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PBS NewsHour

Will labeling calorie counts on menus bring down America’s obesity rates?

Photo by Flickr user King Huang

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JUDY WOODRUFF: Let’s turn to a different story on the domestic front today, one that could affect many Americans and their dietary habits.

The Food and Drug Administration announced new rules that require chain restaurants to list calorie counts clearly and conspicuously on their menus and their displays. They will apply to — this will apply to chains that have 20 locations or more. But that’s not all. The requirements will also apply at coffee shops, bakeries, pizza places, movie theaters, vending machines, and prepared foods at grocery stores. And if alcohol’s on the menu, the calories per drink will be listed too.

Americans get as much as a third of their calories from eating out. But several industry groups say they are disappointed with the rules and they contend they will affect what they offer and how much it costs.

I spoke earlier today with FDA Commissioner Margaret Hamburg.

Dr. Margaret Hamburg, welcome.

This is a pretty sweeping set of requirements. It affects just about all the prepared food people buy. What was your goal here?

MARGARET HAMBURG, Commissioner, Food and Drug Administration: Well, as you know, Congress passed a law in 2010 asking the FDA to put in place new requirements for menu and vending machine labeling.

Obviously, this reflects the fact that overweight and obesity is a huge problem in this country affecting millions and millions of people, and that consumers have a very big interest in knowing more about the food that they eat and the food that they feed their families.

So we’re trying to provide uniform, consistent information about calories in particular, but access to other nutritional information as well for consumers when they eat outside the home.

JUDY WOODRUFF: But isn’t the research on this, on whether providing this kind of information actually leads to cutting calories, isn’t that research mixed?

MARGARET HAMBURG: Well, the research is mixed. We need to learn more about it.

Some studies have indicated that there are clear benefits, both to individuals and also that the companies, the restaurants involved may change their menus to offer more low-calorie food choices. But this is about giving people choices and information that we know consumers like to have.

Right now, consumers do get access to clear, quality nutritional information on the packaged foods that they buy, thanks to the FDA nutrition facts panel that is present on the backs of — or on all food containers, packaged food.

But when you go to a restaurant or similar food business, you can’t get that kind of information. And so what we’re doing, really, is filling a gap. And I think it matters because about — when you look at where Americans are eating, Americans eat about a third of their calories outside of the home, and often purchasing foods outside of the home have no idea whom calories are in that food or other important nutritional aspects of the food that they’re eating.

JUDY WOODRUFF: We know the National Restaurant Association is now supportive, but we know pizza chains and others have been seriously opposed to this. Why limit it to chains of 20 stores or 20 — 20 restaurants or more?

MARGARET HAMBURG: Well, that was explicit in the law. So we’re building on the legislation that Congress gave us.

But in defining restaurants and restaurant-like establishments, we spent a lot of time listening to stakeholders and looking at the different ways that foods are prepared and sold in this country and, you know, really tried to put forward rules that would make a difference in terms of giving consumers information that they want and need, but would reflect the realities of the marketplace.

JUDY WOODRUFF: We have — we have seen today the National Grocers Association saying they’re disappointed. Quote — they say this imposes such a large and costly regulatory burden.

And we know you’re saying that if the food is prepared for one individual, it’s to be labeled, but if it’s for more than one, it doesn’t have to be. Isn’t there going to be a good bit of confusion for people?

MARGARET HAMBURG: Well, we’re going to work closely with industry, and certainly the grocery stores are going to be one important area of focus.

There are a lot of questions right now. I think as people dig down into the rules, number one, the grocery stores will recognize that fewer of the products they’re concerned about actually will fall under our labeling requirement. It’s really the food that’s for immediate consumption, the salad bars, the hot food bars and the deli sandwiches that are prepared and are presented to consumers in much the same way that they would be in certain fast food restaurants.

You know, it’s intended for immediate consumption or soon after you leave the premises. And there are menu boards and the calories will just have to be added to those menu boards.

JUDY WOODRUFF: So how soon does this take place?

MARGARET HAMBURG: Well, for the menu labeling, there’s a year for implementation. We actually extended our original plan in the proposed rule in order to accommodate the needs and concerns of food businesses.

For vending machines, which are also subject to this rule, if it’s part of a chain of 20 or more locations, for vending machines, it’s actually two years to implement the law.

JUDY WOODRUFF: Dr. Margaret Hamburg, commissioner of the Food and Drug Administration, we thank you.




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New FDA rules will require calorie counts in food establishments

Photo by Flickr user King Huang

While certain cities have passed local laws requiring restaurants and other food establishment to post calorie counts, long-delayed FDA rules will expand the requirement nationwide. Photo by Flickr user King Huang

WASHINGTON — Whether they want to or not, consumers will soon know how many calories they are eating when ordering off the menu at chain restaurants, picking up prepared foods at supermarkets and even eating a tub of popcorn at the movie theater.

The Food and Drug Administration is announcing long-delayed calorie labeling rules on Tuesday, requiring establishments that sell prepared foods and have 20 or more locations to post the calorie content of food “clearly and conspicuously” on their menus. Companies will have until November 2015 to comply.

The regulations will also apply to convenience stores, bakeries, coffee shops, amusement parks and vending machines.

The idea is that people may pass on that bacon double cheeseburger if they know it has hundreds of calories — and, in turn, restaurants may make their foods healthier to keep calorie counts down. Beverages are included in the rules, and alcohol will be labeled if drinks are listed on the menu.

“Americans eat and drink about one-third of their calories away from home and people today expect clear information about the products they consume,” FDA Commissioner Margaret Hamburg said. The effort is just one way Americans can combat obesity, she added.

The menus and menu boards will tell diners that a 2,000-calorie diet is used as the basis for daily nutrition, noting that individual calorie needs may vary. Additional nutritional information beyond calories, including sodium, fats, sugar and other items, must be available upon request.

The rules deal a blow to the grocery and convenience store industries, which have lobbied hard to be left out since the menu labels became law in 2010 as a part of the health care overhaul. Even before the new rules were announced, some Republicans in Congress had expressed concern that they would be too burdensome for businesses.

The law came together when the restaurant industry agreed to the labeling in an effort to dodge a growing patchwork of city and state rules. But supermarkets, convenience stores and many other retailers that sell prepared food said they wanted no part of it. The restaurant industry pushed to include those outlets, as they have increasingly offered restaurant-like service.

The FDA issued proposed rules in 2011 that included supermarkets and convenience stores but excluded movie theaters. The final rules being released Tuesday include all of them.

The restaurant industry, along with nutrition and consumer advocates, has said any business that sells prepared foods should be included. If a rotisserie chicken is labeled with a calorie count at a takeout restaurant, it should be labeled at a grocery store, they argued.

Representatives for the supermarket industry have said it could cost them up to a billion dollars to put the labels in place — costs that would be passed on to consumers. They said the rules could cover thousands of items in each store, unlike restaurants, which typically have fewer items.

To assuage some of their concerns in the final rules, FDA excluded prepared foods that are typically intended for more than one person to eat and require more preparation, like deli meats, cheeses or bulk deli salads.

But a sandwich for sale at the same counter would have to have a calorie label nearby, and the majority of prepared foods in the grocery store will have to be labeled — from the salad bar to the hot food bar to cookies and birthday cakes in the bakery.

The pizza industry, led by delivery giant Domino’s, has also vigorously fought the rules, saying there are millions of ingredient combinations possible. The FDA attempted to mollify some of their concerns by allowing pizza restaurants to label pizza calories by the slice, as they had requested, but would still force the labeling on menu boards in takeout restaurants.

The delivery pizza industry had asked to post information online instead, saying only a small percentage of customers walk into their stores and about half order online.

As in the proposed rules, the final version still exempts airplanes, trains, food trucks and other food served on forms of transportation.

The idea of menu labeling is to make sure that customers process the calorie information as they are figuring out what to eat. Many restaurants currently post nutritional information in a hallway, on wrappers or on their website. The new law will make calories immediately available for most items.

New York City was the first in the country to put a calorie posting law in place, and other cities and states have followed since then. Several restaurant chains have already put calories on menus and menu boards nationwide.

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Why you don’t want a high-tech ambulance if you’re in cardiac arrest

Photo by Getty Images

“Advanced Life Support” ambulances may lead to more death, according to a new study by Harvard University researchers. Photo by Getty Images

Emergency treatments delivered in ambulances that offer “Advanced Life Support” for cardiac arrest may be linked to more death, comas and brain damage than those providing “Basic Life Support.”

That’s according to a study published Monday in JAMA Internal Medicine, which suggests that high-tech equipment and sophisticated treatment techniques may distract from what’s most important during cardiac arrest — transporting a critically ill patient to the hospital quickly.

“They’re taking a lot of time in the field to perform interventions that don’t seem to be as effective in that environment,” said Prachi Sanghavi, lead author of the study and a PhD student in Harvard University’s Program in Health Policy. Those interventions include the use of advanced defibrillators to shock the heart, the administration of IV drugs, and perhaps most risky in the field, intubation — the insertion of a plastic tube in the airway to help with breathing.

“Of course, these are treatments we know are good in the emergency room, but they’ve been pushed into the field without really being tested,” she said. “And the field is a much different environment.”

Adding to the danger is the fact that many paramedics in “advanced” units are trained in these procedures but rarely have a chance to perform or practice them in high-pressure situations, often leading to more delays, Sanghavi said.

Basic Life Support (BLS) ambulances stick to simpler techniques, like chest compressions, basic defibrillation and hand-pumped ventilation bags to assist with breathing. More emphasis is placed on getting the patient to the hospital as soon as possible.

For decades, ALS has been the standard method for transporting patients to the hospital after an emergency. But little scientific evidence supported the “advanced” practices over BLS. And while studies in other countries called into question the effectiveness of these high-risk procedures in the field, the topic hasn’t received much attention in the United States.

Survival rates for cardiac arrest patients are extremely low regardless of the ambulance type. In fact, roughly 90 percent of the 380,000 patients who experience cardiac arrest outside of a hospital each year don’t survive to hospital discharge.

But in this study, researchers found that 90 days after hospitalization, patients treated in BLS ambulances were 50 percent more likely to survive than their counterparts treated with ALS. The basic version was also “associated with better neurological functioning among hospitalized patients, with fewer incidents of coma, vegetative state or brain trauma.”

The researchers collected Medicare data for ambulance services provided to patients in non-rural areas between 2006 and 2011. They then compared neurological outcomes and survival rates for the two types of care, using statistical methods to balance for differences between the groups, including age and other factors that could influence the type of ambulance used and chance of survival.

“Our study shows that we clearly need a shift in the way we respond to cardiac arrest in this country,” Sanghavi said.

But not everyone’s so convinced. Judith R. Lave, a professor of health economics at the University of Pittsburgh, called the study “interesting”, but far from definitive.

“They’ve done as much as they possibly can with the existing data,” she said. “But I’m not sure that I’m convinced they have solved all of the selection biases.”

For instance, some hospitals might send a BLS ambulance if the patient is close to the emergency room or relatively stable. That would mean the comparison is not truly equal and other factors besides the type of ambulatory care may have been at play.

“There’s no way you can really control for this,” Lave said. “I would say that it should be taken as more of an indication that there may be some very significant problems here.”

The Harvard team agrees that more research is needed. Joseph Newhouse, co-author of the study and director of the Division of Health Policy Research and Education, said it’s “a little bit premature to talk about any implications for programs like Medicare.

“But I think that if these results were found to be similar for other kinds of diseases, then we could start to have a conversation about whether Medicare should be more proactive in trying to make some changes in the way it reimburses hospitals,” he said.

Which is among the reasons the group’s next project will be to investigate how ambulatory care impacts patients facing other emergencies, including stroke, respiratory failure and trauma.

“Stay tuned,” Newhouse said. “We’ll be back.”

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Is the U.S. really facing a serious doctor shortage?

With growing health care demand, will the U.S. have enough doctors in the future? A doctor checks a patient during an
         examination at the St. John's Well Child and Family Center in Los Angeles, California, in Sept., 2013. Photo by Patrick
         T. Fallon/Bloomberg via Getty Images

With growing health care demand, will the U.S. have enough doctors in the future? A doctor checks a patient during an examination at the St. John’s Well Child and Family Center in Los Angeles, California, in Sept., 2013. Photo by Patrick T. Fallon/Bloomberg via Getty Images

You hear it so often it’s almost a cliché: The nation is facing a serious shortage of doctors, particularly doctors who practice primary care, in the coming years.

But is that really the case?

Many medical groups, led by the Association of American Medical Colleges, say there’s little doubt. “We think the shortage is going to be close to 130,000 in the next 10 to 12 years,” says Atul Grover, the group’s chief public policy officer.

But others, particularly health care economists, are less convinced. “Concerns that the nation faces a looming physician shortage, particularly in primary care specialties, are common,” wrote an expert panel of the Institute of Medicine (IOM) in a report on the financing of graduate medical education in July. “The committee did not find credible evidence to support such claims.”

Gail Wilensky, a health economist and co-chair of the IOM panel, says previous predictions of impending shortages “haven’t even been directionally correct sometimes. Which is we thought we were going into a surplus and we ended up in a shortage, or vice versa.”

Those warning of a shortage have a strong case. Not only are millions of Americans gaining coverage through the Affordable Care Act, but 10,000 baby boomers are becoming eligible for Medicare every day. And older people tend to have more medical needs.

“We know essentially with the doubling of the population over the age of 65 over the course of a couple of decades, they’re driving the demand for services,” says Grover.

In addition to a numerical shortage, there’s also a mismatch between what kind of doctors the nation is producing and the kind of doctors it needs, says Andrew Bazemore, a family physician with the Robert Graham Center.In addition to a numerical shortage, there’s also a mismatch between what kind of doctors the nation is producing and the kind of doctors it needs, says Andrew Bazemore, a family physician with the Robert Graham Center, an independent project of the American Academy of Family Physicians.

“We do a lot of our training in the northeastern part of our country, and it’s not surprising that the largest ratio of physicians and other providers, in general, also appear in those areas,” says Bazemore. “We have shown again and again that where you train matters an awful lot to where you practice.” That ends up resulting in an oversupply in urban centers in the Northeast and an undersupply elsewhere.

Even aside from geography, there are other questions, he says, such as “do the providers reflect the populations they serve? And that means by their race and ethnicity, by their age, by their gender?”

While few dispute the idea that there will be a growing need for primary care in the coming years, it is not at all clear whether all those primary care services have to be provided by doctors.

“There are a lot of services that can be provided by a lot of people other than primary care doctors,” says Wilensky. That includes physician assistants, nurse practitioners, and even pharmacists and social workers.

“How many physicians we ‘need’ depends entirely on how the delivery system is organized,” Wilensky says. “What we allow other health care professionals to do; whether they are reimbursed in a reasonable way that will increase the interest in having people go into those professions.”

Currently, physicians who are specialists make considerably more than those who practice primary care, which many experts say is a huge deterrent to doctors becoming generalists, particularly when they have large medical school loans to pay off.

At the same time, “team-based care,” in which a physician oversees a group of health professionals, is considered by many to be not only more cost-effective, but also a way to lower the number of doctors the nation needs to train.

“All of the efforts to the future…are to mold and morph our medical system into one that is less ‘single-combat warriors’ practicing medicine here and there, and physicians and others practicing in efficient systems,” says Fitzhugh Mullan, a professor of medicine and health policy at George Washington University.

Until that happens, though, Atul Grover of the AAMC says the nation needs to be training far more physicians.

“We don’t think we should put patients at risk by saying ‘Let’s not train enough doctors just in case everything lines up perfectly and we don’t need them,’” Grover said in a recent appearance on C-SPAN.

Wilensky is among those who find that attitude wasteful. “Are you really serious?” she says. “You’re talking about somebody who is potentially 12 to 15 years post high school, to invest in a skill set that we’re not sure we’re going to need?”

And it’s not just the individuals who could be at risk for wasteful spending. “Training another doctor isn’t cheap,” says Mullan. “Isn’t cheap for the individual doing the training, isn’t cheap for the institution providing the education, and ultimately isn’t cheap for the health system. Because the more doctors we have, the more activity there will be.”

Princeton health economist Uwe Reinhardt points out that groups like the AAMC have a self-interest in saying there’s a shortage, to move more money towards the medical schools and hospitals it represents.

“Anything that would move money their way they would favor,” he says.

Reinhardt also says that a small shortage of physicians would probably be preferable to a surplus, because it would spur innovative ways to provide care.

“My view is whatever the physician supply is, the system will adjust. And cope with it,” he says. “And if it gets really tight, we will invent stuff to deal with it.”

This article was produced by Kaiser Health News with support from The SCAN Foundation.

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