Culture Wars' Impact on the Outlook for People With Diabetes

Earlier this week, New York's Metro newspaper, a free newspaper given away in the NYC subways and other transit hubs (the publisher is actually a big Swedish company that gives free newspapers away in big cities around the world, including Boston and Philadelphia here in the U.S., as well as Toronto, Mexico City, Moscow, Stockholm, Paris, Amsterdam, and elswhere), reported that the Sesame Street Twitter account (@twitter.com/sesamestreet) hinted that Bert and Ernie were gay. (You can read the full issue of that newspaper HERE). Of course, they are puppets/muppets, so one could effectively argue that since the only reproduction that occurs for them is on a factory assembly line or on someone's personal sewing machine, they could only be described as "asexual" beings. Regardless, the now infamous tweet was one in which the character Bert was commenting on a recent film adaptation of the "A-Team", a 1980's television show starring muscleman Mr. T, who is perhaps best known for sporting a mohawk hairstyle and wearing a lot of gold jewelery. On June 11, 2010, Bert tweeted the following (that Tweet is still there, incidentally):

"Bert: Ever notice how similar my hair is to Mr. T's? The only difference is mine is a little more 'mo,' a little less 'hawk.'" 12:56 PM Jun 11th via web

The culture war fighters immediately jumped all over that, interpeting the statement "mo" to mean ho"mo" (as one of several urban dictionary definitions for the term, see HERE for more). Although I chuckled when I read the article, I really couldn't help but think how toxic all of this rediculousness really is, and how U.S. society truly has more serious issues to worry about than this kind of stuff. What's more, people with diabetes are being caught in the crossfire!

We've been down this path before.

Once upon a time, it was the children's purple dinosaur Barney who was being called gay, then it was cartoon character Sponge Bob Square Pants as the homo du jour. Its not enough that kids are being bullied to death for their perceived sexuality, but now that's being extended to puppets! Seriously, I've heard of sponges being used for female birth control, but I never saw the connection in this case. Besides, these protesters seem to have a collective case of amnesia when it comes to gays in children's media. Think back to some of Warner Brothers' most popular animated features in 1940's and 1950's, notably Bugs Bunny. Looney Tunes was (and still is) for many years a mainstay in children's TV programming. Although these cartoons were actually created for adults, they became a staple for after-school TV programming for kids that grew up in the 1960's and 1970's long before Boomerang and the Cartoon Network started showing this stuff 24/7/365. The wisecracking rabbit with a Brooklyn-Bronx accent actually had a history of "batting for the other team" -- and on screen! If you don't believe me, check out this classic clip:

Bugs the Beautician



There is also another episode HERE if you really want more, but all I can say is who's a 'mo now?! I don't think Bugs Bunny turned these culture warriers gay. So why the sudden irrational concern about polluting kids minds with non-existent pro-homosexual messages in children's media today? Seriously, why don't these people find a much more worthy cause like CURING diabetes to spend their time on?

The dumb part about all of this is that the perpetrators of these cartoon coming-out-of-the-closet stories are actually losing the culture wars. Today, most younger voters have grown up in an environment where they actually know homosexuals and most really don't care, nor do they feel threatened by them. Its no different to them than knowing someone who is African-American, Asian, Hispanic, Jewish, Bhuddist or any other minority group. Contrary to what they might claim, there are no recruiting efforts to join them. Do they really think kids can be attracted to have sex someone of the same gender unless they are likely gay to begin with?

But what really gets me is the fact that the very groups doing most of the talking (or should I say complaining and worrying over nothing) about this subject are the ones claiming to want to end the era of big government. Apparently, it's not OK to regulate industries, but it IS acceptable to regulate the personal, sexual behavior of adult individuals in the privacy of their own homes. Seriously, worry about the fact that most marriages ending in divorce and stop worrying about what two men or two women are doing in the privacy of their own homes.

Your Vote Can Impact Diabetes Care and Outlook for a Cure

Now that I've given my soap-box speech for the day, as I noted, there actually IS a diabetes-related reason for bringing this up. While all politics may be local, as I wrote in an editorial for Insulin-Free Times back in 2004, your vote actually can and does influence how your diabetes may be managed, how much it costs to care for yourself, whether you'll have access to care, and whether or not we could possibly ever see a cure.

This is because the U.S. Government, principally through the National Institutes of Health (NIH), is the single biggest source of funds for scientific and medical research in the world. Yet some politicians are openly hostile to scientific evidence. Do you really think we'll ever see a cure for diabetes under the leadership of people who argue with the basic tenets of science? Remember, Frederick Banting and Charles Best did not discover insulin by praying to a higher being for their discovery (they may have prayed for strength to keep their work up), they actually did scientific experiments that lead to the hormone's discovery. That's called the "Scientific Method" and its been proven unequiocally with empirical evidence across the globe. Whatever your personal beliefs may be, no person can rationally argue that scientific discovery has not advanced mankind's existence and increased the average life expectancy. When you head to the polls, you are entitled to know whether a candidate will support scientific investment, and how their views might impact policy decisions made for the U.S. Department of Health and Human Services. If they cannot articulate this for you, you may wish to reconsider giving that person your vote. I sincerely hope my readers will think about this when they head to the polls next Tuesday.

Friday Thoughts: Quotes

I have mentioned this before, but for those of you who weren't aware of it, in the last few months, blogging has taken a back seat to other priorities (mainly work). Actually, I don't mind and I rather enjoy what I'm doing, but it also means that spare time to blog, Tweet or anything else in the social media space has been pretty much the last thing I do (if at all) when I get home from work each night. Alas, I haven't disappeared, and had something of an inspiration last night and this morning, which was a random collection of some great quotes that I encountered over the last few days. Several have been courtesy of the diabetes online community (the "D-OC"), while others came from some less likely places. But I thought I would share those with you today. It's not heavy content, but I hope it will make readers think!

The first quote comes from fellow D-OC member Riva Greenberg's recent Huffington Post article "Curing Diabetes: How Close Are We?", in the first of a terrific 2-part interview with the Diabetes Research Institute's (DRI) Scientific Director, Dr. Camillo Ricordi at the University of Miami's (I should also note that this is in Miami, Florida, because someone once asked me if I meant Miami University in Ohio) Miller School of Medicine. His priceless quote is one I may very well add to my running collection of quotes that I keep in the right hand margin of my blog under the "D-Quotes" heading. When Riva asked Dr. Ricordi "What Keeps You Going?", he began his response with this gem:

Most diabetologists tell patients, "You can live a long, acceptable life with diabetes. It is just an inconvenience." It's easy to think diabetes is acceptable if you don't have it. Without being dramatic, because the treatment has improved significantly, it is still not acceptable.

In fact, over the years, I have heard how acceptable and great life can be with diabetes, but NEVER from an endocrinologist or diabetes educator who actually had diabetes themselves (and I have had a few over the years). The reality is these people are reciting well-rehearsed lines without even thinking about them, and sometimes, I find it downright insulting. This is one of the key differentiators that makes the DRI such an amazing research facility: the staff there actually gets it. Life with diabetes stinks, and no treatment is exactly the cat's meow. I wouldn't dream of diverting the DRI's attention from it's mission to eradicate diabetes by actually curing it, but let's just say that many clinical practitioners (why do we say doctors "practice" medicine, shouldn't they be done with practice by the time they start treating patients?!) should spend some time learning this valuable skill: understanding what it means to live life with a CHRONIC disease.

Ninjabetic's Analogy on Life With Diabetes

Another gem comes courtesy of George Simmons' (sometimes known as THE "Ninjebetic") Facebook page from Thursday, October 14, 2010 at 1:51am, although I was not able to find a permalink to his brilliant analogy (one of his followers has it HERE) that might be useful in trying to explain life with a chronic disease like diabetes really means. Most people out there believe its merely a matter of willpower and following some basic rules. Unfortunately, even when a person DOES follow the ever-changing rules of diabetes management (and trust me, over the past 30 years, I have seen a lot of changes, and not all of them have been great progress ... for example, the demands placed on a patient with diabetes has grown steadily, as has the cost of care, while guarantees of a life without complications remain completely absent from the equation). Without babbling too much, here was Ninjabetic's classic analogy which I think I might actually use when trying to explain this disease when someone says something I think is utterly stupid about diabetes:

Imagine having to pump your own heart because it didn't do it by itself. And when you want to sleep you have to pump it slower. For exercise you would have to speed it up. You would have to know the rate of pumping for every activity. Do you think you could do it? Do you think that would be easy?

I would just add that if you forget to pump your heart, you are likely to die quickly. The same is true for type 1 diabetes: failure to take insulin will quickly result in DKA, which is deadly. No person with type 1 has the luxury of skipping their "medication" (meaning insulin) for long. If you're a reporter writing on World Diabetes Day next month, please learn this!

NYC MTA Train of Thought™ Campaign

Beyond that, the next quote comes from the New York City Metropolitan Transit Authority's (a.k.a. the "MTA") Train of Thought™ campaign which features quotations from what several NYC universities including Columbia and New York University and their humanities professors believe are some of the world's great thinkers. These quotes appear in some of the MTA's "Subtalk" posters that appear in NYC subway cars. I have seen the following poster on my commute to and from work each day, and I honestly think it's true.



I have lifted the graphic for this particular one because I kind of like it, but for those of you reading it via an RSS feed, I also provide the text:

"The whole history of science has been the gradual realization that events do not happen in an arbitrary manner, but that they reflect a certain underlying order, which may or may not be divinely inspired."
Stephen W. Hawking, from his book "A Brief History of Time"

That one may be a bit deeper, but in essence, I think it does speak to how science and medicine has tended to view things from the paradigm that some things, such as autoimmunity, are isolated incidents. That's probably untrue. The reality may very well be that the man-made environment we've all helped to create, whether it is pollution, or widespread vaccination programs (which are widely regarded as beneficial) might in fact be planting the seeds for unintended consequences, such as autoimmune diseases -- and the incidence (including for type 1 diabetes mellitus) is growing rapidly. Recently, there was some analysis done on the DNA of some Eqyptian mummies that suggest that yes, even cancer is probably man-made. So if man's collective actions caused all of these diseases and ailments, why is it ever OK to blame the patients for getting these diseases? The answer is that it is NOT OK.

How to Handle Blog Plagiarism

I suspected that it was only a matter of time before some slug stole (yet again, it's happened before!) my copyrighted work here on Scott's Web Log since that's been rampant in the last few weeks. Sure enough, one of my d-friends, in this case Ronald Gregory who writes "The Poor Diabetic" (on Twitter, his handle is @thepoordiabetic) sent me a message via Twitter that my blog had been plagiarized by someone ambitious enough to lift my content, but too lazy to give proper attribution to me as the copyright owner, in spite of my copyright notice which is quite clear that attribution is required (see the right margin of my blog under the heading of "Content Rights" for more detail). Let's just say the user of my content never bothered to contact me and ask for permission to use my content!

I am merely the latest diabetes blogger to have had my blog content stolen without attribution. Kelly Kunik at Diabetesaliciousness(TM), for example, recently wrote a post entitled "Diabetes Blog Plagiarism Is Rising Faster Than My Blood Sugar After A Six Course Pasta Dinner!!", as have several other diabetes bloggers. However, I have dealt with this issue quite effectively in the past, so I was very well prepared this time around!

Back on April 25, 2007, I wrote a post entitled "Copyright and My Cat". Experience taught me how to deal with copyright invasions very effectively. But I figured it might be worth repeating the contents from that post here, as well as the correspondence (redacted with my personal information removed, naturally) to the offending domain registrar and host. For my fellow d-bloggers dealing with this issue, I hope this helps you deal with these creeps!

Copyright and My Cat
April 25, 2007

The other day, I was searching the Internet for something completely unrelated to diabetes and stumbled upon a posting that looked strangely familiar because it was actually MY 2006 Year-End Annual Review on developments on diabetes, except that none of the links I had in the original post were included, nor was there any acknowledgement or attribution of me as the author or even my blog address.

After investigating further, I discovered at least a half dozen of my other postings had been lifted, again without the links, pictures or attribution. That probably wouldn't have bothered me too much since I discovered that the site was registered to someone in Thailand (although the domain was registered with Yahoo! in the U.S. and hosted by a server in Texas) but what really got me mad was the fact that they lifted my post about my cat Phyllis and didn't even have the courtesy to include her picture!


Anyway, that brought me back to Amy Tenderich's post on the same issue and her recommendations on how to deal with this increasingly annoying problem. I would like to add a few simple, but useful steps. I would add that including some language on your blog about content rights likely helps your position should someone steal your work!

1. First, if you discover one of your posts somewhere online, identify the company that has registered the domain name where the copied post appears. This can easily be done at WHOIS.net. Note that this identifies only what company actually handled the registration of the site in question, not necessarily the company that hosts the site -- sometimes they are the same, but not always. Make note of the information listed -- it may be easiest to print a copy for reference.

2. Next, confirm the company that HOSTS the site in question. After some trial and error on my part, I discovered that you may conduct a domain name lookup at the following site, http://www.networksolutions.com/whois/index.jsp, which enables you to locate the site administrator or host. Again, copy or print the information you find there.

3. Finally, write a letter citing the copyright infringement. Amy recommended filing what is known as a Digital Millennium Copyright Act (DMCA) violation notice, which protects intellectual property and injured parties can file a detailed complaint for review by the web host. If the host does detect copyright infringement, they will issue a warning and can even shut down the offending site if necessary. As Amy recommended, I used the sample provided as my template. Include the web address of the offending site, as well as the site with your post, and send it to the HOST identified in step 2. There should be a mailing address, adminstrator, fax and e-mail address which you may use. I sent both an e-mail complaint, and a fax copy with my written signature just to make sure it gets to their lawyers.

If I have any further updates on this issue, I'll post them, but I hope this additional information saves you time and effort if this ever happens to you!


What to Say in Your Copyright Complaint:

I used the basic template outlined in the sample letter noted above. But after identifying both the domain registrar and host as GoDaddy.com, I made a quick telephone call to their customer service department and asked what e-mail address I should send my DCMA Copyright Complaint to, and was told to send it to: copyrightclaims@godaddy.com, just be sure to send this correspondence to the right domain registrar and host!

Here's what I said in my correspondence:

To: copyrightclaims@godaddy.com
Date Friday, Oct 9, 2010 at 10:48 PM
Subject: DMCA Notice of Copyright Infringement


Sender Information:
C. Scott Strumello
Publisher and owner of "Scott's Web Log" (http://blog.sstrumello.com/)
MY PERSONAL E-MAIL ADDRESS
Tel/Fax: (I USE MY GOOGLE VOICE NUMBER FOR THIS)
MY MAILING ADDRESS
CITY, STATE ZIP



Recipient Information (THIS WILL BE UNIQUE IN EACH CASE):
GoDaddy.com
14455 N. Hayden Rd., Ste 219
Scottsdale, AZ 85260 USA
Tel: 480-505-8899
Fax: 480-505-8844


Regarding (THIS WILL BE UNIQUE IN EACH CASE AND MAY OR MAY NOT BE THE SAME AS THE HOST):
Domains By Proxy, Inc.
15111 N. Hayden Rd., Ste 160, PMB 353
Scottsdale, AZ 85260 USA
Tel: 480-624-2599
Fax: 480-624-2598

C/O Copyright Agent for Notice of Claims of Copyright Infringement

Sent via: e-mail
DMCA Notice of Copyright Infringement
re: [http://questions.freediabetescure.info/ (IP 173.201.216.41)] (BOTH OF THESE ITEMS WILL BE UNIQUE IN EACH CASE)


Dear GoDaddy.com, registrar and host for Domains By Proxy, Inc. (AGAIN, UNIQUE IN EACH CASE):

I, C. Scott Strumello, owner and publisher of "Scott's Web Log" (http://blog.sstrumello.com/) certify under penalty of perjury, that I am the only agent authorized to act on behalf of the owner of certain intellectual property rights.

I have a good faith belief that several items or materials listed are not authorized by law for use by the above named domain name owner or their agents and therefore infringes the copyright owner's rights. I hereby demand that you act expeditiously to remove or disable access to the material or items claimed to be infringing. Under the Digital Millennium Copyright Act (DMCA) of 1998, my I am able to file a detailed complaint for review by you as the both the web host and registrar.

My contact information is as follows: (YOU SHOULD INCLUDE YOUR CONTACT INFO. HERE)

C. Scott Strumello
Publisher and owner of "Scott's Web Log" (http://sstrumello.blogspot.com/)
MY PERSONAL E-MAIL ADDRESS
Tel/Fax: (I USE MY GOOGLE VOICE NUMBER FOR THIS)
MY MAILING ADDRESS
CITY, STATE ZIP


Infringing material that I demand be disabled or removed in consideration of the above:

The URLs for these are as follows:

http://questions.freediabetescure.info/d-laid-d-art-day-32/

http://questions.freediabetescure.info/a-diabetes-meme/

http://questions.freediabetescure.info/roche-social-media-summit-part-1-weve-only-just-begun/

http://questions.freediabetescure.info/public-health-is-enough-to-chronic-non-fight-transmittable-diseases-bek/

http://questions.freediabetescure.info/no-d-blog-day-classic-tv-on-dvd/




Allegedly Infringing items or materials:

The URLs for these are as follows:

1. http://questions.freediabetescure.info/d-laid-d-art-day-32/

2. http://questions.freediabetescure.info/a-diabetes-meme/

3. http://questions.freediabetescure.info/roche-social-media-summit-part-1-weve-only-just-begun/

4. http://questions.freediabetescure.info/public-health-is-enough-to-chronic-non-fight-transmittable-diseases-bek/

5. http://questions.freediabetescure.info/no-d-blog-day-classic-tv-on-dvd/



Location of ORIGINAL WORKS:

These correspond with my copyrighted work which can be found my my website known as "Scott's Web Log" (http://blog.sstrumello.com/) at the following URLs for my original, copyrighted work:

1. http://blog.sstrumello.com/2010/09/d-layed-d-art-day.html

2. http://blog.sstrumello.com/2010/09/diabetes-meme.html

3. http://blog.sstrumello.com/2010/09/roche-social-media-summit-part-1-weve.html

4. http://blog.sstrumello.com/2010/10/is-public-health-doing-enough-to.html

5. http://blog.sstrumello.com/2010/10/no-d-blog-day-classic-tv-on-dvd.html


My actual or electronic signature follows:

Sincerely,
(YOUR NAME & BLOG INFO GOES HERE)
C. Scott Strumello
Publisher and owner of "Scott's Web Log" (http://blog.sstrumello.com/)

No D-Blog Day: Classic TV on DVD

The 1970's are back with a vengance! Well, not really, although a lot today looks quite like the decade everyone loves to pick on: Converse All Stars, double-digit unemployment, gridlocked political system and yes, bad hairstyles. Much of the credit for the last item belongs to hip-hop artist Usher for signing a Canadian kid named Justin Bieber to his record label. This kid has the absolutely ugliest hairstyle known to humanity, and it looks incredibly stupid, the point where I think shaving his pre-pubescent head with some clippers would be a huge improvement. My cat has a better coiffure than this kid (see HERE if you need proof). The sad part is that many other guys are now imitating his sheer ugliness by sporting bushy, unkept hairstyles of their own. Consider Tom Brady, QB of the New England Patriots who is usually considered by women's magazines to be one of the NFL's best-looking players. When a 33 year-old man imitates a kid whose top selling record consists mainly of a single word being repeated to the point of irritation: baby, something is just plain wrong. It wouldn't be so bad if Brady wasn't the only dude sporting a look that could just as easily be a mop that hasn't been rinsed clean; he kind of looks like he could be one of the Sweathogs on the 1970's sitcom that brought John Travolta to the public "Welcome Back, Kotter". I don't really care what Tom Brady looks like, but when I ride the train to and from work each day, I have to endure similar bushy hairstyles from teenage boys who actually think they look hot. All I can say is in 30 years, they'll look back to photos of themselves taken today, and they're sure to say the same thing that kids of the 1970's said years later: "What the hell were we thinking ... that hairstyle is f'ing ugly!" Still, I keep wondering if and when Minnie Ripperton's 'fro is going to come back in vogue?

Oh well, speaking of "Welcome Back, Kotter" that brings me to my topic du jour. Today, George Simmons has declared it to be "No D-Blog Day", and it's been way too long since the last one. I'm going to honor that with something that has nothing to do with the big-D; which shouldn't be too hard because I try to minimize the impact this chronic disease has on my life to the extent possible.

But today is "No D-Day" (see also HERE), something I'm going to honor.

I have noted this before, but I'm a classic TV junkie. I have a large collection of DVDs, most of which are old television shows that are either not on when I want to see them, or no longer even shown as reruns on TV Land (cable) or RTV, the Retro Television Network (which is now broadcast over the airwaves!) or AntennaTV (also broadcast over the airwaves). I love good television, but the reality is that in recent years, that has been in pretty short supply. Much of the 1990's, for example, was dominated by cheap-to-make reality television, which I view as disposable TV which is good to watch only once but basically worthless as re-runs. These are shows like American Idol, Survivor, Amazing Race, Dancing With The Stars and whatnot which may or may not be entertaining the first time they're on, but basically worthless thereafter. There have been a handful of recent series that meet the definition of good, among the few I watch now: Two and a Half Men and Glee. I also like Big Bang Theory, which is about some really nerdy guys (who work as scientists) who share an apartment together and their very awkward social situations with real people. There are probably a few others I haven't mentioned but also fit the bill, but I just can't think of them by name right now.

Right now, I'm pretty psyched because just over a week from today, on October 19, 2010, the original "Bionic Woman: Season 1" starring Lindsay Wagner will be delivered to me on DVD (the remade series from 2007 just didn't live up to the original IMHO, thus it was cancelled, but still made it to DVD sooner than the original did, more than 30 years later). In the past, I have written about the special bond I have with that show (see HERE). I always felt like my bionic pancreas was due, but today, 34 years later, I am still waiting. The JDRF promises something will be available by 2014, but I can't even get a continuous blood glucose monitor (CGMS) system covered, so I tend to view costly new technology as something that the U.S. healthcare system just cannot afford for a vast majority of its population. However, by 2014, barring Congress dismantling elements of the recently-passed healthcare law, perhaps these might become a possibility for more people. Personally, I wonder if the artificial pancreas project is really the best use of the money me and millions of other fundraisers have raised for the organization given that this costly technology remains out-of-reach for so many. But the good news is that we know the CEO, Jeff Brewer, actually donated $1 million of his own money for this as his pet project, although that still isn't going to bring these products to million patients who don't have platinum healthcare plans.

Anyway, the Bionic Woman is due out shortly, and when it arrives, me and Lindsay Wagner are going to celebrate a reunion of sorts. If you have NetFlix, you can soon add this to your queue! Have a look at the promotional video HERE or the press release:



I cannot possibly do this show adequate justice here, but if it interests you, try visiting "The Bionic Woman Files" website with much more detail on this classic television show. There's more there than I ever knew existed!

There's also another classic TV series that just came out on DVD on September 23, 2010 I thought I'd speak about.

Back in the days before NetFlix, RedBox machines in most supermarkets, and VOD (video on demand), people went to video rental stores (the biggest chain was Blockbuster, which filed for bankruptcy on September 23, 2010) and physically carried a DVD, or before that, a videocassette home from the store with them. You could choose from many titles that were in the store. But increasingly, that model has gone the way of the horse and buggy -- it still works, but its no longer the most efficient business model on the planet.

Today, I am recommending that you add another classic television show which only became available on DVD to your Netflix queue. That is/was a one-hour weekly television show back in 1975 on NBC. The name: Ellery Queen, which is a classic "whodunnit" mystery series. This 1975 show ran only for a single season (22 episodes + the pilot known as "Too Many Suspects"), but it helped pave the way for the the more modern whodunnit genre. In fact, Angela Lansbury's well-known and long-running "Murder, She Wrote" series was written and produced by the exact same team that put Ellery Queen together. The latter series was more successful (it ran for over a decade from 1984 to 1996) because the producers used lessons learned on Ellery Queen to improve the latter show's odds for success.

Ellery Queen was both a pseudonym for the mystery writers as well as the name of a fictional detective character set in New York City back in the late 1940s. Mystery writer Ellery Queen would help his dad (a police investigator) solve baffling murder cases. I don't believe the father character was found in the original Ellery Queen mystery books; it may have been added (very successfully) by the show's writers.

What were the lessons learned by the show's producers that made "Murder, She Wrote" such a success? First and foremost, the clues were far more subtle in Ellery Queen, meaning you really have to watch (or re-watch on DVD) closely for clues. Also, given that today's TV viewers do not watch a show uninterrupted (commercials, phone calls, etc.), in "Murder, She Wrote", the producers wrote the story so that the viewer could solve the crime without having seen all the clues. But their original work was still pretty good, and very challenging to solve!

Now, I must admit, I don't have a really great recollections of this show when it was on back in 1975 (the year before I was diagnosed with type 1 diabetes). I was only 6 years old at the time, but my parents watched the show regularly. I do remember watching it with them, but sometimes I found it scary because someone was always murdered, which is creepy for a six-year old who has to go to bed after seeing a dead body in a pool of blood on the floor or sitting in a bathtub. Since it was very recently released on DVD, I have since rewatched some of this series as an adult and found it great because of the regular cast, the stories themselves, and a phenomenal guest roster which includes so many great names, including the following:

Joan Collins (best known for her portrayal as Alexis Colby on the 1980s evening soap opera "Dynasty"), Tom Bosley (known as Howard Cunningham on the 1970s TV series "Happy Days"), George Burns (one of Hollywood's comedy legends), Jim Backus (he played millionaire Mr. Thurston Howell on "Gilligan's Island" and was also the voice of the Mr. Magoo cartoon character), John Larroquette (portrayed the sleazy lawyer Dan Fielding on the 1980s sitcom "Night Court"), Larry Hagman (best known for his portrayal as J.R. Ewing on the 1980s soap "Dallas", but equally famous for playing Major Anthony Nelson on TV's "I Dream of Jeannie" in the late 1960s to early 1970s), Eva Gabor (known as the ditzy Lisa Douglas on the 1960s sitcom "Green Acres", but also known as the "nicer" sister to the Hungarian diva Zsa Zsa Gabor), Tab Hunter (a 1960's teen idol who was in over 40 films -- he's gay, but was subject to Hollywood studio publicity machine's efforts to portray him as straight back in those days -- some of his more recent work was in John Waters' 1981 film "Polyester"), Dick van Patten (a frequent guest in 1980s television, but best known for his recurring TV role of Tom Bradford as the father in the 1970s TV drama "Eight Is Enough"), Pat Harrington (the building superintendent Dwayne Schneider on the 1970s sitcom "One Day At A Time"), Betty White (do you really need a description for her?!), Dick Sargent (the second Darrin on "Bewitched"), Dr. Joyce Brothers (playing a character similar to her own, as a famous psychologist and advice columnist), Vincent Price (best known for his distinctive voice which was featured in the late Michael Jackson's "Thriller" song and video, frequently playing in horror movies as a creepy character), Ken Berry (known for his role as Vinton Harper on "Mama's Family"), Bert Parks (known as the host of the Miss America pageant until 1980) and so many others that it makes the "Love Boat" look like a mere cruise!

In hindsight, the show had all the makings of a great show: a regular cast consisting of the late Jim Hutton (who died at age 45 of liver cancer, but had great on-screen chemistry with the actor who played his father on the show). The television producers took some creative license, but it worked really well in this series, as the chemistry between the show's recurring cast is terrific. I can say it's definitely worth adding to your Netflix queue especially if you're looking for something "fresh" that hasn't been killed by incessant re-runs.

This series remained a fan favorite, and like "The Bionic Woman" and "Six Million Dollar Man" was one of TVShowsOnDVD.com's (the site is now owned and operated by TV Guide) most-requested and has finally been released to relatively little fanfare. It's now available from retailers online (I found it for half the manufacturer's suggested retail price on BlowItOutaHere.com although it's now back-ordered, probably for it's low price), or you can simply rent it from Netflix. There used to be pretty a good website on Ellery Queen that's no longer operational, but is now found on the Internet Archive. The link to that site can be found HERE.

Catch the following videos for more information. The first, is a promotion for the DVD series which can be viewed HERE:



The second video is an interview with one of the show's creators (you will also he helped create "Murder, She Wrote" in the aforementioned video above), and that video can be viewed HERE:



If you're sick of the latest television has to offer, the great news is that much of the classic stuff is now available on DVD anytime you want to watch it! I hope you find these two series worth looking at again (or for the first time if you're that young)! For a list of other "no d-day" bloggers, click HERE.

Is Public Health Doing Enough to Address Chronic, Non-Communicable Diseases?

September 2010 happened to be the first-ever National Childhood Obesity Awareness Month in the United States. This designation was meant to increase awareness of the issue and the bill (now a law) was introduced by my own U.S. Senator Kirsten Gilibrand (of New York) back in February, and passed (unanimously, if I'm not mistaken) on March 26, 2010. Its not surprising, then, that in September, there was a fair amount of chatter and news stories about the issue. In fact, in September, officials from the U.S. National Institutes of Health (NIH) via the National Heart, Lung, and Blood Institute (NHLBI) and the Centers for Disease Control announced new plans meant to help prevent and supposedly treat childhood obesity, although exactly how the program would treat the already diagnosed cases remains unclear. Curiously the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) chose NOT to participate in spite of having a vested interest to do so. The NIDDK has also opted NOT to participate in the Autoimmune Diseases Coordinating Committee, which is being coordinated by the National Institute of Allergy and Infectious Diseases (NIAID), even though type 1 diabetes is proven to be an autoimmune disease -- raising the question is just what the NIDDK is actually doing, but that's a separate conversation!

This idea of the childhood obesity awareness month was championed by First Lady Michelle Obama's "Let's Move" campaign. And while no one questions the necessity of these programs today, more than a few thought leaders are left wondering if the U.S. would still have such an epidemic of type 2 diabetes today had these investments actually been made 30 years ago when the problem actually began? Also, why the primary focus on kids?

The sad reality is that the type 2 diabetes "epidemic" isn't occurring in children specifically (yes, some are now getting it, but the real epidemic is among adults, not kids), and can be attributed to the demographic onslaught of the Baby Boom headed into their retirement years, when many people are more likely to develop type 2 diabetes anyway, regardless of body weight. These things tend to happen with age, its just that we are entering a "silver boom" of the elderly. But it does raise the question why public health officials have chosen to focus exclusively on children, when the bulk of the problem exists in adults? I suppose its easier to focus on kids, and the long-term payoff could be beneficial in a few decades. But what about America's short-term issues leading Tea Party activists to argue we must drastically reduce our spending on such frivolous programs? It looks like policymakers are trying to score PR points while investing almost nothing into the real issues. Unfortunately, U.S. politics is too often reactive, rather than proactive on a majority of important social issues, and public health is no exception to this rule.

When it comes to public health as a function, the ONLY proven way to control any disease has historically been to eradicate the disease, not by keeping the disease around but "under control". We did not maintain polio as a chronic disease that could be managed (with sufferers having iron lungs, the way PWD's may someday get "artificial pancreases" assuming the 2014 timeline is accurate). However, if polio was discovered today, we might have people with portable iron lungs walking around given the modus operandi of the drug/biotech companies (rather than researchers and/or universities) were doing the most of the research into the disease today, as is so often the case with new diabetes treatments.

Most commonly, disease eradication has been accomplished with efforts aimed at disease prevention (such as with population-wide vaccinations, etc.). But besides initiatives to improve sanitation, there there is really no relevant historical precedent for how to control chronic, non-communicable diseases such as asthma, hypertension, cardiovascular disease, or any type of diabetes. Consequentially, to date, public health intiatives to try and do this have produced mainly disappointing, and widely inconsistent results. The word "control" regarding diabetes also gets used a lot by public health people these days, yet the disease itself cannot be addressed with the same tools used to responded to acute, communicable ailments like influenza, tuberculosis or even STDs like gonorrhea. There's a not-so-little problem with the logic of public health and chronic disease: surveillance really doesn't work the same way with chronic diseases because the causes of these ailments is not viral in nature, but a combination environmental and miscellaneous other factors (such as lifestyle issues). Yet too often, the public health response has been one of blame-transferrence to the individuals inflicted with diabetes, rather than taking a closer look at the problems and trying to address them in a logical and creative way.

Type 2 Diabetes: "A Public Health Humiliation"

This summer, an editorial in the esteemed British medical journal The Lancet referred to the the worldwide epidemic of Type 2 diabetes as a "public health humiliation," in what many regarded as a rebuke of public health's collective posture about diabetes. While much progress has been made in such public health areas as infant health (especially for low-income families), in many respects, as we've done more to help children and the elderly, so much urban health among adults has simultaneously declined rapidly from lack of access to healthy, nutritious foods, and little if any genuine public access to safe and convenient places to get exercise. Investing in children may be politically popular, but it won't solve the diabetes problem unless every child can be protected from ever getting any form of diabetes -- and since a majority of children with diabetes are diagnosed with type 1 (not type 2), that's a tall order without an approved vaccination to offer.

Meanwhile, recent worldwide trends, such as demographic aging, urbanization, and the globalization of less physically active lifestyles have all contributed to a rise in chronic noncommunicable diseases, whereas acute, communicable diseases worldwide have been dramatically reduced over the past 100 years and exist mainly in places where proper santitation does not exist. The tools in public health authorities' arsenal were built primarily to prevent acute illnesses, while non-communicable diseases have remained at the bottom as a global health priority, and their utter lack of understanding of the issues speaks volumes about why efforts to bring diabetes under control have failed. Some in public health leadership circles acknowlege the issue with chronic diseases frankly, but have yet to offer any solutions. For example, the World Health Organization under the leadership of Dr. Margaret Chan, is finally acknowledging that the worldwide paradigm has shifted away from acute, communicable diseases towards chronic ailments, and this trend is not limited to the developed world. Whether the traditional tools being used (surveillance combined with prevention) will work in this instance remains an unanswered question.

Diabetes Education Gets Lots of Talk, But Isn't Necessarily The Answer to an Epidemic

Diabetes education gets a lot of discussion from public health officials; doctors and diabetes educators love to argue that it tends to get short-changed by Medicare and private insurance companies alike (usually because their paychecks are adversely impacted) in favor of costly new drugs and medical devices. While that may be so, the medical profession turns an annoyingly blind-eye to a sad reality most don't really want to admit: education is really just another Band-Aid meant to cover-up their failure to eradicate diabetes in the first place. Diabetes Education is essentially just another form of Palliative Care (e.g. treatment aimed at relieving symptoms of the disease, rather than eradicating the disease itself), but one cannot call it a public health tool. Also, its worth reminding everyone that it's a bit too late to stop an epidemic that has been many decades in the making -- we must now reap what was sewn decades ago, and public health officials have done almost nothing on that front.

Indeed, while chronic diseases of all types (not only diabetes) are gobbling an increasing share of limited healthcare dollars, the response from public health officials is perhaps best exemplified by the Partnership to Fight Chronic Disease (PFCD), which focuses mainly on prevention, while simultaneously neglecting the challenges -- and enormous costs -- involved in actually managing a chronic disease in perpetuity. In effect, the victims of this epidemic are being blamed for the costs they are inflicting, while receiving little of the kind of help they really need to fix things: healthcare insurance (many Tea Party advocates want to dismantle the healthcare bill that was passed into law earlier this year; Colin Powell, a moderate Republican who endorsed Barack Obama in 2008, recently told "Meet the Press" that the impact of Tea Party candidates, if elected, who have been most vocal on the healthcare bill -- could very well be that Republicans will be forced to actually DO something about the issues instead of just saying "no" to everything and sitting around beating up the President ... a very interesting perspective!).

Many people lack access to healthy foods in urban (and even suburban) environements, as well safe places to exercise without additional expense, etc. Besides sexually transmitted diseases, how many any other diseases are out there where the victims are routinely blamed for getting the disease, and/or their failure to manage it? The answer is not very many. Interestingly, although we know that many cancers are actually fueled by adipose tissue and even fructose (such as high-fructose corn syrup) consumption, few cancer victims ever have to bear the blame for their conditions the way so many people with diabetes routinely are.

Non-Surveillance: New York City's HbA1c Registry Excludes Populations Most At Risk

Public health authorities have had real trouble "thinking outside the box" when it comes to chronic, non-communicable diseases like diabetes. In 2006, New York City's Department of Health and Mental Hygiene implemented a non-disclosed, involuntary HbA1c "registry" that patients have no means of opting out of (individuals CAN opt out of receiving communications from the NYC Health Department, but there is no "opt out" provision for having their medical information excluded from the registry itself, which would be called the "nanny state" in the UK, except unlike in the UK, New Yorkers do not have access to a state-funded healthcare insurance to pay for their costly healthcare).

Indeed, I have written and spoken about the assault on my personal medical records and even appeared on Canadian television (see that interview HERE). I also established a website called "StopNYCA1CTracking.org" (which I am presently making some modifications to) to provide interested parties with more balanced information about this registry than what has come from public health officials, which has been mostly self-congratulations, in spite of the fact that the program has yet to prove it was worth the invasion of medical record privacy.

In 2005, Dr. Diana K. Berger, the medical director of the city's so-called diabetes prevention and control program, boldly claimed "that Surveillance and intervention are essential if we are going to deal with this epidemic."

The idea for this registry was the brainchild of the Director (at the time) Dr. Thomas R. Frieden, who today is President Obama's Director for the U.S. Centers for Disease Control and Prevention ["CDC"] in Atlanta, but was formerly the Director of the New York City Department of Health and Mental Hygiene. Dr. Frieden was something of a dictator; quite unlike one of his predecessors, Dr. Margaret Hamburg, who was tasked by President Obama to run (and clean up) the Food and Drug Administration.

The NYC Health Department boldly promised that the registry would help to reduce the risk of blindness, kidney failure, leg amputations and early death among people with diabetes, but the department has yet to provide a shred of solid evidence to validate those bold assertions. In reality, the program has done little to prevent diabetes since being implemented several years ago; the rate of diabetes diganoses has grown since that time, as has the rate of childhood obesity in the city's public schools. Meanwhile, according to a May 21, 2010 PowerPoint presentation prepared by the NYC Department of Health and Mental Hygiene (see HERE), the city is planning to release some data in 2011; 5 years after being implemented.

At the time the registry was implemented, the City claimed that the first area they hope to target was the South Bronx, a neighborhood known for being among the poorest in the City with high unemployment and an equally high crime rate. But what good is surveillance data that excludes people who AREN'T receiving hemoglobin A1c tests done? After all -- those groups would seem to be most at risk, and we aren't even capturing data about their glycemic control (or lack thereof)! As of December 31, 2009, the program was reportedly only reaching 16% of New York City residents with diabetes. The New York City Department of Health and Mental Hygiene has provided little if any solid evidence to validate its assertions about improved patient outcomes, although it claims "outcome evaluation [is] currently being designed" and completion is anticipated by 2011". Many suspect the department will be busy massaging the numbers to focus on areas that actually did show improvement in glycemic control, but really, does this take 5 years to accomplish? All of this, while simultaneously violating patient and doctor privacy is hardly a terrific accomplishment in my humble opinion!

People with diabetes are ideally supposed to have a glycosated hemoglobin (HbA1c) test 4 times per year to help track their glycemic management, but in general, those who are actually getting these lab tests regularly represent a segment of the population with diabetes who are already receiving medical attention. Their numbers may not be within the narrow recommended goals of the American Diabetes Association, but the fact that they are even having the test done suggests that they doing something right, and health department intervention is unlikely to change that, but could piss a lot of patients (and caregivers) off. Sending them a postcard telling them they're too fat and need to walk more and eat better is unlikely to produce dramatic improvements in patient outcomes. So many doctors have already told the health department they don't want any intervention that the program had to add opt-out procedures for doctors that were never part of the initial plan. Nothing has been done for angry patients who don't want their data included in the surveillance plan.

Critics of this registry, including a fair number of doctors, have noted the surveillance data that comes from a registry of this sort is actually far too biased and could be misleading because it only includes the data of people who are now receiving medical care and having these tests done, while completely missing those who never have hemoglobin A1c tests done -- the very population that is MOST at risk for complications from poorly-managed diabetes.

Dr. Diana K. Berger, the medical director of the city's diabetes prevention and control program admitted this to The New York Times when she told the newspaper that people with diabetes should get HbA1c tests two to four times a year, but she acknowledged that "many people do not". Her former boss, Dr. Frieden himself also acknowledged this, although brushed the criticism aside. In an October 22, 2006 interview with Bloomberg News, he stated "I can't tell you what portion of how many people are in poor control. Ninety percent don't know themselves." What's more, the registry also conveniently excludes, according to NYC Health Department Statistics, "almost a third who don't even know they have diabetes." Hello .... the reason these populations don't know is because they aren't even having the HbA1c tests done!!

... And the Intervention Is?!

It's one thing to use surveillance, one of the primary tools used by public health officials, to indicate that the incidence of diabetes is growing in prevalence, but it's not possible (at least presently) to vaccinate populations for diseases that medicine doesn't really have a well-defined etiological agents for.

Today, medicine cannot even predict with certainty exactly who will develop diabetes (although there are some good clues about who might be at risk for type 2 diabetes, type 1 diabetes is an entirely different matter, and that is much more costly and complex to predict, although great strides have been made), nor can they defininitely prove what causes either these diseases (which have different etiologies).

The City's intervention was mainly aimed at doctors providing them with a stratified listing of their patients by HbA1c range. Some vocal supporters said this would be very helpful, but critics claimed it would not be a meaningful intervention or initiative (for the record, doctors can now be excluded if they don't want to receive this information from the city, unlike patients who have no way of actually being excluded from the registry). Most doctors, even general practitioners, will look at patient lab results prior to an appointment. But it is typical for low-income patients who do not have healthcare insurance to avoid going to the doctor unless they are actually ill, so while the program can alert doctors to patients that are not within recommended HbA1c ranges, it is unclear what they can actually do about it -- does the Health Department think that doctors are going call patients on the list in their spare time to prompt people whose glycemic control is deemed "poor" (meaning an HbA1c of >9) to come in for a visit? A reminder postcard isn't going to prompt someone who can't afford to see a doctor to do so, either. Patients who lack healthcare insurance aren't going to come in until they are sick, and by then, too often, it's too late.

The same patients also receive letters from the Health Department telling patients their HbA1c is too high, complete with a chart that might be the kind aimed towards individuals with a pre-school education or less. (see HERE for a sample of the letters being sent to patients). Between September 2008 and December 2009, the NYC Department of Health and Mental Hygiene reports that "over 16,750 of the high A1C letters were mailed to approximately 14,000 people". (see HERE for details), and letters to those who are overdue for an HbA1c test supposedly began in Spring 2010. To date, the city has been mum about just how effective these campaigns have been, but has stated that "outcome evaluation currently being designed" (why this wasn't done 5 years ago when the program was implemented is anyone's guess) and that the completion is anticipated by 2011.

The sad fact is that the traditional tools used by public health officials don't have a very great track record of success with chronic diseases. Vaccinations work for infectious diseases, but what would public health authorities try to vaccinate people from in order to respond to the so-called "diabetes epidemic" ... food?

A high-profile ad campaign (see The New York Times story HERE and the press release on the expensive media campaign HERE) that cost roughly $286,000 and graphically depicts globs of human fat gushing from a soft-drink bottle in a TV ad has garnered a lot of media fascination.



The print campaign also features the soda bottles and fat, but also includes an equivalent number of teaspoons/packets of sugar (26 to be exact) in each regular soft-drink bottle (The New York Times coverage can be viewed HERE) to drive the point home. These efforts get a lot of press coverage, but quantifying their impact is almost impossible.

Junk Food Is A Target, But Is It The Right Target?

To date, the public health intervention target has (rightly or wrongly) been so-called junk-food such as the NYC "pouring fat" soda campaign, but if one looks closer at some large urban populations, it becomes painfully evident that many neighborhoods don't even have supermarkets with fresh produce at affordable prices, so just where do health officials think residents of those areas are going to stock their pantries?

A different New York Times article quoted Kai Siedenburg, of the Community Food Security Coalition, a group based in Portland, Oregon, that promotes access to healthy food, who said "If you are educating people to make good choices, but those choices aren't available nearby and they don’t have a car to drive out to the suburbs to the supermarket, or an hour to ride two buses to get there, then it's really hard for them to make good choices." Very wise observation!

Solid evidence backs this up. Indeed, in 2008, The American Journal of Epidemiology reported that people with no supermarkets near their homes were up to 46% less likely to have a healthy diet than those with more shopping options. It's not rocket science, it's common sense, yet it has taken public health officials soooo long to figure this out, and one has to wonder why.

Healthy Bodegas: The First Bright Idea to come from Public Health in a Very Long Time

This is one reason why I believe one of the most important initiatives undertaken by the NYC Department of Health and Mental Hygiene actually began in 2005, which it calls the "Healthy Bodegas" initiative. (see HERE), which aims to increase access to and promote healthy foods, such as fresh fruits and vegetables, whole grain bread, low-fat milk and dairy products, and low-salt and no-sugar-added canned goods. The effort, which comparatively speaking, is vastly under-funded, doesn't get nearly the same kind of press coverage as the city's higher-profile media campaign. The New York City Healthy Bodegas initiative only addressed three of the city's poorest neighborhoods: Harlem in Manhattan, the South Bronx and North and Central Brooklyn (home to the Bedford-Stuyvesant, which is acknowledged as one of the city's toughest neighborhoods with a homocide rate to prove it), which is relatively small in a city consisting of 5 counties (Boroughs), 8.4 million residents, and covering some 305 square miles over a peninsula and 4 major islands. But at least it's a starting point. However, the Healthy Bodegas program has reached out to over 1,000 stores in a variety of ways, including helping owners secure zoning permits to allow fruit and vegetable displays on the sidewalk, as navigating the city's bureauocracy and red-tape could dissuade even the most willing retailer otherwise.

Last October, The New York Times ran an interesting story about a similar program in Newark, New Jersey that went even further to assist neighborhood bodegas and convenience stores address the problem in a different manner: instead of blaming the victims, public health authorities were trying to address issues in the environment that helped cause the problem in the first place. How? The City of Newark, the State of New Jersey and the National Institutes of Health acknowledge that it's tough to tell people to eat healthy when there are few retailers selling the wholesome ingredients health officials are telling people to eat.

For the most part, local residents applaud these initiatives.

"We need more fresh produce in this area," Yvonne Melendez, a mother of three who lives near Tremont Avenue in the Bronx told The New York Times. "It's very difficult to eat healthily in the Bronx."

Similar programs have emerged in places like Philadelphia, Baltimore, Cleveland, Hartford, CT, Oakland, CA, and Louisville, KY. Each has had to adjust their strategies to work in their locations. For example, the Cleveland Corner Store project encourages small groceries to sell fruit near the check-out counter — prime locations where candy and chips are usually found — and promotes participating stores with sidewalk signs and posters and at neighborhood health events.

Jerry Jones, executive director of Hartford Food System, a 31-year-old nonprofit group in Connecticut actually quantifies the "return" on it's investment. The program encourages store owners to replace 5% of their junk food and soft drinks each year with regular groceries, including low-salt selections and produce. In return, it provides the stores with market research on what neighborhood shoppers are looking for and negotiates low prices from a big produce wholesaler.

Forty small groceries have signed up and are entitled to display a sticker that says "Healthy Food Retailer," Mr. Jones said. In 2008, after the program had been under way for about year, the Hartford Food System took measurements and reported an overall 8% switch of food inventories from junk food to regular groceries.

"There are all these neat programs popping up," said James Johnson-Piett, a consultant to Newark's program who previously worked with the Food Trust, a nonprofit group that developed some groundbreaking initiatives in Philadelphia.

Of course, coaxing supermarkets, which are increasingly turning to the big-box store designs with expansive parking areas, has had mixed results, partially because retailers are moving to a large superstore model that doesn't work everywhere. As a result, it's not just so-called urban "food deserts" that need this kind of help. Increasingly, many rural areas have lost local supermarkets to more distant big-box retailers in the exurbs and are increasingly looking at these types of programs as models to try and encourage their local convenience stores to offer healthier choices.

There are also some possible alternatives (or additions) on the horizon, although how much involvement local Health Departments are having with these is unclear. For example, Stop & Shop (part of the Royal Ahold, a major supermarket chain in the Northeast that according to Supermarket News, ranked Ahold's U.S. division No. 7 in the 2007 "Top 75 North American Food Retailers" based on 2006 fiscal year with estimated sales of $24.0 billion), operates a free delivery service in areas of it's retail markets where it has stores called Peapod which could help fill the void by enabling consumers to have fresh ingredients delivered to their doorsteps. A rival, NYC-based company called Fresh Direct has made a name for itself with it's tagline "Our food is fresh, our customers are spoiled" also operates in the space, but with more focus on more higher-end consumers. Access to these types of services requires access to a personal computer (or smartphone) and the internet, which is out-of-reach and frequently beyond the skillsets of many individuals. The elderly, for example, may need training, and may also require assistance to help navigate websites (or mobile phones) that are designed for younger eyes with perfect vision.

What if local health officials helped build an infrastructure to enable stores and delivery services to receive orders by text messages? Increasingly, mobile technology may help to bridge the gap for many customers in need, but public health can play a role in making these services more widely known.

Healthy Bodegas: Check. Access to Places to Exercise: Still Needs Work

Of course, on the fitness front, access to safe places for exercise is one front public health officials have done far too little to address, but really need to looking into. For example, ongoing healthclub memberships in NYC cost more than downpayments on homes in many parts of the U.S., and typically cater to an affluent clientele. Where does the rest of the city's residents, in Michelle Obama's words, "Let's Move"?

Public parks work fine when the weather is good, but what about mid-winter when temperatures are so cold that only the bravest souls step outside, or when it's pouring rain outside? Even the recently remodeled locations of the city's indoor public park facilities operate on very restrictive hours, and do not accommodate varied work schedules. If we want to address the diabetes "epidemic" this needs to change, although the parks department is facing budget issues, too. Can't make it to the public pool or gym by 8:00 PM? You're shit out of luck, as my paternal grandmother used to say after she'd had a few too many cocktails. Perhaps the Health Department should help fund keeping these facilities open, even if it's just a trial to see if doing so might help.

If Public Health Officials are serious about the obesity and type 2 diabetes epidemic, they need to start thinking outside of the box. For too long, they have responded using public health tools developed in the 1920's for infectious diseases, but those just don't work the same way with chronic diseases. But Health Departments can indeed play a role. In much the same way as they're helping convenience stores and bodegas navigate the city's red tape to get sidewalk produce permits, they could step in and help the parks department do an analysis of traffic patterns at their facilities. They might learn, for example, that there are many times of the day that employees are paid to work and there's nary a visitor to be found at those facilities. It might make sense to close the pool or gym during those hours, and instead stay open until 11:00 PM so clients can use the facilities when they need to. The obesity and type 2 diabertes epidemic did not happen overnight, nor will it be solved overnight. And with budgets tight everywhere, it may be harder to get the parks department to help on these issues. But we know that relying on stale old tools that work to keep infectious diseases under control simply won't work for chronic, far more complex diseases like diabetes. It will take some creativity to approach the problem in a more comprehensive manner, but the net result could prove beneficial for everyone -- not just people with diabetes!