Monthly Archives: January 2009

Sanjay Gupta a victim of obesity myths?

Sanjay Gupta Fit Nation

One group that opposes the nomination of Sanjay Gupta as the next surgeon general is the Center for Consumer Freedom (CCF), an organization that promotes the interests of the restaurant and food industries. Anyone who suggests eating less can expect criticism from an industry that wants us to eat more. Gupta took on the topic of obesity in 2006 with his “Fit Nation” campaign.

In the CCF we encounter two of my favorite and related subjects. One is the difficult balance between corporate and public interests in a free-market economy. The other is how the “personal responsibility for health” mantra works against our best interests. If you are personally responsible for your own healthy lifestyle, then the food industry is totally innocent of contributing to heart disease, high blood pressure, diabetes, and obesity. The slogan of the CCF is “Promoting personal responsibility and protecting consumer choice.” They’re a wolf in sheep’s clothing.
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Sanjay Gupta, George Lundberg, and Obama’s Enneagram type

Sanjay Gupta

Back in November, following a two-hour meeting in Chicago, president-elect Obama offered Sanjay Gupta the position of Surgeon General. (This from a presumably reliable source: Gupta’s mother, Damayanti.) Gupta has been prudently tight-lipped about the appointment ever since the Washington Post broke the story in early January.

Gupta, the chief medical correspondent for CNN, discussed the situation with his employer in mid-December. He no longer covers health policy stories for CNN, but he can still be seen on “House Call,” his weekend health and wellness feature. When a plane crashed into the Hudson, CNN called on Gupta to discuss hypothermia, and when Senator Edward Kennedy collapsed at the post-inauguration luncheon, he was similarly “pressed into duty.”

The majority of press coverage has been favorable. Ezra Klein, in a “Momma said wonk you out” column, says the 1993 Clinton healthcare reform failed because it didn’t have a media strategy. The selection of Gupta signals that the Obama administration realizes it needs “a far more sophisticated media operation.”

On the other hand, Fox News refers to Gupta as “the TV doctor,” as if he were a cast member of General Hospital. Michigan Congressman John Conyers, a strong supporter of universal health care, opposes the nomination. He’s promoting Dr. Herb Smitherman, a public health advocate from Detroit.

There’s also support for Dr. George Lundberg as Surgeon General. Lundberg, a surgeon like Gupta, was the longest-running editor of JAMA, the Journal of the American Medical Association (17 years). He was abruptly fired by the AMA when he chose to publish the research article “Would you say you ‘had sex’ if…?“, a survey on the definition of “having sex” among college students. The offense was not simply the subject, but the timing. The publication date of the article was January 20, 1999. The Monica-Lewinsky-inspired impeachment trial of President Clinton had begun on January 7. Lundberg was fired on January 15. The AMA, of course, did not cite this incident as the reason for firing Lundberg. (For those curious about the results of the survey, see the footnote below.)

Lundberg, the author of Severed Trust: Why American Medicine Hasn’t Been Fixed, has a lot to recommend him. See the extensive commentary on the post “Dr. George Lundberg for Surgeon General” on The Health Care Blog (THCB). One thing I don’t see mentioned at THCB is that Lundberg’s appointment would be a slap in the face to the AMA, assuming 10 years isn’t long enough to let bygones be bygones. Such lack of diplomacy would be highly uncharacteristic of Obama, who strikes me as a Nine on the Enneagram.

The Enneagram is a spiritually based personality typing system, associated with Gurdjieff, Oscar Ichazo, and Claudio Naranjo. Type Nine on the Enneagram is called the Peacemaker. Since I’m a Nine myself, my opinion on this is highly subjective.

Here’s a cartoon about the nine Enneagram types that I think illustrates how we tend to see in Obama what we value in ourselves. That’s a good quality in a leader. If Obama thinks Sanjay Gupta is the right choice for Surgeon General, I’m inclined to agree.

Barack Obama Supporters Come In All Types
Obama Supporter Enneagram Types Cartoons

Cartoons by Elizabeth Wagele

Footnote: Would you say you “had sex” if…?

The JAMA article doesn’t say this, but one conclusion you could draw from the survey of college students is that they make a distinction between sexual activity that can lead to pregnancy and behavior that leaves one technically a virgin. The research survey was done in 1991 at a midwestern college and included students from 29 states. Close to 80% considered themselves moderate to conservative politically. Sixty percent reported that what happened between President Clinton and Ms. Lewinsky does not qualify as having “had sex.”

The medical purpose of the survey was to ensure that public health officials are gathering accurate information relevant to disease transmission. The sexual activity with the greatest risk of transmitting an HIV infection did not qualify as having “had sex” for 20 percent of those surveyed. In a situation comparable to that alleged between Clinton and Lewinsky, 75 percent of students would not list the other party as a sexual partner. (This latter statistic is from a later (1996) survey.)

Sources and additional links:

(Hover over book titles for more info.)

Editor, Gupta’s Surgeon General Appointment Runs Into Opposition, The Link, January 26, 2009

Reuters, Obama offers CNN’s Gupta US surgeon general post, January 6, 2008

Brian Stelter, Still Calling Dr. Gupta, The New York Times, January 20, 2009

Ezra Klein, The Three Constituencies for Health Reform. The American Prospect, January 8, 2009

FOX News Watch, January 10, 2009

Kenneth P. Vogel, Conyers: Gupta not up to S.G. post, Yahoo! News, January 8, 2009

Stephanie A. Sanders and June Machover Reinisch, Would you say you “had sex” if…?,
JAMA 281 (3), January 20, 1999, 275-7.

George Lundberg, Severed Trust: Why American Medicine Hasn’t Been Fixed

Brian Klepper, Dr. George Lundberg for Surgeon General, The Health Care Blog, January 25, 2009.

Here’s an article that argues Obama is an Enneagram Nine with a One wing (the same as Abe Lincoln).
Barack Obama’s Enneagram Type: The Peacemaker (9w1)

Here’s a blog post that labels Obama an Enneagram Six, based on his community leadership experience, and types Michelle a One.

Here’s a site where you can peruse or join the discussion of Obama’s Enneagram type.


Science, engineering, and the recession

It was the UK’s Bryan Appleyard who started me thinking about health and the recession. In an article on what to expect in 2009, he interviewed Chris Ruhm, who stands by his 1996 findings that recessions are good for your health.

“People get physically healthier and mortality rates fall during bad economic times,” he tells me. “It’s the opposite of what I expected to find.” . . .
“When times are hard, [people] control the things they can control – they live healthily.”

I think it makes sense that anxiety of any sort prompts some people to adopt healthy lifestyles, but I still don’t buy Ruhm’s conclusion that health gets better in bad economic times.
Appleyard also interviewed Rick Haythornthwaite, Chairman of the Board of Directors of MasterCard. Haythornthwaite comments that our brightest college graduates have preferred careers in finance since the early 1990s. If the Wall Street collapse encourages the “best young brains” to choose more valuable careers, that would be a plus.

“My hope,” says Haythornthwaite, “is that some of the most talented people will go back into science-based and engineering careers. So much of the financial sector is a zero-sum game, whereas science and engineering create sustainable wealth. That’s what’s going to get us out of this recession. It’s a good thing that jobs in the financial services are now so much less appealing.”

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Body awareness and the health culture

OK. So the economic downturn is really, really bad. We’re worried about being laid off. We may have already lost our jobs. Even if we’re still employed we have financial worries. And hearing about it all the time on the news gets us down. We start to have physical symptoms of poor health: headaches, muscle aches, sleeplessness.
I know this will be small comfort, but the symptoms don’t necessarily mean there’s really something wrong with our health. What I mean is, the symptoms don’t necessarily indicate an underlying physical condition. It’s not that we’re imagining the symptoms — it’s more complicated than simply calling it a psychosomatic mind-body thing.
We all experience physical symptoms every day: fatigue, headaches, stomachaches, rashes, coughs, and let’s not forget the unpredictability of our bowels. Such symptoms are like background noise. Sometimes we ignore them. Sometimes they become the focus of attention.
Four things influence our awareness and interpretation of physical symptoms:
· Our immediate circumstances. For example, the deli boy who made your sandwich was sneezing, coughing, and had a runny nose, and now you’re on the lookout for the signs of a cold.
· What we believe is the cause of our symptoms. Do we assume it’s something benign or believe it’s truly ominous?
· The amount of attention we give our symptoms. Symptom intensity decreases when we’re distracted, like when we watch TV or play basketball or even talk on the phone.
· Our mood. Strong emotions actually produce physical sensations. An angry person gets red in the face. Plus, moods like anxiety or depression can make us more symptom-sensitive.

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"Screw You Yahoo"

Losing your job is a powerful stressor that can have a long-term impact on health. A 2006 study by Sullivan and Wachter found that, in the 20 years following the loss of a job, your chances of dying increase by 15 to 20 percent. This makes a lot more sense to me than Chris Ruhm’s recessions-are-good-for-your-health studies.

Losing your job is often preceded by an incredibly stressful period of not knowing what to expect and fearing the worst. My friend Michelle Millis Chappel, singer/songwriter/musician and high tech usability consultant, wrote about her recent experiences at Yahoo. First there were the incongruities.

The fact that Yahoo would be having another round of layoffs was first announced at a company-wide meeting an hour before Yahoo threw a huge Oktoberfest party in which beer, bratwurst and German chocolate cake were served to everyone on campus. A week later we received sparkling wine and cupcakes to celebrate a recent Developer Network (YDN) success. Many people were curious as to why so much money was being spent on these parties, not to mention the upcoming Christmas party, because Yahoo was in such dire straights.

There was a massive re-org, generating lots of rumors.

One woman who lost all her reports packed up her desk weeks in advance of layoffs because she couldn’t take the pressure anymore. … Some people just stopped working altogether because there was nothing to do. … The VP of my division sent LinkedIn invites to all his reports …, so we figured that meant he was going to be asked to leave. But we weren’t sure because he was such a stellar boss. It made no sense. It was a crazy time.

Yahoo ended up laying off 10 percent of its workforce on December 10. Michelle, who was working there on a six-month contract, was not among them. To cheer up her friends and colleagues, she wrote and recorded a music video, “Screw You Yahoo.”

Nothing against Yahoo, says Michelle. It’s one of her favorite companies to work for. “You rhymed the best.”

Related posts:
The economy, stress, and health
An upside to the downturn?


Daniel G. Sullivan and Till Von Wachter, Mortality, Mass-Layoffs, and Career Outcomes: An Analysis Using Administrative Data, FRB of Chicago Working Paper No. 2006-21, November 2006

Michael Arrington, “Screw You Yahoo” Says Former Consultant, [L] Washington Post, December 17, 2008

Elise Ackerman, Layoffs spark public venting, San Jose Mercury News, December 23, 2008


How to read health news

Here’s a good companion thought to HRT and the incredible shrinking brain. It’s from Dr. Alicia White, an employee of Bazian, the evidence-based medicine firm in Great Britain. Bazian does research for the health news on Behind the headlines, the National Health Service site I recommend as a source of health news.

If you’ve just read a health-related headline that has caused you to spit out your morning coffee (“Coffee causes cancer” usually does the trick), it’s always best to follow the Blitz slogan: “Keep Calm and Carry On”. On reading further, you’ll often find the headline has left out something important, such as, “Injecting five rats with really highly concentrated coffee solution caused some changes in cells that might lead to tumours eventually. (Study funded by The Association of Tea Marketing)”.
The most important rule to remember is: don’t automatically believe the headline. It is there to draw you into buying the paper and reading the story. Would you read an article called, “Coffee pretty unlikely to cause cancer, but you never know”? Probably not.


Dr. Alicia White, How to read health news, Behind the headlines, January 6, 2009


HRT shrinks women's brains? What's wrong with this picture?

There was a widely reported story today about hormone replacement therapy (HRT) and a decrease in the size of women’s brains. The headlines were predictably but needlessly sensational. In fact, the study did not measure a decrease in the brain size of any individual woman.

Amsel Incredible shrinking woman

Source: Richard Amsel, The Movie Posters

First, the headlines. There were 27 stories listed when I checked Google news this afternoon. 19 of these (70 percent) used the word “shrink,” definitely a frightening choice of words when talking about one’s brain. Five stories (18.5 percent) used a less provocative descriptor: brain-tissue loss… reduced brain size… reduction in brain volume… affects brain mass… loss of brain tissue… You get the idea. Three stories (11 percent) elected not to refer to brain size in the headline. But two of those talked about brain “shrinkage” in the first paragraph, another waited until the third. So all of these stories led you to believe that the brains of women on HRT got smaller.
The rush of stories was based on two papers published in the January 13 issue of Neurology. The primary paper analyzed brain scans for abnormal tissue (lesions) in blood vessels. The second paper analyzed MRIs of the brain and reported:

Much to our surprise, we found a small but significant decrease in the hippocampal and frontal volumes, and a nonsignificant trend towards reduced total brain volume in women who had been randomized to hormone therapy.

I haven’t had an opportunity to see the original study, but none of the quotations I have seen use the word “shrink.”

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The economy, stress, and health

In October the American Psychological Association (APA) released its Annual Stress in America Survey. Compared to 2007, the 2008 survey found an increase in stress related to money, the economy, job stability, housing costs, and family health problems. Stress-related symptoms also increased: fatigue, feeling irritable or angry, lying awake at night, lack of motivation, feeling depressed or sad, headaches, and muscle tension.

Name your poison: Food, alcohol, tobacco

Almost half of those surveyed reported overeating or eating unhealthy foods in response to stress. Other behaviors that respondents claimed were stress induced: 25 percent cited skipping a meal in the last month, almost 20 percent used alcohol to cope, and 16 percent used smoking.
Katherine Nordal, the APA’s executive director for professional practice, commented:

With the deteriorating economy dominating the headlines, it’s easy to worry more about your finances than your health, but, stress over money and the economy is taking an emotional and physical toll on America, especially among women. … If Americans continue to experience these high levels of stress for prolonged periods of time, they are at risk for developing serious illnesses.

According to Nordal, it’s the stress we feel we have no control over that’s the worst. “It’s almost like a different threat level.” Sort of like going from orange to red.
Rajita Sinha, director of the Yale Stress Center at Yale University School of Medicine, explains the connection between stress and illness. Chronic stress weakens the immune system, interferes with sleep, increases our appetite, raises blood pressure, and justifies unhealthy habits.
In my view, health behavior in response to stress can go in two different directions. Some of us crave our favorite comfort foods (ice cream, potatoes, chocolate) or the vice of our choice. Why bother to be healthy at a time like this? But when risks seem beyond our control, some of us will intensify the pursuit of a “healthy lifestyle.” The ability to exert control over something, in this case our own bodies, is a strategy for reducing anxiety.
The APA’s parting advice on dealing with stress? Seek professional help. Hey, we’ve all got to look out for number one, right?

Related posts:
The financial crisis: Blame it on the collapse of Communism


America Psychological Association press release, APA Poll Finds Women Bear Brunt of Nation’s Stress, Financial Downturn, October 7, 2008
Sharon Jayson, Health takes a hit as economy creates more stress, USA Today, October 7, 2008


An upside to the downturn?

Money tape measureForeclosures. Layoffs. Retirement savings down the tube. One scary or embarrassing financial disaster after another. Such is life in the Great Recession of 2009. What if anything does this mean for our health?

It makes intuitive sense that health would suffer. But some research shows we’re actually ‘healthier’ in economic hard times and that death rates start to pick up right along with the economy.

Downsizing health: Dieting, cutting corners, and losing insurance

A majority of registered dietitians and nutritionists believe their ‘patients’ will have problems with weight during an economic downturn, since junk food is less expensive than fruits and vegetables. Financial concerns distract people from the discipline of a healthy diet.

Maybe. Maybe not.

Dietitians and nutritionists aren’t an unbiased source of opinion when it comes to the demand for their services. Still, one hard statistic is that enrollment in Weight Watchers has declined in recent months.
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The death of a child

One of life’s most tragic events is the death of child. Whether a child falls unexpectedly and hits his head or suffers from a disorder that progresses inevitably towards the premature end of a life – one cannot measure and compare such experiences.

We sometimes think of today’s biomedicine as an impersonal, corporate machine that prolongs the life of the terminally ill simply because it can. We criticize — I’ve criticized — maintaining the life of an elderly patient in an ultramodern ICU until she dies a lonely and undignified death. When the patient is a child, the decision to let go must be even more difficult for both family and physicians.

The Journal of the American Medical Association (JAMA) publishes a weekly feature where physicians (and others) can write about their more personal experience of medicine. In a recent essay, a doctor described how she was ready to let go of a young man’s life. The father was not. Eventually the doctor came to understand the father’s feelings.

the-doctor-luke-fildes-largeThe patient, Jason (not his real name), had suffered from Wilms’ tumor or nephroblastoma, a malignant tumor of the kidneys that occurs primarily in children. It’s a rare disease: Only 500 cases are diagnosed in the US each year. Jason had made it through his first year of college, but blood clots from his heart had traveled to his brain. After a series of strokes, his cognitive function was minimal.

Dr. O’Brien, a surgeon, was consulted about performing a biopsy of Jason’s remaining kidney. She advised a less invasive procedure, given the child’s condition. “[B]ut I didn’t feel that was even indicated given Jason’s advanced disease. This was my recommendation as a surgeon, an objective bystander, an unemotional witness, and a stranger.”

Jason’s father, Gabe, was angry and upset, and his interactions with Dr. O’Brien were hostile. “He was a surly and angry man, surly with both the nurses and the physicians. … The nurses assigned to Jason’s care would often be reduced to tears by his father’s remarks or his critique of their care. … His son’s diagnosis made him so angry he was the most feared and despised parent on the unit.”

The physicians and nurses had given up on Jason, but Gabe demanded that his son be kept alive with intravenous feeding and a mechanical respirator. He refused to consider hospice care. Jason’s severe inflammation of the bladder worsened over the next few months, but his neurological condition improved to the point where he could feel pain.

Gabe never left his son’s room, sleeping and eating there. Dr. O’Brien writes: “I would see him in private moments embracing Jason, talking to him, kissing his cheek and stroking his brow – always maintaining contact with his son’s body, the body that I regarded as an empty shell and that Gabriel worshipped and loved.”

After a second operation for the bladder condition, Dr. O’Brien and Jason’s oncologist had a difficult conversation with both parents. The surgeon reported her findings: Jason’s disease was widespread. When Gabe asked what she would do next, she replied, “I’m not going to do any more surgery.” The oncologist agreed.

Gabe was furious.

“Doctor,” he said, “I’m not stupid. I know what’s left of Jason but all I want is him.” His voice broke and this hard man crumbled into sobs: “All I want is to have him. I want to hold my boy.”

I had been the object of this man’s rage for so long that I hadn’t realized that he saw in Jason’s dying form a beautiful, vibrant young man. A young man who had survived babyhood against all odds; a young man who was planning a degree in English and political science; a young man who had been so wretchedly torn from his parents’ embrace. Suddenly I understood and, despite all my training and conditioning to the contrary, I held Gabriel’s hand and we wept.

Related posts:
Baby Isaiah May, October 24, 2009 – March 11, 2010
Baby Isaiah: Ethical dilemmas of modern medicine (2)
Baby Isaiah: Ethical dilemmas of modern medicine (1)
Baby RB: Ethical dilemmas of modern medicine


(Hover over book titles for more info. Links will open in a separate window or tab.)

Jeanne O’Brien, MD, Bodies and Spirit, JAMA Vol. 300 No. 20, November 26, 2008, 2348-2349.

A collection of essays from this JAMA column are featured in the book A Piece of My Mind.


Happy New Year

I love music and hope to write more about the relation between music and health in 2009. In the meantime, here’s the video Playing for Change.

The Playing for Change Foundation provides resources to musicians and their communities around the world and is dedicated to achieving peace through music.
May 2009 bring you health, contentment, and abundance.