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MR. DAVID GREGORY: This Sunday, the White House predicts high unemployment through next year's election. On this Labor Day weekend, the jobless rate stands at 9.1 percent, new numbers showing zero job growth for August, as companies are still slow to hire and a slow housing market prevents recovery. The president prepares to speak to Congress and the nation about what the government can do to get people back to work. But what are the prospects of Washington acting during a fierce ideological fight over the economy? Political paralysis is just one of the factors holding America back and raising new fears that our country is in decline.
This morning, a special discussion featuring New York Times columnist Thomas Friedman, co-author of the new book "That Used to Be Us: How America Fell Behind in the World It Invented and How It Can Come Back."
Plus, previewing the political battles ahead in the 2012 campaign, as Republicans prepare to square off for the first debate that will include the new force in the Republican field, Texas Governor Rick Perry.
Also with us this morning, historian and author Doris Kearns Goodwin; The Wall Street Journal's Paul Gigot; Democratic Congresswoman from Los Angeles, Maxine Waters; and political strategist Mark McKinnon.
Then, as the nation prepares to mark 10 years since the 9/11 attacks, Army Captain and veteran of Iraq and Afghanistan, Joseph Kearns Goodwin, joins his mother, Doris, to discuss how that day changed his life and how the attacks define his generation.
Announcer: From NBC News in Washington, MEET THE PRESS with David Gregory.
MR. GREGORY: Good morning. Labor Day weekend marks the unfortunate end of summer and kicks off an intense, high-stakes political season. And if there is a headline that underscores what this campaign is all about, it's Saturday's lead news in The New York Times, "Zero job growth latest bleak sign for the U.S. economy." This morning as we near the 10th anniversary of the 9/11 attacks, America is taking stock of what the decade meant and what challenges the country now faces.
The president this week will yet again try to focus attention on jobs as the economy is stuck in slow growth. This week America was reminded of what's wrong with Washington, a short-lived but intense back and forth over when the president should address a joint session of Congress and the American people. In the end, it will be Thursday at 7, avoiding a conflict with Republicans who on Wednesday will debate about how and who should try to replace the president.
MR. JAY CARNEY: The sideshows don't matter. The economy matters.
(End videotape)
MR. GREGORY: It does, and it's not getting better. The question is, how likely is it that Congress will pass an Obama jobs package that includes more spending or investment in the economy? You remember the debt ceiling debate.
(Videotape, Tuesday)
PRES. BARACK OBAMA: We have to create more jobs, and we have to do it faster, and, most of all, we've got to break the gridlock in Washington that has been preventing us from taking the action we need to get this country moving.
(End videotape)
MR. GREGORY: Gridlock happens when there's an election, and next November is coming faster than you may like. This is a week for serious jockeying in the race. Is Sarah Palin or out? She dangled the prospect of a candidacy in Iowa this weekend.
FMR. GOV. SARAH PALIN: The challenge is not simply to replace Obama in 2012, but the real challenge is who and what we will replace him with.
(End videotape)
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MR. GREGORY: Mitt Romney, now trailing Texas Governor Rick Perry in the polls, will no doubt use this Wednesday's NBC News/Politico debate to begin a line of attack.
FMR. GOV. MITT ROMNEY: I spent most of my life outside politics dealing with real problems in the real economy. Career politicians got us into this mess, and they simply don't know how to get us out.
(End videotape)
MR. GREGORY: Republicans and Democrats are having the debate. The question is, as a nation, are we having the right conversation about the best way forward? That's what we're going to attempt right here this morning.
Joining me now, editorial page editor of The Wall Street Journal, Paul Gigot; presidential historian Doris Kearns Goodwin; Democratic Congresswoman from Los Angeles, Maxine Waters; and co-author of the new book "That Used to Be Us: How America Fell Behind in the World It Invented and How We Can Come Back," Tom Friedman; as well as former adviser to Presidents George W. Bush and John McCain, as well as co-founder of No Labels, an organization dedicated to putting party labels aside in politics, Mark McKinnon.
Welcome to all of you. Happy end of summer. That's what this means, as I said, and the challenges that await us as we get into the fall are pretty steep. Here's the context of this debate that we're having in politics and the debate about the economy. The unemployment numbers that came out in August have kept unemployment at 9.1 percent. No job growth in August, a pretty bleak headline. And these are the projections that the White House has released, keeping unemployment at 9 percent through the election year. They project it comes down to 7.8 percent by 2014. Something caught my eye this weekend. Howard Rosen from the Peterson Institute of International Economics in The New York Times yesterday, he said, "This is not just a jobless recovery, it's a recovery-less recovery."
Tom Friedman, the book is "That Used to Be Us," it talks about what's holding America back. It talks about fears of America's decline. With that backdrop, what is the major point in the framing of this book?
MR. TOM FRIEDMAN: Well, David, what I and my co-author Michael Mandelbaum from Johns Hopkins are basically arguing is we've got good news and bad news. The bad news is this problem didn't start in 2008 with the subprime crisis. This problem, in our view, started at the end of the Cold War. The good news is, there is a way out if we understand exactly where we are. I beg four big points, basically.
First of all, we made the worst mistake a country or species can make at the end of the Cold War, we misread our environment. We interpreted the victory in the Cold War--for the end of the Cold War as a victory and not understanding it's actually an onset of one of the biggest challenges we've ever faced as a country. We had just unleashed two billion people just like us. But the '90s turned out to be quite a party, thanks to the peace dividend, thanks to the massive productivity boost of the Internet, and thanks, most importantly, in many ways, to the collapse in oil prices, which was like a huge tax cut. Then that brings us into the 21st century. So really the '90s was like a 3,650-day victory parade for the United States.
Start with the 2000s, 9/11, which we're going to talk to here. Tragically, 9/11 set us on a really bad course. We spent the last decade, in many ways necessarily, many ways excessively, chasing the losers from globalization rather than the winners. And we made up for a lot of the fall behind there by basically injecting ourselves with steroids. Just as baseball players did it to hit home runs, we injected ourselves with credit steroids, created a huge housing boom and construction boom to create jobs.
The third, I think, big change is a big technological change. The world--we, we--the grid of the world, basically, the number of people who can compete, connect, and collaborate exploded in the last decade. You know, I wrote a book in 2004 called "The World is Flat," which is about this connecting of the world. We've gone from connected to hyperconnected in terms of the people who are now competing with us and connecting with us. When we sat down to write this book, I actually went back to "The World is Flat." I looked in the index, and I realized that Facebook wasn't in it. When I said the world was flat, Facebook didn't exist--or for most people it didn't exist, Twitter was a sound, the Cloud was in the sky, 4G was a parking place, LinkedIn was a prison, applications were what you sent to college and for most people, Skype was a typo. OK. That all happened in just the last seven years, David. And what it's done is taken the world from connected to hyperconnected. And that's been a huge opportunity and a huge challenge.
Lastly, I just say one thing, all of this is overlaid--and I'm interested in Doris' view on this, in particular--with a generational shift. We went from the greatest generation, whose philosophy was basically save and invest--and we are still living off their saving and investing--to basically the baby boomer generation, whose philosophy turned out to be borrow and spend. And we've really shifted from a generation born in the Depression, World War II, and the Cold War--these were serious people; they wouldn't think of shutting down the government for a minute, OK--to a generation basically that is much less serious. We've gone from basically the values of the greatest generation where--which were what my philosopher friend Dov Seidman calls sustainable values, values that sustain--to a baby boomer generation whose values are situational values. Do whatever the situation allows. You put them all together and I think you really account for a lot of the hole we're in right now structurally.
MR. GREGORY: That's the big picture, which we'll unpack a little bit.
Paul Gigot, to the immediate term...
MR. PAUL GIGOT: Mm-hmm.
MR. GREGORY: ...which is, again, this background, not just what got us here, but the fact that we're facing persistent unemployment. And it's not just about the jobs, it's the fact, the fact that the economy's not growing and here--we're going to hear from the president this week. What is he possibly going to say? What is it that government can possibly do?
MR. GIGOT: I think the president has to decide whether he wants an election issue or whether he wants to get something done. If he wants an election issue, he'll go big. Some of the--his liberal colleagues are talking about--friends are talking about saying, "We'll go F.D.R. all over again. We'll go with a big new jobs program financed by government. We'll go with more regulation." I think that's going to be a recipe for gridlock coming for the rest of the year, and may--will certainly set up a framework for the election debate.
But if he wants to get something done, I think he can confound the Republicans in part by going for a big tax reform, saying, "We're going to--you want tax cuts, OK. We'll reduce the rates. Let's get rid of the, the credits and other things in--to help pay for that and that will"--I don't know what they'd do. I think they'd be back on their heels and say, "Whoa, this changes the debate in a way that we hadn't expected. We're going to plan a run against Washington. He's now arguing on our turf." I think that's the fundamental choice the president has to make. I don't know which way he'll go, but if he wants to change the debate, that's the direction I would go in.
MR. GREGORY: We've been talking, as we get close to Labor Day, Congresswoman Waters, Labor Day being tomorrow, we spoke to James Hoffa, president of the Teamsters, about the American worker. And what he would like to see from the president this week--it was part of our Press Pass conversation that's available online, and I'll play just a portion of it here.
Mr. JAMES HOFFA: I think we've got to start jawboning big business to start hiring people. He's got to have a plan that's bold. He's got to have a plan that hires people. Maybe we have to come out with a WPA program, start putting people to work, you know, hiring some of the unemployed and put them to work, you know, basically rebuilding America.
MR. GREGORY: Is this possible? This is what Paul was just talking about. You're in Congress. You saw the debt debate. Do you really think that's going to happen now?
REP. MAXINE WATERS (D-CA): I absolutely agree that the president must be bold. I agree that he must have a jobs program, must create jobs. I'm talking about a program of $1 trillion or more. We've got to put Americans to work. That's the only way to revitalize this economy. When people work and they earn money they spend that money, and that is what gets the economy up and going. I don't think he can shrink from the threats of the right. I don't think he can have a program that simply gives more tax breaks to the very people who got us in this trouble in the first place. And so I'm hopeful, I'm very hopeful that the president is going to put a big program out there, and that he's going to fight very hard for it.
MR. GREGORY: Mark McKinnon.
MR. MARK MCKINNON: Well, the problem, David, is not just our economy, but it's our politics. And Bill McInturff, who's a great pollster, did an amazing study this weekend that's sort of draw-jopping--jaw-dropping. The Consumer Confidence Index has dropped 15 points in the last two months, and it's a result of the way the debt ceiling debate was handled. Not just the outcome itself, but the debate and the nature of the debate. And that's what we've been talking about at No Labels, that it's the politics and the way that our politics are being handled in this country that's creating a breakdown in confidence, not just in the economy, but in government and our elected officials to handle the problems that are out there today.
We talk about unemployment, but the Consumer Confidence Index is a really key barometer. And it's interesting to note that it--an average for incumbent presidents, the average when they win, the Consumer Confidence index is 95.9. When they lose it's 78.4. The Consumer Confidence Index today is 55.7.
MR. GREGORY: Let me--it's interesting you talk about that, also faith and leadership.
Doris, this is a cartoon that we like this week from Jimmy Margulies from The Record of Hackensack, New Jersey. And, of course, the president's visiting flood victims in Paterson today. So the president's in a boat because of the flood zone and he's got a copy of his polls in his hand. And he says, "I remember when I could walk on this water," which to me really symbolizes the fact that this was great expectations and now there's a great amount of disappointment in the president. Not just on the right, of course, but among his core supporters.
MS. GOODWIN: I hope he's got enough sense of self to be able to save those cartoons. Teddy Roosevelt loved all the terrible cartoons about him, put them all up on his wall. But I think the key thing right now, and to pick up on what Mark said, it's a political crisis as well as an economic crisis that we're facing. And he has to somehow in his speech be able to persuade people that government can do something about it. We've lost confidence the government knows what to do. So I think he confounds the Republicans in two ways. What you said, I think he goes for tax reform somehow and figures out how to pay for a big, bold jobs program. Every Republican has said, "Jobs creation, that's what we want." Tell them, "If that's what you want, I'm going to give you specific things that you can do," and challenge them to do it.
And that's what Harry Truman did in 1948. The Republicans were saying all the right things. "We're going to deal with the housing crisis, we're going to deal with inflation, we're going to deal with education." So he called them back in a special session, he called it the "turnip session" from Missouri. They did nothing, and then he was able to say, "Why didn't you do anything? You're the do-nothing Congress." If they want to deal with job creation, he has to be very clear about what he wants them to do. He has to make visual what those job--he can't just list things, an infrastructure bank. He has to explain how it would work and then challenge them to do it and find a way to pay for it at the same time. That's what he did before he got screwed up in the debt crisis. He had a bold plan that was balanced by tax increases. But then it--and people loved it. And then he got--lost it.
MR. GREGORY: Isn't a big part of this debate--and Paul it's, it's embedded in, in Tom's book, is the role of government, the debate about the role of government.
MR. GIGOT: Sure. It's government.
MR. GREGORY: You know, historically you've had great public/private partnerships. Now the notion of government being the last actor to try to create demand in the economy seems anathema to a generation of conservatives, and I say this new generation in the past, who've--the outgrowth of this past decade who say, "Hey, no mas. We, we've done enough of that as government." Is that--I mean, is there any way to get that back?
MR. GIGOT: I think that's the fundamental dispute here. The problem with what Doris is suggesting on the spending side is that the stimulus, the trillion dollar or so stimulus, $900 billion, is widely perceived to have not created any jobs. So it's going to be a very hard sell to try to get Republicans, in particular, to agree to more spending, particularly with the debt figures what they are. The other problem is the general broad mistrust of government. I mean, the Gallup survey out I think this last week showed that the approval rating for government was below oil and gas companies. Probably even below journalists.
MR. FRIEDMAN: No, no.
MR. GIGOT: Which is very hard to believe. And so that 17 percent approval rating, the country is saying, "We don't think government can create the jobs." We have to give incentives to the private sector, which is what we did in the '80s and the '90s, to grow again.
MR. GREGORY: Tom, you read a lot about this.
MR. FRIEDMAN: Well, you know, again I don't know about the immediate. And we--Michael and I, in this book, we're really focused on, on the longer term trend.
MR. GREGORY: Yeah.
MR. FRIEDMAN: And what we did was actually interview four employers, four major employers, one of whom actually is the new chairman of the Joint Chiefs of Staff, General Martin Dempsey. And we interviewed him when he was head of the Army Education Corps, and--which is just very recently. And here's what employers will tell you, David. They'll tell you that they're all looking for the same kind of employee now, someone who can do critical reasoning thinking, dot, dot, dot, in order to get an interview. That's not table stakes. What they're actually looking for are people who can adapt, invent, and reinvent the job because, in this hyperconnected world, change is happening so fast.
You know, there are companies now in Silicon Valley that do quarterly employee reviews now because their product cycle's changing so fast. You can't wait till the end of the year to find out you have a bad team manager. Now, that's got to work back toward education. What we argue in the book, basically going forward, is there are really just two kind of countries in the world, HIEs and LIEs, high imagination enabling countries and low imagination enabling countries. Forget developed and developing. Why is it? Because if I have a spark of an idea now I can go to Delta in Taiwan, they'll design it; skip over to Alibaba in Hangzhou, they'll give me a cheap Chinese manufacturer; and make a jump over to amazon.com, they'll do my fulfillment and delivery; go to Craigslist and get an accountant; and freelancer.com will do my logo. They're all commodities now. What isn't a commodity is this (snapping fingers). And the countries, actually, that are thriving today, look at Israel, start-up nation. We--we're not going to bail our way out of this crisis. We're not going to stimulate our way out of this crisis. We are only going to educate, ultimately, and imagine and invent our way out of this crisis.
MR. GREGORY: And, Congressman Waters, on the topic of education, look inside the unemployment numbers as we did for August, and this is what you find. If you have less than a high school degree, the unemployment rate is 14.3 percent. High school, 9.6 percent. But if you have a bachelors or higher it's 4.3 percent.
REP. WATERS: Yes.
MR. GREGORY: About half of what the national average is.
REP. WATERS: Yes.
MR. GREGORY: We always pay lip service to the fact that education is the top issue. It's not ultimately what becomes the top issue when you get into the voting booth, however.
REP. WATERS: Absolutely not. To tell you the truth, the plight of education in this country is shameful. Just a few days ago I learned that more cities, more states are reducing the number of education days down to four instead of five. And I could not help but stop and think, "Is this America? Is this the country that said and continues to say that education is a top priority?" Why are we not investing more in education? Why do we have dropouts? Why do we have educational systems that are failing? Why is it that we have a situation where many of our young people will not be able to compete in this high technological society because they're not properly educated? And so, no, we do pay lip service to education. We don't really invest in it, and that's got to change. But let me just say this, Americans want to work. This joblessness is not only hitting the middle class, but it is hitting all classes. It is absolutely unconscionable what is happening in the minority communities. When we look at this no jobs haven't been created in August and we find in the African-American community it has increased from 16 percent, 15.9, 16 percent, up now 16.7 percent, and now we're going to talk about cutting government by $1.5 trillion, this new 12 committee membership that we have after the raising the debt ceiling debate? And that means that we're going to lose more jobs, that means more people are going to be unemployed. The African-American rate will probably go up to about 20 percent. I don't know how our country can sustain that kind of...
MR. GREGORY: But this is the issue...
REP. WATERS: Yes.
MR. GREGORY: ...Mark McKinnon. I mean, as, whether you are more of a centrist or you're a conservative, I mean, there is a different level of faith in government to usher in the kind of change that the congresswoman is talking about, for government to do what government did in FDR's time.
MR. MCKINNON: No question. And what people believe is that we need big, bold changes. And what I'm worried about is that we're nibbling around the edges and people tend to disconnect the jobs discussion from some of the bigger issues, like entitlement reform. And I think they're connected. And my biggest criticism of the president is that he had two fiscal commissions over a year ago that he could have embraced and, and taken on some of these big challenges. And, had we done that, I think we've--we'd be having a much different discussion today.
MR. GREGORY: You know, there, there's something, Doris, in, in this book, in Tom's book about risk taking. What is the big risk that President Obama should be willing to take and what is he actually willing to take?
MS. GOODWIN: Well, I think he has to show that he's willing to take a risk. I think what we need now is strength in Washington, strength coming from him. I mean, one of the sad things about this whole contretemps about whether he should give it on Wednesday or Thursday night was once again giving in to the Congress when he has to challenge them. I don't think he has anything to lose by going for broke, going for--he's got to make people believe in government. Government is not only Washington. Government are our teachers, government are the people that you want to be out there that are policemen. Got to remind us that we, collectively, are government.
What does it mean during The New Deal? We worked together to solve our country's problems. What did we do during World War II? The country came together in a public-private partnership. We produced ships, tanks and weapons that were the miracle of the world, and it was the best government partner and labor partnership in our country's history. We can do that again, but we've lost--we've somehow made government out there and here we are. And the people who run for politics now hate government. What's the point? Why do you want to go in and be a politician if you hate government?
MR. GREGORY: Right.
MS. GOODWIN: It doesn't make any sense to me.
MR. GREGORY: Well, but, but see, conservatives are unabashed about that point saying that we've had too much government, it's not the answer, it's part of the problem; you know, getting in, in touch with their inner Ronald Reagan and reviving that and refreshing it.
Tom, what you have seen are, I mean, liberals like the congresswoman here have embraced, you know, the, the government and the role of government, but from the president, an unwillingness to really stand up and say, hey, I'm, I put my hand up for government because government is actually part of the answer here.
MR. FRIEDMAN: Yeah. Just to put up on Doris's point, and this is really the core argument of Michael's and my book, which is that we didn't get here by accident as a great country. We, we actually won in every historical turn. How did we win in every history turn? Because we had a formula for success that you could actually date back to Hamilton, but you certainly see it in Lincoln. It was five pillars. Basically, educate our people up to and beyond whatever the level of technology is, whether it's the cotton gin, OK, or the super computer. Immigration, attract the world's most talented and energetic people. Third, infrastructure, have the world's best infrastructure. Fourth, have the right rules for incenting capital formation and risk-taking and preventing recklessness. And last, government-funded research. Put those together, stir, bake for 200 years, and you get the United States of America. Now, if you take all five of those, David, and you look at the last decade, which we call the terrible twos, possibly one of the worst, if not the worst decade in American history. Education, boop; infrastructure, boop; immigration, boop; rules for capital investing--how'd you like that subprime crisis--boop.
MR. GREGORY: Right.
MR. FRIEDMAN: Government...
MR. GREGORY: Research and development.
MR. FRIEDMAN: Research and development, boop.
MS. GOODWIN: Right.
MR. FRIEDMAN: So all five of our pillars of success have been weakening. That's the underlying thing here. And, and, and, and that's what we've got to be looking at, that's what the president's got to be out there defending.
MR. GREGORY: And...
MS. GOODWIN: But he actually gave a speech about the pillars, about--one of the best speeches he made...
MR. GREGORY: Right.
MS. GOODWIN: ...you know, a year and a half ago, was about the need to restore those pillars. But the bully pulpit just doesn't have its bulliness anymore.
MR. GREGORY: Well...
MR. FRIEDMAN: But there's a notion that, I did all of this on my own. You didn't do squat on your own, OK? You did it thanks to the greatest public-private partnership...
MS. GOODWIN: Absolutely.
REP. WATERS: That's right. That's right.
MR. FRIEDMAN: ...working together in the right balance.
MR. MCKINNON: Our...
MR. GREGORY: Yeah.
MR. MCKINNON: ...(unintelligible)...is about policies that create growth. It's not just about investment, because growth is where the jobs come from, and that's where the big debate is, what creates growth.
MR. GIGOT: But the irony is...
MR. GREGORY: Yeah.
MR. GIGOT: ...of the last 30 or 40 years is the prestige of government has collapsed most rapidly when government has tried to do much more and more and, and do far more than it's capable of doing. Government prestige increased under Ronald Reagan, the great supposed enemy of government, because he showed when you focused on a couple things and did it well and got the economy growing that people said, "You know what, they're competent. It's working."
MR. MCKINNON: The confidence built.
MR. GREGORY: Confidence and competence.
MR. GIGOT: Absolutely.
MR. GREGORY: I think that is a huge issue. I mean, I, I think, you know, the issue for President Bush was not just Katrina, but it was how the Iraq war turned out. I, I always thought people were not opposed to the Iraq war, they were opposed to failure. They don't like when things don't go well. If it had just gone well, it would have been a completely different reaction.
I want to come back--I want to take a break, but talk about politics, because one of the things you write about, Tom, is the political system and its failings. We'll be back with our panel. We'll continue this special discussion, plus talk about the big political week ahead when we come back right after this.
MR. GREGORY: Coming up, what are the hot political stories trending this very morning? We'll be back with more from our roundtable right after this brief commercial break.
MR. GREGORY: We're back now with more of our roundtable. Big political week ahead. This is Labor Day weekend kicking off the marathon that is the presidential raid. Let's--race. Let's look at our week ahead. Romney's got a tea party rally in New Hampshire. A big one, tea party rally, in Columbia, South Carolina, tomorrow as well. We've got a new poll coming out on Tuesday.
Wednesday is what I really wanted to flag. It's the NBC News/Politico debate. It's at the Reagan Library, 8 PM Eastern. That's going to be a big event principally because it'll be Texas Governor Rick Perry's first debate, and we'll be watching that very closely.
And speaking of Governor Perry, he was asked this weekend by a nine-year-old who his favorite superhero was. And here we're talking about how to, how to get the country back on track, what's holding America back, fears of America's decline. This is a conversation that's happening in some ways on the campaign trails. So, again, here's the nine-year-old who asks Perry about his favorite superhero and this is what he said.
(Videotape, Yesterday)
GOV. RICK PERRY (R-TX): I'm going to show you my age a little bit, Ari, because I don't know any of the real current superheroes. But there was one back in my day named Superman.
CROWD: (In unison) Yeah!
GOV. PERRY: And Superman came to save the United States.
(End videotape)
MR. GREGORY: So, Paul Gigot, it inspires a little bit of laughter, but the serious point in all of that is that this is really the framing of his candidacy.
MR. GIGOT: Yeah.
MR. GREGORY: Which is America is off on the wrong track, and you need a--basically, "Waiting for `Superman'" like the film about education. Is that what this political campaign is about? And is Perry Superman?
MR. GIGOT: Well, he's going to contrast the record in Washington over the last decade with the record in Texas over the last decade, particularly in job creation; and it's a very different and very good message for Perry to make because they have created jobs. They have done a lot of the things that we say we want to do in Washington and haven't. That's his big, big strength.
He also--he has the best line of the campaign, where he says so far I think for the Republicans, which is, "I'm going to make--I'm going to get up every day and try to make Washington as inconsequential in your lives as I can." And that's a message that really resonates with Republican primary voters.
MR. GREGORY: Mm-hmm. Well, yeah.
MR. GIGOT: Now this is a big challenge for him Wednesday, though, because the question is with all of that behind him, he has rocketed up in public attention. Now does he have the staying power to do that or is he going to make mistakes that knock him back down?
MR. GREGORY: Mark McKinnon, you framed this fight on the Republican side in only--as only you can do with "Happy Days" references. And for those who might be, you know, under 30 watching right now, that was a fairly successful television program. How, how do you see Perry vs. Romney?
MR. MCKINNON: Well, I see it as a race between Arthur Fonzarelli and Richie Cunningham. And I think we know who Richie Cunningham is. Perry has taken off because he is giving voice to the anger and the heat in the Republican primary, that anti-Washington sentiment. He has honed that down to a fine art. And he's got the job story. He's created--there's been more private sector jobs created in Texas in the last 10 years than the entire country combined. So he's got, he's got, he's got a compelling message. Now he's getting up on the big stage this week, and he's never been on the national stage before, never been in a debate before. He's had nine successful elections in Texas, he's a very aggressive campaigner. This is going to be a big moment, a lot of people's first look. And it's a big stage, first time, so it's a lot on the line.
MR. GREGORY: Yeah. Go ahead, Congresswoman.
REP. WATERS: Well, as I understand it, the majority of the jobs that were created were government jobs in Texas. And I think we have to get...
MR. GREGORY: Private sector jobs, more private sector jobs.
REP. WATERS: We've got to get the exact information about where these jobs came from.
MR. GREGORY: I think that will, right, that will be, that will be vetted over time. Let's look at the line-up in terms of how the field looks right now according to Quinnipiac. And you do have Perry on top, followed by Romney and Sarah Palin, which gets to our Trend Tracker right now, tracking the hot political stories. And you may not be surprised when you look at the tracker that it's Sarah Palin. Still the question as she was in Iowa over the weekend and dropping hints and making speeches. Will she run?
Tom Friedman, there's still a great deal of interest in Sarah Palin as this political force in the middle of this huge conversation we're trying to have.
MR. FRIEDMAN: Well, to me, personally, that's a sign of the apocalypse. But I mean, you know, I--because this woman, everything I hear from her is--has nothing to do with what we argue in our book for the long-term trends of where our country's at. There is no short-term solution. It's not just getting rid of Obama. What strikes me about this moment, David, is like we're having an economic crisis and the politicians are having an election, and there's like no overlap between the two, almost. You know, these two circles.
You know, one of my favorite quotes in researching this, we went to Singapore. Singapore's a country that lives on the edge. A Singapore economist said to us, he said, "You know, Tom, we here in Singapore, we live in a thatched hut with no doors and no windows. We feel every change of breeze, every change of temperature, and we have to adjust. You Americans, you live in a brick house with central heating. You think you can sort of feel nothing." So where are we starting the conversation in the country right now? Are we starting the conversation where we should start it? What world are we living in? What are the big changes in the world? Here's a change, I just watched Mark McKinnon read his notes off an iPhone being captured by a robotic camera. Ten years ago, he had a secretary draw up those notes and there were three people who were operating that camera. They're gone. Those jobs are gone. They're not coming back. How do we adapt to that world? That's the question.
MR. GREGORY: It's...
MS. GOODWIN: In a scary time like this, what's interesting, though, is somebody like Perry, even though he might not appeal to the independents easily, as much as Romney might, eventually, because of some of his stands saying Social Security's unconstitutional, the income tax is bad. We go back to having the senators elected by state legislators. That was great when we had Mr. Oil and Mr. Gas and you could buy your way in the Senate.
MR. GREGORY: Mm-hmm.
MS. GOODWIN: But on the other hand, the strength, the confidence, the jazziness, the swagger that he shows, is sometimes what people care about even more than identity of issues when they're in tough times. So it means not looking at where this person's going to bring us, but the fact that this guy loves campaigning and he's got strength. But then the interesting thing is, if Romney does beat him, it will make Romney much stronger than if he had coasted as a candidate because he'll have to show--and then he'll look more moderate in comparison to Mr. Perry.
MR. GREGORY: Congresswoman, I want to ask you about something.
REP. WATERS: Yes.
MR. GREGORY: You know, one of the things that you talk to people around the country, and they're, frankly, disgusted with Washington. They want to see more compromise.
REP. WATERS: That's right. That's right.
MR. GREGORY: But then there's people, yourself and others...
REP. WATERS: Yes.
MR. GREGORY: ...who say, "Hey, out of the president we want to see more fight."
REP. WATERS: Yes.
MR. GREGORY: And it's, it's the extremity in language, it's the intensity of fight, and, and you have an example of this, as well.
REP. WATERS: Sure.
MR. GREGORY: Going back to this August, you said the following when you were out in Inglewood, in your district, about the tea party.
REP. WATERS: Yes.
MR. GREGORY: And I want to play it.
REP. WATERS: Oh, I did, yes.
(Videotape, August 20, 2011)
REP. WATERS: As far as I'm concerned, the tea party can go straight to hell. And I intend to help them get there.
(End videotape)
MR. GREGORY: Now, it's an applause line, but honestly, Congresswoman, is that really how you win the debate?
REP. WATERS: Let me say this, Americans are angry, and they're angry at politicians and government because they feel as if their government really does not care enough about them and their plight. They want jobs. The Congressional Black Caucus went to five cities during our break and some of the information that we gained basically helped us to understand there's desperation, there's hopelessness, and people think that they have to bail out the big banks and these financial institutions, and they're getting nothing for it. And one thing they're really angry about is the fact that these call centers are off-shore, where, for example, you had AT&T said, "Well, if you give me my merger, I'll bring my call centers back." And they feel as if the call centers should be brought back, That we should make it too expensive for our companies, our businesses, to take these jobs offshore. They want the jobs, and they want them back.
MR. GREGORY: Right. But this is a little bit like fighting the last war. I mean, you know, times have changed.
There's populism on the left, Paul Gigot, and there's populism on the right.
MR. GIGOT: Sure.
MR. GREGORY: That's what's fueling Perry. That's what's fueling the tea party.
MR. GIGOT: Sure. Of course.
MR. GREGORY: But that's not necessarily what's getting us to a place with some solutions.
MR. GIGOT: Well, in the end, this is going to be an election that's going to be settled on big ideas, which is the direction of the country, I think, in 2012. Are you going to have--if, if, if President Obama is re-elected, his economic policies will have been validated, and he will be able to continue in that direction. If, however, they are repudiated, I think you're going to see us move in a direction not unlike the kind of watershed election we had in 1980, where Ronald Reagan said, "I have a different idea, and I want to go in a different direction," and we'll give that a try. Yes, they'll be agreements in the middle; but, ultimately, what's what we do in elections, we set a direction. We've had a direction now for 30 months. The public is saying, "We're not satisfied with that direction." We're going to have a referendum on those policies. That's what we do in politics in this country.
MR. GREGORY: Right. But this is--Mark McKinnon, you've become a no labels guy, after working for Republican candidates or a Republican president, then Governor Bush. How do we somehow change incentives in campaigns so the kind of risk taking that all of us around the table seem to agree is a good idea in, in public policy and in politics, actually gets rewarded instead of penalized?
MR. MCKINNON: Well, that's exactly why No Labels was launched in December, and we have 300,000 members strong now. And we hear from Americans across the country saying, "We want everybody at the table, everything on the table." Politics is a market, and, and that market is the majority out there. They've just been quiet. And, in recent years, because of everything that was happening, their response was simply to throw their hands up and say, "We don't care." Now, the stakes are too high and they're engaging. And I think that there's going to be a huge response from the middle of America, and what they want is their parties working together. They want everybody at the table, everything on the table, and they know it's going to take big bold solutions and that everybody's going to have to sacrifice.
MR. GREGORY: It's interesting, it's interesting, Doris, one of the applause lines that Mitt Romney had that we, we played earlier was the idea that we've got a lot of government lifers, a lot of people who have been in government a long time. They're not necessarily the ones to lead us out of this mess because the sparks (snapping fingers)--this is not something you said (to Tom Friedman), but this is something you did, that's a communication for freedom.
MS. GOODWIN: I couldn't even do that. I was trying.
MR. GREGORY: But a lot of this, we know now what this means is going on, not in government, unfortunately, because the penalties are too high for that sort of, of spark creation. That seems to be a factor.
MS. GOODWIN: I, I mean, I think there's something to that. I mean, there's something about a bureaucratic mentality when you've been in these big buildings in Washington for a long period of time, you've got tons of regulations going on top of you, that you can't think imaginatively. But, again, you have to remember, government is not just that. I mean, government, as I said before, it's people working together collectively to put their talents to use with private energy, with the labor unions, and together those threesomes doing something. You can't take government out of the picture because government is collective will of us. Do you want to go back to the rugged individuals and the robber barons of the 19th century? That was great. Government was nothing. And we were terrible back then.
MR. GREGORY: Tom, you advocate a third party. Mayor Michael Bloomberg in New York has said on this program no way, no how is that going to happen. He would be among the strongest contenders to try to carry that off.
MR. FRIEDMAN: Well, it does seem to me that we do need a shock. We're the ones who need shock therapy that we administered to the Soviet Union at the end of the Cold War. The system needs a shock. I agree with Paul the next election, I hope, will be on a big idea. But I hope it isn't just big government against small government. I hope it's about our formula for success and getting back to it. You know, David, people have come to Michael and me and says, "Your book, `That Used to Be Us,' does it have a happy ending?" And we tell everyone it does have a happy ending. We just don't know whether it's fiction or non-fiction. You know, that really depends on us.
But I'll tell you what makes me optimistic, is that this country is still full of people who just didn't get the word. And they are starting things and inventing things and creating things and organizing things. If you want to be an optimist about America, stand on your head. You look at this country from the bottom up. You see the potential. We're like the space shuttle, all that thrust coming from below. But right now the booster rocket, Washington, D.C., is cracked and leaking energy. And the pilots in the cockpit are fighting over the flight plan. So we can't achieve the escape velocity we need now to get to the next level. You fix those two things, we take off. My favorite quote in this book is from...
REP. WATERS: Before we get to, before we get to the next level, we've got to recognize that there are big problems in this country. Foreclosures, the banks will not do loan modifications, and we have not come up with a program by which we can people in their homes. We need to be bold enough for the president to say to the bankers, "You come into this office, we're going to talk about how we're going to write down principals, how we're going to keep people in these homes, how we're going to make sure the interest rates are no more than 4 percent." People want to hear the answers about how they're going to have just a decent quality of life.
MR. GREGORY: OK. Let's get a final...
MR. MCKINNON: But to your question to Tom, there's something he's written about, there's going to be an effort on all 50 states that will be ballot accessed for an alternative nominating convention in all 50 states next year. So there's going--there's some things going on out there. It's called Americans Elect, and they're--so there will be an alternative nominating process. So there's frustration out there, and they're--people are tired with the system the way it is. They're working within the system and No Labels, but there's things happening outside the system as well.
MR. GREGORY: All right, we're going to leave it there. Thank you all very much. This morning, before we take a break here, a programming note. For more on Tom Friedman's book, "That Used to Be Us: How America Fell Behind in the World It Invented and How We Can Make--How We Can Come Back," you can watch his live interview on the "Today" program. That's Tuesday morning; plus, listen to an audio excerpt on our Web site, mtp.msnbc.com.
And coming up here, for many, the events of September 11th led to life-changing decisions. For Joseph Kearns Goodwin, it was a call to serve. As the nation prepares to mark the 10th anniversary of the 9/11 attacks, we'll look back on how that day affected his life, how it defined his generation. Forming--former Army Captain Joseph Kearns Goodwin and his mother Doris will join us right after this break.
MR. GREGORY: We're back with a special discussion as we look ahead to the 10th anniversary of 9/11. Joining me now, bronze star veteran of the wars in Iraq and Afghanistan, former Army Captain Joseph Kearns Goodwin and his mom, presidential historian Doris Kearns Goodwin, who is back with us.
Welcome to both of you. This gets a lot more personal, right, Doris...
MS. DORIS KEARNS GOODWIN: Oh, God almighty.
MR. GREGORY: ...than talking about the "big issues."
Well, Joe, it's great to have you here.
MR. JOSEPH KEARNS GOODWIN: Thank you.
MR. GREGORY: And as we talk about 10 years after 9/11, I wanted to talk about what that day meant, and what actually happened on that day for you and, and the days that followed.
MR. GOODWIN: Sure. Well, I was sort of--I graduated from college in the spring of '01, I was getting ready to go work at a political consultancy down in Washington, down here. And I'd sort of tossed around the idea of going into the Army, but never took it seriously. Then, after September 11th, I realized that my world was sort of inexorably changed, as it was for a lot of people. I remember I went in to see my mom, and I said, "Well, I guess I know what I'm doing now." She goes, "Yeah, you're not joining the Army, right?" And I go, "Well, you know, it might be the opposite." So on September 12th I went down to the closest Army recruiting station, signed the paperwork for what I thought was three years. It ended up being six, which is a life-long lesson in sort of reading fine print. But, that being said, it turned out to be an incredible experience.
MR. GREGORY: You know, I know you're here this morning as a veteran and also as a mere representative of so many others who served and volunteered to serve and who were already serving...
MR. GOODWIN: Right. Absolutely.
MR. GREGORY: ...prior to 9/11 and were trained and ready for that moment of great consequence. But describe the emotions of that time for you and what compelled you to say, "I got to do something."
MR. GOODWIN: You know, it was not so much, sort of, anger or the sense I wanted vengeance against the people who attacked us. I mean, there's maybe an element of that. It was more an understanding of there I was. I had just graduated college, I had not yet embarked on a career, and it became pretty clear on September and the days that followed that some young people were going to be needed to do something somewhere. We didn't know what it was. It was before Afghanistan, let alone before Iraq. And I just felt that I'd been sort of granted almost every advantage that a free and prosperous society can give you. I went to a great public school system. I went to a great university. I was prepared for it because of that public schools. I have a great family. I have a great Red Sox team. Although in 2001 that was probably more heartache than joy. And just sort of felt that because I was ready, willing and in relatively good shape it was incumbent on me to give something back to this great country that had given me so much.
MR. GREGORY: Doris, you were on the program the week after the war in Iraq started, with Tim, and this is the exchange you had.
(Videotape, March 23, 2003)
MR. TIM RUSSERT: You are a historian, but your most important job is a mother. Your son enlisted in the military after September 11th, Second Lieutenant Joseph Kearns Goodwin. What are your thoughts as a mother this morning as he finishes his flight school?
MS. GOODWIN: Well, he's currently in jump training, parachute training. I couldn't even go on a roller coaster, so physically I'm in awe of what he's been through. But, mentally, he feels that the Army has trained him as best as it could. He's been in leadership positions all along the way. He's met people he never would have met at Harvard College or Concord Massachusetts. And he's never second-guessed it. So I have to respect his decision. He'll be going overseas--whether he gets deployed or not to Iraq, we don't know--but he'll be going overseas in about 10 days.
(End videotape)
MR. GREGORY: He was about to go to war, and that was a pretty brave face, Mama.
MS. GOODWIN: Yeah, it was--it was a game face...
MR. GREGORY: Yeah.
MS. GOODWIN: ...because underneath, especially once he got to Iraq. I mean it was something at the very beginning I was so proud of his decision. I thought he would be part of a whole generation that were going to join and do something to help our country. And, as a historian, I was thrilled for him that he would have that experience. But then, once Iraq was there and once we started getting letters back from him from Iraq, very, very scary kinds of things, he even didn't tell us half of what was going on. Then you wake up, like any military family does, and every time you read something you worry, "Will something happen?" You obsessively look at the television, then you don't want to look at the television. I think the hardest part for me, to be honest, was not Iraq, because we got through that. He did well, he did incredibly well, but then he came back home. And then like so many others he was called back to another tour of duty. And it came to our house, the gobbledygook, from the military. I couldn't quite read it, saying, I think, "You're being called back to active service in Afghanistan." And I had to tell him.
MR. GREGORY: Mm-hmm.
MS. GOODWIN: He was working down here at NBC. But all those ranging emotions, as a mother, as a historian, in the end, I think he has seen a world he would not otherwise have seen. I am so proud of him.
MR. GREGORY: Joe, what, what--you wrote a few years ago that you really didn't feel America was at war.
Mr. GOODWIN: Right.
MR. GREGORY: As we are a decade later, where are we after 9/11? Do we, as a country, feel less secure. Do we have less, less faith in government? How have we changed?
MR. GOODWIN: Well, I do think, I mean, to your original point, that there was a huge missed opportunity after 9/11. I mean, as tragic as those events were, they really did bind us together as a country for a brief period of time, and I felt that a lot of the kind of mess we find ourselves in today might have been forestalled if back then people had been asked to contribute to the effort to the country in ways that they weren't. Now, that doesn't mean necessarily just bolstering the ranks of the Army. I mean, that would be great so you don't have these poor kids going back on their fifth and sixth tour. But, I mean, when, during World War II, and she's probably far more--can talk about this far better than I can, you had people that undertook tax increases, there were fuel rationing, kids were putting together rubber bands to contribute to the war effort. That call to service never came for us. And if we had asked people to sacrifice on September 12th, and I think they were ready, willing and able to do it, instead of putting two wars on a credit card, maybe we would not be in the mess we are today had that call to service came, because I think people were ready to respond.
MR. GREGORY: This has been defensive the last decade, preventing another attack. We've been at it for 10 years. We will conclude wars in Afghanistan and Iraq likely without much fanfare and without very clear results. This is not the end of World War II. We've been having this conversation about the restoration of America's greatness, if there's that feeling of decline. What are our emotions, do you think, emotions of a country 10 years later?
MS. GOODWIN: I think the hardest thing in contrast to the decade after Pearl Harbor was when everybody participated in that decade of World War II, you had everybody knew somebody who was fighting overseas. You had a Manhattan Project for atomic energy. You had, as you said, the rubber bands being rolled up. There was a feeling of closure when the war came to an end and a feeling of we all did it together. We've been spectators, most of the country, in this decade to the wars that have been fought in Iraq and Afghanistan. I mean, that was one of the things that was so difficult. When Joey's letters would came home, not only did we read them to everybody because everybody in our family wanted to read them. It was like primitive, going back to the letters 100 years ago. There was no e-mail in the beginning. But everybody we knew would want to hear about them because it was their one brush. Because especially in our world, our Ivy League world up in Boston, not very many kids had joined the Army then. The letters were, I think, the, the lifeline for me and for him. His brother Michael, who is 15 months older than him, wrote to Joey every single day, a hand-written letter, while he was in Iraq. And I kept thinking when they were four and five years old arguing over how many person had more cereal in their box.
MR. GREGORY: Mm-hmm.
MS. GOODWIN: And now they were best friends. That's all I needed to know, "I'll be dead, they'll have each other."
MR. GREGORY: You know, it's interesting the images that played out when Osama bin Laden was killed were really striking. Outside the White House, jubilation. I mean, young people, I--there was a young guy I know who was at college here in Washington who went down there to be part of it.
MR. GREGORY: At least this was an element of 9/11 that you can remember from being scared as a young person...
Mr. GOODWIN: Right.
MR. GREGORY: ...to now at least having some element of, of closure there. these scenes playing out at Ohio State University.
Mr. GOODWIN: Yeah, no, they're, they're, they're pretty spectacular. And I think you're right. I mean, for my generation at the close of the Cold War, there was that 10-year period where there was sort of this sense of maybe, "Hey, nothing's really wrong in the world. You know, everything is going to OK, everything's safe. We're all--everything's going forward." 9/11 was a stark reminder that the world is a dangerous one, it's a tough one, it's one with real issues and real problems. I don't think that's new for my generation, but that was sort of the time when my generation realized something that previous generations had realized from previous events.
MR. GREGORY: There, there's a conversation going on even as we're having ours, digitally and on Facebook. This caught our attention from Bryce G. "Graduating from high school in, in 2000 means many of my friends and family have served and continue to serve. This makes us a generation desensitized and accustomed to conflict and war. I have a sick feeling that if a time of peace ever actually happens again, we will be suspicious of it."
A final thought here, Joe. It ties together with this notion of being the new, greatest generation. What defines your generation that experienced 9/11 and served afterward, as you think about leadership, as you think about national purpose?
MR. GOODWIN: Sure. Well, I think what is great about America, what is great about any generation is 9/11 was a defining moment, but it's not what defines our generation. I think what's been go--so great about us throughout our history is to be able to encounter an event like 9/11, see what needs to be done, try to overcome it, but then go on with our lives. Go on with the business of, you know, of work and play and, you know, and everything all together. So while, like I said, while it is sort of definitional, I don't think it should define us.
MR. GREGORY: All right. Thank you for your service.
MR. GOODWIN: It was my honor. It really was.
MR. GREGORY: Joe, thank you. Doris, thank you.
As we think about 9/11 this morning and next Sunday's 10th anniversary, we want to remember those who were lost that horrible day, innocent victims as well as our first responders, firefighters, police and others. And we remember to say thank you to the men and women of our volunteer armed forces, like Joe, who have fought and died and served multiple deployments in Iraq and Afghanistan while their families endured their absence back home.
One such warrior who defined military leadership in the post-9/11 era took off the uniform this week. General David Petraeus, commander of U.S. forces in Afghanistan and, before that, CENTCOM commander, and, before that, commander of U.S. forces in Iraq, retired after 37 years of service in the Army, as he prepares to take the helm as director of the Central Intelligence Agency. Petraeus changed the Army, re-engineering how troops are trained and how they engage and fight the enemy. He most notably led the surge in Iraq. Chairman of the Joint Chiefs of Staff, Admiral Mike Mullen, called Petraeus not just one of the most important military figures of our time, but of all time. To him and to his wife, Holly, we offer our thanks and gratitude.
Next Sunday, on 9/11, MEET THE PRESS will not air as normal. Instead, I'll be part of our special network coverage along with Brian Williams, Tom Brokaw and Lester Holt, "9/11: America Remembers." We'll span the events and critical moments during the morning of 9/11. Join us as we look back on that fateful day one decade later.
And one other programming note. You can watch the rebroadcast of today's program this afternoon on MSNBC at 2 PM Eastern, as well as tomorrow morning for early risers at 6:00 AM Eastern.
That is all for today. If it's Sunday, it's MEET THE PRESS.


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Author(s): Jane Godwin
From a dynamic author-illustrator team comes this fresh, fun and rhythmic exploration of colour. Bold and bright, it's the perfect book for reading aloud and sharing with young children as they learn to identify the colours of their world.
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Heart and Circulation
Herbs and the Heart and Circulation
Keeping you up to date
by Herbal Practitioner Alan Hopking MA MNIMH
From the depths of my heart
"Dear Mr Hopking, I just wanted to let you know how pleased I am with your treatment of my high plood pressure. It was 190/105 when I went to the GP and I didn't want to go on his drugs. I came to you and you put me on Heart and Circulation medicine. I went back to him for another assessment today after 1 month and my reading is 130/85. He was astonished that I only took your herbal medicine. I will of course continue taking a low dose daily as you have advised. I feel so well and I thank you from the depths of my heart!!"
Mrs George.
Update on my husband (who is taking the Heart and Circulation Tonic) and his blood pressure, it is coming down and he is losing weight as well. He is taking the ABC powder also. We have always taken supplements but don't believe any have worked as well and as quickly as these. Again thank you for all you do.
Regards, Kay (USA)
A. Right BP - Key to Long Life
The relationship between blood pressure and cardiovascular disease is a continuous one. A normal blood pressure through your years is the key to a long life say the experts. Excess risk for cardiovascular disease begins to increase substantially at a SBP (Systolic Blood Pressure) greater than 140 mm Hg and a DBP (Diastolic Blood Pressure) greater than 83 mm Hg.(2) Factors such as age, race, sex, socioeconomic status, and other cardiovascular risk factors should be considered in determining the need for treatment.(3) Since it is estimated one fifth of British adults have SBP that averages over140 mm Hg and/or DBP that averages 90 mm Hg or greater. The Joint National Committee on Detection Evaluation and Treatment of High Blood Pressure V (JNC V) has reclassified hypertension to emphasize elevation of SBP and to phase out the outmoded adjectives mild, moderate and severe. (1)
Category ...SBP ....DBP
Normal ....<130 .....<85
Borderline 130-139.... 85-89
Stage 1.... 140-159.... 90-99
Stage 2.... 160-179.... 100-110
Stage 3.... 180-209.... 110-119
Stage 4.... >210.... >120
There is elevated risk of disease and death at all levels of hypertension and each requires long-term management.
Cardiovascular disease, which includes heart attack, heart disease, angina, heart failure and stroke, is still the nomber one cause of death in the West. It is becoming increasingly clear to scientists that the real causes of heart disease are sugar, the wrong kind of fats, processed meats, chronic severe stress, inflammation, high levels of homocysteine, gum disease, vitamin C deficiency, chromium deficiency and lack of exercise ... and not a high-fat diet and high cholesterol.
B. Risks of Hypertension
The choice of 140 mm Hg to define high SBP or 90 mm Hg to define high DBP should not imply a fixed threshold by which to initiate therapy. Persons with consistent readings between 85 89 mm Hg should be considered as having borderline diastolic hypertension, and although in most cases this does not warrant treatment, non-medication treatment should be started.
"Borderline" hypertensive persons are usually significantly heavier, and have higher total and LDL (bad) cholesterol, lower HDL (good) cholesterol, and higher glucose and insulin levels. (4) It has been concluded that "borderline" high blood pressure is associated with other cardiovascular risk factors. (4)
Coexisting high SBP is an important factor to consider since it has been found to be more predictive of cardiovascular disease and death in the majority of British men. (5) (6) Isolated high SBP is predominantly found among the elderly.
The six year risk of coronary artery disease mortality among men, 35 to 57 years of age, screened for the Multiple Risk Factor Intervention Trial (MRFIT) confirms earlier reports from Framingham that multiple cardiovascular risk factors increase the risk of coronary heart disease (CHD) and death. Cigarette smoking increases the risk by two to three fold independent of DBP and cholesterol levels. As cholesterol levels increase the risk of CHD mortality increases by three fold from the lowest to the highest category.(6) Between 1972 and 1990 the US experienced a significant reduction in the mortality rates for coronary heart disease (50%) and stroke (57%) in both men and women (1) compared to a decrease of <10% in mortality from all non cardiovascular diseases. (7) Goldman and Cook (8) estimated that lifestyle factors (less cigarette smoking, less saturated fat consumption and healthier dietary habits, and increased physical activity) have contributed to about 50% of the decline; physician initiated factors are estimated to account for about 40% of the decline. Recent data from the Framingham study suggest that the decrease in incidence of coronary heart disease is related to changes in lifestyle and to treatment of hypertension. (7)
C. Herbal Medicine and High Blood Pressure
The heart pumps 100,000 times a day. The blood travels through a maze of 60,000 miles of vessels. Blood pressure is vital to life. High blood pressure threatens it. Low SBP below 100mm Hg is also a danger. Blood pressure depends on the strength of the heart beat, the elasticity of the blood vessel walls, back-pressure resistance (e.g. body fat), muscle, blood thickness and volume, also the health of the liver, kidneys and lungs. Blood pressure has now been found to be totally unrelated to age - it doesn't rise with age. There are often no signs or symptoms of high blood pressure. But don't be deceived. To optimize heart health, choose foods such as green veggies and berries with low glycemic index ratings. If you occasionally must have foods with simple carbs, avoid those made from white flour; instead, have a modest portion of brown rice or whole-wheat pasta.(9) And exercise three times a week for half an hour. If you want to get off your diuretics, adrenergic antagonists, vasodilators, beta-blockers, etc contact your local NIMH herbalist. S/he will give you a full examination and monitor your withdrawal, as you take a mixture of herbs like Lime Flowers, Hawthorn, Motherwort, Yarrow, Garlic, Dandelion leaves, and Ginger root. Other herbs s/he may give are for the liver, kidneys, immune system, gentle detox and relaxants for a stressed nervous system. Recommended supplements for high blood pressure: vitamin C 1000mg; vitamin E 400 IU; B complex; Magnesium 300mg; Selenium 50mg. Or better still take just ½ tsp of our ABC Daily Herbal NutriPowder Plus to fully support and supplement your nutritional needs.
Health matters. Live a lifestyle that's both healthy & happy!
There are two important tonics important for heart health:
1. Cholesterol herbs used for those with a need to keep cholesterol under control - designed to gently cleanse the heart and arteries of lipids (fats). It's also a gentle stimulant for those who have circulatory problems like cold hands and feet. With Hawthorn, Ginkgo, Melilot tops, Safflower, Buck wheat, Madder root, Ginger root, Prickly Ash and Red Sage root.
2. Heart and Circulation herbs to normalize blood pressure and regulate the circulation - great for those who have general good health but are looking to support their heart health into the latter years. With Hawthorn berry, Lime flower, Motherwort herb, Horse Chestnut, Blood root, Stevia, Heartsease, Broom tops, Jujube seed and Hart's Tongue leaf.
References: 1. Joint National Committee on Detection Evaluation and Treatment of High Blood Pressure. The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med 1993;153:154 183. 2. Kannel WB, Stokes JI. Hypertension as a cardiovascular risk factor. In: Bulpitt CJ, ed. Epidemiology of Hypertension: Handbook of Hypertension, Volume 6. New York/Amsterdam: Elsevier Science Publishing Co, Inc., 1985: 15 34. 3. Browner WS, Hulley SB. Effect of risk status on treatment criteria: Implications of hypertension trials. Hypertension 1989;13(suppl I):I 51 56. 4. Julius S, Jamerson K, Mejia A, Krause L, Schork N, Jones K. The association of borderline hypertension with target organ changes and higher coronary risk: Tecumseh blood pressure study. JAMA 1990; 264(3) :354 358. 5. Lichtenstein MJ, Shipley MJ, Rose G. Systolic and diastolic blood pressures as predictors of coronary heart disease mortality in the Whitehall study. Br Med J 1985;291:243 245. 6. Kannel WB, Neaton JD, Wentworth HD, et al. Overall and coronary heart disease mortality rates in relation to major risk factors in 325,348 men screened for the MRFIT. Am Heart J 1986;112:825 836. 7. Sytkowski PA, Kannel WB, D'Agostino RB. Changes in risk factors and the decline in mortality from cardiovascular disease: The Framingham Heart Study. N Engl J Med 1990;322(23):1635 1641. 8. Goldman L, Cook EF. The decline in ischemic heart disease mortality rates: an analysis of the comparative effects of medical interventions and changes in lifestyle. Ann Intern Med 1984;101:825 836. 9. Am J Clin Nut 2000; 71(6): 1455-61.
Find out about herbal medicine for treatment of this condition
Intermittant Claudication
This is an awkward condition especially when you're out walking with friends! You keep have to ask them to hang on while you sit on the nearest bench and wait for your calf to reset. It is a cramping in the muscles a circulatory deficiency. We have a tried and tested herbal medicine for this condition which treats the spasms in the muscles and the circulatory deficiency.
This tonic can be taken for all kinds of cardiovascular issues.
It's good for heart health, the circulation, the blood itself, the blood vessel walls, etc.
Buy from our store
Heart and Circulation Tonic
Cholesterol Tonic
WorryLess Tonic
BloodCleanser Tonic
Intermittant Claudication
Varicose Veins
Related Products
|Heart & Circulation Tonic — for better heart, ciculatory and BP function. Also see Cold Hands and Feet Lotion.
Our herbal tonic medicines are carefully prepared on a personal and individual basis for your healing by medical herbalist Alan Hopking MA MNIMH FINEH.
Only whole herbs are used in our herbal medicines. Nothing else is added. If you have symptoms which you consider might be helped with herbal medicine please contact herbal practitioner Alan Hopking for a friendly confidential professional consultation. See terms and fees.
Once you have received your herbal prescription you can contact Alan Hopking at any time for more free advice (preferably by email). When you have completed your bottle of herbal medicine and if you want a repeat prescription you are requested to phone or email so that your progress can be assessed and adjustments made if necessary so that there is no break in your treatment. To order or re-order, click here.
MRCHM - see Alan Hopking's statement about renouncing his association with membership of this organisation
HERBACTIVE Centre of Herbal Medicine, England, UK. Freephone 0800 0834436
General advice to consumers on the use of herbal remedies from the Medicines Healthcare products Regulatory Agency
From the website of the Medicines Healthcare products Regulatory Agency (www.mhra.gov.uk) Department of Health, UK
• Remember that herbal remedies are medicines. As with any other medicine they are likely to have an effect on the body and should be used with care. • Herbal remedies may sometimes interact with other medicines. This makes it particularly important to tell your doctor or pharmacist if you are taking a herbal remedy with other medicines such as prescribed medicines (those provided through your doctor or dentist). • Treat with caution any suggestion that a herbal remedy is '100% safe' or is 'safe because it is natural'. Many plants, trees, fungi and algae can be poisonous to humans. It is worth remembering that many pharmaceuticals have been developed or derived from these sources because of the powerful compounds they contain. Any medicine, including herbal remedies, which have an effect on the body should be used with care. • Treat with caution any herbalist or other person who supplies herbal remedies if they are unwilling or unable to provide written information, in English, listing the ingredients of the herbal remedy they are providing. • If you are due to have a surgical operation you should always remember to tell your doctor about any herbal remedy that you are taking. • Anyone who has previously experienced any liver complaint, or any other serious health complaint is advised not to take any herbal remedy without speaking to their doctor first.
Pregnant/Breast-feeding mothers
Few conventional medicines have been established as safe to take during pregnancy and it is generally recognised that no medicine should be taken unless the benefit to the mother outweighs any possible risk to the foetus. This rule should also be applied to herbal medicinal products. However, herbal products are often promoted to the public as being "natural" and completely "safe" alternatives to conventional medicines. Some herbal ingredients that specifically should be avoided or used with caution during pregnancy. As with conventional medicines, no herbal products should be taken during pregnancy unless the benefit outweighs the potential risk.
Volatile Oils
Many herbs are traditionally reputed to be abortifacient and for some this reputation can be attributed to their volatile oil component.(6) A number of volatile oils are irritant to the genito-urinary tract if ingested and may induce uterine contractions. Herbs that contain irritant volatile oils include ground ivy, juniper, parsley, pennyroyal, sage, tansy and yarrow. Some of these oils contain the terpenoid constituent, thujone, which is known to be abortifacient. Pennyroyal oil also contains the hepatotoxic terpenoid constituent, pulegone. A case of liver failure in a woman who ingested pennyroyal oil as an abortifacient has been documented.
A stimulant or spasmolytic action on uterine muscle has been documented for some herbal ingredients including blue cohosh, burdock, fenugreek, golden seal, hawthorn, jamaica dogwood, motherwort, nettle, raspberry, and vervain. Herbal Teas Increased awareness of the harmful effects associated with excessive tea and coffee consumption has prompted many individuals to switch to herbal teas. Whilst some herbal teas may offer pleasant alternatives to tea and coffee, some contain pharmacologically active herbal ingredients, which may have unpredictable effects depending on the quantity of tea consumed and strength of the brew. Some herbal teas contain laxative herbal ingredients such as senna, frangula, and cascara. In general stimulant laxative preparations are not recommended during pregnancy and the use of unstandardised laxative preparations is particularly unsuitable. A case of hepatotoxicity in a newborn baby has been documented in which the mother consumed a herbal tea during pregnancy as an expectorant. Following analysis the herbal tea was reported to contain pyrrolizidine alkaloids which are known to be hepatotoxic.
Breast-feeding mothers
A drug substance taken by a breast-feeding mother presents a hazard if it is transferred to the breast milk in pharmacologically or toxicologically significant amounts. Limited information is available regarding the safety of conventional medicines taken during breast-feeding. Much less information exists for herbal ingredients, and generally the use of herbal remedies is not recommended during lactation.
Paediatric Use
Herbal remedies have traditionally been used to treat both adults and children. Herbal remedies may offer a milder alternative to some conventional medicines, although the suitability of a herbal remedy needs to be considered with respect to quality, safety and efficacy. Herbal remedies should be used with caution in children and medical advice should be sought if in doubt. Chamomile is a popular remedy used to treat teething pains in babies. However, chamomile is known to contain allergenic sesquiterpene lactones and should therefore be used with caution. The administration of herbal teas to children needs to be considered carefully and professional advice may be needed.
Perioperative use
The need for patients to discontinue herbal medicinal products prior to surgery has recently been proposed. The authors considered eight commonly used herbal medicinal products (echinacea, ephedra, garlic, ginkgo, ginseng, kava, St John's Wort, valerian). On the evidence available they concluded that the potential existed for direct pharmacological effects, pharmacodynamic interactions and pharmacokinetic interactions. The need for physicians to have a clear understanding of the herbal medicinal products being used by patients and to take a detailed history was highlighted. The American Society of Anaesthesiologists (ASA) has advised patients to tell their doctor if they are taking herbal products before surgery and has reported that a number of anaesthesiologists have reported significant changes in heart rate or blood pressure in some patients who have been taking herbal medicinal products including St John's Wort, ginkgo and ginseng. MCA is currently investigating a serious adverse reaction associated with the use of ginkgo prior to surgery. In this case, the patient who was undergoing hip replacement experienced uncontrolled bleeding thought to be related to the use of ginkgo.
From the website of the Medicines Healthcare products Regulatory Agency (www.mhra.gov.uk) Department of Health, UK
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Annual General Meeting of 18 April 2019 / 2018 Registration Document
Information available concerning the Annual General Meeting to be held on Thursday 18 April 2019 and the 2018 Registration Document.
L'Oréal informs its shareholders that its Annual General Meeting will be held at Le Palais des Congrès de Paris (2 place de la Porte Maillot - 75017 Paris) at 10 a.m. on Thursday 18 April 2019.
Information concerning this meeting was published in the BALO (Bulletin des Annonces Légales Obligatoires) on Wednesday 13 March 2019 and includes the agenda, the draft resolutions and details on attending and voting. This notification about the meeting together with the Board of Directors' report on the draft resolutions and legal information are now available on the www.loreal-finance.com website (under Regulated Information / Annual General Meeting Documents).
Other documents and information concerning this meeting will be available to shareholders and also published on the www.loreal-finance.com website under legal and regulatory conditions from Wednesday 27 March 2019.
The 2018 Registration Document was registered with the French Market Authorities on Thursday 14 March 2019. It is available to the public under current regulatory conditions and may be consulted on the www.loreal-finance.com website (under Regulated Information / Registration Document).
The Registration Document comprises the annual financial report, an integrated report, the reports from the Auditors and their fees, and the information required for the share buy-back programme.
"This news release does not constitute an offer to sell, or a solicitation of an offer to buy L'Oréal shares. If you wish to obtain more comprehensive information about L'Oréal, please refer to the public documents registered in France with the Autorité des Marchés Financiers, also available in English on our Internet site www.loreal-finance.com.
This news release may contain some forward-looking statements. Although the Company considers that these statements are based on reasonable hypotheses at the date of publication of this release, they are by their nature subject to risks and uncertainties which could cause actual results to differ materially from those indicated or projected in these statements."
Contacts at L'Oréal
Individual shareholders and market authorities
Mr Jean Régis CAROF
Tel.: +33 1 47 56 83 02
[email protected]
Financial analysts and institutional investors
Mrs Françoise LAUVIN
Tel.: +33 1 47 56 86 82
[email protected]
Mrs Stephanie CARSON-PARKER
Tel.: +33 1 47 56 76 71
[email protected]
Tel.: +33 1 47 56 70 00


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US hit by two fish recalls
True Taste is recalling hot smoked vacuum packaged Rainbow Trout, Whitefish, Herring, Mackerel, Salmon Steak and Cold Smoked varieties Mackerel and Whitefish because they could be contaminated with Clostridium botulinum.
Ocean's Beauty Seafoods is recalling Nathan's Brand Cold Smoked Atlantic Salmon 3 oz and LASCCO Cold Smoked Atlantic Salmon 4 oz.
Botulism in True Taste fish
True Taste of Kenosha, Wisconsin, issued a market withdrawal on 18 December and it affects products with production dates beginning on 1 January 2012 to the current date.
Potential for contamination was identified after routine samples collected by the Wisconsin Department of Agriculture, Trade and Consumer Protection found that the product did not meet the 3.5% minimum requirement for water phase salt.
Sample analysis reported water phase salt concentrations of 2.2% (hot smoked white fish); 3% (hot smoked herring); and 3.4% (hot smoked rainbow trout).
The recalled product is vacuum packaged and can be identified with either the True Taste Label in California and Illinois or the Lowell Foods Label in Illinois.
It has a white sticker applied to the package with the first set of numbers representing the date of processing and the second set of numbers representing the best if used by date.
No illnesses have been reported as yet but Botulism is a potentially fatal form of food poisoning.
Nathan's brand linked to listeria
Ocean Beauty Seafoods is recalling 371 cases of ready-to-eat cold smoked salmon products because of possible contamination by listeria monocytogenes.
The recalled products, made in Chile, were distributed to retailers from 20 November to 12 December.
The potential for contamination was noted after internal testing by the company revealed the presence of listeria monocytogenes in samples.
No other Ocean Beauty products are included and there have been no complaints or illnesses reported.
Lascco 4 oz Nova Salmon with the UPC 072840017517 involves 96 cases of fish and Nathan's 3oz Nova Salmon 073030803682 involves 275 cases.


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Online shopping is changing how retailers develop their global expansion strategies. A.T. Kearney's E-Commerce Index reveals which developing markets hold the most potential for online growth.
Retailers are constantly seeking new paths to growth. As revenue plateaus in developed markets, expansion into developing markets is a popular means for reaching new growth targets and boosting returns in overall portfolios. But choosing a developing market is more complex than looking through the traditional bricks-and-mortar lens to determine where to locate — it also requires looking through the online lens. As online sales skyrocket in developing markets, an online presence is a low-risk way to test new markets and complement existing store footprints.
As e-commerce sales skyrocket across the developing world, building an online presence is a low-risk way to test new markets or complement existing store footprints. Gaining maximum advantage from such strategies requires knowing a country's true e-commerce potential and its online market challenges.
A.T. Kearney's 2012 E-Commerce Index, the first in a series, examines the top 30 countries in the 2012 Global Retail Development Index™ (GRDI). Using 18 infrastructure, regulatory, and retail-specific variables, the Index ranks the top 10 countries by their e-commerce potential. The findings provide a wealth of information for retailers use in developing successful global e-commerce strategies and identifying emerging market investment opportunities.
Read more.


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- Home
- Flower Girl Dresses
- Ivory Flower Girl Dress with Baby Pink Petals
Product Description
This amazing Flower Girl Dress is the perfect addition to your wedding party. Beautiful petals float in the skirt, and can be changed to match any color scheme, thanks to a hidden slit under the back bow. This appealing dress features opulent bridal satin, and a multilayer tulle skirt that folds over too hold the petals. Gorgeous organza waist sash, is held in place with side stays, and comes around to tie in the back. This is the perfect dress for the discerning bride, who wants a real custom look for her Flower Girl. Our customer service department will help you create your own one-of-a-kind look. These beautiful gowns are made in the USA by artisans using the finest fabric available. This dress is made for babies and toddler. We have this dress in sizes 6/9 months, 12 months, 18 months, 24months and also in 2T, 4T, 5/6, 7/8, 9/10, 11/12. The fabric for baby sizes may vary a little.


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Porta del Sol Travel Guide
When Christopher Columbus reached Puerto Rico in 1493, he staggered ashore somewhere on the balmy west coast, a sun-soaked region known today as the PORTA DEL SOL, or "gateway to the sun". This is Puerto Rico's playground, with an enticing coastline rimmed by low-key resorts offering sensational snorkelling, diving and surfing. Yet tourists rushing to the beaches miss out on a traditional hinterland steeped in colonial history, with rickety old towns, crumbling ruins and a diverse landscape that runs from the forest-drenched northern mountains to the arid saltpans of the south.
The northwest coast begins at Isabela and Playa de Jobos, a gorgeous arc of sand and the perfect place for surfers to get warmed up. Punta Borinquen marks the start of Puerto Rico's prime surfing real estate, a chain of nonstop breaks that peaks in Rincón, one of the world's most revered surf centres but just as inviting for divers, horse riders and beach bums. Inland, the French elegance of the Palacete Los Moreau, the delicate lace of Moca and the historic towns of Aguada and Añasco provide aesthetic relief from the coast, while serious divers and adventure seekers should target Isla Desecheo and Isla de Mona further offshore. Mayagüez is the underrated capital of the west, slowly recovering some of its former glitz and loaded with fine colonial architecture, plus the best zoo on the island. The southwest is vacation central for Puerto Ricans, dominated by unpretentious resorts with heaps of character: Playa Joyuda has the seafood, Playa Buyé and Boquerón the beaches, and La Parguera an intriguing patchwork of canals and mangrove cays. Towering Cabo Rojo and its nineteenth-century lighthouse guards an otherworldly landscape of lifeless salt flats and reserves thick with bird life, while San Germán is a colonial pearl of a city with quiet, narrow streets and cobbled plazas, perfect for idling away an afternoon.
Porta del Sol
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On the last episode of the Real Housewives of New Jersey, millions of viewers watched as Joe Giudice not only got drunk in his home, but also berated his wife Teresa Giudice in front of guests and called his brother-in-law a gay slur.
Fast forward to today and in usual Teresa fashion, she is now defending the actions of her husband. Teresa, who graces the latest cover of In Touch Weekly magazine with photos of her extravagant vow renewal to Joe, tells the mag despite coming off as a jerk on national television, Joe is still her Prince Charming.
"He doesn't act for the cameras," says Teresa (Not helping his case there Tre!) adding that deep down Joe's really a "sweetheart."
When asked about Joe's "drunken bullying" on the recent episode of the RHONJ, Teresa asserts that she wasn't hurt by the incident. "He was drunk, in his own home and upset. I get where he was coming from."
Teresa also insists that Joe is not verbally abusive to her — but simply a guy who speaks his mind. "Joe is Joe," she states. "You really have to know him to know it's not malicious." She adds, "You learn, with age, to let things bother you less and less."
In other news, Melissa Gorga discusses the hardship of doing the RHONJ in the beginning and how she decided to join the show in an interview with The Insider. Below are excerpts from Melissa's interview –
TheInsider.com: What's it been like watching yourself on television?
Melissa Gorga: In the beginning it was hard, but the more I watch it, the more I enjoy it. I'm now at the point where I feel grateful that I'm getting to share my life with America. Show them how I do things. It's a great experience and I'm eating up every minute of it.
Insider: Teresa and her husband have not said very nice things about you and your husband. Has that been hard?
Melissa: It is. We all went through it months ago so to sit there and rewatch it and find out all these new things that people said behind your back in the confessionals is hard. It's hard not to pick up the phone and ask, "How could you say that about me?!?" But I take everything I see with a grain of salt because it was said when we were in that place. It's always hard to go back and watch it, but we knew what we were signing up for.
Insider: Having watched Teresa go through it for two seasons, what made you want to be a part of this?
Melissa: You know, in the beginning, Joe and I weren't sure if we wanted to do it. But because it really involved my husband's family, I completely left the decision up to him. It was so much more personal for him, so if he said yes, we were in, if he said no, we were out. I think he knew that we had something to offer and he went for it.
Insider: The cast is about to go on a big vacation together. Can't imagine that's going to be good.
Melissa: Yea, we go to Punta Cana and it's crazy. Kathy & Teresa get into a little tiff on the beach, but there's always a lot of fun mixed in with the drama – which is the Housewives way!
And finally, following a two week hiatus, a new episode of the RHONJ airs tonight on Bravo! On the 16th episode this season titled 'Singing in the Pain," the wives are up and running when they participate in a charity race, with Teresa's competitive nature on full display. Meanwhile, Melissa premieres her song to an unforgiving crowd in Hoboken. And Teresa throws a birthday bash for one of her daughters, highlighted by a jaw-dropping gift.
The episode airs at 10/9c. A preview clip is below!


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April 19, 2011 -- The average length of a hospital stay for hip replacement surgery has decreased significantly in recent years, new research indicates. But the rate of readmissions for complications or referrals to skilled care facilities has increased.
Researchers say the two findings are not likely coincidental. They say the readmissions and increased need for specialized care may be related to the shorter stay in hospitals after hip replacement.
Scientists examined data on 1.5 million Medicare Part A beneficiaries who underwent primary total hip replacement between 1991 and 2008, and also 348,596 people who underwent revision total hip replacements (replacement of an artificial hip joint).
The average age for hip replacement patients rose from 74.1 in the 1991-1992 period to 75.1 in 2007-2008, and obesity prevalence rose in the same period from 2.2% to 7.6%.
Revisions for Hip Replacements
For revision total hip replacement, the average age rose from 75.8 years to 77.3 years. Obesity prevalence went up from 1.4% in the early period to 4.7% in the most recent one.
Also, researchers say the average length of stay in a hospital for primary hip replacement patients decreased from 9.1 days in 1991-1992 to 3.7 days in 2007-2008.
Risk-adjusted 30-day mortality over the study period decreased from 0.7% to 0.3%. And 90-day mortality fell from 1.3% to 0.7%, according to the study.
Researchers also say that the proportion of primary total hip replacement patients who were discharged to their homes decreased from 68% in 1991-1992 to 48.2% in 2007-2008, while the proportion of patients sent to skilled or intermediate care facilities increased from 17.8% to 34.3%.
The readmission rate for all causes in 30 days decreased from 5.9% in 1991-1992 to 4.6% in 2001-2002, but then increased to 8.5% in 2007-2008.
"For revision total hip arthroplasty [replacement], similar trends were observed in hospital [length of stay], in-hospital mortality, discharge disposition, and hospital readmission rates," the scientists write.
Hip Replacement Becoming More Common
The authors write that total hip replacement is considered a safe and effective therapy for people with advanced degenerative joint disease, but that there "has been a dramatic increase in performance of this procedure both in the United States and abroad."
And though it has been assumed that increasing experience with total hip replacement procedures has resulted in improvements in patient outcomes, data to support this belief is limited, the authors say.
Study author Peter Cram, MD, MBA, of the University of Iowa, and colleagues suggest that statistics may indicate that reducing length of stay in hospitals after hip replacements might increase readmission rates and discharge of patients to non-home settings.
They also write that despite increasing patient complexity, unadjusted and adjusted mortality rates for primary total hip replacement procedures showed substantial improvement over time.
But the unadjusted revision total hip replacement mortality rate increased modestly, though this was "largely explained by increasing patient complexity," the study says.
Shorter Hospital Stays: Implications
The finding of a "marked decrease" in hospital length of stay after hip replacement surgery may have policy implications, the authors write, adding that hospitals may be motivated to reduce length of stay for payment reasons.
"We found that the reduction in hospital [length of stay] in both primary and revision total hip [replacement] patients was accompanied by a significant increase in the proportion of patients discharged to post-acute care facilities" such as nursing homes and rehabilitation centers "and a significant reduction in the proportion of patients discharged directly home."
Readmission rates have increased markedly in recent years, suggesting, among other things, that "perpetual reductions" in hospital lengths of stay seem to be occurring.
The study is published in the April 20 issue of the Journal of the American Medical Association.


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Recipe from Faith Hacker of Lexington, Ky.
Total Time: 8 hours
1 2lb. pork loin roast
2 T dijon mustard
1/2 tsp. kosher salt
1/4 tsp. black pepper
1 cup fresh apple cider
1. Place pork roast in crock-pot. Spread mustard over top. Sprinkle with salt and pepper.
2. Pour apple cider around roast.
3. Cover and cook on low heat for 8 hours.
4. Slice and serve.
Servings: 6
Comments: This was a favorite on my website (http://www.faithfuldinners.com/) last fall, and I've put it, along with others on the Sample Menu for all to enjoy!
*DISCLAIMER*: The information contained in or provided through this site section is intended for general consumer understanding and education only and is not intended to be and is not a substitute for professional advice. Use of this site section and any information contained on or provided through this site section is at your own risk and any information contained on or provided through this site section is provided on an "as is" basis without any representations or warranties.