Beyond the Breastfeeding Mothers' Bill of Rights

In 2009, New York passed its Breastfeeding Mothers' Bill of Rights, affirming mothers' rights to breastfeed any place, public or private. The focus of many provisions was on increasing mothers' access to information. Subsequently, hospitals had to share breastfeeding rates and other statistics.

A study to be published this fall in the American Journal of Law and Medicine finds that the law may have had larger effects, as hospitals and their staff responded to new disclosure rules by changing their practices. In a blog post today, Timothy Lytton writes:

The DOH regulation requiring hospitals to disclose breastfeeding rates among their maternity patients also influenced management within hospitals. Maternity unit managers used the breastfeeding data required by the regulation to train clinical staff, set performance goals, and monitor outcomes. The regulation has also encouraged frequent collection and use of breastfeeding data for quality improvement. A perinatal clinical nurse specialist in one New York hospital told us that she generates daily reports on breastfeeding rates in her unit and has been able to document a steady increase in the rate of breastfeeding among mothers in the unit. Data have also helped maternity unit managers advocate more effectively within their hospitals for changes in clinical policies.

Repeated reviews of compliance with DOH’s model breastfeeding policy and periodic data reporting have maintained a prominent place for breastfeeding promotion on the agenda of maternity care units and hospital management. Policies must be reviewed for compliance. Data must be disclosed to patients. These requirements continuously demand the attention of administrators, unit managers, and staff.

Our findings suggest that transparency policies can significantly influence government regulators and hospital administrators independently of their effects on patients. DOH officials and maternity unit managers appear to have used the pressure and information generated by New York State’s breastfeeding transparency laws to reform hospital policies and practices proactively, not merely in response to signals from patients.

Lytton and coauthors Barbara Dennison, Trang Nguyen, and Janine Jurkowski suggest that the study may have implications beyond just breastfeeding policy, providing an example of the ways that disclosure rules may have a downstream impact on actual services.

Pucker up! Pickling and Fermentation Cookbooks

Sour flavors are growing in popularity in the US and there’s a whole bunch of great cookbooks to help satisfy this flavor fixation.

Asian Pickles

Karen Solomon has done it again. She has written yet another very informative and useful book in her inimitable personable and upbeat style. She balances solid information with a down-to-earth sometimes playful approach. Her books are always fun. In this book she offers up recipes for Japanese, Chinese, Korean, Indian and Southeast Asian pickles. There are very traditional recipes for things like Miso Pickles or Green Mango Pickle as well as her own creative “inspired” pickles like Five Spiced Pickled Carrots and Sichuan Cucumbers with Orange and Almonds. You’ll also find chutneys and sauces. 

Bottom line? KEEPER unless you really don't like anything pickled. 

Fermented Vegetables

The subtitle to this book is krauts, kimchis, brined pickles, chutneys, relishes and pastes. Interspersed in the book are visual guides and profiles of people who make pickles and the like. It’s a wonderful resource and filled with both the usual as well as the unexpected. If you have a subscription to a CSA or a bountiful garden you will particularly enjoy how this book provides recipes to use your overabundance of everything from basil leaves to winter squash. There are even some wacky dessert recipes like Sauerkraut Coconut Macaroons. I particularly like the suggestions for how you can create your own recipes using the ones in the book as a guide. 

Bottom line? KEEPER especially if you are adventurous. 

Pickles and Preserves 

If you’re looking for something a little less exotic, Pickles & Preserves, a slim volume from the Savor the South series might be just the thing. It has recipes for classic Southern style pickles, relishes and chutneys. Dilly Beans, Pickled Okra, Watermelon Rind Pickles and Chow Chow. The recipes are easy to follow and well written. It's a short book, and narrowly focused. 

Bottom line? MAYBE KEEP only if you’re a Southern pickle fan

Kombucha Revolution

What is kombucha? It’s a fermented tea with sugar and bacteria from a starter culture. This book, one of the first of its kind, not only shows you how to make kombucha but also what to do with it. There are recipes for kombucha based juices and smoothies, cocktails, dressing and even both savory and sweet dishes that use it as an ingredient. The recipes such as Long Kombucha Iced Tea and Vegan Kombucha Chèvre Spread are creative and appealing—so long as you like kombucha! 

Bottom line? MAYBE KEEP only if you are an avid kombucha fan (even though I love sour flavors, I'm not)

Disclaimer: These books were provided as review copies, there are affiliate links in this post. 

Tofu Feta Tomato Bake Recipe

Recipes for tofu fall into two camps, those that highlight it versus those that hide it. While I do sometimes add tofu to recipes to increase moisture and tenderness, I don’t need it to be camouflaged to enjoy it. I like both the soft and firm textures and I appreciate how it plays well with others. While we are used to it in Asian dishes, the truth is it gets along with lots of other flavors too. I’ve been playing around with some products from Pulmuone, a company that makes quite a few soy products and this is one of my favorite creations. I used Wildwood sprouted tofu, which is made from sprouted organic soy beans. It has more calcium, iron and protein than conventional tofu and is a pleasantly firm. Anything but the softest tofu should work fine in this recipe. 

I got the idea to use tofu and feta together because they have a similar texture, then I found a member submitted recipe for Baked Tofu with Feta and Spicy Greens in the Epicurious database and decided to take it in a slightly different direction. Basically I used the ingredients I had in my fridge at the time, and hoped for the best. I was not disappointed. Sometimes cooking works like that, other times, well, it turns out ok, but nothing you’d necessarily bother repeating. I try to take good notes of what I’m doing and measure as I go, just in case I hit upon a winner. 

I would now like to implore you DO NOT FOLLOW THIS RECIPE. Change something or everything. The amounts and the kinds of green herbs would be a good place to start. Throw in some caper or olives if you like them. Use sundried tomatoes instead of fresh ones. Use white onions instead of green onions. Omit the cilantro or add parsley instead. Skip the feta altogether and make this your very own vegan masterpiece. This recipe is as forgiving as they come. It would be really hard to mess up. 

Tofu Feta Tomato Bake

Serves 2-4 

10 ounces firm tofu, preferably sprouted 

Salt and freshly ground pepper 

1/3 cup chopped green onions

1/3 cup basil chiffonade (thin slices)

1/3 cup roughly chopped cilantro 

2 teaspoons minced serrano chile, optional 

1 Tablespoon extra virgin olive oil 

3/4 cup diced fresh tomatoes 

1 cup crumbled feta cheese 

Preheat oven to 450 degrees. Slice the tofu in pieces to fit in a one quart casserole. Sprinkle the tofu generously with salt and pepper. Add the greens and drizzle with olive oil. Top the tofu with the diced tomatoes and finally with feta cheese. Transfer casserole to the oven and bake uncovered for 20 minutes or until feta begins to turn brown and gets crusty. 

Enjoy! 

Disclaimer: My thanks to Pulmuone for providing me with soy products to use

Is it really so bad that WTO ruled against U.S. in country-of-origin labeling dispute?

The World Trade Organization (WTO) today ruled in favor of Canada and Mexico, saying that U.S. country-of-origin labeling (COOL) rules violate our commitments in previous trade agreements.

The COOL rules in dispute required new labels on fresh beef, pork, and lamb, but not on processed foods such as hot dogs. The labels would say what country the product comes from. In some cases, the labels might have to be complex ("this cow was born in Canada, fed in the United States ...").

Many people who care about food policy from a public interest perspective will say the WTO ruling is terrible. For example, Food & Water Watch Executive Director Wenonah Hauter says today:

The WTO’s continued assault against commonsense food labels is just another example of how corporate-controlled trade policy undermines the basic protections that U.S. consumers deserve.

But let me ask, is the WTO ruling really so bad? I have two reasons for asking this question.

First, perhaps the WTO ruling has some merit.

Canada and Mexico claimed that the U.S. law was designed as a trade barrier, not merely as a consumer labeling provision. They pointed out that the tracking and record-keeping burdens fell more heavily on Canadian and Mexican producers than they did on seemingly similar U.S. producers. They also cast doubt on the consumer information merit of all this tracking and record-keeping, because so much of the meat was destined for processed food that never would carry a country-of-origin label anyway. If the U.S. asks Canada and Mexico to incur tracking and record-keeping costs, and then fails to share the resulting information with processed meat consumers anyway, it does look like maybe the whole point was just to create a burden for our trading partners.

It would be one thing if the United States simply never negotiated a trade agreement in the first place. But, it is another thing altogether if the United States does negotiate a trade agreement, saying we will reduce trade barriers in return for Canada and Mexico doing the same, but then we fail to do what we promised.

Second, from the perspective of Food & Water Watch and other trade-skeptical consumer groups, perhaps the consequences are not so terrible.

WTO critics claim such rulings violate U.S. sovereignty. For example, Lori Wallach, director of Public Citizen's Global Trade Watch says today:

Many Americans will be shocked that the WTO can order our government to deny U.S. consumers the basic information about where their food comes from and that if the information policy is not gutted, we could face millions in sanctions every year.

This is not true. The WTO cannot order our government to deny U.S. consumers such information. The WTO cannot rewrite U.S. laws. The U.S. can simply refuse to comply.

When the WTO rules against the United States, the only remedy the WTO has is the power to permit Canada and Mexico to put up trade barriers of their own, without these trade barriers being ruled non-compliant with the same trade agreements. In other words, the only power the WTO has is the power to state for the record, "fair is fair."

For example, if the U.S. chooses not to honor the WTO ruling, Canada has proposed a list of U.S. exports that may get new import tariffs at the Canadian border: corn, meat, apples, pasta, orange juice, and so forth.

The United States may honor its trade agreements, or we may fail to honor them. If we don't honor them, surely it is right to be good sports when Canada and Mexico establish new import tariffs.

On what grounds should Food & Water Watch or Public Citizen's Global Trade Watch complain about the WTO ruling? If it is fine for the United States to exercise our sovereignty, it is fine for others also. Far from griping about the WTO ruling, trade-skeptical public interest organizations could just tip their hat to the WTO, contemplate the consequences for reduced food trade, and declare, "all is well."

There is a good reason why they don't do so. Many Americans, especially in agricultural regions of the country, are glad for the business that trade brings in the form of increased export markets for our farmers. When we remember that Americans are food producers as well as consumers, the trade agreements begin to seem more sensible and the WTO begins to seem more reasonable.

Further information

Chapter 4 of Food Policy in the United States: An Introduction addresses trade issues. I do my best to make the case for a public-interest pro-trade perspective in a talk at Cornell University last fall (video here).

Spirit Works Barrel Aged Gin: Drinks on Friday

Barrel aged gin has been gaining popularity the past couple of years. It started perhaps with Seagram’s Distillers’s Reserve and then a handful of craft distillers got in on the act and more recently Beefeater began producing one. Some distillers use charred new American or French oak barrels, others use barrels that once held red wine, whisky or bourbon, and even Lillet, but I have to admit, on the surface barrel aging gin seems like an odd move. 

I like gin, especially London dry gin, and the reason I do is because of the botanicals. I like a touch of clean bracing juniper, the freshness of the citrus, the brightness of coriander combined with delicate floral aromas. Barrel aging adds richness and roundness to spirits, not something I necessarily look for in gin. But Timo and Ashby Marshall proprietors of Spirit Works Distillery in Sebastapol are fans of gin too, and in fact, Timo told me his favorite gin was the same as mine, so I was particularly curious to try their barrel gin. 

Spirit Works is a family affair, run by Timo and Ashby Marshall with their little bundle of energy, Bandit, a Boston terrier who runs circles around the place. Ashby is the head distiller and she makes a base gin using organic California Red Winter wheat and a proprietary blend of botanicals. She uses classic spices like cardamom and coriander plus painstakingly hand peeled lemon and orange zest, as well as angelica, orris root and hibiscus. The gin is aged for several months in new American oak.  

The result is really lovely. There is a slight mellowness to the gin, but the freshness is still intact. The barrel aging emphasizes those baking spices plus it layers on some vanillin and caramel. It’s a gin so smooth you can actually sip it, but try it in either a gin or a whisky cocktail such as a Negroni or a Manhattan, or use a splash of it in eggnog.

I highly recommend a visit to Spirit Works Distillery, not only because you are sure to be charmed by the adorable Bandit on a tour, but because you'll get a chance to see some of the very interesting things they are doing, like hooking up headphones to barrels to see how the musical vibrations of say the Nutcracker versus Metallica affect the spirits (personally I’m rooting for the Nutcracker). You can even sign up to help with bottling if you like. And even if you only visit the tasting room you can pretty much see the entire operation from large picture windows.

Disclaimer: My thanks to Spirit Works Distillery for inviting me to be part of the historic first bottling line for their barrel gin and for providing me with a bottle for review purposes. 

The "Trouble with Antibiotics" in U.S. animal agriculture production

Frontline last night had an excellent report, the Trouble with Antibiotics, on the plausible link between dangerous antibiotic resistant diseases and the overuse of antibiotics in U.S. meat production.

Poultry and hog producers use large amounts of antibiotics even in healthy animals, as a growth promoter and to prevent disease. As bacteria evolve to become resistant to these antibiotics, we lose important tools for treating deadly diseases in humans, including Methicillin-resistant Staphylococcus aureus (MRSA).

For readers who want to inspect the scientific evidence for themselves, here are some links to research mentioned in the Frontline report.

Jessica Rinsky, Lance Price (interviewed in the report), and colleagues found livestock-associated MRSA in workers from industrial livestock operations but not workers from antibiotic-free livestock operations.

Andrew Waters, Lance Price, and colleagues found that MRSA bacteria reaches meat on supermarket shelves.

Joan Casey, Brian Schwartz, and colleagues found in the Journal of the American Medical Association (JAMA) that antibiotic-resistant bacteria cases in humans were geographically associated with the proximity of nearby meat producers in Pennsylvania. The Frontline interviewer did a great job questioning the scientists and explaining both the strengths and limits of this type of geographic association.

Concerned about the Frontline story, the federal government's National Pork Board has been scrambling to persuade people not to worry about this issue. Reuters reports today that the NPB is funding an online public information campaign to defend antibiotic use. The most damning part of the Reuters report alleges that the NPB is using search engine optimization (SEO) tools so that web users seeking information about antibiotics are directed to industry-friendly web sources.

Both Reuters and the Frontline report describe the pork board as an "industry" association, but the National Pork Board is a semi-public checkoff program. The U.S. Congress created this board, the Secretary of Agriculture appoints its members from a slate of candidates suggested by the industry, and the federal government uses its powers of taxation to collect the "mandatory assessment" -- a tax -- that funds this public information campaign. This is not a voluntary industry association. All pork board messages must be approved by the federal government as its own "government speech," so our government is complicit in this public information campaign to rebut the Frontline report.

The industry representatives interviewed in the Frontline report didn't really dispute any of the facts, but they engaged in a rhetorical game of shifting the burden of proof. They argued that no further regulation is needed, because there is not yet certain proof that some of the research associations represent true cause and effect. Since nothing is ever certain in this type of research, the industry representatives can feel safe that no level of evidence would ever clear their hurdle.

One of the best passages in the Frontline report was an interview with FDA Commissioner Margaret Hamburg. The interviewer asked why FDA does not collect information about the quantity of antibiotics administered by meat producers. Though Hamburg squirmed under the question, she essentially confirmed that FDA wanted this information but could not get it because of industry opposition. In other words, the industry representatives say no action should be taken until we have certain proof, while simultaneously hindering access to the data needed to investigate the question.

The industry is pursuing some voluntary steps to reduce antibiotic use for the purpose of "growth promotion," but it has defined this term narrowly so that most antibiotic use even in healthy animals will still continue.

The Frontline report is strongly recommended. Now is the time for stronger measures to restrain the overuse of antibiotics in U.S. meat production.

Frontline, October 14, 2014.

Web search interest in "food policy" and "agricultural economics"

Circa 2005, U.S. web search interest in the terms "food policy" and "agricultural economics" was about equal. Nowadays, web search interest in "food policy" is much higher. There may be lessons in this for U.S. agricultural and applied economists.

Taste of Toronto

This Summer I got a chance to visit Toronto and to attend the Taste of Toronto food festival. Lucky me! Quite a few years ago I attended Taste of London so I had a sense of what it would be like. The Taste food festivals are not your typical free for all food event, because the restaurants are really consistently high quality and included by invitation only.

This event is a particularly good one if you want to familiarize yourself with the Toronto restaurant scene. Here were some of my favorite dishes and the restaurants I would surely like to visit, on my next trip.

One of the first things I tried was a gazpacho like soup from The Harbord Room. The crushed heirloom tomato soup with spicy wild watercress, creamy buffalo mozzarella, crunchy toasted sourdough crumbs and a refreshing dollop of tomato and white balsamic sorbet was perfect on a fairly steamy evening. Truly a winner.

Khao San Road was the one booth where I tried all three offerings, starting with the cooling iced Thai shake. The crispy rice salad with ginger, cilantro, sour pork sausage, lime leaf and peanuts was the knock out dish for me, it was just an explosion of flavors and cooked to order so fresh and crunchy.

The final dish I tried from Khao San Road was the spicy shrimp salad with onion, red pepper, fish sauce, chili, garlic and cilantro. It was cool and perfectly cooked, but a tad too spicy.

I was curious to try something from Anthony Rose, the chef and restaurateur with three successful spots in Toronto. From Rose & Sons came a BLT with Dr. Pepper bacon (more like pork belly) fresh tomatoes, lettuce and a feta and herb mayonnaise. It was extremely succulent and I could understand why this nice Jewish boy is revered for his sandwiches, and the BLT in particular.

Two of my favorite dishes came from Yours Truly a cutting edge restaurant which sadly just closed. Needless to say I will keeping my eyes peeled for the next venture with chef Lachlan Culjak. The first dish was a creamy fresh made "queso" with early Summer garnishes and an orange blossom vinaigrette. It was bright and had layers of texture. The freshness of the produce including ramps, fiddle heard ferns, mushrooms and berries shone brightly. And the plating was gorgeous.

The other dish from Yours Truly was charred sous vide BC octopus with chorizo and green mango.

While I didn't necessarily think of maple syrup and Toronto before, I do now. Thats's because I got to try the maple products from Ninutik. They were serving a variety of cheese wrapped in maple taffy, thanks a bed of fluffy snow. The thick maple syrup is usually poured over fresh snow to make a chewy candy, but in this case, a popsicle stick with a piece of cheddar or blue cheese (yes!) was wrapped in ensconced in maple. It was divine! 

So too were the little buttons of maple sugar that melt in your mouth, nothing like the dry crusty maple sugar candy I was used to eating. They can also be used in cocktails. 

And best of all? Maple Supreme, something I've seen elsewhere before and which I have had in other parts of Canada too. But it never quite as good. It looks white and creamy but it really has the consistency of butter, and the flavor of maple. Divine! Wonderful on buttered toast, but also over ice cream or oatmeal. 

Toronto, you sure are a delicious town. And Taste of Toronto was only the tip of the iceberg... 

Disclaimer: My thanks to Tourism Toronto for hosting me on this trip. 

USDA's new Food Insecurity Nutrition Incentive (FINI) for affordable fruits and vegetables

Friedman School graduate student Cailin Kowalewski reports today in the student publication Sprout on USDA's new financial incentive program:

The USDA this week announced a new grant program that will help participants in the Supplemental Nutrition Assistance Program (SNAP) afford fruits and vegetables. The Food Insecurity Nutrition Incentive (FINI) program will offer $31.5 million in competitive grants to organizations from across the food system. These organizations will be able to use FINI funding to support projects that increase SNAP participant access to fruits and vegetables through incentive programs at the point of sale.

The Sprout article provides a history and overview of the new program, and it notes divergent views on implementation questions, such as whether the focus should be on farmers' markets or whether it should encompass larger-scale retail channels as well.