Read on for details about various types of fat—brown, white, subcutaneous, visceral, and belly fat.

Brown Fat

Brown fat has gotten a lot of buzz recently, with the discovery that it is not the mostly worthless fat scientists had thought.

In recent studies, scientists have found that lean people tend to have more brown fat than overweight or obese people—and that when stimulated it can burn calories. Scientists are eyeing it as a potential obesity treatment if they can figure out a way to increase a person's brown fat or stimulate existing brown fat.

It is known that children have more brown fat than adults, and it is what helps them keep warm. Brown fat stores decline in adults but still help with warmth. "We've shown brown fat is more active in people in Boston in colder months," Dr. Cypess says, leading to the idea of sleeping in chillier rooms to burn a few more calories.

Brown fat is now thought to be more like muscle than like white fat. When activated, brown fat burns white fat.

Although leaner adults have more brown fat than heavier people, even their brown fat cells are greatly outnumbered by white fat cells. "A 150-pound person might have 20 or 30 pounds of fat," Dr. Cypess says. "They are only going to have 2 or 3 ounces of brown fat."

But that 2 ounces, he says, if maximally stimulated, could burn off 300 to 500 calories a day –enough to lose up to a pound in a week.

"You might give people a drug that increases brown fat," he says. "We are working on one."

But even if the drug to stimulate brown fat pans out, Dr. Cypess warns, it will not be a cure-all for weight issues. It may, however, help a person achieve more weight loss combined with a sound diet and exercise regimen.

White Fat

White fat is much more plentiful than brown, experts agree. The job of white fat is to store energy and produce hormones that are then secreted into the bloodstream.

Small fat cells produce a "good guy" hormone called adiponectin, which makes the liver and muscles sensitive to the hormone insulin, in the process making us less susceptible to diabetes and heart disease.

When people become fat, the production of adiponectin slows down or shuts down, setting them up for disease, according to Fried and others.

Subcutaneous Fat

Subcutaneous fat is found directly under the skin. It is the fat that is measured using skin-fold calipers to estimate your total body fat.

In terms of overall health, subcutaneous fat in the thighs and buttocks, for instance, may not be as bad and may have some potential benefits, says Dr. Cypess. "It may not cause as many problems" as other types of fat, specifically the deeper, visceral fat, he says.

But subcutaneous fat cells on the belly may be another story, says Fried. There is emerging evidence that the danger of big bellies lies not only in the deep visceral fat but also the subcutaneous fat.

Visceral Fat

Visceral or "deep" fat wraps around the inner organs and spells trouble for your health. How do you know if you have it? "If you have a large waist or belly, of course you have visceral fat," says Dr. Whitmer, the researcher. Visceral fat drives up your risk for diabetes, heart disease, stroke, and even dementia.

Visceral fat is thought to play a larger role in insulin resistance—which boosts risk of diabetes—than other fat, Dr. Whitmer tells WebMD. It is not clear why, but it could explain or partially explain why visceral fat is a health risk.

Dr. Whitmer investigated the link between visceral fat and dementia. In a study, she evaluated the records of more than 6,500 members of Kaiser Permanente of Northern California, a large health maintenance organization, for an average of 36 years, from the time they were in their 40s until they were in their 70s.

The records included details on height, weight, and belly diameter—a reflection of the amount of visceral fat. Those with the biggest bellies had a higher risk of dementia than those with smaller bellies. The link was true even for people with excess belly fat but overall of normal weight.

She does not know why belly fat and dementia are linked, but speculates that substances such as leptin, a hormone released by the belly fat, may have some adverse effect on the brain. Leptin plays a role in appetite regulation but also in learning and memory.

Belly Fat

Belly fat has gotten a mostly deserved reputation as an unhealthy fat. "Understand that belly fat is both visceral and subcutaneous," says Kristen Gill Hairston, MD, MPH, an assistant professor of medicine at Wake Forest University School of Medicine, Winston-Salem, (NC).

"We don't have a perfect way yet to determine which [of belly fat] is subcutaneous or visceral, except by CT scan, but that's not cost-effective," says Dr. Hairston.

But if you have got an oversize belly, figuring out how much is visceral and how much is subcutaneous is not as important as recognizing a big belly is unhealthy, she says. How big is too big? Women with a waist circumference more than 35 inches and men with a waist circumference more than 40 inches are at increased disease risk.

Abdominal fat is viewed as a bigger health risk than hip or thigh fat, Dr. Whitmer and other experts say. And that could mean having a worse effect on insulin resistance, boosting the risk of diabetes, and a worse effect on blood lipids, boosting heart and stroke risks.

Thigh Fat, Buttocks Fat

While men tend to accumulate fat in the belly, it is no secret women, especially if "pear-shaped," accumulate it in their thighs and buttocks.

Unsightliness aside, emerging evidence suggests that pear-shaped women are protected from metabolic disease compared to big-bellied people, says Dr. Fried, another researcher. "Thigh fat and butt fat might be good," she says.

But the benefit of women being pear shaped may stop at menopause, when women tend to deposit more fat in the abdomen, referring to that area's stores of subcutaneous fat.

Weight Loss and Fat Loss

So when you lose weight, what kind or kinds of fat do you shed? "You are losing white fat," Dr. Fried tells WebMD. "People tend to lose evenly all over."

The results change a bit, however, if you add workouts to your calorie reduction, she says. "If you exercise plus diet you will tend to lose slightly more visceral fat from your belly."

"We are at an exciting point in science," says Dr. Whitmer, echoing the input from other scientists in the field.

Dr. Whitmer and others expect more discoveries about fat of all types to be made in the near future.

According to Brewer's Dictionary of Phrase & Fable, a cat is "more tenacious of life than many animals." Atum-Ra, the Egyptian Lord of Life, was associated with the cat and held to be the creator of 9 gods. In fact, the number 9 is thought to have originated in Egypt, where cats were revered.

November 12, 2009 - 2nd Article

3 Simple Steps to Help Prevent Alzheimer's Disease

(Ed's Note: Dr. Andrew Weil is a licensed physician who specializes in holistic and integrated medicine; meaning, natural cures to medical problems are oftentimes better than man-made solutions involving prescription drugs, surgery, etc. Here Dr. Weil gives some tips on how to help prevent Alzheimer's Disease.)

Dr. Andrew Weil

To help preserve mental function and protect against age-related cognitive decline including dementia and Alzheimer's disease, consider implementing these healthy lifestyle strategies:

1) Get 30 minutes of physical activity per day. Regular physical exercise, specifically aerobic exercise, can help slow memory loss and improve mental function.

2) Develop healthy habits in all aspects of life. Not smoking, drinking only in moderation, staying socially involved, managing stress, getting adequate rest, and cultivating a positive attitude and outlook—have all been associated with a lowered risk of Alzheimer's.

3) Keep an active mind. "Use it or lose it" applies to mental as well as physical health. Enjoy crossword puzzles, mind games, challenging reading, and take educational classes.

September 27, 2009 - 2nd Article

Guest Article:

Multiple Sclerosis by the Numbers, But Who Really Cares, and Who Is Really Counting?

(Ed's Note: My sister Loretta contracted Multiple Sclerosis and it contributed to her premature death. For some reason, we do not know exactly how many of our fellow Americans are affected by this disease, and no one seems willing to actually find out. Learn why it matters. The source of this article is Ann Pietrangelo; I have edited the article to add more information and clarity.)

More than a million people in the United States have multiple sclerosis, or is it half a million, or a quarter of a million, but then again, who's counting?

When I was first diagnosed with MS, I was stunned by the number of acquaintances who said they were related to, or knew someone with MS. It seems like everybody has a story, yet most sources indicate that only about 400,000 people in the U.S. have MS. With a population of more than 304,000,000 people, that would make MS quite rare.

In April 2009, the Christopher and Dana Reeve Foundation announced the results of a study conducted by the University of New Mexico's Center for Development and Disability, that indicated that 939,000 people in the United States have some degree of MS-related paralysis. That would mean that the actual number of people with MS is much higher than that.

Current estimates from reputable sources vary:

It's 250,000 to 300,000 according to the National Institutes of Health - National
Institute of Neurological Disorders and Stroke.

It's 350,000 to 500,000 according to the Multiple Sclerosis Foundation.

It's 400,000 according to the Multiple Sclerosis Association of America, and National
Multiple Sclerosis Society

It's 1,000,000 according to the Montel Williams MS Foundation.

From the low estimate of 250,000 to the high estimate of 1,000,000, could 750,000 sufferers of MS be uncounted in their misery?

So how many people in the United States actually have multiple sclerosis, why don't we know, and does it matter?

We do not know the exact numbers because MS is not tracked by the Centers for Disease Control or any other federal agency. In fact, there is no coordinated effort at all to track the incidence of MS in the United States. The last national study of MS rates took place in 1975, and much has changed since then.

Both the Senate and the House have pending legislation that, if passed, would create separate registries for two devastating neurological conditions—Parkinson's disease and Multiple Sclerosis—at the Agency for Toxic Substances and Disease Registry (ATSDR) at the Centers for Disease Control and Prevention.

If the legislation passes, the information collected will provide valuable insights into MS regarding the gender ratio, age at onset, geographic clusters, etc.

Tracking the numbers may also help researchers gain insight into pediatric multiple sclerosis. MS, for all its variations and symptoms, is an extremely difficult disease to confirm in any case. Typically, MS is diagnosed in people over the age of 35, so pediatricians generally do not look for symptoms in children. Mild symptoms in children, especially if they come and go, are easily missed—or dismissed without official notice.

The introduction of magnetic resonance imaging (MRI) has enabled physicians to pinpoint lesions in the central nervous system, leading to a diagnosis of MS sooner, and in younger patients, more than ever before.

The National Multiple Sclerosis Society reports that "up to 10,000 of the estimated 400,000 Americans who have MS are children or adolescents. At least that many children also have experienced at least one symptom suggestive of MS. Increasing evidence suggests a slower disease course in children with MS, but significant disability can accumulate at an earlier age compared to individuals with adult onset MS."

Is the incidence of pediatric MS increasing, or is it that doctors are getting better at diagnosing MS in children?

Some research suggests that MS is caused by a combination of genetics and pinpointing the number of children with MS, in the early stages of the disease, could help researchers find important new leads in the search for a cause, better treatments, and a cure.

Understanding how many people are affected by MS, and who they are, may also have an impact on funding for research and community programs that assist the disabled.

The numbers matter, and if you are diagnosed with multiple sclerosis, or know someone who is, the numbers should matter to you. Go online and Google "multiple sclerosis", "senate bills", and "house bills" to find out more information, and how to take action for yourself or others.

August 12, 2009

Health Care Reform: Why Are We Treating the System, and Not the Underlying Cause?

(Ed's Note: The following guest article was written by Dr. Andrew Weil and appeared in the Huffington Post.)

By Andrew Weil

I'm worried -- and if I'm worried, you should be, too.

The reason I'm worried is that the wrong diagnosis is being made.

As any doctor can tell you, the most crucial step toward healing is having the right diagnosis. If the disease is precisely identified, a good resolution is far more likely. Conversely, a bad diagnosis usually means a bad outcome, no matter how skilled the physician.

And, what's true in personal health care is just as true in national health care reform: Healing begins with the correct diagnosis of the problem.

Washington is working on reform initiatives that focus on one problem: the fact that the system is too expensive (and consequently too exclusive). Reform proposals, such as the "public option" for government insurance or calls for drug makers to drop prices, are aimed mostly at boosting affordability and access. Make it cheap enough, the thinking goes, and the 46 million Americans who can't afford coverage will finally get their fair
share.

But what's missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what's even worse than its stratospheric cost is the fact that American health care doesn't fulfill its prime directive -- it does not help people become or stay healthy.

It's not a health care system at all; it's a disease management system, and making the current system cheaper and more accessible will just spread the dysfunction
more broadly.

It's impossible to make our drug-intensive, technology-centric, and corrupt system affordable. Consider that Americans spent $8.4 billion on medicine in 1950, vs. an astonishing 2.3 trillion in 2007. That's $30,000 annually for a family of four.

The bloated structure of endless, marginal-return tests; patent-protected drugs and "heroic" surgical interventions for virtually every health problem simply can't be made much cheaper due to its very nature. Costs can only be shifted in various unpalatable ways.

So, a far more salient question that must be addressed is: Are we getting good health for our trillions? Unfortunately, the answer is a resounding, "No." The U.S. ranked near the very bottom of the top 40 nations – below Columbia, Chile, Costa Rica and Dominica -- in a rating of health systems by the World Health Organization in 2000.

In short, we pay about twice as much per capita for our health care as does the rest of the developed world, and we have almost nothing to show for it.

I'm not against high-tech medicine. It has a secure place in the diagnosis and treatment of serious disease. But our health care professionals are currently using it for everything, and the cost is going to break us.

In the future, this kind of medicine must be limited to those cases in which it is clearly indicated: trauma, acute and critical conditions, disease involving vital organs, etc. It should be viewed as a specialized form of medicine, perhaps offered only in major centers serving large populations.

Most cases of disease should be managed in other, more affordable ways. Functional, cost-effective health care must be based on a new kind of medicine that relies on the human organism's innate capacity for self-regulation and healing.

It would use inexpensive, low-tech interventions for the management of the commonest forms of disease. It would be a system that puts the health back into health care. And it would also happen to be far less expensive than what we have now.

If we can make the correct diagnosis, the healing can begin. If we can't, both our personal health and our economy are doomed.

Politicians aren't going to resolve this issue overnight. Any health care reform bill that gets jammed through Congress in the next month or two will be dangerously flawed. Washington needs to take a step back and re-examine the entire task with an eye toward achieving the most effective solution, not the cheapest and most expeditious.

July 30, 2009

Alan Romatowski – A Model for a Positive Attitude Despite Contracting Alzheimer's

Three years ago, when Alan Romatowski was diagnosed with younger-onset Alzheimer's at the age of 55, he was a pilot for USAirways, a profession he had enjoyed for the past 30 years.

"The diagnosis put a sudden stop to my career as an airline pilot," Alan says. "The news that I had Alzheimer's was, of course, initially devastating. But as time passes I am finding more and more to be thankful for."

Today Alan volunteers at a local Specialty Care Center, working in the physical therapy department and escorting Alzheimer's patients to and from medical appointments. Alan also delivers Meals on Wheels and works part time at a gas station.

"I became involved with the Alzheimer's Association shortly after my diagnosis," Alan says. "I turned to the Association for help and began participating in one of their support groups."

It was not long before Alan's natural leadership abilities came to the forefront. In 2008, Alan was appointed to the National Early-Stage Advisory Group, a leadership body of individuals living with Alzheimer's. In this role he serves as an advocate, traveling to speak about his experiences and rally others with Alzheimer's to help defeat this disease by participating in clinical trials of new treatments.

"I just completed a term with the Early-Stage Advisory Group for the Alzheimer's Association," Alan says. "I now work with the local Pittsburgh office and will once again be participating in Memory Walk. Recently I was elected to the Greater Pennsylvania Chapter Board of Directors."

"After my diagnosis I had a choice of either surrendering to Alzheimer's or go on fighting. I chose to fight," Alan says. "My wife and I stand shoulder to shoulder to fight this disease, and I appreciate and cherish my wonderful family more than ever."

When Alan is not working to advance the fight against Alzheimer's, he enjoys volunteering and working part time at a local gas station. He is also applying to volunteer at the Pittsburgh Zoo cleaning the shark tanks!

January 28, 2009

December 14, 2008

Are you secretly envious of your co-workers and friends who, like superheroes, never seem to get sick? You know, the ones glowing with good health while everyone around them is sneezing, sniffling, and coughing like villains.

Don't hate the healthy people. Instead, steal the secrets of people who manage to stay above the sickroom fray and take steps to boost your body's immunity.

Jennifer Cassetta, a martial arts instructor in New York City, claims she never gets sick, and neither do her father and grandmother, who also teach martial arts. "I believe it is the holistic approach to exercise that calms the mind and relieves stress," she says. "And the cardio, strengthening, and conditioning help boost the immune system."

Cassetta says her health has changed dramatically after she picked up martial arts eight years ago. Before then, she was a smoking, take-out-every-night, espresso-drinking girl in her 20s.

"As I started to train, I started to change my habits drastically," she says. "I cleaned up my diet, trained more, and quit smoking. Now in my 30s, I have more energy, I look better, and am stronger than I ever have been."

One bout of vigorous exercise can increase circulation, says Christiane Northrup, MD, author of Women's Bodies, Women's Wisdom. "Whenever circulation is increased, you get far more white blood cells," she says, "so they check for foreign germs and are far more apt to be able to gobble them up."

Chicago public relations consultant Joanna Broussard says gargling regularly with an antiseptic mouthwash has helped improve her dental health and may have helped fend off other illnesses.

Twelve years ago, Broussard's dental hygienist convinced her to gargle consistently after brushing her teeth. "So I made the effort and got into the habit every morning," she says, "Since then I have not had colds. When people all around me have colds or the flu, I seem to be immune."

Another reason to bone up on your brushing and gargling is that poor oral hygiene and gum disease have been linked to more serious illnesses, including diabetes.

Your mom may have been right when she said, "An apple a day keeps the doctor away." A natural antioxidant called quercetin, found in red apples as well as broccoli and green tea, may give an immunity boost to individuals under stress.

In a study conducted by David Nieman, PhD, professor at Appalachian State University, results showed that only 5% of cyclists who took 1,000 milligrams of quercetin every day for five weeks reported upper respiratory illness during a two-week period following extreme exercise, whereas 45% of the cyclists who took a placebo reported illness following extreme exercise. However, there were no significant differences in measures of immune system function in the two groups.

Additionally, researchers found that athletes taking the quercetin supplement maintained better mental alertness and reaction time over the placebo group. So go ahead, stock up on those red apples and you may be thanking Mom later.

Stop worrying about getting sick. The fear and expectation of having something adverse happen actually lowers immunity, says Northrup. "When people are worried about it all the time," she says, "they literally scare themselves to death."

Constant worrying causes cortisol and epinephrine levels to rise - and these stress hormones can weaken the body's overall immunity. "The immune system plummets when cortisol levels are chronically high," she says. "Your own body produces high levels of steroids when you're under constant stress."

We have a worldwide epidemic of vitamin D deficiency, says Northrup. Everybody needs vitamin D, which can be found in foods like sockeye salmon, eggs, and milk.

Hyla Cass, MD, an integrative medical practitioner and author of 8 Weeks to Vibrant Health, adds that certain prescription drugs like acid blockers can deprive the body of nutrients like vitamin D.

Surveys show that Americans don't get enough vitamin C, says Elisabetta Politi, RD, MPH, CDE, nutrition director at the Duke Diet & Fitness Center.

Citrus fruits are a good source of vitamin C. "It's a myth that vitamin C prevents the cold," she says. "But having an appropriate amount of vitamin C from fruits and vegetables can boost immunity."

Atlanta interior designer Melissa Galt believes in a "mind over medicine" attitude. "I don't have time for sickness in my life," says Galt, who travels frequently and doesn't take anything to fight germs. "I don't believe in it and don't acknowledge it."

Every thought is accompanied by a chain of biochemical reactions in your body, says Northrup. So a positive attitude can increase levels of nitric oxide, which help to balance neurotransmitters, improve immunity, and increase circulation, she says.

"Whenever nitric oxide levels are high -- from anything ranging from positive thought to exercise -- you're actually improving your resistance to disease," she says.

Santa Monica, Calif., yoga therapist Felice Rhiannon credits her meditation and breathing practices for improving her physical and emotional health. "Meditation practice helps to calm my nervous system and allows the immune system to function with less interference," she says. For Rhiannon, "A calmer mind means a calmer body."

"The greatest change is in my peace of mind and sense of ease," she says. "I don't get colds as often as I did when I was younger. My sleep is better and my ability to cope with life's inevitable stresses has improved."

In a study published in the journal Psychosomatic Medicine in 2003, researchers at the University of Wisconsin and Harvard University found that volunteers who participated in eight weeks of mediation training produced significantly more flu-fighting antibodies than those who didn't meditate.

There are personality factors associated with individuals who are resistant to getting colds when they're exposed to a virus, says Sheldon Cohen, PhD, professor of psychology at Carnegie Mellon University whose research examines the effects of stress and social support on immunity and health.

For example, extroverts are less likely than introverts to get colds when exposed to a virus. "We actually control for their immunity," he says. "The explanation isn't that extroverts interact with more people, and therefore have immunity to that virus. There's something about being extroverted that seems to protect people."

Having a diverse social network is equally important, says Cohen. Individuals who belong to multiple social groups are less likely to develop colds when exposed to a virus. There's convincing literature in epidemiology that people who have more diverse social networks are also less likely to get heart disease and live longer, he adds.

Cohen's research suggests that people who have a positive emotional style -- described as happy, enthusiastic, and calm -- are less likely to catch colds.

Cohen and researchers at Carnegie Mellon University interviewed 193 healthy adults daily for two weeks and recorded the positive and negative emotions they experienced each day, and then exposed the volunteers to a cold or flu virus. Those with positive outlooks reported fewer cold symptoms and were more resistant to developing an upper respiratory illness.

"It's a stable characteristic of individuals," he says. "It's not driven by how happy they are on the day they get exposed to the virus."

Hand washing may sound like obvious advice for combating germs, but surveys suggest that most of us are not vigilant about washing our hands after using the restroom.

"In order to prevent illness, it's important to wash your hands frequently," Cass says. "During cold and flu season, wash your hands with soap many times during the day because you're in contact with all kinds of pathogens -- door knobs, stair railings, other people. You really want to have clean hands."

According to the CDC, proper hand washing for 20 seconds is the most effective way to avoid the 1 billion colds that Americans catch each year, not to mention other infectious diseases.

Sleep is one of the best ways to stay healthy, Northrup says. "People who get a solid eight hours per night absolutely do better."

Sleep efficiency is the key, Cohen says. People who get into bed and fall asleep right away and stay asleep are more protected against colds than those who wake up repeatedly through the night.

A good night's sleep will restore the immune system, Northrup says, because when you get a good night's sleep, melatonin levels rise and that improves immunity.

And best of all, there are no side effects.

Angelina Jolie Steps Into a Spy's Role Originally Written for Tom Cruise (a Man) in "Salt"

May 25, 2010

A Legendary Series Ends

"Law & Order" Airs for 20 Years - Ties "Gunsmoke" as the Longest-Running Drama in Prime-Time Television History

January 8, 2010

The Movie Industry:

Bullock Makes Box Office History With Her Lead Role in "The Blind Side"

(Ed's Note: The following story was picked up online at Variety, which reports the financial side of the entertainment business and a whole lot more.)

Sandra Bullock rang in the new year making box office history.

Some time over the weekend, Bullock starrer "The Blind Side" became the first pic in history driven solely by a top female star to jump the $200 million mark at the domestic box office.

To be precise, the film finished the frame with a cume of $208.5 million in its 7th week in release. Over the weekend, it rose a remarkable 10% over the previous week, and it's still got plenty of life left, according to Warner Bros. prexy of domestic distribution Dan Fellman.

"Blind Side" was fully financed and produced by Alcon Entertainment. The project was brought in by Molly Smith, daughter of Alcon backer Fred Smith, founder of FedEx.

It's hard to believe, but none of the previous films in which Bullock had top solo billing had reached $200 million, nor have any of the solo starring efforts of the likes of Julia Roberts, Meryl Streep, Angelina Jolie or Reese Witherspoon. But indeed, none had, according to Fellman and other box office observers.

Roberts' "Erin Brockovich"—the film most often compared with "Blind Side"—grossed $125.6 million domestically. Streep's "The Devil Wears Prada" fashioned $124.7 million at the domestic box office.

The only femme-driven film that jumped $200 million domestically was romantic comedy "My Big Fat Greek Wedding," the 2002 indie (independent film) hit starring then-unknown Nia Vardalos and "Northern Exposure" star John Corbett, which earned $241.1 million domestically.

Bullock's accomplishment is part of a gender revolution at the domestic box office. Until recent hits like the "Twilight" pics and "Sex and the City," Hollywood studios thought only fanboys could generate big grosses, not femmes. (At the same time, it's not lost on distribs that the top-grossing film of all time, James Cameron's "Titanic," was probably fueled by women who saw the movie numerous times.)

Some femme-driven films have found more love overseas. Musical "Mamma Mia!," with a cast led by Streep, grossed $144.1 million domestically and a massive $465.7 million overseas. (Pic is Streep's top grosser at the domestic box office).

Romantic comedies have long been a studio staple domestically, but even the more successful ones usually generate grosses in the $100 million-$130 million range.

Roberts' "Pretty Woman" scored a bit higher, with an estimated $178.4 million domestically.

Bullock had an exceptionally successful year—except for the little-seen "All About Steve"—with another box office hit in "The Proposal." Bullock starred opposite Ryan Reynolds in the romantic comedy, which grossed $164 million domestically.

"And we're not even done. I think 'Blind Side' has another $30 million left," Fellman said.

In all, Bullock's films have grossed north of $1.72 billion domestically. That compares with $2.31 billion for Roberts, $1.54 billion for Streep and $1.44 billion for Jolie. Any way you look at it, it's not bad company.

October 25, 2009

Guest Article:

Some of America's Greatest Writers and Celebrities Hung Out at O'Rourke's in Chicago

(Ed's Note: This article chronicles the life and times of Roger Ebert, America's best known movie critic, when he visited O'Rourke's in Chicago and mixed with some of the great writers and personalities of our time—Studs Terkel, Mike Royko, Jimmy Breslin, Norman Mailer John Belushi, Tom Fitzpatrick, Jay Robert Nash, Charlton Heston and Cliff Robertson among others. The article originally appeared in the online edition of Granta magazine.)

O'Rourke's was our stage, and we displayed our personas there nightly. It was a shabby street-corner tavern on a dicey stretch of North Avenue, a block after Chicago's Old Town stopped being a tourist haven. In its early days it was heated by a wood-burning pot-bellied stove, and ice formed on the insides of the windows.

One night a kid from the street barged in, whacked a customer in the front booth with a baseball bat, and ran out again. When a roomer who lived upstairs died, his body was discovered when maggots started to drop through the ceiling. A man nobody knew was shot dead one night out in back. From the day it opened on December 30, 1966 until the day I stopped drinking in 1979, I drank there more or less every night when I was in town. So did a lot of people.

Neil Steinberg, a younger columnist for the Chicago Sun-Times, invited me out to lunch one day to complain that he had missed out on all the fun. He had heard that the Front Page era in Chicago had a rebirth in the 1970s, centering around O'Rourke's Pub and the two other nightly stops in the "Bermuda Triangle," Riccardo's and the Old Town Ale House.

The triangle got its name, it was said, because newspaper reporters crashed there and were never seen again. Riccardo's, equidistant from the four daily newspapers, was for after work. The Ale House had a late-night license and was for after O'Rourke's. Few lasted through the whole ten hours. People would ride a while and jump off.

The regulars mostly knew one another. There were maybe a hundred members of the "O'Rourke's Crowd," perhaps fifty or sixty of them lasting the whole duration at that address and many following the bar when it moved to Halsted Street, across from the Steppenwolf Theater. It was driven west by rising real estate prices, the victim of the urbanization it represented.

Jay Kovar, the manager from day one, the co-owner in later years, received a loan from the actor Brian Dennehy to finance the move. Actors had always been part of the mix, many of them from the nearby Second City. And folk singers from the Earl of Old Town. John Belushi, John Prine, Steve Goodman.

Steinberg said he'd heard that on a good night you might see Mike Royko, Studs Terkel and Nelson Algren there all at the same time. Yes, you might, but it was not always a good night. Nelson had an unrequited crush on Jeanette Sullivan, the Japanese-American co-owner, and was pleasant enough but didn't come primarily to hang out with the crowd. During a disagreement with Tom Fitzpatrick, the Pulitzer- winning columnist, he and Fitz pelted each other with shot glasses.

Royko appeared one night after midnight, being supported by two volunteers, his trench coat a shambles. He was scheduled to appear the following morning on the Phil Donahue Show. I made it a point to watch. To my amazement, he was lucid and didn't seem hung over.

Few of the regulars often seemed hung over, although many must have been on some mornings. Michaela "Mike" Tuohy, accounted for that by the practice of "recovery drinking," which you did until your act was together enough to be taken onstage at O'Rourke's. As a general rule, most of the people in the bar were having a good time. There was a lot of laughter. Groups formed and shifted.

O'Rourke's stars like Jay Robert Nash, the prolific crime writer, commanded an audience. He said he had interviewed John Dillinger at his Arizona retirement home in the early 1970s, and told us about it. "He's an old man now, with a shuffling step, and when you see him through the screen-door, you can tell from the bulge in his bathrobe that he's got a gat in the pocket."

Someone would always ask him, "What did he say?" Nash would reply: "He snarled, Who are you? What do you want? I said, You know who I am, Mister Dillinger. He staggered back and shouted: Jay Robert Nash?" We didn't believe Nash was serious, but he never, ever, admitted he was not. You heard a lot of stories in O'Rourke's.

Nash was small and compact, a Cagney type. The bar's Sydney Greenstreet was Alcibiades "Al the Greek" Oikonomides, a mountainous man standing well over six feet and weighing perhaps 300 pounds, with a forehead so high it was said it required its own zip code. With this forehead he would head-butt friends as a gesture of solidarity, chanting, "To the ten thousand years we will drink together."

Years prior to his present position as a professor of antiquities at Loyola University, he said, he had been an aide-de-camp for Haile Selassie in the Ethiopian-Somalian border wars, and had a much-creased photograph of himself in uniform, standing next to a horse, to prove it.

He was a member of an ancient Greco-Venetian trading family that still owned a palazzo on the Grand Canal, he told us, and also was partner in a book shop on Shaftesbury Avenue. About Selassie I was not sure, but I met the cousin in the palazzo
and stood under a Tiepolo ceiling, and when he took me to the book shop his name was on the door.

What brought Al the Greek night after night to this obscure corner of Chicago? O'Rourke's was not boring, and embraced eccentricity. Ordinary yuppies, those who frequented the bars on Rush Street and in Old Town, did not blend in. For one thing, they were unimpressed by the booths and tables, knocked together from plywood, shellacked, caked by years of smoke and sweat; for years the bar had no more air conditioning than central heating. O'Rourke's was the ultimate singles bar, it was said: You went there with a date, and came home alone.

Cabaret could break out at any moment. Bag-pipers drank free. Everybody knew the words to all of the songs on the juke box, some of which had been on the machine since it was new. When Jerry Lewis would sing "Come Rain or Come Shine," it was not unknown for a customer to climb up on the bar and sing along.

The songs of the Clancy Brothers and Tommy Makem played again and again, and customers would sing with them: And always remember the longer you live, the sooner you bloody well die. Press agents would bring visiting movie stars to view the local colour, and they were good sports, Charlton Heston one night autographing Natalie Nudlemann's bra while she was wearing it.

Not long after he won the Academy Award, Cliff Robertson flew his private plane down from Milwaukee for an unannounced visit, and found himself in the back of a red Sun-Times delivery truck on his way to the after-hours hangout Oxford's Pub, in company including Al the Greek, a bag piper, and Jake the Dominatrix, who was flogging a new friend with a belt.

Most evenings, of course, it was not like that. When Chicago still had four dailies (the Sun-Times, the Tribune, the Daily News, and Chicago's American, later renamed Chicago Today) it was as competitive as any newspaper town in America, and many of the reporters and photographers knew one another. Trucks would deliver bundles of the early editions for us to pore over. The day's Royko column might be read aloud. Editors were libelled and publishers despised.

Jay Robert Nash told us that gangsters learned how to speak by listening to the dialogue in Ben Hecht's crime movies. Some of us borrowed our personas from Hecht and MacArthur's The Front Page. In a way, I did. I arrived at the Sun-Times from downstate Urbana, a green kid, intimidated by legendary reporters.

On the first Friday night I was taken to Riccardo's, I had a couple of beers and was delighted by the wise-guy patter that surrounded me. I tried to talk that way, even though I was a doctoral candidate in English at the University of Chicago before dropping out to go full-time with the Sun-Times.

Many of us at O'Rourke's became fake Irishmen, swayed by the Clancy Brothers and the big blown-up photographs of Behan, O'Casey, Shaw and Joyce. I was one-quarter Irish, but submerged the other three-quarters and assured people, "your blood's worth bottling." Fundraisers allegedly from the IRA would visit and we would naively give five bucks to the cause, probably not funding any terrorism because they were con artists preying on boozing Irish wannabes.

Above all we drank. It is not advisable, perhaps not possible, to spend very many evenings in a place like O'Rourke's while drinking Cokes and club soda. Sometimes I attempted to cut back, by adopting drinks whose taste I hated (fernet branca) or those with low alcohol content (white wine and soda).

Night after night I found these substitutes relaxed me enough to switch to scotch and soda. For a time I experimented with vodka and tonic. I asked Jay Kovar what he know about vodka as a drink. He told me: "Sooner or later, all the heavy hitters get to vodka."

I studied Jay as he worked behind the bar, trying to figure out how he did it. A handsome, compact man, fit, looking a little like Jason Patric, he steadily drank half shots of whiskey and smoked Pall Malls. I never saw him clearly appear to be drunk. Indeed I saw relatively few of the regulars when they were drunk, although that could happen after hours at the Ale House. Some people, like Al the Greek, could drink terrifying mixtures of drinks to little apparent effect. Others were simply reasonable drinkers, but steady.

Hank Oettinger, the most-published letter-to-the-editor writer in Chicago, would turn up night after night with his pockets stuffed with letters that either had just been published or were about to be published. These he would read to us.

Hank was a retired linotype operator, then in his seventies, a fervent leftist, a regular at every protest march, a confidant of Dick Gregory's. His black hair slicked back over his big German-American head, he always wore a jacket and tie and ordered a beer. One beer. He had been making his rounds, sometimes composing his letters on a bar, since mid-day stops in the Loop. But only sipping beer. Making his way nightly through the mean streets.

A few of the regulars, I suspect, had little identity other than the one conferred by O'Rourke's. John the Garbage Man was a regular, displaying his sculptures made from objects discovered in the garbage. He would take discarded silverware and melt it down into jewellery that looked like blobs of melted silverware. These were sold to be worn around the neck.

I bought a chess set from him, but it was not a success because the pieces looked interchangeable. These I tried to use only once, while playing in an O'Rourke's chess tournament that sprang up during the Bobby Fischer fever in Iceland. The winner, who played chess for money at the North Avenue beach chess pavilion, was Andre, a stringy hippie, tie-dyed and pony-tailed, who explained he had been the armourer of the Luxembourg Army before fleeing to America as a political refugee.

We regulars knew each other. We dated each other. We slept with each other. We went to Greek Town together, with Al presiding at the head of a long table. We met on Saturday mornings at Oxford's for "recovery drunch," spelled with a d. Tom Butkovich would pull up behind O'Rourke's in his old Volvo station wagon and unload the equipment to barbeque a lamb.

His mother, from the far Southwest Side, would bring in covered dishes of macaroni and
cheese and potato salad, while his stepdad, a steel worker, would dance with his T-shirt pulled above his belly, singing It must be jelly, 'cause jam don't shake like that. We went to each other's marriages and funerals, and observed holidays together. We took a collection for bail money, or helped the Jim and Mike Tuohy family to move, which they did frequently, Mike once complaining that volunteers had failed to move her kitchen garbage.

The 1968 Days of Rage demonstrations passed nearby, and Jimmy Breslin and Norman Mailer came in. We watched the moon landing and the protests after Martin Luther King was killed. We sang, laughed and cried. We rehearsed the same stories over and over. I said we knew each other. We knew who we said we were, who we wanted to appear to be, and who O'Rourke's thought we were, and that was knowing each other well enough.

Now Studs Terkel, Mike Royko and Nelson Algren are dead, and so are John Belushi, Steve Goodman, Tom Fitzpatrick, Mike Touhy, Hank Oettinger, Al the Greek and John the Garbageman. Jay Kovar walks his dogs. I'm telling you, Steinberg, you had to be there.

(Ed's Note: Some of the word spellings used by Roger Ebert in this article favor the British spelling and were done on purpose. I am not about to edit anything Roger Ebert writes.)

July 19, 2009

The Most Influential Women in Media in the United States

(Ed's Note: The following article was cut and pasted from the WMC Newsbrief for 7-16-09, and provides a very interesting look at who among women top the media's chart of influence makers.)

Oprah Winfrey may have been bumped to No. 2 on the Forbes Celebrity 100 list but in media, she reigns supreme. Thanks to her loyal talk show audience, social media followers and, most of all, her remarkable earning power, Winfrey tops ForbesWoman's first Most Influential Women in Media list.

While ratings have slipped over the years, Winfrey's syndicated chat fest is still considered the most important show to promote a person, book, product or idea. The "Oprah effect," could even be said to have helped Barack Obama get to the White House; it certainly didn't hurt.

The list of others who owe their careers to Winfrey--Dr. Mehmet Oz, Rachael Ray, Dr. Phil, Marianne Williamson, Gayle King and Nate Berkus to name a few--is a long and impressive one. Winfrey also helms a Sirius XM satellite radio show, a successful magazine and a cable network.

Winfrey pocketed $275 million last year, far more than any other woman on the list. Ellen DeGeneres comes in a distant second in earnings with $35 million; Tyra Banks third with $30 million.

But earning power alone does not determine who's on the list or her position. The Most Influential Women in Media were ranked in four categories determining their influence: audience, press mentions, earnings and social media outreach (followers on Twitter and friends on Facebook).

After Winfrey, the top five is rounded out by Diane Sawyer, Barbara Walters, Ellen DeGeneres and Tyra Banks.

Sawyer, after almost four decades in front of the camera, is more influential than ever. Sawyer reaches a daily audience with her gig as co-host of Good Morning, America, but her prime-time specials are what routinely attract over 10 million viewers and keep her at the seat of power: On ABC's Primetime she interviewed President Obama extensively on his health care plan, from the White House.

Walters' influence comes in much the same form as Sawyer's. While The View reaches a comparatively small morning audience, her specials--including Most Fascinating People of 2008, Patrick Swayze: The Truth and Barack and Michelle Obama--and her 2009 Oscar special each attracted tens of millions of viewers.

Ellen DeGeneres' talk show audience is half that of Oprah's. However, her earnings and enormous social media following (more than anyone on the list) pushed her to No. 4. Tyra Banks has the advantage of two hit TV shows: her girl-talk chat show and America's Next Top Model, which continues to get pretty ratings for the CW Network. Banks, like all of those in the top five, has leveraged social media and has a large online following.

Among the surprises on the list: Blogger Heather B. Armstrong (No. 26), whose earnings were small compared with the others on the list but whose enormous social media presence (behind only Ellen, Oprah, Rachael Ray and Rachel Maddow) pushed her above more well-known names like Maria Bartiromo and Soledad O'Brien. Conversely, NBC's Andrea Mitchell's (No. 30) lack of social networking counted against her.

The Most Influential Women in Media is based on money, fame, audience and power. Money is determined by an estimation of earnings from approximately July 2008 to July 2009. Audience is determined by average Nielsen Media Research numbers for television ratings and net traffic for the past 12 months. Fame and influence is determined by overall mentions on Factiva and by social media outreach, or the amount of followers on Twitter and friends on Facebook.

July 7, 2009