- Created on 02 December 2013
Photo by News One
Should mothers be encouraging their sons to get a woman to text consent before they engage in sexual intercourse? Sounds extreme, but not for Roxanne Jones, a former executive at ESPN, who says such motherly advice can potentially help save her son from a false rape accusation. In an op-ed published on CNN, Jones encourages other moms to follow her lead, arguing, in part, that sex has evolved over the years to such a degree that parents "still fail to discuss sex and evolving sexual mores frankly with our sons and daughters, all this freedom has led to confusion about the ever-changing rules of engagement when it comes to sex."
To be sure, she makes it clear in her piece that "no" means "no" and that no woman asks to be rape. However, Jones highlights statistics from the National Institute of Alcohol Abuse and Alcoholism which reveal that about 97,000 students between the ages of 18 and 24 are victims of alcohol-related sexual assault or date rape. Such circumstances further complicates the meaning of consent, Jones argues.
So, in order to remove any doubt about consent, Jones recommends the following:
Never have sex with a girl unless she's sent you a text that proves the sexual relationship is consensual beforehand. And it's a good idea to even follow up any sexual encounter with a tasteful text message saying how you both enjoyed being with one another — even if you never plan on hooking up again.
Crazy, I know, but I've actually been encouraging my son and his friends to use sexting — minus the lewd photos — to protect themselves from being wrongly accused of rape. Because just as damning text messages and Facebook posts helped convict the high-schoolers in Steubenville of rape, technology can also be used to prove innocence.
How to protect yourself from false rape allegations is a constant conversation among professional athletes. I've covered many rape cases over my career, including those of Kobe Bryant, the Duke lacrosse team, and many others that never made the headlines. Sports agents and athletes have tried everything from openly or secretly recording their sexual encounters, which is illegal in some states, to asking all women they have sex with to sign a pre-consent form. And though the public may scoff at stories of athletes who frequent strip clubs or solicit prostitutes, many athletes say they do this to avoid unwarranted sex assault charges.
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- Created on 02 December 2013
Photo by Greg Wood/ AFP/ Getty Images
I have an uncle who has always been a robust and healthy guy. He drank a glass of skim milk every day, bragged about how many pull-ups he was doing and fit into pants he was wearing 20 years before. He didn't take a single medication and retired early.
Given that he had no medical problems and ran his own business, he opted to go several years without health insurance. Eventually, when he turned 65, he picked up Medicare.
What happened next was a little strange. He fell off the wagon. He exercised only sporadically, and paid hardly any attention to what he was eating. One day, I saw him eat an entire bag of potato chips. He bemoaned the fact that he was forced to buy new, bigger pants, and he stopped drinking his milk. For him, becoming newly insured had nearly the opposite effect on him of what we doctors hope to achieve. He'd become unhealthier.
In many ways, my uncle was demonstrating a concept known as the moral hazard. Two economists wrote about this exact scenario in 2006
They found that many men, at the time they obtained Medicare, started behaving badly. Moral, or morale, hazard is a term largely used by economists to describe the actions of people more willing to take risks because they are insulated from the cost of their actions, in this case because of their recently obtained health insurance.
In the case of these men, when they got Medicare, they took worse care of themselves; they actually exercised less. Among those who didn't visit the doctor after getting insurance, the effect was dramatic: Their overall physical activity dropped by 40%; they were 16% more likely to smoke cigarettes and 32% more likely to drink alcohol.
Even if that seems extreme, it's still worth asking: Does health insurance make us healthier?
The past five years have seen a tumultuous battle over Obamacare, or the Affordable Care Act, culminating in the bitter recriminations this fall over lost policies and the disastrous launch of the HealthCare.gov website. When I interviewed Health and Human Services Secretary Kathleen Sebelius at the end of October, she downplayed the concerns and seemed certain the site would be up and running by the end of November.
The website may be working better now, but to me that's not the most important issue. In my mind, the real suspense comes from whether Obamacare will really make us a healthier America, even if it succeeds in its ambitions to dramatically expand coverage.
A healthier America: That is the goal we should share as Americans, but access alone won't get us anywhere close.
This past spring, the New England Journal of Medicine followed up on an important experiment in Oregon.
The state created a remarkable strategy to do a minimal expansion of Medicaid. It decided to conduct random lottery drawings to allocate the limited spots.
While it was controversial in its implementation, the situation was a goldmine for researchers. It offered something very rare in these types of studies: a unique opportunity for researchers to compare the newly insured to their highly similar counterparts, who remained uninsured. The results were surprising, and mostly disappointing.
The newly insured Medicaid population did go to the doctor more often, used more preventive health services and received more medications. Problem was, in nearly every area, they weren't any healthier. The scientists sat down with more than 12,000 people and compared some of the most important health indicators. They found having insurance did not improve measures of blood pressure, cholesterol or how well diabetics controlled their blood sugar. Furthermore, the 10-year risk of having a heart attack didn't change in those who had Medicaid. It wasn't at all what the proponents of universal access to health insurance hoped they would see.
The results remind me of a column I wrote a few years ago, shortly after my own marriage. It seemed like a good time to explore the question of whether marriage was in fact good for one's health. I spent a fair amount of time researching the topic and one of the experts I interviewed gave me an answer I have never forgotten: Marriage is good for your health (long pause) ... as long as it's a good marriage.
It was a terrific answer, and a metaphor for so many aspects of our lives.
As you might imagine, I had quite a bit of fun with that article on marriage, but it taught an important lesson. There is almost always a second beat to any story. Being married all by itself isn't necessarily good or bad for your health. It was the effort required to make it a good or bad marriage that made up the entire difference.
The same can be said about health insurance. In this case, I don't mean that "good" or "bad" insurance is the critical factor, but that health insurance alone doesn't lead to better health. None of this works unless we all take personal responsibility, and hold ourselves accountable.
To be clear, there will always be some baseline benefit to being insured versus not being insured, even if you account for the moral hazard. A major Institute of Medicine report in 2009 found that uninsured adults are more likely to be diagnosed at an advanced stage of cancer, more likely to die from a heart attack and less likely to recover from a serious injury.
Even in Oregon, the newly insured enjoyed some benefits. For example, they were nearly a third less likely to suffer from depression, perhaps because they had more peace of mind from being insured. And there were significant benefits in nonmedical areas: Whereas more than 5% of the uninsured faced "catastrophic" medical expenses in a year -- defined as greater than 30% of their income -- those catastrophic expenses were virtually eliminated in the group on Medicaid.
But strictly in terms of health, insurance, like marriage, doesn't guarantee good health. After all, I am sure you can think of people right now who have terrific health insurance and terrible health. It seems the benefits pale in comparison to what we can gain with a few simple personal decisions about our health.
A good example comes from a study in the journal Circulation. Researchers estimated that if all Americans exercised 30 minutes a day, we would reduce the number of cardiovascular events -- heart attacks and strokes -- by a third. A third! Just 30 minutes a day, and suddenly we are starting to get serious about a more healthy America.
You can break up the exercise into 10-minute chunks, according to the Centers for Disease Control and Prevention, and you don't even have to knock yourself out. Just go hard enough that your breathing is slightly labored, enough that it would keep you from singing if you suddenly got the urge.
Problem is that as things stand now, only half of us, at most, exercise that much.
While we are fond of comparing ourselves to France, a place that was ranked as having the best overall health care system in 2000, according to the World Health Organization, there's a huge difference between the United States and France that has little to do with the health care safety net.
We Americans are three times as likely to be obese as the average French person -- and obesity is related to just about every chronic disease imaginable.
I think about this all the time, and here is what I tell my own patients. It is time to stop merely playing defense when it comes to your health, and time to start optimizing yourself.
Yes, of course we are desperate to stamp out disease when it occurs, but we are more desperate for those diseases to never occur in the first place. I say that as a neurosurgeon, someone who is often called in to extinguish the brightest of fires. I also say this, however, as a 44-year-old dad who wants to be around for a long time.
I have been fortunate to have always had health insurance, but a few years ago, I decided to strive for something more. I wanted to optimize myself. I wanted to be the best that I could possibly be, instead of waiting around for the seemingly inevitable diagnosis of heart disease or diabetes. I found that it wasn't that hard. I became diligent about breaking a sweat every day. I made it as important as a meeting with my boss or a dinner date with my wife.
Also, as a student of neuroscience, I know the brain isn't particularly good at distinguishing thirst and hunger; so most people eat when they should drink. As a result we walk around overstuffed and dehydrated. Drinking fluids all day long has cut my calorie consumption by a third.
Studies of the mind-body connection also remind us that it takes about 15-20 minutes for the brain to know the stomach is full. Stop eating when you are 80% full, and you will likely take in the right number of calories. The Japanese call it hara hachi bu. To help, we use smaller plates in our home to trick the brain into believing we are eating more.
We eat meat occasionally, but no longer serve it in our home. I eat seven different colored foods a day, and try to buy locally grown vegetables whenever I can.
These are simple strategies that have made me biologically younger than I was nearly five years ago. At 44, I have the biological age of someone in his mid-30s.
It is true that the American Medical Association supports the aspects of Obamacare that expand insurance coverage, as do many others in the medical community, even if they aren't convinced that it will reliably lead to better health. It appeals to a sense of justice, and a desire to prevent the awful situation of people being turned away when they need help the most.
But, as we follow the story of Obamacare over the coming years, it's important to understand and agree on the true measure of success. As a doctor, I think a healthier America is the rallying cry we can all get behind. We have had a rocky, yet still vitally important start, but the point is that access to health care insurance is not nearly enough.
If we are serious about a more healthy America, the real change starts in each and every one of us, and it's not that hard to do.
- Created on 27 November 2013
Photo by CNN
I love Thanksgiving. I love everything about it: gathering three generations around the table, pausing for a moment with heads bowed to thank God for our abundant blessings, carrying a tradition across the centuries, watching my beloved Texas Longhorns play football. I even love clanging the pots and scraping the plates afterward. And I especially love the eating. We are traditionalists in my family, so it's turkey and stuffing, and three kinds of pie.
I am hoping this year to add one more item to the menu: a small serving of conscience. For as we gorge ourselves, Congress is contemplating drastic cuts in food aid for the least of our brethren. Food stamps, formally known as Supplemental Nutrition Assistance for the Poor, or SNAP, help poor people eat -- simple as that.
And I mean poor. The average SNAP household has a gross income of just $744 per month. I'll bet House Speaker John Boehner spends more than that each month just on cigs and merlot. Requirements to receive food stamps have become so tight that Feeding America, the nation's leading domestic hunger-relief charity, estimates that only 57% of food-insecure Americans are even eligible for food stamps. Can you imagine being too poor to afford food, but too "rich" to qualify for food stamps?
So benefits under the SNAP program go to the poorest of the poor -- and they're not exactly living high on the hog off food stamps, either. The average monthly SNAP benefit per person is $133.85, or less than $1.50 per person, per meal. A buck-fifty per meal doesn't go far. By the third week of the month, most people's benefits have already run out.
And yet even that miserly amount is too generous for some Republican politicians. Rep. Stephen Fincher, R-Tennessee, has likened food aid for the poor to robbery, telling a gathering of his fellow Tennesseans, "The role of citizens, of Christians, of humanity is to take care of each other, but not for Washington to steal money from those in the country and give to others in the country."
I am sure Fincher is a good man, but I prefer to listen to Jesus on the role of Christians. After all, he said, "For I was hungry and you gave me food, I was thirsty and you gave me something to drink." Fincher, like nearly all House Republicans, voted to cut SNAP by $40 billion over ten years.
Those cuts would kick 3.8 million Americans off food stamps and end subsidized school lunches for 210,000 hungry children. Some 170,000 of the people who will be kicked off food stamps are veterans -- an especially heartless way to treat those who have worn the uniform.
Here's the beauty part: While literally taking food out of the mouths of the hungriest Americans, the House GOP farm bill protects corporate welfare, in the form of subsidized crop insurance (among other programs). Rep. Rosa DeLauro, D-Connecticut, somehow manages to talk about this without her head exploding -- which means she has greater self-control than I do.
"Republicans are continuing to protect crop insurance subsidies to some of the wealthiest Americans and at the same time trying to cut the very program that helps keep children, seniors, and disabled individuals out of hunger, the Food Stamp Program," she said. "Unlike food stamps, crop insurance subsidies are not subject to means testing or payment limits. Some farms annually collect more than $1 million in crop insurance."
DeLauro is too polite to mention that one of the well-to-do welfare recipients is her colleague, Fincher. Fincher has received $3.48 million in taxpayer subsidies for his Tennessee farm, including $70,000 in 2012 alone. By contrast, the average Tennessee food stamp recipient gets $1,586.40 per year.
Mark Zandi of Moody's was an economic adviser to the GOP presidential campaign of Sen. John McCain. He studied the effect of various government spending to stimulate the economy. Guess what he said gives us the most bang for the buck -- the single best expenditure we can make to stimulate economic growth? (Drumstick roll, please.) That's right -- food stamps. For every dollar we spend on SNAP, Zandi said, $1.73 surges through the economy: Farmers make more money, truckers haul more food, grocers hire more cashiers. Oh, and hungry people get a meal. It's a win-win-win.
So this Thanksgiving I will once again thank God for my family, my freedom, and my food. And pray a little extra for the Republican politicians to help their fellow Americans -- and our economy -- by supporting food stamps.
- Created on 26 November 2013
Photo by CNN
While the educational prospects for poor children have improved in the 50 years since I was a young boy going to PS 99 in the South Bronx, our country continues to needlessly lose the talents of millions of children because of a failing, entrenched public education system.
There are no shortages of great ideas in education, both small-scale and large-scale. There are some brilliant teachers and educators out there in the field. But we have not done much more than tinker at the edges of the system. For that reason, we have doomed massive numbers of children -- particularly those with the misfortune to be born poor -- to academic underachievement and having no real shot at the American dream of a comfortable middle-class life.
I believe that when large numbers of children fail academically, it is the responsibility of the adults around that child. The schools in my neighborhood in the South Bronx were lousy in the 1960s, and they are by and large still lousy today. Why wouldn't they be? They pretty much have not changed what they do. The kids aren't going to spontaneously get better by themselves.
We, as a country, need to say "enough is enough."
Anyone calling for reform is treated as a radical, but I think we simply need to let the science of education lead the way to real innovation and improvements. If the "summer melt" sets back our students academically -- particularly those in poor neighborhoods with few good summer options -- let's extend the school year.
If we know for a fact that the first three years of a child's life are incredibly important for a child's later learning, let's give up the idea that education starts in kindergarten and train new parents and work with 0-3 children as early as possible.
If you really want to be branded as a radical, suggest that we provide better health care and other services for children.
Over the years, when I raised funds for health care for my kids, I would explain that kids with a toothache can't concentrate on classroom work or that a near-sighted kid without glasses may be classified as "slow" when he just can't see the board. I point out that kids need a safe, enriching environment after school, too. And that sports and arts programs can help a child find a focus and self-discipline that helps their academics.
As I've gotten older, when people push back on that kind of reasoning for wrap-around services, I just tell them I want to do it for a simple reason: I like kids. Or I tell them I want to do it for the same reasons they do it for their kids.
Taking care of children so they can succeed in school and life should be the floor, not the ceiling, of our expectations.
The science of evaluation and assessment also needs to be better incorporated into schools' standard operating procedure. We give students standardized tests in English and math, but schools get the results in July or August; the students and teachers have moved on, and so nothing is done with all this incredibly valuable data that we have spent a fortune obtaining. Teachers need data about how the children are progressing in real time so they can target their efforts at where the children really are.
We can't stifle innovation. Some promising approaches will fail, but that doesn't mean we should give up trying. We need to keep pushing until we nail what works. Look at the world of technology: When the Palm Pilot crashed and burned, no one took that as a signal to stop creating handheld devices.
As with any industry, research and development -- not to mention implementation -- takes money. But the cost of fixing our education system is a relative pittance.
What have we spent in Afghanistan in the past year in the name of national security? I would say that fixing our broken education system is similarly a matter of security for our country. The problems of the system are most obvious in poor communities, but the problems are everywhere: We are not preparing our children for a highly competitive global marketplace of high-skill jobs.
We are still the world's undisputed superpower. When the country cares about something, we spend the money. Americans need to wake up and see this for the widespread crisis it is. Join me in calling for a dramatic reform of our school system.