Monthly Archives: October 2008

Does chocolate prevent heart disease?

chocolateThe Journal of Nutrition published a study on chocolate this month that was immediately picked up by the press. The headline of choice was “Dark Chocolate Prevents Heart Disease.” Slightly more discriminating publications were willing to say “Dark Chocolate May Prevent Heart Disease.” A marginally more accurate but still flawed headline: “Dark chocolate linked to lower risk of heart disease.”

The title of the original journal article is “Regular Consumption of Dark Chocolate Is Associated with Low Serum Concentrations of C-Reactive Protein in a Healthy Italian Population.” OK. Medical journalists need to translate dense, academic prose into everyday language. But there really is a big difference between saying you can prevent heart disease by eating chocolate and saying there’s a correlation between chocolate consumption and a medical marker associated with the risk of heart disease.

The first implies a cause and effect relationship. With the second, you have no way of knowing if the correlation is a coincidence and some other factor actually explains what you’re observing. You need to look at more than one study and the right type of study. Jumping to the headline “Chocolate prevents heart disease” is simply a quick way to get attention. That’s why you need to beware of health news. Read more

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EBM provider Bazian uses Scrubs to make a point

A few more things about Bazian, the company that provides the evidence-based medicine (EBM) analysis used by Behind the Headlines. (Bazian, BTW, is named after the 18th century mathematician Thomas Bayes, as in Bayesian probability.) Those who work at Bazian call themselves evidologists. “Evidology aggregates, filters and synthesizes the entire universe of research about a given question into one odds-based answer.” Hmmm. Well at least they’re the first to admit this sounds grandiose. But they insist it’s not: “If you’re not using evidology then necessarily you are basing decisions on opinion or individual studies, and these routinely turn out to have been wrong.”
Bazian has a colorful, casual, good-natured presentation on their website about EBM and what the company does. (See Sources below.) There’s even a slide of Doctors Kelso and Cox from Scrubs.

Scrubs doctors

Ahh yes, the change in the doctor/patient relationship. That’s a subject for numerous future posts.

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Get your health news here

As promised in the last post, I have a recommendation for a source of health news. It’s a site called Behind the Headlines. It comes from the National Health Service (NHS), the publicly funded health care system of the United Kingdom, and it’s available on the Internet at Behind the Headlines.
The information in Behind the Headlines articles comes from Bazian, a company that provides evidence-based information to publications and healthcare systems. I won’t go into all the pros and cons of evidence-based medicine (EBM) in this post. Just a brief overview, and why it’s useful in analyzing the news. (EBM has a poor reputation in the US because some insurance companies have used it to deny benefits to patients.)

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Health news and competitive journalism

Do you eat trans fats and high-fructose corn syrup? If you know the ingredients of what you’re eating, you can choose to avoid certain foods. But what about the consumption of health news? There is an enormous appetite for the latest medical findings, but no labels to tell us the ingredients: how are the stories selected, what are the sources of information, how accurate is the reporting. If we knew the ingredients, would we choose to avoid the majority of stories on medical research and health? In this post, I’ll discuss the ingredients of health news and, in the next post, I’ll suggest a reliable source.

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How the pharmas make us sick

Medicalization and disease mongering

I don’t have a lot of personal complaints about medicalization. As a woman, I don’t worry about erectile dysfunction or male pattern baldness. I haven’t had to decide to use Ritalin for a hyperactive child or growth hormones for a son who is shorter than his classmates. In my heart of hearts, I consider myself a social deviant (and am proud of it), but I don’t exhibit behavior that brings me to the attention of physicians, psychiatrists, or the law.

Many things that used to be considered a normal part of life – childbirth, menopause, insomnia, sadness, excess weight, aging, death – have been redefined as medical conditions and subjected to diagnosis and treatment. This process is called medicalization: Redefining a non-medical condition as a medical one. Medicalization is a major contributor to the health culture. It broadens the definition of health and encourages us to think of ourselves as in need of medical attention.

The active process of converting a benign condition into a medical disease is called disease mongering. Lynn Payer wrote a whole book on the subject: “[D]isease mongering – trying to convince essentially well people that they are sick, or slightly sick people that they are very ill – is big business. For people to use a diagnostic product or service, they must be convinced that they MAY BE sick. And to market drugs to the widest possible audience, pharmaceutical companies must convince people – or their physicians – that they ARE sick.”
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Are Americans naive about medicine?

There was a follow-up letter to “The Last Well Person” (see previous post) from a doctor in Spain. He pointed out that the “extinction of well people” was anticipated in the 1920s by the French comedy, Knock, by Jules Romains. Dr. Knock purchased the unprofitable practice of a country physician and proceeded to diagnose everyone in the village with an illness. He prescribed cures commensurate with the patient’s income. (This is really quite considerate compared to the reality of bankruptcy caused by medical costs in the US.)

Just as Dr. Meador used the quotation “A well person is a patient who has not been completely worked up,” Dr. Knock was known to say “The healthy are ill people who are unaware they are ill.” Meador’s response to the letter mentions further explanations for the “The Last Well Person” phenomenon: insurance coverage that requires a specific diagnosis even when there is none, disability insurance, worker’s compensation, Medicare, and television advertisements.
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The last well person

last-well-personIn 1994, Dr. C. K. Meador published a now classic, tongue-in-cheek essay called “The Last Well Person.” It appeared in The New England Journal of Medicine and starts with a great anecdote.

A supervising doctor asks a medical resident “What is a well person?” With a straight face — evidently — the resident confidently replies: “A well person is a patient who has not been completely worked up.”

Fortunately, we can recognize the humor in this, but it does give one pause.

Technological advances in diagnostic testing give modern medicine the ability to detect disease. Testing is also used to measure health “markers” that may indicate risk for diseases we do not yet have. Along with this comes an enormous increase in

  • the number of things a healthy individual can worry about
  • a health regimen of lifestyle options that presumably prevent disease
  • the obligation to continually monitor one’s health.

The compulsive pursuit of wellness

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"I" Is for Innocent: Health obsession in fiction

i-is-for-innocentThe rise of the health culture in the seventies and eighties was not gradual and imperceptible. It was abrupt and noticeable. Many commentators – journalists, doctors, sociologists – tried to understand its significance and implications. Here’s an example of how preoccupation with health made its way into fiction, from a Sue Grafton mystery published in 1992.

Kinsey Milhone’s dapper, 83-year-old neighbor, Henry, is a featured character in many Sue Grafton mysteries. In ‘I’ Is for Innocent, Henry’s brother William comes to visit. Over drinks at Rosie’s, Henry complains to Kinsey about his brother’s preoccupation with his health:

His health regimen occupied our entire day. Every hour on the hour, he takes a pill or drinks a glass of water . . . flushing his system out. He does yoga to relax. He does calisthenics to wake up. He takes his blood pressure twice a day. He uses little strip tests to check his urine for glucose and protein. He keeps up a running account of all his body functions. Every minor itch and pain. If his stomach gurgles, it’s a symptom. If he breaks wind, he issues a bulletin. Like I didn’t notice already.

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My personal odyssey through the health culture

When I taught at City University of New York in the seventies, I had a student who used to tell me not to eat chicken. I don’t recall the specifics, except that it wasn’t about cruelty to animals. It had to do with what chickens were fed (probably antibiotics and hormones) and what we consequently ended up eating ourselves. I didn’t stop eating chicken at the time, but I find it curious that I still remember the intensity of that student’s convictions. In retrospect, I think it was one of those “something’s happening here” moments, when you know something important is going on, but you can’t quite put your finger on it. Read more

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The Health Culture: Yesterday. Today. Tomorrow.

Health used to be something we were born with, not something we could personally control. Today most people in Western countries assume they can avoid certain diseases and prolong their lives by practicing a “healthy lifestyle.” How did this happen? Exactly when did this change occur? What does it mean today to be so preoccupied with health? And how will we feel about our health tomorrow when consumer gene-testing services are available for $59.95? My intent for this blog is to explore issues related to the modern health culture.

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