VSP is managing the state of Wisconsin's vision insurance. As a potential member, I must say that my experience with them has already been terrible, making me less likely to use them.

Apparently somewhere on their site is a web page to sign up for the state plan. Our department benefits manager sent along a link to it. It doesn't work. Instead I'm told to call member services. I'm guessing the site is using some sort of session state that makes it difficult to share links. Not a promising start.

I was directed to check out "Find a VSP Doctor" to see if the doctor I wanted to use was covered. Bonk! No help for you. Okay, I'll try the "doctor" link. Bonk! I can't log in because I'm not a member, I'm considering becoming a member. Okay, I'll try "Not a member" Bonk again! I get a warning that they can't reliably tell me which doctors are on my list unless I'm already a member. How can I make an intelligent decision about choosing VSP if I can't find out who the doctors covered are? But I'll try to "Continue as a Non Member" anyway. In we go. So, where do I download a full directory? Oh, I don't. All I can do is search. Worse, I need to fill out a CAPTCHA to search. Why do I need to fill out a CAPTCHA? "This helps us prevent unauthorized use of our doctor information." How do you use a list of doctors in an unauthorized way? My health insurance offers a PDF download and a searchable form, neither of which are hidden behind a CAPTCHA. Oops I got the first two wrong, so it wipes out my address, forcing me to retype it.

I'm a borderline case. I probably don't need vision coverage beyond what my health insurance normally covers, but I am interested in it. So I came to VSP's site to learn more. They had an opportunity to show me how great they are. Instead they set up a series of roadblocks. This doesn't bode well for the service I'd receive as a member. So I'll pass. Congratulations on shooting yourself in the food, VSP.

Then, each year after implementing smoking bans (at least for the first three years, the longest period studied), smoke-free communities have an average 26 percent decline in heart attacks, compared with those areas that still allow smokers to light up in public places.

...

Nonsmokers have a 25 percent to 30 percent higher risk of heart attack if they inhale smoke at home or at work....

The new research suggests that a nationwide ban on smoking in public and workplaces could prevent 100,000 to 225,000 heart attacks each year in the U.S.....

If I ran an interior painting company, and it was discovered that my employees had a 25% higher chance of having a heart attack than the general population, politicians would leap on the opportunity to pass regulations to make the work environment safer. If banning interior paint would prevent 100,000 heart attacks a year, it would be illegal (and wallpaper sales would likely go up). But...

"Opponents have argued that smoking bans drive away customers.

How is this even seriously on the table? There is a major health risk here! According to the American Heart Association, about 35% of heart attacks end in death, so we're talking about 35,000 to 78,750 people dying ever year! Many of these people know that smoking is dangerous, so they don't smoke! But they need a job, and working in smoking-allowed business may be the only job available, or the only job that actually pays enough to feed their family. You're killing thousands of innocent people because you don't want to drive away customers!

And it may not drive away customers!

"Study results have been mixed, with most indicating that the impact on bars and restaurants is neutral or may actually improve business, says Schroeder.

I expect that businesses on the edge of any ban take a hit as smokers move a bit further out of the ban area. Of course, this means that as smoking bans get wider and wider, the number of businesses on the edge shrinks. At a state level, relatively few get hit. If we pass a ban at the federal level a smoker needs to bring his passport to move outside of the ban zone.

Some smokers will decide to pass on going out at all. They'll refuse to exchange a few hours of not smoking (at least not without heading outside) in exchange for socializing and drinking at a bar. They'll decide to have people over at home, or to socialize less. But people like going to bars, and I'm guessing the number who significantly cut down on their visits will be small. Also, some people who hated smoky bars or in some cases were actively made ill by them will be willing to go. I suspect the end result will be nearly a wash once the transition period is over.

A smoking ban in indoor, public spaces where people work is a good idea. We already ban a wide variety of useful materials (like asbestos) that present a serious risk to worker health. We will save innocent lives. We will cut medical expenses that we all pay for.

I at least hope that anyone against a smoking ban in workplaces are consistent enough to also argue that we should eliminate OSHA, allowing businesses to knowing endanger their employers in a wide variety of ways.

I've had an essay on why guaranteed health care for all Americans is a good idea kicking around for a long time. I've realized that if I don't just put something up, I'll never put it up. It will never be as perfect as I want. So in what will likely be permanent draft form "Guaranteed Health Care Is a Good Idea."

I announced this on my other blog, and I'd prefer to keep comments unified. So go post comments there if you are so inclined.

What's life like on performance enhancing drugs like Human Growth Hormone and steroids? Apparently it's pretty good, as we learn in a 2003 article. I appreciate the honest investigation supported with concrete examples of how the regimen helped the author.

So I'm just shy of 12 weeks into Weight Watchers. I've attended 12 meetings (they fencepost the weeks). I've got a backlog of gripes, but like most of my gripes they're relatively minor things. What really matters is: Am I losing weight?

Yes. I'm losing weight. I'm losing weight more quickly than I expected or even hoped. I've lost about 35 pounds, so I'm losing a bit less than 3 pounds per week.

The only times I am hungry are when I have points to use and have delayed or skipped a meal. After a rough first week, I'm not really burning my points allocations. I'm always ending a week with spare weekly points allowance. I even manage to once or twice a week eat a big meal.

Generally speaking I'm not feeling like I'm missing much. Eating things I like, just less, works pretty well. My tastes are changing too. I occasionally get cravings for burgers, but when I actually eat a burger they're not as satisifying.

To stay on our diet, my girlfriend and I are eating in more. It's largely packaged food, but it's better for us. We're reading nutritional information and trying to eat more vegetables. Morningstar Farms burgers are a common dinner. (The Mushroom Lover's is inexplicably tasty, and I hate mushrooms. The Spicy Black Bean Veggie and Tomato & Basil Pizza are also really good.) Regular strawberry smoothies as well (recipe). Add in regular grilled veggies.

The meetings are pretty good. The actual content is only okay. Sometimes the session leader or a member will have a good idea, but all in all it's a predictable mix of motivational speaking. That the group is overwhelmingly female with a strong bias toward middle-age doesn't help. My girlfriend and I simply don't connect to what are apparently common problems: fear of the scale, occasionally failing to count points, and on rare occasions simply failing to follow the program. However, the meetings have an important psychological benefit. At the very least, they provide a marking point for my progress. It's also nice to get third party acknowledgement of my progress. Inane though it is, I look forward to the little gold stars for each 5 pounds lost.

So far, so good. I'm optimistic about going forward.

Right, that's enough being positive about Weight Watchers. On to the complaints.

Today's highlight comes from the week 2 pamphlet, which is about eating out. It has some suggestions for different types of food. The highlight is this: "Out for Japanese food? Ask that your sushi be made with brown rice instead of white." Brown rice? Right. Thanks to my sushi-loving girlfriend, I'm eating sushi moderately regularly now, and I've never heard of sushi made with brown rice. I don't know for sure, but it seems like the bran coating might hamper the stickiness that is essential for sushi. But just to be sure, I checked at three sit down sushi places in town and asked if they would make sushi nigiri and sushi rolls with brown rice. I happened to eat at Takara and asked our waiter. He said no, it would taste wrong. The hostess at Ginza of Tokyo seemed surprised and a bit confused by my request, but ultimately said they did not offer it. Finally Wasabi's hostess quickly confirmed that it was not an option.

Three strikes, and they're out. Where is Weight Watchers finding this highly unusual sushi offering? I have no doubt you can make sushi with brown rice, but I'm skeptical that many Japanese restaurants offer it.

I expect I'm going to have at least a few more posts bashing Weight Watchers, so I thought I should say a few good things about them.

I'm two weeks and three meetings in. We'll see how I'm feeling in a few months, but for now I like the fundamental system.

Weight Watchers now offer two different plans. The "Flex Plan" is what most people think of; you get a daily point (or as they call it POINTS™) allotment (and a weekly "slop" allotment), different foods cost different values. The "Core Plan" doesn't track points or calories, instead giving you a pretty strict list of things you eat; you can splurge a little with a weekly allotment of points, just like the Flex Plan.

The Core Plan seems to brutal to me. The list of acceptable foods is much, much too short for me. It definitely seems implausible if you eat out regularly. I can see it working for other people, but I don't ever expect to try it.

The Flex Plan is pretty straightforward. WW gives you a booklet of some common foods showing the points per item. They'll sell you more complete books, or access to their web database. If you know the nutritional information, you can use the provided cardboard slide rule to calculate the points of anything. For people with calculators, the equation is pretty simple:

Calories are as Americans measure them, or "kilogram calories." Fat is in grams. Fiber is specifically "dietary fiber," is in grams, and is limited to 4 grams in a given dish. Results are rounded to the nearest whole number (matching WW's books), or to the nearest half (matching WW's web site).

(Weight Watchers doesn't, to my knowledge, admit that this is the equation, but it's widely known. No surprise, as it's clearly documented in their patent, 6,040,531. (Backup patent link.) Using my slider I've confirmed that the equation is correct. The observant will notice that the patent was granted in 2000; apparently Weight Watchers changed their system recently.)

WW has an equation for determining how many points you get each day, then they assign a flat 35 points as extra to use over a given week. (I'd share the equation, but it's less clear that it's public information. For a sense of scale, it bottoms out at 18 and tops off at 44. The last page of the patent has a table with some example ranges, but it's clear that the equation and that table don't quite jive.)

Limiting myself to the points I have each day hasn't proven too hard for me. So far hunger hasn't been the problem; the problem has been limiting myself, especially at restaurants. For example, my favorite meal at Culver's is a cheeseburger basket and a chocolate shake. It's 41.5 points (1730 calories, 86 grams of fat), more than I get in a single day. Based on the meetings, many people do have hunger problems, so this might just be me.

The points system has proven very enlightening, and I'm getting a much better grip on how much I eat. Of course, this isn't WW specific, by all accounts a key to any effective diet is learning how many calories you're actually consuming.

You're also given some general guidelines, encouraging you to eat a certain amount of fruits and veggies and to drink milk.

The points system is fundamentaly calorie counting mixed with generally good nutrition. I'm not convinced that it's better than simply calorie counting and good nutrition. However, WW provides guidelines and structure which I do think are effective. I wouldn't think anything of tracking calories, fat, and fiber directly, but I'm a geek who carries around a Palm PDA, so the simplification into points may help others.

You're encouraged to attend one Weight Watchers meeting per week. You start by optionally weighing in (only the staff know your weight). You're given a pamphlet or small booklet based on how many weeks you've attended. Presumably after some number of visits you'll have collected the entire set and won't get any more. You're also offered a little paper booklet for tracking points for a week. Then you head to the meeting proper.

Based on my experience (I gather each meeting group is different), you get a group of about 40 people, the majority of whom are women. A leader gives a short talk and motivational lecture about weight loss, frequently asking audience members for examples of what works for them, or what has proven problematic. It seems very female oriented to me, but the meetings are hyped as being important and I believe it probably is. The weekly meetings act as a sort of chapter marking, giving a concrete marker to your progress. Hearing from other people helps focus the mind and provide some reassurance that weight loss is possible. You get little stickers and later on keychain charms for achieving various goals, and everyone applauds when you do. It's just using peer pressure as positive reinforcement, and I know it's a trick, but it's still an effective motivator. Presumably one can learn useful tips from the meetings, but I haven't hear anything noteworthy yet.

So, fundamentally you've got a simplified calorie counting, good nutrition guidelines, and some positive peer pressure. I can't see anything wrong with it. It sounds reasonable to me and research suggests that it's more effective than other diet plans.

That's probably the last good thing I'll say about Weight Watchers. I'll try to report back later with more on how effective it is, but in the meanwhile I'm going to complain about the stupid and sloppy things WW does.

(For any fellow geeks interested in dieting on their own, I suggest checking out the Hacker's Diet.)

(2007-03-29: Typo fix: proben to proven. Later fix: apparent to apparently.)

So I'm giving Weight Watcher's a try. Normally I wouldn't share such information, but I'm so frustrated with them that I need to share. These are only my initial impressions. We'll see how I feel in a few weeks.

It's just slow. The site regularly timed out or was very slow. Resubmitting a given form or reclicking a link sometimes sped things up.

The web site is bad at guiding potential customers. I spent a modest amount of time looking around, and I never found a clear, "this is what you want" page. The closet you get is the not terribly specific The Plan page with links at the bottom. The links aren't helpfully labelled, "Do you want to attend local meetings, or work online?"

So I go to a meeting, sign up, and pay. Except I haven't really signed up. I need to log in online and re-register. Then I'll print out a temporary ID and they'll mail me the "real" one. Why can't this be handled at their store frontage?

The site demands that credit card numbers be entered without spaces. That's just stupid.

The field for entering my street address is too short. I should be able to see my entire address at once.

The subscription agreement is too long. Is five pages of contract really necessary? Back before they were so internet heavy, I'm confident they weren't dropping that much contract on their customers. Given the length, I'm confident the majority of their customers aren't reading it.

Come to think of it, why am I now agreeing to five pages of contract? I paid back at the store.

Those five pages of contract are initially presented in a little frame, showing about one paragraph of text, requiring lots and lots of scrolling to read.

Their contract is silly. There are "trade secrets" involved? I'm pretty sure if you're presenting information to millions of customers, it's no longer a trade secret.

The contract contains things I'm quite confident wouldn't stand up in court. My sole remedy in any dispute is to cancel my account? I think not.

The contract claims that I'm liable if a third party runs up charges using my credit card. I'm quite sure my credit card company will disagree with that. That this is even a risk suggests that they're willing to charge new charges (beyond the monthly fee) to my credit card on file. Can I opt out of that, because it's a bad idea? If I want to buy someting new, reconfirm my credit card number.

Between taking quite some time to read the overly long contract, then waiting The site is so slow that my attempt to sign up timed out, forcing me to restart from the beginning.

Why are the DIRECTIONS AND ADDRESS IN ALL CAPS? It's the twenty-first century now, we can use lower case.

So I'm finally set up, and I'm excited that they offer some software for Palm devices. Having their database of food and being able to track things on a device that I carry with me all the time anyway. No such luck. The software really wants to link to their web site. That's no good since I almost never HotSync. Even if I was willing, I'm not able; the only two operating systems in my apartment at Linux and MacOS X, neither of which is supported. I tried using Wine to run the Windows binary, but it refused me access since I didn't have the Palm Desktop installed and working.

So, has anyone else written something that might be a suitable tool? Yes, there's a free tool called WWJournal. Oops, Weight Watchers shut it down. It's typical scare letter that overgeneralizes WW's side of the situation and fails to point out that the tool's author could have continued to develop the software; he just needed to be careful to skirt WW's trademarks. Unfortunately the letter had its intended effect and killed off some valuable software. (I did eventually track down a copy, but regrettably since it hasn't been updated it's not much use.)

Finally, I try using the web site to figure out my points for my first day. It's still painfully slow. They have a new Flash based interface that takes forever to load. I'm having difficulty finding entries for things I had. Isn't the web site backed with their entire database? Doesn't that database have decades of research? Why are the only entries for "mocha whole" from for Starbuck's tall size? How do I adjust for different sizes? I can find rice crispies treat (under the slightly hard to find "crisp rice and marshmallow treat"), but it's only for "small." What's small? I have no idea.

Because the web is generally more convenient to me than a pair of books, I'm going to stick with the painfully slow web site. But I'm stuck with abusing the memos in my Palm and not getting any useful automatic calculations.

The local branch and the online site have zero connection. I have to tell the site information the local branch already knows. The local branch expects me to carry about a little piece of paper with my history and bring it to each meeting. The web site knows nothing about the little piece of paper.

Perhaps unsurprisingly I'm pretty displeased with Weight Watchers right now. This is an international corporation with decades of experience. Why does their online face suck so badly? The only ray of hope is that the plan itself seems reasonable and their meetings seem promising. I'm hoping that the problem is a long history of being technology free and that the non-technical aspects are much better. It seems reasonable given that their primary audience appears to be pretty non-technical people, and they high for local staff from their customer base. Absent a techie crowd to get promoted up, it may be that there is no one to beat their technical flaws into shape.

(2007-03-15: Tweaks and clairifications.)

Apparently Walgreens and CVS often charge ten times as much for generic drugs than Costco or Sam's Club. A few numbers. These are all for 30 doses of a given generic drug.

* From the online store. All others listed are retail outlets.

In the case of the generic Zocor, Costco admitted to paying $2.71 each. So even at $12 they're making about 300% profit. By comparison Walgreens is making about 2,100% profit.

Just another anecdote illustrating what a mess our medical system is in: "For Want of a Dentist." Some will focus on the children's health care angle, but they're missing the real point. If this was an adult nothing would be different. An $80 procedure might have saved the boy's life, but our overly complex health care system failed. So instead the problem was put off until it was an emergency, at which point the hospital was obligated to try and save the boy, in the process spending $250,000 that the hospital will likely never see. This sort of thing is endemic. Hospitals in or near poor neighborhoods often run their emergency rooms are substantial loses because they can never reclaim their expenses. To compensate they simply under staff their emergency rooms, leading to multiple hour delays. If as a society we made preventative and early care easily accessible many of these expensive emergency room visits would disappear, replaced by far less expensive earlier solutions.

(Via xoverboard.com.)

I'm biased against New York's ban on trans fatty acids. I would have entirely supported requiring labeling on the menu ("This item contains trans fats"), but I'm hesitant to limit food choices. However this article in Salon does make a compelling case. Apparently there will be no impact on the quality of the resulting food and only a very slight change in price. Assuming it's accurate, I find it telling that when the FDA required processed food to be labeled, the processed food industry swiftly eliminated trans fats from their production. That said, if labeling was good enough for packaged foods, why wouldn't it be good enough for restaurants?