Monthly Archives: February 2011

Imagine a future without cosmetic surgery

American Plastic Laurie EssigA less pithy title – and what I really mean – would be “Imagine a future where aesthetic cosmetic surgery wasn’t motivated by the images of celebrities/advertising/porn and by the dissatisfaction with normal bodies that these images create.”

In the concluding chapter of her new book, American Plastic: Boob Jobs, Credit Cards, and the Quest for Perfection, Laurie Essig suggests we might try using reality-check groups before going under the knife. We could weigh our decision, benefit from the input of friends, then opt for lipo if we were still determined to pursue perfect beauty relentlessly at any cost.

The purpose of such groups would not be to dissuade members from getting cosmetic surgery. It would simply introduce some objectivity. You might decide you really should get that facelift or breast augmentation, but “you will at least be making a far more informed and realistic choice than if you sit at home alone and watch plastic surgery shows while you try to pay your bills and fantasize that if only you looked better you’d have more money because your career would suddenly take off or Prince Charming would finally show up, haul you up onto the back of his horse, and ride off with you.”

The beauty solution

As part of her research for the book, Essig attended a number of conferences for plastic surgeons. One of them was in East Berlin, a meeting of the International Confederation for Plastic, Reconstructive, and Aesthetic Surgery.

The secretary-general of that organization, Dr. Eisenmann-Klein, delivered a speech on the future of cosmetic surgery. She quoted William Mayo (of Mayo Clinic fame) on “the divine right of man to look human.” She cited scientific studies that show the brain is hardwired for the “survival of the prettiest.” Currently 87.5% of cosmetic surgery clients are female, but – according to the good doctor – “the good news is that men in industrialized countries were becoming less satisfied with their bodies.” Read more

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Links: Birthing your own grandchild/Welch’s Overdiagnosis/Al Qaeda/Cats/Polar bears

Woman gives birth to own grandchild61-year-old woman gives birth to her own grandchild, and so what? (Practical Ethics)
The news is that it’s not news. Euthanasia, divorce, same sex marriage, in vitro fertilization — the common perception of these practices has changed radically in the last 30 years. Comments from Italian bioethicist.

Creeping sickness: Our epidemic of diagnosis (New Scientist)
Review of H. Gilbert Welch’s new book, Overdiagnosed: Making People Sick in the Pursuit of Health. (Just got my copy) Today people have pre-diseases: pre-diabetes, pre-hypertension, pre-hyperlipidemia, pre-osteoporosis. Healthy people with no symptoms are urged to seek treatment.

Overdiagnosis and the dangers of early detection (BMJ)
Ray Moynihan reviews H. Gilbert Welch’s new book. Overdiagnosis is one of medicine’s biggest problems, causing millions of people to become patients unnecessarily, producing untold harm, and wasting vast amounts of resources. Many of the big and costly medical conditions of our time are not in fact diseases, but rather are risk factors portrayed as diseases. “These decisions [about the definition of a disease and guidelines of its treatment] affect too many people to let them be tainted by the businesses that stand to gain from them.”

Cats Adore, Manipulate Women (Discovery)
Cats attach to humans, particularly women, as social partners, not just for the sake of obtaining food. They hold some control over when they are fed and handled, functioning very similar to human children in some households. “A relationship between a cat and a human can involve mutual attraction, personality compatibility, ease of interaction, play, affection and social support. A human and a cat can mutually develop complex ritualized interactions that show substantial mutual understanding of each other’s inclinations and preferences.” I can so relate to that. Read more

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The unavoidable and burdensome responsibility to be happy

Victoria Huggins American IdolI came across this photo of Victoria Huggins, of American Idol fame, while searching for an image of an annoyingly cheerful person. It was on a relatively new blog called Media Studies, written by Andover media student (I presume) Kristina.

Kristina describes Victoria as “Possibly the most annoyingly loud, optimistic, cheerful person you will ever encounter. With an incredibly high-pitched, overly exaggerated Southern accent and a specialty in church music, she is the poster child for America.”

Fortunately, I missed the episode of American Idol when Victoria appeared and was promptly eliminated.

Another post on Kristina’s blog caught my attention, as the subject is close to my heart: How media/advertising images of the ideal body have … how shall I put this … messed us up. She comments on how her college-age contemporaries found the cast of MTV’s Skins so ugly they couldn’t watch it, when these young people are in fact – Kristina says — uniquely attractive. I agree. (Click here for image.) Kristina’s comment:

What is beauty anymore, anyway? What have you done to our standards? You have raised them to an impossible high that will never be met without a computer unless eating disorders and cancer-causing beauty products become common practice.

Precisely.

Anyway, all this by way of introducing the following video. It’s been around for a year, but I just discovered it (thanks to Psychiatric Times). It comes from The Onion and has had a million and a half viewers on YouTube. Production level is high, as is the humor level. Read more

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Sex, lies, and pharmaceuticals

Sex lies and pharmaceuticals Ray MoynihanJust a quick word in reply to a review of Ray Moynihan’s Sex, Lies, and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction (co-authored by Barbara Mintzes).

First, the reviewer, British sociologist Linsey McGoey, criticizes the book for continuing its attack on the medicalization of life.

A few pages in, it’s hard not to feel déjà vu. Moynihan came out a few years ago with Selling Sickness, a book tackling the problem of medicalization, the tendency for typical life phases or human behaviour such as shyness to be medicalized – treated as disorders and diseases requiring medical treatment.

IMHO, there can never be enough books educating the public about medicalization.

Next she defends the pharmaceutical industry:

They [the authors] want to condemn [the pharmaceutical] industry for preying on human insecurity and profiting from the oldest adage in the book: Sex sells. The problem is, just as Viagra has been embraced by millions, its pink equivalent would be a sure seller – and not because consumers are dupes, or because industry is inherently malevolent, or because doctors are in the pockets of companies. Sure, some are, but such a thesis always oversimplifies the links between human disease and human desire. Most of them [sic] time, people want to be told that a problem is medical in orientation. It helps to exonerate a sense of personal blame.

Eliminating a sense of blame or shame is exactly the tactic pharmaceutical marketing employs. (See How the pharmas make us sick.) Viagra has been embraced by millions because ED has been medicalized! I was just reading about a “renegade” Canadian doctor who’s quoted on the subject: Read more

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Out of Practice: The demise of the primary care practitioner

Out of Practice Frederick M BarkenThe business of practicing medicine has not been good for doctors over the last 30 years. A post of mine called “Are doctors tired of practicing medicine,” on a site for primary care physicians, elicited the following complaints.

  • Doctors are no longer doctors, but poorly paid employees of the health insurance industry.
  • Without changes in how we treat doctors, more will retire early and med students won’t opt for primary care.
  • Everyone in the system is unhappy, obnoxious, or unsupportive, not just the doctors.
  • Maintaining electronic health records has a higher priority than caring for patients, and the effect on morale is disastrous.
  • The work doctors once did has been taken over by nurses, NPs, PAs, and hospitalists. We saw it coming, so we have only ourselves to blame.
  • No time for patients and too little reimbursement is extremely stressful.
  • Students these days prefer “lifestyle” specialties that pay well and give them nights and weekends off.
  • Even though you may love what you do, paying off med school loans lasts way too long, and that’s frustrating.
  • Despite modest financial ambitions and a strong motivation to help people, “managed care medicine really killed the doctor in me.”
  • This is not what doctors signed up for.
  • Interruptions, time pressure, low pay, high overhead, unrealistic expectations – who needs this?
  • We are not tired of practicing medicine … WE ARE EXHAUSTED.

There was not one response from a happy and satisfied physician. Read more

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Union busting and the inequality of wealth

International Association of MachinistsMy father was a member of the International Association of Machinists. As a child I remember seeing the IAM newsletter, with its logo, on the bathroom floor.

Times have changed. Union membership has declined. Behind the union-busting of Wisconsin’s governor, there’s an issue larger than organized labor, however. Paul Krugman writes about this in a New York Times editorial. (emphasis added)

[W]hat’s happening in Wisconsin isn’t about the state budget, despite Mr. Walker’s pretense that he’s just trying to be fiscally responsible. It is, instead, about power. What Mr. Walker and his backers are trying to do is to make Wisconsin — and eventually, America — less of a functioning democracy and more of a third-world-style oligarchy. …

In principle, every American citizen has an equal say in our political process. In practice, of course, some of us are more equal than others. Billionaires can field armies of lobbyists; they can finance think tanks that put the desired spin on policy issues; they can funnel cash to politicians with sympathetic views (as the Koch brothers did in the case of Mr. Walker). On paper, we’re a one-person-one-vote nation; in reality, we’re more than a bit of an oligarchy, in which a handful of wealthy people dominate.

Given this reality, it’s important to have institutions that can act as counterweights to the power of big money. And unions are among the most important of these institutions. …

[T]hey’re among the few influential players in our political system representing the interests of middle- and working-class Americans, as opposed to the wealthy. … Read more

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Links: History of modesty/Hygiene hypothesis/Men into boys/Koch brothers/Obese pets

Patient modesty mothers and sonsHistory of Modesty, Part 2 (Patient Modesty & Privacy Concerns)
Part two of my post on the history of patient modesty is up as a guest post on the Patient Modesty blog. I discuss how, in the 19th century, doctors got patients to accept a much more invasive physical exam than what patients were used to.

Greater Germ Exposure Cuts Asthma Risk (WSJ)
Another example of the hygiene hypothesis. Children living on farms have a lower risk of asthma than children who don’t because they are surrounded by a greater variety of germs. Key is exposure to diversity of germs, not just more of them. “You have to have microbes that educate the immune system. But you have to have the right ones.”

Where Have The Good Men Gone? (WSJ)
This is sure to get lots of attention. From Manning Up: How the Rise of Women Has Turned Men into Boys. “Today, … with women moving ahead in our advanced economy, husbands and fathers are now optional, and the qualities of character men once needed to play their roles—fortitude, stoicism, courage, fidelity—are obsolete, even a little embarrassing. … Women put up with him for a while, but then in fear and disgust either give up on any idea of a husband and kids or just go to a sperm bank and get the DNA without the troublesome man.”

Judge Tosses Suit Against Health Care Law (NPR)
Yeah! Suit was against universal mandate, but on narrow grounds: that it violates religious freedom of those who rely on God to protect them. The judge expressed doubts that plaintiffs can really determine they’ll never need health care. Read more

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Reluctant patients: The mental health of doctors

Mental health of doctorsThe British medical journal The Lancet surveyed a number of studies that discuss troubling statistics on suicide and depression among American physicians. The subject is not new, but the studies attempt to provide a few new insights.

A 2004 analysis in The American Journal of Psychiatry found that male doctors were 1.41 times more likely to commit suicide than other men. The statistic for female doctors was significantly higher, 2.27.

The cause of the increased rates is not known, but the problem seems to start in medical school.

At medical school, competitiveness, the quest for perfection, too much autonomy coupled with responsibility, and the fear of showing vulnerability have all been cited as triggers for mental ill health.

The stigma of not being able to cope

A study in JAMA published last year looked at the fear of showing vulnerability. It found that 53% of medical students who had high levels of depressive symptoms were concerned about revealing their state of mind. They felt such honesty would be risky for their careers. Many saw the mere act of asking for help as an acknowledgment that their coping skills were inadequate.

Medical students are under extraordinary demands. They feel they are making life and death decisions and that they can never be wrong. There is such tremendous pressure to be perfect that any sense of falling short makes them very anxious.

If medical students are critical of each other about depression, how does that transfer to patients? We don’t want the medical education experience to make them less tolerant of mental illness. Stigma seems to be lessening among the general public. But it is possible the medical professional is lagging behind.

Read more

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Links: Cerrie Burnell/Widow’s Lament/Drug shortages/Insurance profits/Cholesterol & women/Kochs

Cerrie BurnellTV presenter Cerrie Burnell: ‘I don’t care if you are offended’ (Guardian)
Born without a right forearm, Burnell now sings, dances, and presents on children’s show. Some parents objected (it frightened their kids). Others suggested long sleeves. “Ultimately, I don’t care if you’re offended.”

Joyce Carol Oates’s Widow’s Lament (NYT)
“A Widow’s Story: A Memoir.” She “has assembled a book more painfully self-revelatory than anything Oates the fiction writer or critic has ever dared to produce.” Touches on the power balance between artist and spouse.

Drug shortages prompt hospitals to use older treatments, pay more when they do find a supply (LA Times)
Manufacturing issues, quality-control problems limit supply of about 150 drugs, many used to treat cancer or needed in surgery. These are critical drugs for which there are limited alternatives. Hey! Medicine is not just another business like selling cars.

Profits keep rolling in for big insurers despite reform (Amednews)
“The operating environment for commercial insurers continues to improve as federal agencies issue guidelines with softer language and delayed compliance dates,” says health care investment analyst. Not what I wanted to hear. Read more

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Feeling sorry for plastic surgeons

sean-mcnamara-christian-troy-plastic-surgeons-nip-tuckFor her new book, American Plastic: Boob Jobs, Credit Cards, and the Quest for Perfection, Laurie Essig spent time interviewing plastic surgeons. She was interviewed herself on Salon, where she was asked what else surprised her — besides statistics like 85% of cosmetic surgery is purchased on credit and over 70% of patients earn less than $60,000 a year. (emphasis added)

One of the things that surprised me is how out of control the cosmetic surgeons themselves felt in all this. I felt a lot of sympathy for the cosmetic surgeons, even when they were telling me that I needed a facelift. Cosmetic surgeons are primarily men, well over 90 percent. They’d gone to medical school and they came out with huge amounts of debt themselves, often well over $200,000. They meant to be reconstructive surgeons, they meant to fix people after horrific accidents or cancer, and they started doing some boob jobs on the side and it started to eat up more and more of their practice because it was so lucrative. They want to send their kids to nice schools, they have mortgages, they have family, and you could see that they felt a little bit helpless as well. It wasn’t what they meant to do.

They seemed just as much products of the system as the middle-aged women going in for a facelift or boob job. They were hoping for a better future. Of course, they create the desire — they advertise, people come into their office and they tell them what they need — but I think that if they hadn’t graduated from school with so much debt, most of them would be selling cosmetic procedures a lot less than they are.

A compassionate view and undoubtedly true. For a similar and depressing take on the financial dilemma of primary care physicians, see the comments following my post on KevinMD, Marcus Welby and the relentless growth of specialization. Read more

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Links: Sociable robots/MSG/”Fresh”/Male pregnancy/Pubic hair fashions/Climate change

Paro the seal sociable robotA Soft Spot for Circuitry (NYT)
Paro the seal, a sociable robot, accomplishes its lifelike interaction through hidden sensors that monitor sound, light, temperature and touch. Sociable robots are now being used as therapy for the elderly. “We as a species have to learn how to deal with this new range of synthetic emotions that we’re experiencing — synthetic in the sense that they’re emanating from a manufactured object.”

If MSG is so bad for you, why doesn’t everyone in Asia have a headache? (Guardian)
History of Japanese discovery of the fifth taste, ‘umami’ (translated ‘savoury,’ ‘deliciousness’) and the manufacture of MSG. How MSG got a bad reputation in the US and how the food industry fought back. Fascinating.

What’s the Matter With Corn Syrup? (NYT)
Review of documentary “Fresh” on industrial farming and its devastating toll on soil, health and livestock. More folksy in tone than “Food, Inc.” and more focused on practical solutions. Addresses class barrier to healthy eating.

The Case of the Pregnant Seaman (PLoS Blogs)
Scientists have now shown that normal, healthy men often undergo real bodily changes when they’re expecting children. What for years was considered a disorder of the mind is actually a natural physiological reaction to impending fatherhood. Read more

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Love and marriage in China

Chinese weddingPrevious articles on the “second wives” of well-to-do Chinese men have focused on how unfair it is that mistresses of corrupt officials become exorbitantly wealthy. Or on the government’s foot-dragging in putting marriage databases online. But in an article ostensibly about the branding of luxury goods, Tom Doctoroff, a leading authority on marketing in China, offers a cultural analysis of the phenomenon. (emphasis added)

Because China has never had a humanist revolution, sex and marriage have always been relatively divorced. That is why many Asian cultures have an immensely commercialised and categorised [sex industry]. … [I]f a husband is a man of means, and has a significant income, then he can take on a second wife without violating his obligation to his first wife. …

Second Wife culture is just one part of a much bigger and more interesting area which is the difference between love and marriage in China and the West. Marriage in the west is rooted in romantic passion, and although that passion evolves over time we basically assume that if it’s is [sic] gone from marriage it’s a shallow marriage. Yes, there are other concerns that surround it – children, money – but it’s not the core of the relationship.

In China it’s fundamentally true that a marriage is not between two individuals, it’s between two clans. Marriage is a way that people connect into a broader society in which the individual is not the basic productive unit. This has always been the case.

In China, a romance is not ideal unless it is also accompanied by commitment. In Chinese, when we translate “a diamond is forever”, we don’t mean that passion lasts forever. It translates as “he will do anything for you, forever”. And that’s why people buy a lot of things for their mistresses – that affection needs to be demonstrated, too. Read more

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Links: Planned Parenthood/Sleep/Internet empathy/Tobacco in China/Doctors who tweet

Planned parenthood opposition in CongressHouse votes to defund Planned Parenthood, national health-care law (WaPost)
In votes on amendments to federal spending bill, House Republicans block federal funding of Planned Parenthood and cut off funds to implement health care law. Republican congresswoman took the floor to relate her abortion.

The Fact-Free Far Right: Laura Ingraham’s Lies are Dangerous to Our Health (RH Reality Check)
Fox: Planned Parenthood makes most of its money from abortions. Fact: It’s 15% and not federally funded. PP’s main services: contraceptive delivery, testing/treatment of sexually transmitted diseases, screening for cervical and breast cancer

Sleep and heart risk link is uncertain (NHS)
The association of both long and short extremes of sleep with poor cardiovascular health is of interest, but the “mechanisms that underlie these associations are not fully understood”. The association may be a by-product of other factors.

Is the internet killing empathy? (CNN)
Serene Branson migraine. Have our brains become so desensitized that we’ve lost all perspective on appropriateness and compassion when another human being apparently suffers a medical emergency? Are we a society of detached voyeurs? Read more

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Links: Superbugs on meat/Insomnia/Longevity gene/Severe weather & climate change/Baby animals

Superbugs on chickenFDA Report: Alarming Amounts of “Superbugs” in Supermarkets (Bnet)
Superbugs (bacteria resistant to antibiotics) in meat are a much more common and widespread problem than anyone would like to admit, according to federal government report. Chicken breasts, ground turkey, ground beef and pork chops tested.

Superbugs in Canadian chicken? Yes, and US too (Wired)
15% of bacteria on chicken breasts and ground turkey are resistant to 4 or more classes of antibiotics. Drug-resistant bacteria in food won’t diminish until we reduce the amount of drugs that food animals receive while they are raised.

An insomniac learns to make the most of getting the least sleep (WaPost)
Insomnia affects 1 in 3 Americans. For one in 10 it’s chronic. “Are you getting adequate sleep when you are up for an hour or two a night or truncating your sleep on either end?” Sleep expert says no. There’s a cost to overall health.

Can relaxation drinks put you to sleep? (Health News Review)
Gary Schwitzer gives 4 stars to story on drinkable melatonin, valerian, other supplements. “The public should understand that behavior change will nearly always trump a pill (or supplement, etc.) for long-term efficacy and health effects.” Read more

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Links: Patient modesty history/Value of life/Human clones for body parts/UK health inequalities

Modesty catHistory of Patient Modesty – Part 1: How Bodily Exposure Went from Unacceptable to Required (Patient Modesty & Privacy Concerns)
I have a guest post today on the #1 medical privacy blog. Part one describes what medicine used to be like before it was based on modern, anatomical theories of disease. Well into the 19th century, doctors did not expect patients to remove their clothes.

U.S. Raises Value of a Life, and Businesses Fear Impact (NYT)
How much should the government spend to prevent a single death? Environmental, consumer, and worker protection standards have been going up, despite protests from business.

How Never Let Me Go gave up and died (Guardian)
Film about human clones created for their body parts misses the point: the acquiescence of the weak to their exploitation by the strong. Film’s organ donors are comparable to “the lackeys of capitalism [who] compete to become employee of the month.”

A close call on health inequalities (Guardian)
BMJ study, plus Sir Michael Marmot’s. There’s more to life expectancy than a simple north-south divide of UK. Wealth determines health. Some of the starkest differences occur not between regions but between neighbors. Read more

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Links: Hygiene hypothesis/Grief/Computers vs. humans/ Tobacco for the poor/Genetics via Lady Gaga

Girl playing in mud - hygeine hypothesisWhy Keeping Little Girls Squeaky Clean Could Make Them Sick (NPR)
The hygiene hypothesis: children exposed to lots of germs early in life less likely to develop allergies, asthma, autoimmune disorders. Women have higher rates of these disorders. Is that because girls are held to higher standards of cleanliness?

Grief, Unedited (NYT)
Memoirs on the loss of a spouse, such as the latest from Joyce Carol Oates, don’t teach us about typical mourning experience. Most older people whose spouse dies from natural causes recover much more quickly than we have come to expect. For many, acute grief subsides less than six months after the loss. By the author of The Truth About Grief: The Myth of Its Five Stages and the New Science of Loss.

A Fight to Win the Future: Computers vs. Humans (NYT)
As machines simulate skills that were once exclusively human, designers are faced with the challenge of rethinking what it means to be human. It’s not just about putting people out of work. Read Sherry Turkle’s Alone Together: Why We Expect More from Technology and Less from Each Other, where she argues that we’re in danger of preferring sociable robots (Paro, Nursebot, My Real Baby) to real human beings. This article is about IBM’s Watson and artificial intelligence vs. intelligence augmentation.

The Computer Made Me Do It (NYT)
Review of Virtually You: The Dangerous Powers of the E-Personalityby Elias Aboujaoude and Reality Is Broken: Why Games Make Us Better and How They Can Change the Worldby Jane McGonigal. Two opposing views. Read more

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Links: Cosmetic surgery as investment/DSD/Never let me go/Losing a spouse/Kissing

Cosmetic surgery as an investmentWhen cosmetic surgery is a marker of ambition (Guardian)
Why aren’t people more concerned about the medical risks of cosmetic surgery? We’re increasingly socialized to believe we must invest in ourselves to improve our chances and opportunities in life, whether it’s paying for higher education, looks or both.

The Tale of Tea with Jim the Third (Bioethics Forum)
Alice Dreger on the story of a man with a disorder of sex development (formerly termed “intersex”). One patient heard his urologist say to the nurse, outside the door, “I don’t deal with this shit.” The biggest issue is not surgery, hormonal treatments, or lack of psychological support for families. It’s shame and how no one deals with it.

Why “Disorders of Sex Development”? (Alice Dreger)
Dreger discusses the change in terminology from “intersex” to “Disorders of Sex Development” (DSD). The term “intersex” was a moving target. “DSD” gives patients a means to talk openly about what’s happened to them, without shame. “Intersex” did not.

Hermaphrodite (Lancet)
The unease generally provoked by sexual ambiguity exposes our continuing discomfort with transgression of binary categories, whether the boundaries are broken by anatomy, sexuality, or non-conformity with gendered stereotypes of identity. Read more

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Chocolate has antioxidants but is that a good thing?

Chocolate antioxidants Valentine's dayChocolate is a perennial favorite as a health topic. Readers are eager to learn of medical research that justifies something they want to do anyway.

WebMD recently ran an article called “Is Chocolate the Next Super Food?” The excuse for this particular article was a study that found the antioxidant activity of dark chocolate was higher than that of various “super” fruits (blueberry, acai, cranberry, pomegranate).

The article’s very last paragraph did mention — very casually — that the number of calories and fat grams in a serving of dark chocolate exceeds those of fruit juice. There was nothing but praise, however, for the ability of the antioxidants in chocolate to fight free radicals. The wisdom of the widespread consumption of antioxidants has recently been questioned. Getting the word out on that subject may prove awkward for WebMD, a site littered with ads for antioxidant supplements.

Free radicals fight toxins and cancer

Health and science journalist Sharon Begley had an excellent article on antioxidants and free radicals – “Antioxidants Fall From Grace” – in a recnt Newsweek. (emphasis added) Read more

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Links: Handedness/Spare parts baby/Thinspiration/Vaccine/Ripeness/Sore muscles

Left handed parrotHere’s why you’re right-handed or left-handed (MSNBC)
It depends on eye dominance. In recent U.S. history, the majority of presidents have been left-handed (Ford, Reagan, G.H.W. Bush, Clinton, Obama). Scientists haven’t yet found a link between hand preference and an individual’s abilities. Study based on eye and foot preferences of parrots (see left-footed parrot, right).

France’s first genetically-engineered baby born (M&C)
The headline is misleading. This is the first “savior sibling,” “spare parts baby” (think “My sister’s keeper”) in France. An embryo was screened both for lack of disease and being a sibling match. Genetic engineering implies something was changed, not just selected.

Anorexics are finding ‘thinspiration’ on Web (The Daily)
Pro-ana and pro-mia (bulimia) websites went underground a decade ago, but are now making a comeback on microblogging platform Tumblr. New sites deny extreme weight-loss is an eating disorder. Claim it’s a healthier lifestyle.

Flu breakthrough promises a vaccine to kill all strains (Guardian)
Scientists at Oxford have successfully tested a universal flu vaccine that could work against all known strains of the illness. Targets proteins. Would not need expensive reformulation every year. Read more

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The states’ rights argument against health care: An ugly tradition

Constitutionality of health care individual mandateCommentators will be debating the constitutionality of the individual mandate right up until the day the Supreme Court issues its decision. The New York Times had an editorial this week criticizing the reasoning of a Georgetown law professor, Randy Barnett. He recently argued before a Senate Judiciary Committee that, if the mandate is upheld, “Congress would have all the discretionary power of a king and the American people would be reduced to its subjects.”

But after reading the analysis of another Georgetown law professor, David Cole, my mind is at rest. Cole explains why the arguments about “tax” vs. “penalty” or “activity” vs. “inactivity” are irrelevant. He readily dismisses the “make them eat broccoli” argument. (emphasis in original)

A decision to sustain the individual mandate would not mean that Congress could require all Americans to exercise or eat only healthy food, as some have suggested. The individual mandate regulates an economic decision that is in turn an essential part of a comprehensive economic regulation of the interstate business of insurance.

What I liked most about Cole’s discussion was the historical perspective he provides on the politics behind opposition to the individual mandate. (emphasis added) Read more

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Links: Veggies & skin color/Individual mandate/Diet soda/Healthy eggs?/DTC ads

Vegetables give skin golden glowHow vegetables can give you that golden glow (Guardian)
Carotenoids, stored in fat under the skin and found in tomatoes, peppers, plums and carrots, can give Caucasian skin a healthy-looking golden glow – a look equated with attractiveness.

Is Health Care Reform Unconstitutional? (NY Review)
One of the best discussions I’ve read on the subject. Constitutionality won’t be an issue. Health care opponents simply looking for a way to prevent government from imposing a collective solution to a social problem.

Do diet sodas really cause stroke? I’m dubious. (Food Politics)
People who drink diet sodas every day are apt to do many other things – like eat a lousy diet. Those who drink any kind of soda daily, whether or not it’s diet, are probably not the most healthy minded.

The Updated Egg: Less Cholesterol, But Is It a ‘Healthy’ Food? (Time)
Eggs now have less cholesterol and more vitamin D than they did in 2002. May be due to better chicken feed. “The impact of dietary cholesterol consumption on blood cholesterol levels isn’t fully understood.” Read more

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The ethics of a neuroenhanced future

NeuroscienceImplementing the discoveries of modern brain science raises ethical issues. For example: (emphasis added)

Issues of personhood and authenticity, for example, have become hotly debated among neuroethicists as pharmaceuticals developed for improving mental health disorders, sleeping disorders, or attention disorders in children are now being consumed at high rates as off-label “cognitive enhancers” to boost mood, memory, and alertness. If these drugs, or substances like oxytocin, become the Viagra of daily functioning and create new benchmarks for productivity, wakefulness, and emotional love, what will happen to the fabric of society and the character of our interactions with one another? Are these altered states a genuine reflection of a new and improved “me” or “we”, or some transient drug-induced condition that thoroughly confounds what we inherently value? Will we be coerced into conforming to a wave of drug intervention in the ever expanding, do-it-yourself, self-help world? The race for cognitive enhancers poses questions of social justice as well. Will the opportunity gaps between those who can afford them and those who cannot be widened or narrowed?

[H]ow shall scientists, physicians, legal scholars, policy makers, and society at large manage new tests that may soon be able to forecast with acceptable reliability unacceptable levels of risk for aggression, sociopathy, psychopathy, and suicide?

With advanced capabilities, will an integrated understanding of the genetics and brain biology of these conditions [Alzheimer’s, schizophrenia, addiction, anxiety, stress] … plunge those affected into fatalistic states of hopelessness out of which they feel they cannot ever emerge?

Entrepreneurs will surely lose no time in selling the technology directly to consumers who may be curious for what they interpret to be a neurogenetic signature or fearful about their neurogenetic status. What, and how much, would you want to know? At what personal and financial cost?

Read more

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Links: Awake cosmetic surgery/Dentist demographics/more

Awake cosmetic surgeryNipped, tucked and wide awake? (MSNBC)
Awake cosmetic surgery can be performed by doctors with two days of training and no hospital privileges. “This is just a gimmick by people who can’t operate their way out of a wet paper bag.”

Awake Cosmetic Surgery–The Pros and Cons (EmpowHer)
Growing trend alarms doctors. Presented to patient as a benefit. No side effects (or cost) of anesthesia, but requires near toxic levels of lidocaine. Selecting a cup size during surgery is like “making a decision while drunk.”

Wall Street Ogles Breast Augmentation as New Market Indicator (CBS)
Plastic Surgery Indicator correlates forehead and face lifts, lipo, breast augmentation with positive direction of NASDAQ, S&P, Dow-Jones. Explanations? More money to spend, more job-seekers, increased consumer confidence.

Which Countries Have The Most Dentists Per Capita? (Business Insider)
Greece has 127 dentists per 100,000 inhabitants. US has 60 (ranks 15th out 30). Mexico 10. Hat tip to Tyler Cowen at Marginal Revolution. Read more

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Constitutional law will trump politics on health care reform

Health care individual mandate consitutional lawSome strong words on the constitutionality of the individual mandate from a renowned expert on the constitution, Laurence Tribe, author of The Invisible Constitution. The Harvard Law School professor once described President Obama as “”the best student I ever had.” He was an active supportor of Obama’s presidential campaign, serving as a judicial adviser.

Tribe generally opposes a literalist interpretation of the Constitution. Speaking of the anticipated Supreme Court decision on the health care bill: (emphasis added)

[T]he predictions of a partisan 5-4 split rest on a misunderstanding of the court and the Constitution. The constitutionality of the health care law is not one of those novel, one-off issues, like the outcome of the 2000 presidential election, that have at times created the impression of Supreme Court justices as political actors rather than legal analysts.

Since the New Deal, the court has consistently held that Congress has broad constitutional power to regulate interstate commerce. This includes authority over not just goods moving across state lines, but also the economic choices of individuals within states that have significant effects on interstate markets. By that standard, this law’s constitutionality is open and shut. Does anyone doubt that the multitrillion-dollar health insurance industry is an interstate market that Congress has the power to regulate?

Tribe compares health care to Social Security: Read more

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Links: Female infanticide/Goodbye Darvon/End-of-life talks/more

Riwayat the filmThe tyranny of tradition (Lancet)
Review of film written by two doctors: “Riwayat” (traditions). Indian practice of killing baby girls. 10 million girls aborted in last 20 years, even though prenatal sex determination outlawed in 1994.

Physicians Say Good Riddance to ‘Worst Drug in History’ (Medscape Today)
Pain reliever propoxyphene (Darvon, Darvocet): “No single drug has ever caused so many deaths.” Small benefits, big risks, addictive. Banned in UK 5 years ago due to suicide risk. Read more

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Inequality and the financial crisis

Inequality shoeshine“Inequality has been getting worse. … One thing that this has done is it has encouraged governments, who are aware of the resentment caused by the rising inequality, to try to take some kind of steps to make it more politically acceptable.” Rajan has a chapter called ‘Let them eat credit’. “The US in particular has stimulated the housing market, it has subsidised lending to people, which drove up home prices in an unsustainable way.” Read more

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Misc Links 2/6/11

Alone Together Sheryl TurkleHit Send, Take a Bow (WSJ)
Sherry Turkle’s Alone Together. Precisely because there is so much opportunity for digital communication, we are losing the ability to make simple, genuine connections with actual human beings. “A behavior that has become typical may still express the problems that once caused us to see it as pathological.”

Who’s the Boss, You or Your Gadget? (NYT)
All of this amped-up productivity comes with a growing sense of unease. Too often, people find themselves with little time to concentrate and reflect on their work. Or to be truly present with their friends and family. “Nobody seems to actually pay full attention; everybody is doing a worse job because they are doing more things.” Read more

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Guest post: A fat lot of good

Slow bicycleThis delightful person, who signed off with “Yours fatly,” is a woman after my own heart. Her wise words took me back to a holiday in France, where the supermarkets were filled with full, fat, soft, unpasteurized cheeses, divine pastries, calorie and fat-laden crème fraiche and whole aisles of wine. I looked for low fat products and found one tiny, slender end-of-aisle display, where a small coterie of non-Europeans searched for fat-free yogurt and pre-packaged egg whites. Read more

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Misc Links 2/5/11

Cloned dogDog cloning is not as cuddly as it looks (New Scientist)
Review of Dog, Inc.: The Uncanny Inside Story of Cloning Man’s Best Friend. Dogs are very difficult to clone due to opaque eggs. Requires large canine population, which Korea had, since canines are on the menu there.

Role of Age, Sex, and Race on Cardiac and Total Mortality Associated With Super Bowl Wins and Losses (Clinical Cardiology)
A Super Bowl loss for individual’s favored team triggered increased deaths in both men and women, especially in older patients. A Super Bowl win reduced deaths more in people age 65+ and women. Read more

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