I’ve become a great fan of the cooking column in the Guardian by Felicity Cloake @FelicityCloake . The Column, usually titled ‘How to cook the perfect’, sets about deconstructing the recipe world by picking the eyes out of well known recipes and professional cooks and presenting the ideal version of a dish. The recipes are generally favorites and often comfort foods.

This got me thinking. FC is promoting perfect recipes but what about perfect recipe books. So what constitutes the perfect recipe book? By perfect recipe book I mean the one that best allow the home cook to reproduce the recipe at hand.

Cook books vary quite a lot…some are just text (Elizabeth David for example) and others are masterpieces of photography (see Moderniste Cuisine)…..others are over glorified Women’s Weeklies (see Donna Hay).

For me the most perfect, but not the perfect, recipe book is Ferran Adria’s Th Family Meal: Home Cooking with Ferran Adria http://www.amazon.com/The-Family-Meal-Cooking-Ferran/dp/B00CF5WL0A . Ferran Adria ran the world’s foremost restaurant and the restaurant associated with molecular gastronomy. But this cookbook is about what he fed his stafff…honest to goodness home cooking. And why is it great and not just good?

The recipes are laid out with specific of the ingredients and quantities, indeed there are photographs of the ingredients standing alone, the progress of he recipe and the final product….pictures are a must. This cookbook also provides instructions for different quantities: numbers of portions are specified but you could simplify and say couple, family and banquet but most importantly it specifies a minimum quantity. When I cook I sometimes need to cook for two and sometimes more…it helps to convert the quantitites.

My second most favorite purveyor of recipes is Jamie Oliver….and not because of his overuse of adjectives. His recipes almost always are distilled to the simplest version, they are adaptable and they include (in the back of the book) nutritional information like calories, etc. I don’t care if what you are making is mussel infused seaside smoke….in 2014 the calories count.

A pet hate of mine is in-exact amounts. What the heck is a ‘bunch’ or a ‘pinch’. Let’s use quantities and metric ones at that.

So in conclusion: lots of photographs, accurate quantitities, calorie counts, step-by-step instructions….then it will be perfect

Listening to the Acacia Quartet on the vexations840 label playing Lyle Chan’s String Quartet: An Aids Activist’s Memoir in Music

Why is it that most recipes serve 4-6?

Most families max out at 4 and in reality when you have little kids you really cook for 2+2…..yet almost every recipe in every recipe book serves 4 to 6.

I admit it….some recipes work better when you cook for more….

But if you don’t have more consumers you end up with either supersizing your evening meals or more left-overs or more rubbish…after all many dishes don’t actually translate into left-overs very well.

The converse is the recipes for 1 websites.

Whatever happened to in-between?

One of my favourite cookbooks “The Family Meal” by Ferran Adria is a book that describes the meals the famous molecular gastronomist cooks for his staff. The perfect cookbook in terms of format it describes how to cook each meal for 2, 6, 20 and 75. It has pictures and detailed illustrated instructions. All it lacks is nutritional information….a detail that Jamie Oliver has tackled in his latest cookbooks.

Let’s promote more cookbooks for couples!

Billie Holiday – The Complete Decca Recordings

Don’t make Diva’s like this no more

Woolworths, or as we know it, Woolies, has been trialling in store health checks conducted by registered nurses http://www.woolworthslimited.com.au/page/The_Newsroom/Press_Releases/Woolworths_trial_of_in-store_cholesterol_and__blood_pressure_checks/

This is a trial but Woolies has signalled an intention to expand this in advertisements for health care professionals and students to conduct these checks. Is this acceptable or not?

The ‘Professions’ are hitting back claiming that the selected health practitioners don’t have the expertise to conduct these checks which might be done at the local GP or maybe the local pharmacy. This is just a land grab….don’t step on our turf.

The real issue is whether or not Woolies can actually produce a flow on effect to influence both shopper (patient?) behaviour and more importantly purchasing in favour of health care outcomes. A risk averse Woolies would have to have strict guidelines about who to refer on to medical practitioners in order to avoid medico-legal problems. The target population is everybody else i.e. the overweight – probably 60-70% of the population, the consequently pre-diabetic, the consumers with mild hypertension, etc, etc.

The other issue is whether this corporate social responsibility approach is duplicitous. What are they trying to sell (after all that is what Woolies does to earn value for shareholders). Will Woolies stop selling high-carb, high-sugar, health damaging products? What about tobacco? Or the alcohol business? What about it’s ‘home brands’? Will Jamie Oliver front the show after the farmers levy debacle?

Finally, is this just the first push into having US-style pharmacies in supermarkets (or as is the case, supermarkets in pharmacies). In the US pharma/markets capture a huge segment of the health care market?

Woolies is ultimately only doing this because it is commodifiable, and monetisable. That’s fine if it also produces health benefits for the population ad also isn’t misrepresenting itself as comprehensive patient-centred healthcare. Woolies also needs to remember its’ real competitors in the health space aren’t the doctors, nurses and pharmacists but the telecommunications companies.

Riccardo Muti and the Chicago Symphony Orchestra on CSO-Resound – live recordings

Anna Clyne – Night Ferry

Mason Bates – Alternative Energy

Jeremy Denk plays Charles Ives:

Piano Sonata No.1

Piano Sonata No.2 Concord Sonata

The Abbott Government has proposed a $7 co-payment for visits to general practitioners and a number of diagnostic services. In addition the co-payment for medicines may also be raised. This follows a recommendation from a National Commission of Audit that recommended a higher level of co-payment. Ostensibly the funds saved will be be invested in a Healthcare Research Fund that will in turn be used to support future health-related research. The purpose of healthcare research is essentially to gain evidence to support best practice – or what is commonly known as evidence-based medicine (EBM). So are health co-payments evidence-based?

The introduction of co-payments aims to reduce unnecessary visits to general practitioners and reduce unnecessary diagnostic testing. The problem with this approach is that it does not actually identify the extent to which unnecessary visits are a problem nor does it take into account that most individuals can’t actually identify whether their proposed visit is unnecessary nor do they have the tools to work it out. A flow on consequence is that it is individuals in lower socioeconomic strata that will choose not to attend their general practitioner regardless of whether the visit is unnecessary or for a genuine problem. In essence the introduction of co-payments reduces access to healthcare and possibly for those most in need. The Government argues that only those that really need the attention will now seek it. The naysayers say the individuals will just attend emergency departments.

If co-payments reduce access to care then what will be the effect? Worse health outcomes. This is graphically illustrated by the alternative scenario described by Sommers et al in Annals of Internal Medicine (2014) http://www.ncbi.nlm.nih.gov/pubmed/24798521 . This paper describes through time series analysis the introduction of near universal health care in the state of Massachusetts in 2006. These changes are similar to the Affordable Healthcare Act a.k.a Obamacare. Following the introduction of improved access to healthcare all-cause mortality in the state fell. I doubt the all-cause mortality in Australia would rise significantly with a co-payment, in part because of the acute care sector and also because avoidance due to co-payments tends to wane quickly but it is likely to increase the burden of illness especially for patients with chronic disease.

An alternate way to look at this issue is to look at patient adherence to medications. Lack of adherence is a major contributor both to healthcare morbidity and also rising healthcare costs. Sinnott et al in PLoS One (2013) http://www.ncbi.nlm.nih.gov/pubmed/23724105 looked at factors that improved patient adherence and demonstrated co-payments to be associated with worse adherence. Similarly Viswanathan et al in Annals of Internal Medicine (2012) showed that reduction in out of pocket costs, case management and patient education improved medication adherence in chronic disease settings.

So what are the implications for the co-payment policies related to general practice visits, diagnostics and medicines? Overall the literature (and this is but a small sample) would suggest that health outcomes will be worse and consequently there will be greater health expenditure in the rush to treat the side effects of these policies.

There is no doubt that ways of paying for healthcare to ensure a sustainable system must be found but co-payments as taxation is probably not the means. Other forms of taxation are required and perhaps Governments should reflect that the message they should be sending is not so much about the elevated taxes but how and where the money will be spent.

Bohuslav Martinu:

Sonata No.1 for Cello and Piano (H277 1939)

Sonata No.2 for Cello and Piano (H286 1941)

Sonata No.3 for Cello and Piano (H340 1952)

Olli Mustonen:

Sonata for Cello and Piano 2006

Jean Sibelius:

Malinconia Op.20 100

The Abbott Government has committed over $11 Billion to roads and Mr Abbott has himself declared that he wants to be the infrastructure PM.

This is all well and good. Roads are important – especially given the weekend gridlock in Australian capital cities…..and we all know Rome was built on roads, and not in a day.

But is this 21st century infrastructure?

Health is flagged as one of the major sources of growing expenditure yet there is no investment, only disinvestment (at least from the States), and taxation.

On of the major things a Government could do to reduce duplication, waste and unwarranted clinical variation would be to introduce widespread use of electronic health records. These would serve the purpose of recording each individual’s medical history and provide a platform for communication of health information between medical providers. Furthermore, if properly implemented, the record becomes a system for documenting healthcare resource use which would in term allow for better planning as as well as quality and safety improvements.

But health records don’t seem tangible infrastructure?

Well if this is the case then what the heck is the National Broadband Network….a system for more rapid distribution of Instagram pictures of cute cats?

Electronic health records need to been urgently regarded as critical infrastructure for Australia. I don’t actually care if the Commonwealth doesn’t control it providing it provides funds for the States to implement it properly rather than in a piecemeal fashion. Or alternately, if we bypassed the traditional Federalist approach we could genuinely have a system that is National and timely, rather than 6 or 7 approaches that need to be harmonised.