Hispanic Business Magazine Shifting Paradigms

Healthcare Reform May Leave Illegal Immigrants Worse Off

Healthcare Reform May Leave Illegal Immigrants Worse Off
May 13, 2010
By Rob Kuznia, Staff Writer

Weeks after passage of a historic health bill, Hispanic advocacy groups say the sweeping new law will generally bring much-needed benefits to Hispanics and businesses across America.

Those same groups, however, are raising concerns about how the health care reform bill will affect illegal immigrants who currently have coverage.

While it’s been widely reported that illegal immigrants are left out of the newly signed health law, less talked about is how the new law could actually make things worse for insured illegal immigrants — as opposed to merely maintaining the status quo.

The Patient Protection and Affordable Care Act will bring coverage to 32 million of the current 45 million uninsured Americans and cost roughly $850 billion over 10 years. But it could also cause many illegal immigrants to lose the coverage they have. And the number of illegal immigrants with coverage is surprisingly large.

The Pew Hispanic Center estimates that roughly 40 percent of the 11 million or so illegal immigrants residing in this country are insured, either because they purchased health coverage themselves or received it through their employers. The U.S. Hispanic Chamber of Commerce puts the estimate even higher.

“I don’t think many people know that approximately 50 percent purchase coverage,” Javier Palomarez, president and CEO of the chamber, told Hispanic Business magazine. “These folks are in jeopardy of losing what little coverage they have.”

The bill that was signed into law March 30 not only prohibits illegal immigrants from receiving federal subsidies, it also — to the chagrin of immigration-rights advocates — bars them from purchasing insurance with their own money on the soon-to-be created statewide exchanges that will pool ratepayers to lower premiums.

To be sure, under the new law, illegal immigrants still will be able to purchase coverage out of pocket. It’s just that, because their plans will be excluded from the exchanges, they could see the cost of their premiums skyrocket out of reach.

This is because the creation of the new exchanges could have the effect of draining current risk pools of almost everyone except the illegal immigrants, said Jennifer Ng’andu, deputy director for health policy project with the National Council of La Raza.

“I think you could say on some level that undocumented immigrants (with coverage) are the ones who will be worse off than before,” she told Hispanic Business magazine.

Thus far, nobody knows exactly how the market is going to react, as the exchanges won’t take effect until 2014.

“But many people are starting to anticipate drastic increases in health insurance costs,” Ms. Ng’andu said.

Ultimately, fewer illegal immigrants getting coverage would translate into more people using emergency rooms or community health clinics for their health-care needs. These costs tend to ultimately be borne by ratepayers and taxpayers.

Elena Rios, M.D., president and CEO of the National Hispanic Medical Association, said the issue underscores the need for comprehensive immigration reform.

“I think this country needs immigration reform to allow unauthorized immigrants who live here and work here and pay taxes to be able to have certain services,” she told Hispanic Business magazine.
Broadly Many Benefit

On a broad scale, though, many Hispanic groups are generally pleased with the new law.

With one in three of all U.S. Hispanics uninsured — and at least 20 percent of Hispanic-American citizens and legal residents uninsured — the population has more to gain than any other, Dr. Rios said. (About 15 percent of the entire U.S. population is uninsured.)
“It’s a phenomenal step forward for the Hispanic community,” she said.

Small Business Fares Well

Hispanic-owned businesses also stand to benefit.

With 98 percent of Hispanic-owned businesses employing fewer than 50 people, the legislation’s effect on small business is of primary importance to many Hispanics.

Over the past decade, the meteoric rise of health care costs has significantly hampered the ability of small businesses to offer health benefits to their employees.

Since 2000, the proportion of small businesses offering health benefits has dropped more than 20 percent, from two-thirds to less than half. The bulk of that drop has occurred over the past three years.

The new law benefits small businesses in several ways, Mr. Palomarez of the chamber said. First, it allows them to purchase insurance through the exchange. Also, small businesses that opt out still stand to benefit, as most of their employees will qualify to purchase individual plans on the exchange, improving the ability of those businesses to stay competitive with larger companies.

Finally, and most immediately, all small businesses offering health benefits to their employees will qualify for tax breaks.

“They can avail themselves this year of essentially free money,” David Ferreira, the chamber’s vice president for government affairs, told Hispanic Business magazine.

Mr. Ferreira said one disappointment to the chamber is how the law requires businesses with more than 50 employees to provide coverage. The chamber had hoped that the threshold would be set at 100 employees — or, better yet, dropped altogether.

But in terms of how the bill affects Hispanic-owned businesses, the difference between 50 employees and 100 employees is relatively slight, he added. While about 99 percent of all Hispanic-owned companies employ fewer than 100 people, about 98 percent employ fewer than 50.

“We’re fighting over inches at this point,” he said.

Other Benefits

The new law stands to benefit U.S. Hispanics in many ways, advocacy groups said. It comes with a huge prevention component, meaning, for instance, that doctors will have financial incentives to discuss healthy lifestyles with patients.

This is particularly beneficial for Hispanics, who suffer disproportionately from obesity, diabetes and heart disease, Dr. Rios said.

The new law also means doctors and nurses in many areas of the country will have to undergo cultural competency training, which could include taking Spanish classes or hiring translators.

“It exists now, but not like with the court system,” Dr. Rios said. “The health care system has been light years behind. This is going to bring the system into the 21st Century.”

As it is, she added, just 5 percent of the nation’s doctors and nurses are Hispanic — a percentage that the National Hispanic Medical Association would like to see grow.

The new law also increases to 26 the age in which young people can stay on their parents’ plans. The current age varies from state to state, but in general coincides with the college years of middle-class families, which generally end around age 22, Dr. Rios said.

Also experiencing some improvements are the citizens of the U.S. commonwealth of Puerto Rico, which received about $1 billion to establish an exchange and provide more affordable care.

“In the end, we think there are key gains that give us a foundation to be able to extend affordable insurance to many Latinos and immigrants across the country,” Ms. Ng’andu said. “The bill was by no means what we hoped to have, but it’s something we believe sort of lays the foundation for a better health care system

Hispanic Business Magazine Shifting Paradigms

The Hispanic Paradox: U.S. Hispanics Live Longer, Despite Socio-Economic Hurdles

The Hispanic Paradox: U.S. Hispanics Live Longer, Despite Socio-Economic Hurdles

When it comes to Hispanics and health care, the horror stories are well known. Less so is the mysterious phenomenon known as the “Hispanic Paradox.”

Again and again, we hear that the Hispanic population is disproportionately beset by the bugbears of poverty, obesity, Type 2 diabetes and lack of access to quality health coverage and insurance.

These unfortunate facts are indisputable. But what many people don’t realize is that, when it comes to the bottom line — that is, mortality — the news for Hispanics is good. Very good.

In the United States, Hispanics, despite their socio-economic hurdles, on average live longer than blacks by seven years, and whites by five years, says Dr. David Hayes-Bautista, a professor of medicine at UCLA.

“There’s something about being Latino that is good for their health,” Hayes-Bautista told, adding wryly: “Just think if we had access to health care.”

Widely known as the “Hispanic Paradox,” the phenomenon was discovered and coined by researchers decades ago.

At the time, many scientists were skeptical, speculating that the data must have been skewed. They hypothesized that immigrants who came to the United States were simply younger and healthier than the average American, or that a large share of older immigrants returned home to die.

But recent studies have refuted the doubting theories, and the science community today generally accepts the Hispanic Paradox as real.

Now, Hayes-Bautista is on the front lines trying to figure out why this is so.

“There’s something going on here,” he said. “Is it diet, is it family, is it spiritual, is it the Latino mind-body balance? I don’t know.”

Hopefully, Hayes-Bautista said, his extensive research on the topic will eventually shed some light.

The longer lifespan of Hispanics has been described in several ways by different studies, and to varying degrees.

In 2007, the Public Policy Institute of California found that the average lifespan of a Hispanic man in that state is 77.5 years, compared to 75.5 among white males and 68.6 among black males. The lifespan of Hispanic men was topped only by Asian men, whose average lifespan came in at 80.4.

In 2008, the National Center for Health Statistics released a study showing that the overall mortality rate for Hispanics in 2006 was 550 deaths per 100,000 people, compared to 778 for whites, and 1,001 for blacks.

Hayes-Bautista said that Hispanics in the United States are 35 percent less likely than whites to die of heart disease, and 40 percent less likely to develop cancer.

Immigration plays a factor, he said, albeit a small one.

For instance, the mortality rates of first-generation immigrants are consistently better than that of U.S.-born Hispanics. But he said the difference between these groups is seldom statistically significant.

More noteworthy, he said, are the behavioral differences between immigrants and the U.S.-born.

Immigrants, he said, are far less likely than U.S. born Hispanics to smoke, drink, do drugs and contract sexually transmitted diseases. Similarly, he said, U.S.-born Hispanics with high levels of education also tend to avoid these high-risk behaviors and their consequences.

Perhaps more surprisingly, another stark contrast between immigrant and the U.S.-born Hispanics is tied to infant mortality. Hayes-Bautista said that although both groups rate “extremely good” on this measure, the U.S.-born Hispanics have a 20 percent higher infant-mortality rate than that of the immigrants.

“U.S.-born Hispanics have higher income, higher education, are far more likely to have health insurance, yet their outcome (on infant mortality) isn’t quite a good as immigrant parents.”

This might lead one to ask whether this means that Mexicans live healthier than Americans. Not so, according to the CIA World Factbook of 2008.

On that index, the life expectancy of Americans in 2008 reached 78 (a national record). For Mexicans, it was about 76.

However, Hayes-Bautista said the lifestyle in rural Mexico is much healthier than that of urban Mexico. What’s more, he says, the bulk of Hispanic immigrants in America hail from the rural pockets of Mexico.

Elena Rios, President and CEO of the National Hispanic Medical Association, said overall, the immigrant Hispanics are younger, and abide by healthier habits, than U.S. born Hispanics.

“With the immigrants, the first generation has healthier habits: less driving, less smoking, less fast foods, more walking,” she told “As the second-generation Hispanic families happen, they pick up the Western — the American — lifestyle.”

As a result, Rios said she wants any healthcare reform package to include an educational component urging Hispanics to get back to their basics, such as traditional foods.

“It is important to have more prevention and education when they are younger, before they get into bad habits,” she said.

Pacific Standard Magazine

The Sun Is Bad For You; The Sun Is Good For You

The Sun Is Bad For You; The Sun Is Good For You

Go outside without sunscreen and risk melanoma, the deadliest version of skin cancer. Fail to get enough sunlight and risk dying of heart disease, cancer, diabetes and a host of other awful maladies. It’s enough to cause paralysis-by-analysis over a simple walk in the park.

In the past few months, a spate of surprising studies has added to a growing body of evidence suggesting that getting adequate amounts of vitamin D — the “sunshine vitamin” — protects against the risk of not only the osteoporosis and depression that people have long known about, but also colon cancer, breast cancer, heart disease, rheumatoid arthritis, diabetes and even multiple sclerosis.
This summer, media outlets such as the Los Angeles Times, U.S. News & World Report and The Dallas Morning News have responded to the studies by vaunting the value of the sun. They’ve also implied — and even reported — that sunscreen enthusiasts are taking their message too far.

“Don’t run from the sun’s vitamin D benefits,” proclaimed the Morning News in July.

Meanwhile, in a newly launched national ad campaign, the American Academy of Dermatology is trumpeting what seems to be the opposite message: Limit your exposure to ultraviolet rays. Called “Indoor Tanning Is Out,” the campaign that began in July includes TV public-service announcements featuring the testimonials of young women talking about the link between indoor tanning and melanoma.
The academy’s warnings about UV exposure don’t stop at the tanning booth.

Dr. William Hanke, president of the American Academy of Dermatology, told that there is almost never a good reason to stay out in the sun without protection.

“If you’re going to play golf or tennis, play early in the day, use sunscreen, cover up,” he said. “We’re not advocating, ‘Don’t go outdoors.’ What we’re advocating is, ‘Protect your skin from UV radiation.’ It’s the only skin you’re ever going to have.”

It’s a quandary. How can we reduce melanoma risk without cutting off the vitamin D supply that, according to recent studies, protect against all those other diseases?

Researchers on both sides of the debate agree — to a point, at least — that there’s an answer: vitamin D supplements.

Certain foods can also be helpful, but not as much as you might think.

Vitamin D generally cannot be found in fruits or vegetables and really only exists naturally in fish, especially of the larger ocean-dwelling variety, such as tuna. Also, certain foods, such as milk and orange juice, have been artificially fortified with the vitamin. But one would have to down 20 glasses or milk a day to get the minimum 1,000 International Units of vitamin D that institutions such as the Harvard Public School of Health and University of California, Berkeley now recommend.
In general, researchers — sun enthusiasts and sun-phobics alike — are urging people to take vitamin D supplements every day. Younger adults generally are recommended to take about 1,000 International Units; older adults, 2,000. These amounts greatly exceed the official recommendations of the Institute of Medicine, which suggests between 200 and 600 units, but many now think the official guidelines are out of date.

In any case, it’s probably no surprise that Hanke gets his daily 2,000 units of Vitamin D through supplements.

More tellingly, another advocate of the pill form is University of Wisconsin-Madison professor Hector DeLuca, who by all accounts is among the world’s brightest vitamin D stars.

DeLuca’s research on the benefits of vitamin D spans decades and has been extensively cited in media articles focusing on the benefits of getting more sun. But DeLuca himself doesn’t believe there’s much need to go into the sun without protection.

“I think the only real way to go is by mouth,” he told

As for going into the sun unprotected, he added, “I’m not going to do it because I don’t want to deal with the skin-cancer risk.”

In the late 1960s, DeLuca discovered that vitamin D must pass through the liver and kidney to work its magic. This paved the way for synthesis, and then vitamin D-based drugs — such as DeLuca’s namesake Hectorol — used to combat bone diseases like osteoporosis.

DeLuca concedes sunlight can be beneficial, although he cautions that the surprising epidemiological studies on vitamin D’s relationship to protecting the body from those diseases so far have merely pinpointed a strong correlation, not causation. Still, he said as early as the late 1970s, it was observed that multiple sclerosis rates were lowest in high-sunlight areas and vice versa.

Nonetheless, DeLuca said he is in complete agreement with the dermatologists who say it’s generally a bad idea to go out into the sun without protection.

“I like to garden, but I wear big hats and protect my body with clothes,” he said.

DeLuca said there is no meaningful difference between how the body processes vitamin D from a capsule and from sunlight, except the former doesn’t leave a person vulnerable to skin cancer.
“I don’t want to tangle with melanoma,” he said.

Even one of America’s most controversial sun enthusiasts is a vitamin D pill-popper. Boston University Medical Center professor Michael Holick wrote the incendiary book The UV Advantage, which advocated getting more sun.

Despite Holick’s love for the sun, he still ingests 1,400 units of vitamin D in the form of a capsule and a multivitamin every day.

But unlike DeLuca, Holick still urges people to get moderate amounts of direct sunlight.

Holick’s career actually began as a grad student working under DeLuca. He went on to become the chief of endocrinology, nutrition and diabetes and a professor of dermatology at Boston University. But in 2004, the head of the dermatology department fired him from his dermatology professor post in response to his book, calling it “an embarrassment.” (He is now a professor of medicine, physiology and biophysics at the university.)

Holick believes he was punished for challenging the anti-sun dogma of the dermatology world. He also believes it’s unrealistic to expect every man, woman and child in the world to take the supplements that he does.

“Most humans on this planet depend on and have always depended on the sun for their vitamin D,” he said.

In addition to taking supplements, Holick makes a point to absorb sunlight for two to three hours a week while cycling or playing tennis. He said he typically applies sunscreen to his face but leaves his arms and legs bare. His vitamin D blood levels, he boasts, are usually right in line with what many researchers now recommend: between 40 and 50 nanograms per milliliter.

Holick’s recommended dosage for sunlight depends on a range of variables, such as a person’s skin color and whereabouts. In general, the darker the skin — and the farther away from the equator — the longer a person needs to stay in the sun to absorb healthy levels of vitamin D.
A fair-skinned person, say, at Cape Cod around noon in June, he said, should get maybe 10 to 15 minutes a day, but African Americans generally need to be out in the sun five-to-10-times longer, he said.

When it comes to melanoma, which kills about 8,000 Americans every year, Holick’s view is nuanced. On the one hand, he believes moderate sunlight exposure actually decreases one’s risk of acquiring the disease, citing a study of Navy personnel in 1990. (The surprising study found that sailors who worked indoors displayed higher rates of malignant melanoma that those who worked outdoors.)
But burning, Holick said, is always bad.

“Never get a sunburn,” he said. “It’s the most likely way to increase your risk of malignant melanoma. … That’s why moderation is so important.”

Although Holick says he doesn’t advocate indoor tanning, his studies are routinely celebrated by the indoor tanning industry. In a 2007 study, published in the New England Journal of Medicine, Holick concluded that adults who visited a tanning salon at least once a week showed healthier levels of vitamin D at the end of the winter than adults who merely took a multivitamin. (Multivitamins are not the same as vitamin D supplements. In general they contain just 400 units of vitamin D, compared to the supplements, which usually contain 1,000. The Harvard School of Public Health suggests taking one of each daily.)

Holick’s study was panned by critics who noted that it was partly funded by the indoor tanning industry; he responded that the industry’s support amounted to just 2 percent of his budget.
One major Holick supporter, the Indoor Tanning Association, in March launched its own public relations gambit to counter the campaign of the American Association of Dermatology. The association’s home page is filled with links to recent articles lauding the benefits of the sun.
Association spokeswoman Sarah Longwell said there is no proof that tanning beds cause melanoma.
“It’s been frustrating to see dermatologist after dermatologist speak about it as though it was a fact,” she said. Longwell conceded that sun-burning is bad and said the industry standard is to encourage moderation by imposing limits on the number of visits a person can make in a specified period of time.

“One thing about tanning salons that is superior to sun exposure is that it is a controlled environment,” she said. “When I go out in the sun, I am likely to burn. I fall asleep, my foot gets sunburned because I missed it with sun lotion.”

But one thing the American Association of Dermatology has that its adversary doesn’t is the power of anecdotal stories. Take 24-year-old Meghan Rothschild, whose story is featured in the association’s print ads.

A member of a fair-skinned family in Massachusetts, Rothschild was no sun-worshipper as a teenager. But when she returned from a family vacation in Florida with an attractive tan on her stomach at age 17, she decided to maintain it.

Over the course of about 2½ years, she went to a tanning salon once a week, for about 20 minutes each time.

“I’d actually been told tanning was much safer than the sun,” Rothschild told
When Rothschild discovered a slightly itchy mole on her stomach, she was worried enough to see a doctor, but the doctor told her it didn’t look like anything malignant. She nonetheless had it removed, and went to the tanning salon the same day. But in January of 2004, when getting the stitches removed, she was startled by the grave expression on the face of her new doctor.
“Is there anyone here with you?” he asked her. Puzzled, she said no. Then, he dropped a bomb: she had stage II melanoma.

“He starts throwing out words like ‘cancer,’ ‘survival rate,’ ‘lymph nodes’ and ‘treatment,’” Rothschild remembers. “Basically I’m traumatized for the next two weeks.”

A month later, after a three-hour surgery, a six-inch chunk of skin was removed from her stomach, leaving a C-shaped scar. The surgery required 75 internal and external stitches.

Although Rothschild’s extended family has some history of cancer — her grandmother had breast cancer and an aunt had stomach cancer — Rothschild said she is the only one who has contracted melanoma. She firmly believes the tanning bed caused it.

The cancer has remained at bay, but now Rothschild doesn’t go anywhere outside without sunblock. Complicating matters, she works as an event-promotions manager at Six Flags, which requires her to spend much of her time outdoors. “I can’t hibernate — I’m 24 years old,” she said. “I just have to be really proactive.”

Meanwhile, vitamin D experts warn that it’s also possible to overdo it with the supplements.
When this happens, a person starts to experience the hardening of soft tissues, such as kidneys. Oddly, this cannot happen through sun exposure: Once the body burns, it stops producing vitamin D.
“The debate now is where is the safe place, and where is even 1 percent of the population at risk,” DeLuca said. “We don’t know that. Some people think we can go as high as 10,000 units a day. I think 2,000 units a day is safe.”

Pacific Standard Magazine

Big Tobacco’s ‘Other’ Products Catch Fire

Also on the rise is the ‘cool quotient’ of mini cigars, which are not subject to the same level of legal scrutiny as cigarettes.

Big Tobacco’s ‘Other’ Products Catch Fire

Just because cigarette sales have been steadily falling in recent years doesn’t mean the tobacco industry is going up in smoke.

On the contrary, sales of other tobacco products, such as snuff, snus, roll-your-owns and especially cigars are on the rise, according to a new Harvard University study.

Two years ago, R.J. Reynolds purchased moist snuff manufacturer Conwood. Philip Morris in the past two years has also begun testing snuff and spit-free snus in Dallas and Indianapolis.

Meanwhile, the popularity of mini cigars is exploding among young people, especially in the hip-hop world. In the last eight years, their sales have mushroomed by more than 100 percent, according to the study.

The most popular brand of mini cigar in the hip-hop culture is Black and Mild, a name taken up by several small-time rappers and DJs. In December, Philip Morris purchased the brand from John Viet Middleton Inc.

Researchers attribute the growing demand for the other products partly to the fact that the federal and state governments and the courts don’t seem to apply the same level of scrutiny to them as they do cigarettes.

In what the researchers call a “loophole for death,” the other products are cheaper due to lower taxes. The federal tax on cigarettes is at least 10 times higher than that for snuff, snus, roll-your-owns and cigars, according to the study.

Also, the leading producer of anti-smoking ads — the American Legacy Foundation — is prohibited by court order from targeting any type of tobacco product other than cigarettes.

The foundation’s hands are tied by the terms of a landmark settlement in 1998 between the tobacco industry and 46 states called the Master Settlement Agreement. Part of the $206 billion settlement required the tobacco companies to fund anti-tobacco ads, but the focus was on cigarettes because they were the product being marketed to minors at the time, said Najma Roberts, communications manager for the foundation.

Now, she said, the foundation is stepping up its research of mini cigars to determine whether they should ask the federal government to allow them to train their crosshairs on that tobacco product as well.

“They are big in the urban community, specifically among Hispanics and African Americans,” Roberts told “There’s definitely a misconception that they are not as bad as cigarettes.”

Meanwhile, Congress is moving ahead on giving the U.S. Food and Drug Administration the power to regulate tobacco products with a bill that in part would outlaw sweet- and spice-flavored cigarettes. Specifically omitted from that ban on “any artificial or natural flavor” is menthol, a flavor especially popular among African-American smokers. The Congressional Black Caucus has protested the exclusion.

In the eight-year Harvard study, which was published in the June 11 edition of the Journal of the American Medical Association, the researchers concluded that the growing demand for the other products has offset by one-third the 18 percent drop in the sale of cigarettes since 2000.

Put another way, even though the sale of cigarettes has fallen by 18 percent in eight years, the sale of all tobacco products in that time has decreased by only 12 percent due to the rising consumption of cigars, snuff, snus and roll-your-owns.

“The apparent magnitude of overall decline in tobacco use in the U.S. may be illusory,” the authors of the study said in a statement.

Associate researcher Hillel Alpert, one of the study’s two authors, told that he is worried about what seems to be a widespread belief that cigars and the other alternative tobacco products are somehow healthier than cigarettes.

“If somebody were to jump out of a tall building, it doesn’t matter whether they jump from the 10th story or the 20th story — it leads to the same result,” he said.

In the study — the first of its kind in the U.S. — the researchers attributed the growing demand of the other tobacco products largely to their lower prices. Ever since the 1998 Master Settlement Agreement, the largest civil settlement in American history, cigarettes have been heavily taxed but not the other tobacco products.

The researchers urge the federal and state governments to tax the other products equally.

“Lower federal and state taxes on these non-cigarette products are keeping tobacco addiction affordable and encouraging preventable disease and death,” professor Greg Connolly, the study’s lead researcher and the director of Harvard’s Tobacco Control Research and Training Program, said in a statement. “State campaigns to curb tobacco use should address this loophole for death.”

Meanwhile, the American Legacy Foundation isn’t the only tobacco watchdog that would like to take aim at mini cigars.

Similarly hamstrung is the National Association of Attorneys General, which, although it is allowed to go after tobacco companies for using inappropriate marketing tactics to sell cigarettes, roll-your-owns and smokeless products, is prohibited from going to court over the portrayal of small cigars such as Black and Mild. The association has argued that the “cigars” are erally just cigarettes in disguise.

Because such products are wrapped in tobacco leaf, rather than paper, they fall under the category of cigar and are thus exempt from many restrictions that apply to cigarettes, according to a study from the Baltimore City Health Department. But the study also says that the mini cigars, unlike regular cigars, tend to be inhaled.

Like the American Legacy Foundation, the Association of Attorneys General is trying to change the rules pertaining to mini cigars. It has requested that the federal government broaden its definition of cigarettes to include them but, so far, to no avail, said an attorney with the association who asked that his name not be used because he is not authorized to speak to the press.

Meanwhile, mini cigars are the fastest-growing tobacco product on the market.

In 2000, Americans bought enough cigars to equal 112 million packs of cigarettes. By 2007, that number had jumped to 242 million.

Cigarettes are still by far the biggest seller. In 2007, Americans purchased 17.4 billion packs. The next most prevalent form of tobacco consumption is moist snuff, which in 2007 sold the equivalent of 2.9 billion packs of cigarettes — a 30 percent increase over the amount sold in 2000. The consumption of roll-your-own cigarettes has also sharply risen, jumping in that time frame from the equivalent of 281 million packs to 537 million.

The amount of money the tobacco industry spends on marketing has also increased in the past decade. Between 1996 and 2005, the amount spent on smokeless tobacco ads more than doubled, from $121 million to $251 million, according to a report from Tobacco Free Kids. The amount spent on cigarette ads rose in tandem, from $5.1 billion to $13.1 billion, according to the organization.

The meteoric ad budget seems a little counterintuitive, given how the 1998 settlement banned cigarette ads on billboards and how cigarette ads seldom make appearances in newspapers or magazines anymore. Now the ads show up in the form of in-store promotions, coupons and direct mail.

Speaking on behalf of Philip Morris, Greg Mathe, spokesman for parent company Altria, made no bones about the fact that the industry is trying to grow and make money. But he said the tobacco company knows better than to try to target minors.

“We have an adult-only focus,” he said.

What’s more, he said, the company does not try to pitch any of its products as somehow healthier than others.

“There is no such thing as a safe cigarette,” said Mathe, who, when asked, said that he does not use tobacco products. “Tobacco products are harmful. They cause serious diseases and they are addictive.”

Pacific Standard Magazine

Red Meat: A Healthy Choice?

An award-winning journalist says not red meat but refined carbohydrates are responsible for heart disease, diabetes, cancer and many other maladies of civilization. He and other experts weigh in.

Red Meat: A Healthy Choice?

In the wake of the meteoric rise and fall of the Atkins Diet, the concept of eating red meat in recent years has taken a beating in the wider public consciousness.

From books like Fast Food Nation — which brought to light the foul quality of much of the meat in fast food — to attack ads like a recent PETA campaign portraying Inconvenient Truth-teller Al Gore as a portly hypocrite for eating meat, the general message has been that meat is bad. Even environmentalists have joined in, stressing that a calorie of cow has a much larger carbon footprint than a calorie of carrot.

Moreover, many nutritionists and doctors have for decades warned that eating too much red meat is unhealthy.

“The less red meat, the better,” Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard School of Public Health, told Time magazine in 2001, in an article titled “Red Alert on Red Meat.” “At most, it should be eaten only occasionally. And it may be maximally effective not to eat red meat at all.”

At the same time, vegetarianism is increasingly associated with going green and living healthfully. In What to Eat — a widely praised book that came out in 2006 — leading nutritionist Marion Nestle says vegetarians are “demonstrably healthier than meat eaters.”

But are steak dinners really so bad for our health? A controversial, award-winning journalist who is making the rounds on the university lecture circuit says no. In his book, Good Calories, Bad Calories, Gary Taubes isn’t so much endorsing red meat as he is challenging the very foundation on which the nutrition establishment bases its advice.

“(The balanced diet) has the advantage of being politically correct,” he wrote. “Whether it is healthier, however, than, say, a mostly meat diet absent any refined or easily digestible carbohydrates … is still anybody’s guess.”

His 450-page book, which came out in the fall, hypothesizes that the maladies of western civilization — heart disease, cancer, obesity and even Alzheimer’s — are caused not by the red meat and saturated fat we’ve been told to avoid but by the refined carbohydrates that until recent years were largely overlooked and in many cases even encouraged.

The book isn’t necessarily setting out to vindicate the Atkins Diet, which encourages people to eat meat, eggs, cheese and animal products and abstain from white bread, sugars, potatoes and other carbohydrates. Still, its conclusions amount to a tacit endorsement.

To some extent, Taubes’ book, which delves deep into the history of nutrition research, is bolstered by a surprising spate of recent studies indicating that the Atkins Diet not only may be the most effective weight-loss method but may also protect against heart disease.

Nonetheless, experts of all stripes say long-range studies are still lacking.

Agreement — Up to a Point
Speaking with, Taubes, a self-described carnivore, said his research has led him to believe that humans can thrive on all-meat diets. Indeed, he says, some of the world’s healthiest populations lived this way for centuries.

“The fuel for the low-fat dogma was a kind of anti-meat movement that started in the 1960s,” he said. “I think back to the ’80s, when I was eating skinless chicken breast, pasta and burritos and believed if I had a steak I was going to kill myself. But there never was any particularly compelling evidence that red meat, per se, was particularly bad for you.”

Taubes’ ideas are shunned by much of what he likes to call the nutrition establishment. By now, most of the experts in the field know his name, and many resent his characterization of their life’s work as fatally flawed. His 2002 New York Times article, “What If It’s All Been a Big Fat Lie?,” is widely credited for single-handedly reviving the Atkins craze — for a time. The headline alone suggests today’s nutrition experts might be about as wrong as the ones who once insisted that the sun rotates around Earth. In fact, it’s an analogy that Taubes regularly invokes to illustrate how backward he thinks many dieticians have it.

For all of Taubes’ contrarian views, some experts are coming to his defense. His book has been endorsed by Michael Pollan, author of the best-selling The Omnivore’s Dilemma. In his latest book, In Defense of Food — published this year — Pollan refers to Good Calories, Bad Calories as an “important new book.”

To Taubes’ own shock, his work has been publicly praised by Dr. Andrew Weil, the alternative-medicine guru who has long warned against eating too much red meat. In October, shortly after the release of Good Calories, Bad Calories, Weil, who shares a publisher with Taubes, was the lone expert in a group of three on Larry King Live who spoke favorably of the book. The TV moment created a mini-stir in the diet world and was streamed on YouTube.

“I think this is a very important book; I have been recommending it to my medical colleagues and students,” said Weil, eliciting a somewhat relieved-looking nod from Taubes, who had spent the first segment of the show sparring with Oprah Winfrey’s doctor. “He raises big questions, and I think there are some very big ideas in this book. One of them is that there is absolutely no scientific evidence for the belief that fat is the driver of obesity.”

(Later in the show, Winfrey’s doctor, Mehmet C. Oz — co-author of the best-selling You: On a Diet — called Taubes “psychotic” adding, “I think you really believe it’s true.”)

Both Pollan and Weil embrace one of Taubes’ biggest points: that the science leading to the government’s enduring recommendation to eat less fat — and in particular less saturated fat — was flawed, and alternative hypotheses, such as the one condemning simple carbohydrates, were pushed to the margins.

However, both Pollan and Weil stop short of sharing Taubes’ enthusiasm for red meat. Pollan urges people to “eat food, not too much, mostly plants.” Weil repeats his praise for Taubes on his own Web site, which produced a deferential article called “The Surprising Reason People Get Fat,” but says he draws the line at the recommendation to eat a lot of meat. Instead, he steers people toward eating fish.

At least one meat-endorsing expert finds this paradox puzzling. Sally Fallon, who co-authored Eat Fat, Lose Fat with longtime nutrition maverick Dr. Mary Enig, criticized Pollan for not taking a stronger stance, even though his book gives props to the work of Enig. “He talks about (the merits of) traditional foods. Then when you get to his recommendations, they are the opposite of what he just said,” Fallon told “It’s like he forgot what he said.”

Disagreement Is the Spice of Life
Taubes is lecturing at more and more universities and academic conferences. The growing list includes the University of California, Berkeley, the University of Pennsylvania, Canada’s McGill University and the University of Southern California.

Taubes also may speak soon at the University of Minnesota, the birthplace of the now increasingly questioned notion that saturated fat and red meat cause heart disease.

One of Taubes’ critics is Willett, chair of the nutrition department at Harvard University, who was quoted in the Time article. Speaking to, Willett stood by his statement from seven years ago on the dangers of red meat.

He said he agrees that sugars and starches, from candy to potatoes, are problematic. In fact, he said, now that trans fats are on the run, refined carbohydrates have replaced them as the No. 1 nutritional problem in the United States. But just because those carbohydrates are bad, he said, does not mean red meat is good.

“You’ve got two bad things being compared,” said Willett, author of the best-selling Eat, Drink, and Be Healthy. “Empty calories increase weight gain. … If you replace that with red meat, it’s just about a wash.”

When it comes to heart disease, Willett, one of the leaders of a decades-long project called the Nurses’ Health Study, said he agrees that a diet heavy in red meat is no more dangerous than a diet heavy in refined carbohydrates. But he said red meat seems uniquely correlated to other ailments, such as colon cancer.

“It does look like you would be better eating less red meat,” he said, “particularly processed red meat.”

Willett recommends a diet high in polyunsaturated fats, the kind found in olive oil, fish, nuts, beans, poultry and “maybe some eggs.” Asked to comment on Taubes and his thesis, Willett said, “Taubes has simplistic answers, but there is no simple path to truth.”

Another expert, Dr. Diana Schwarzbein, says eating too few carbohydrates can be just as damaging as eating too many. Unlike Willett, Schwarzbein, an expert on hormone replacement therapy, says there is nothing wrong with eating red meat in moderation. But she says a dearth of carbohydrates leads to a shortage of the insulin needed to keep serotonin levels normalized in the brain. This, she says, can lead to such side effects as sugar cravings, depression, weight gain around the midsection and sleep disturbances.

In general, she believes people should consume two carbohydrate grams for every protein gram. Back in the high-carb craze of the 1980s, she says, the ratio was more like 10-to-1 or 20-to-1. But now “with the pendulum swung to the other end, and the overconsumption of protein, it’s more like 1-to-10 to 20,” she said.

“How ironic is it that the guy (Taubes) who says, ‘Hey, that (high-carb diet) is going too far’ is now advocating something extreme that is low-carb?” she said. “I believe in moderation.”

A Polarizing Figure
A three-time winner of the Science in Society award from the National Association of Science Writers, Taubes studied physics at Harvard and has written well-received books about other scientific controversies, such as cold fusion.

But he touched a nerve with “What If It’s All Been a Big Fat Lie?” The gist of the article was that Atkins, who had always been widely maligned by experts, might have had it right all along. Maybe the diet was not only the best way to lose weight but also — contrary to what the leading authorities were saying — better for your health.

The article sparked an uproar. Reason magazine printed a scathing article about Taubes called “Big Fat Fake.” And some of the sources in Taubes’ article — including Willett — claimed they were quoted out of context.

In any case, “Big Fat Lie” led to a $700,000 book advance for Good Calories, Bad Calories.

The book took five years to write, and though obviously denser than the article, is no less provocative. While it devotes most of its pages to highlighting the flawed science that led to the many still-existing public notions about nutrition, it does dedicate one section to the possible health benefits of a diet that is 100 percent meat.

In this section, Taubes tells the story of anthropologist Vilhjalmur Stefansson, who dropped out of Harvard around 1900 and spent a decade with the Inuit, a tribe in Alaska and Canada. The Inuit ate nothing but animal fats — mostly caribou but also fish, seal, polar bear, rabbits and so on. They ate no fruits and vegetables and no carbohydrates.

“The Inuit, (Stefansson) insisted, as well as the visiting explorers and traders who lived on this diet, were among the healthiest if not the most vigorous populations imaginable,” Taubes wrote.

That experience later inspired Stefansson to embark on an experiment in which he and another man — Danish explorer Karsten Anderson — were the subjects. In 1928, overseen by a committee of researchers, the two men ate nothing but meat for one year. After a year of eating 2,600 calories a day, not only did the men lose weight; their blood pressure either dropped or stayed low, their kidneys continued to function without flaw and their mineral and vitamin counts displayed no deficiencies.

“The only dramatic part of the study was the surprisingly undramatic nature of the findings,” wrote Eugene DuBois, the Cornell researcher who summarized the results.

Most striking was the good health of the men despite their deprivation of fiber and Vitamin C — two nutrients lacking in a meat-heavy diet. Taubes explains this by positing a still-untested theory: Perhaps people only need these nutrients when their diets include significant amounts of sugars and starches.

However, the passage about Stefansson is the book’s lone example of an all-meat diet, and Taubes acknowledges that few scientists today will pay much heed to a study containing just two subjects. But few if any other all-meat studies have been done, he added.

“It would probably be considered unethical today,” he said.

In any event, Taubes isn’t convinced that it’s vital for diligent carb-watchers to consume much in the way of fruits, fiber or even leafy greens. “Once you remove (the sugars and white bread), I don’t know if you get any benefit from eating vegetables, other than that it might make your mother happy,” he said.

The best modern-day equivalent to the all-meat studies might be those looking into the merits of the Atkins Diet. Until about five years ago, no such studies existed.
The findings are surprising.

In 2003, a pair of studies from Pennsylvania published in The New England Journal of Medicine showed that the meat-heavy, carb-light diet showed not only good results on weight loss but also no adverse health effects. In 2007, a yearlong Stanford study comparing the effects of four different diets on obese women showed similar results: The Atkins Diet was, by a modest margin, the biggest pound-shedder. Also, the cardiovascular health of the Atkins women improved significantly: Their triglycerides plummeted, their blood pressure dropped and their high-density lipoprotein (also known as the “good cholesterol”) rose — all good results.

The study was “pretty much in line with what all the other studies have shown comparing Atkins and low-fat diets,” Bonnie Brehm, assistant professor of nutrition at the University of Cincinnati College of Nursing, told The Washington Post.

And just this month, a University of Illinois study concluded that a high-protein diet with lean meats and low-fat dairy foods was more effective for helping women lose weight without losing bone than a conventional weight-loss diet based on the food-guide pyramid.

“This is an important finding because many people, especially women in midlife, are concerned with both obesity and osteoporosis,” said Ellen Evans, a U of I associate professor of kinesiology, in a statement. “Many people lose bone mass when they lose weight.”

Still, it’s unclear in any of the cases whether the pounds stayed off, and researchers say studies tracking long-term health effects of Atkins are still lacking. Also, the Atkins studies certainly don’t jibe with Schwarzbein’s life experience as a practitioner: She blames the diet for the hormonal problems exhibited by many of her own patients.
The Atkins studies aren’t the only surprising developments of late.

In the book In Defense of Food, Pollan writes that the most up-to-date studies show that “the amount of saturated fat in the diet probably may have little if any bearing on the risk of heart disease.” He furthermore stated that researchers have been backpedaling from this so-called lipid hypothesis quietly, almost sheepishly.

“The lipid hypothesis is quietly melting away, but no one in the public health community, or the government, seems quite ready to publicly acknowledge it,” he wrote.

Origin of the Thesis
The widespread belief that saturated fat leads to heart disease started in the 1950s. The father of the theory was a University of Minnesota scientist named Ancel Keys, who championed a Mediterranean diet consisting primarily of fruits, vegetables, pastas and bread. His work has enjoyed tremendous staying power.

In 1977, when Sen. George McGovern drafted what came to be known as The Dietary Goals for the United States, he drew heavily on Keys’ research. The first recommendation: Increase carbohydrate consumption. The second (of six) was to decrease the amount of fat in the diet, particularly saturated fat. To this day, such carb-laden grains as bread, pasta and cereals still make up the largest share of the five food groups depicted on the Food Pyramid (now known as MyPyramid). The “Meat & Beans” group is still consigned to the smallest.

When Keys died in 2004 at age 101, The Washington Post published an obituary that — in the first paragraph — stated that he had “discovered that saturated fat was a major cause of heart disease.” (Atkins, by the way, died at age 72.)

If Taubes’ beliefs on carbohydrates are true, wrote Pollan, “then there is no escaping the conclusion that the dietary advice enshrined not only in the McGovern ‘goals’ but also in the National Academy of Sciences report, the dietary guidelines of the American Heart Association and the American Cancer Society and the U.S. food pyramid bears direct responsibility for creating the health crisis that now confronts us.”

Pollan was referring to the oft-mentioned obesity epidemic, which officially began in the early 1980s, the dawn of the high-carb craze.

Willett acknowledges that some of the conclusions drawn from Keys’ studies were “overly simplistic.” But he says Keys’ contribution to science is still valuable. “The main thing that Ancel Keys did was show there was a huge difference in heart-disease rates in different countries,” he said.

As for the results of the recent Atkins studies, Willett isn’t surprised. “Those are the studies that compare a high-fat diet with a high-carbohydrate, -starch and -sugar diet,” he said. “Most of those studies show not very much of a difference.”

According to Willett, the real story is how the twofold increase in Americans’ consumption of polyunsaturated fats — fish, beans, nuts, lean meats — has coincided with a 50 percent drop in heart-disease deaths over the past 40 years.

“That was a huge public health accomplishment that was sort of overlooked,” he said.

(Pollan counters this point, however, by suggesting that the lower mortality rates may simply owe to better treatment of heart disease.)

Moving forward, Taubes says he would like to see a study comparing the mostly meat diet to the widely accepted idea of a “balanced diet.” To date, he says, it’s never been done.
He also calls for more studies in what he views as a specific area of neglect: the carbohydrate hypothesis, or the idea that eating too many starches and sugars is the main driver of obesity and heart disease.

“Such trials would be expensive,” Taubes wrote. “But it’s hard to imagine that this controversy will go away if we don’t do them.”