"Mommy, why is my hot dog bun blue?"

I'm a bit of a food safety zealot, poking cooked meats with thermometers and whisking leftovers into the refrigerator. But it's hard to keep food fresh and safe when you eat outdoors. On the second day of a camping trip last summer, for example, my daughter held up a bun and said "Mommy, why is my hot dog bun blue?" Horrified, I tossed the bun right away, along with a bag of its azure-tinged companions.

One in six Americans will get food poisoning this year, which causes about 3,000 deaths annually and, not surprisingly, spikes in the summer months. The CDC argues that forces such as the centralization of food production and increased consumption of food produced outside the United States make it increasingly difficult to prevent these outbreaks. Currently, Salmonella bacteria are infecting alfalfa and spicy sprouts in the northwestern U.S. and New Jersey, and a strain of E.coli bacteria in vegetables has killed almost 50 people in Germany and other parts of Europe.

It's scary stuff. But even without food contamination that originates in a farm or a factory, Americans do a pretty good job of giving themselves food poisoning on their own. To prevent food poisoning caused by lax food preparation habits at home, the USDA, FDA, CDC, and the Ad Council just launched a consumer ad campaign. Their clever, friendly campaign encourages everyone to keep food preparation areas clean, separate raw meat from other ingredients, cook food to the right temperature, and chill uneaten food adequately.

To remind us all to be careful with food this summer, here's a sample of the ads:

Health Reform and the ER

Many years ago, I developed a sore throat and a cough at the tail end of recovering from a cold. The sore throat became worse and worse each day, so I called my primary care doctor. But her office refused to see me. They were swamped with patients, it was flu season, and "you just have the flu," the receptionist told me.

Ultimately, sick and fed up, I dragged myself to my local emergency room. There, the professional and refreshingly compassionate nurses evaluated me and gave me a prescription for antibiotics to treat a raging sinus infection. When I recovered, I found a new primary care provider.

The problem I had was what many uninsured patients face every day: no access to a primary care provider. Without this access, they, like me, end up in the emergency room for urgent but non-emergency problems. This frustrates emergency room doctors and nurses, but they also understand that some patients don't have other choices for care. A pediatric emergency room doctor once explained to me that there was a tacit understanding between some uninsured parents and ER staff that many visits were not true medical emergencies, but their children had an urgent medical problem and the ER was the only place they could go.

Massachusetts legislators hoped to mitigate this and other problems with the health care system by mandating insurance coverage for all state residents, who must be insured through private or government plans. This grand experiment, initiated in 2006, has not turned out exactly as they had planned. But a recent study in the Annals of Emergency Medicine found that, although ER visits increased in Massachusetts after 2006, the number of "low-severity visits" decreased slightly ("Emergency Department Utilization After the Implementation of Massachusetts Health Reform").

Ideally, Massachusetts health care reform should have more dramatically decreased emergency room use. Increasing insurance coverage, however, also increases the need for primary care providers, and these providers are in short supply in both Massachusetts and elsewhere. The state's subsidies to expand health care coverage "do nothing to increase the supply of medical services in a market suffering from shortages of everything from family doctors to nurses to hospital beds," writes Shawn Tully in an article about health care reform for CNN Money ("5 painful health-care lessons from Massachusetts").

The CNN article, and a recent article on the LA Times ("One in three employers may drop health benefits, report says"), also point out that as health care reform is rolled out nationally, many employers might drop insurance coverage for their employees and choose to pay a non-compliance fine instead. This would increase the government's fiscal burden of health care.

There are a lot of challenges ahead for health care reform, and I hope the state and federal governments can work all this out. Although there's work to be done, I'm glad that Massachusetts is making some progress with reform, because I know how frustrating, costly, and inefficient it is to be forced to use the ER when you can't get care elsewhere.

Low-tech Bone Density Test Could Cut Health Care Costs

A paper presented today at the 93rd annual Endocrine Society meeting in Boston describes a possible link between bone density and facial wrinkles in women. The study's principal investigator, Lubna Pal, MD, looked at the number and depth of face and neck wrinkles and facial skin firmness in 114 post-menopausal women in their 40s and 50s.

Pal and her colleagues found that the women with fewer wrinkles and firmer skin also had greater bone density. Bone density was measured by dual X-ray absorptiometry (DEXA) and by ultrasound ("Severity of facial wrinkles may predict bone density in early menopause"). Skin wrinkles and bone density may be related because collagens that are present in both bones and skin change with age, Pal stated. In the future, measuring wrinkles could be a low-cost method of evaluating bone fracture risk in older women, Pal said.

Today, we face both the enormous expense of treating chronic diseases, costs which consume about three-quarters of the U.S. health care budget, and a large aging population poised to strain or end Medicare. Health care providers will probably increasingly turn to low-cost tests such as the wrinkle test, effective generic medications, and wellness campaigns to help manage their patients' health.