Tag Archives: healthism

When health was something we could simply “forget about”

get-well-soon

I came across the following sentence in The Positive Thinkers, a book originally published in 1965. It strikes me as a good example of how the meaning of health has changed. (emphasis added)

Health is ordinarily regarded — when it is “regarded” at all, for ordinarily the point of being healthy is to be able to forget about it — as a means to other things; healthy men are those able to pursue their ends.

Health is hardly something we’re able to forget about today. We live in a culture where it’s commercially profitable to constantly remind us of widespread, proliferating risks. The conscious, highly intentional pursuit of health is a mark of social status for which we expect to be admired and envied. We “regard” it all the time. Read more

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Big Data, privacy, and civil disobedience

privacy-big-data-civil-disobedience

Back in May, Evgeny Morozov wrote a review for The New York Times Book Review of two books: The Naked Future: What Happens in a World That Anticipates Your Every Move? by Patrick Tucker and Social Physics: How Good Ideas Spread — The Lessons From a New Science by Alex Pentland. The review is excellent. I’m mostly going to quote from this review (plus one of Morozov’s books), since this is a huge topic in which I have considerable interest but no expertise. I’ve been thinking about a JAMA article I read recently that discusses the need to convince the public to allow extensive use of Big Data in connection with health care (What’s that you bought at the grocery store? You didn’t renew your gym membership?), and Morozov’s ideas seem related. (Morozov, by the way, considers Big Data an “ugly, jargony name.”) Read more

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When healthy eating becomes unhealthy

healthy-eating-orthorexiaMeghan O’Rourke, poet and author (Halflife: Poems, Once: Poems, The Long Goodbye: A Year of Grieving), has written a wonderful piece for The New Yorker on living with a chronic illness. It’s called What’s Wrong with Me? I had an autoimmune disease. Then the disease had me.

For years O’Rourke experienced symptoms that she tried to attribute to her latest source of stress. Doctors were unable to offer a diagnosis, a situation that tends to suggest the suspicion that the symptoms may be all in your head.

She writes: “I was ill for a long time — at least half a dozen years – before any doctor I saw believed I had a disease.” Eventually, after she received a label for her symptoms (autoimmune thyroiditis or Hashimoto’s disease), she connected to the online community of chronic disease sufferers. There she found not only a great many individuals with similarly frustrating histories, but an abundance of home-grown advice for the relief of symptoms.

A more or less definitive diagnosis for a disease that is only vaguely understood may at least confer some legitimacy on one’s status as a patient (for an historical perspective on diseases that do not fall neatly into diagnostic categories, see Robert Aronowitz, Making Sense of Illness .) The individuals who suffer, however, are still very much on their own when it comes to recovery and the alleviation of symptoms. Thus the home-grown advice.

Orthorexia and healthism

What I’d like to focus on in this post is one small part of O’Rourke’s narrative: her attempts to alleviate her symptoms through a growing obsession with the selection and control of the food she ate. It’s not difficult to find media stories and blog posts that put a positive spin on (what amounts to) an excessive preoccupation with healthy eating. It’s rare, however, to find an experiential account that recognizes the obsessive pursuit of health as itself unhealthy.

A classic discussion of the latter is Steven Bratman’s Health Food Junkies: Orthorexia Nervosa – the Health Food Eating Disorder. In O’Rourke’s case, of course, she was not simply eating to be healthy. She was seeking relief from very real and disturbing symptoms. That’s not quite the same thing as orthorexia, although both provide the health food consumer with an opportunity for reflection. Read more

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Neoliberalism, tobacco, and public health (1)

This post became much too long, so I’ve divided it into two parts. The first part is mainly about neoliberalism; the second mainly about graphic warnings on cigarette packs (plus smoking among the homeless). When I read, in a recent NEJM article, “The Supreme Court’s increasing sympathy for corporate speech and decreasing deference to public health authorities makes it more difficult for government to protect the public’s health,” my first thought was: What a perfect example of neoliberalism in action.

fda-graphic-warning-labels-i-cause-diseaseNo one would claim that neoliberalism strives for consistency when implementing its ideals. For example, neoliberalism blames individuals for the health consequences of cigarette smoking (“I cause disease”) and at the same time opposes legislation to reduce cigarette consumption (graphic warnings on cigarette packs). When there is a choice to be made, the deciding factor for neoliberalism will be the efficiency with which wealth can be upwardly redistributed.

Personal responsibility

Personal responsibility — including personal responsibility for health — is a fundamental principle of neoliberalism. David Harvey writes on this in the context of neoliberalism and labor: (emphasis added in this and subsequent quotations from Harvey)

[L]abour control and maintenance of a high rate of labour exploitation have been central to neoliberalization all along. The restoration or formation of [elite] class power occurs, as always, at the expense of labour.

It is precisely in such a context of diminished personal resources derived from the job market that the neoliberal determination to transfer all responsibility for well-being back to the individual has doubly deleterious effects. As the state withdraws from welfare provision and diminishes its role in arenas such as health care, public education, and social services, which were once so fundamental to embedded liberalism, it leaves larger and larger segments of the population exposed to impoverishment. The social safety net is reduced to a bare minimum in favour of a system that emphasizes personal responsibility. Personal failure is generally attributed to personal failings, and the victim is all too often blamed.

Personal responsibility for health — fundamental to healthism (a frequent topic on this blog) — serves the interests of neoliberalism in a number of ways. It can be used to justify reduced spending on health care and social services by the state. This is desirable in itself, according to neoliberals, but it also increases consumer spending on health care, which in turn benefits the health care, pharmaceutical, and insurance industries. Read more

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Healthy lifestyles: Social class. A precarious optimism

Social determinants of health. Marmot, WilkinsonContinued from the previous post, where I noted that the Lalonde report — despite its good intentions — was followed by an emphasis on healthy lifestyles and personal responsibility for health, as well as increased health care costs.

Personal responsibility and social class

In Why Are Some People Healthy and Others Not?, Marmor et al, writing in 1994, were disappointed that the Lalonde report had not effectively prompted governments to address the underlying causes of health and disease. One reason for this, they believed, was that health policy reflects public opinion. If the public holds traditional views on what makes us sick (pathogens), what prevents disease (medical care), and what we can do to be healthy (take personal responsibility), new policies that include social determinants are unlikely. Those who are on the forefront of professional, scientific opinion may very well understand the importance of social determinants, but public opinion changes slowly. Without an education program, such as the relatively successful anti-smoking campaign, the public is unlikely to endorse change.

This is certainly true, although I believe there’s also something more fundamental at work here, namely, how a society accounts for the different life outcomes of its citizens. In Unequal Childhoods: Class, Race, and Family Life, Annette Lareau describes the assumptions people make when they hold others personally responsible for their life circumstances. Read more

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Healthy lifestyles: The unfortunate consequences

Healthy lifestyles yoga poseContinued from the previous post, where I discussed the expansion of universal health care prior to the 1970s, how this created a growing demand for health care, and the problem health care costs posed for governments, especially when the economy suffered a downturn in the seventies. One response to the situation was to consider new ideas. Rather than limit strategies to what could be done by the health care industry, why not directly address the underlying causes of disease by considering social determinants of health.

Canada’s Lalonde report

In 1974, Canada produced the Lalonde report. It has been described as

[the] first modern government document in the Western world to acknowledge that our emphasis upon a biomedical health care system is wrong, and that we need to look beyond the traditional health care (sick care) system if we wish to improve the health of the public.

The US Congress emulated this thinking in 1976 by creating the Office of Prevention and Health Promotion. The US Department of Health, Education, and Welfare began publishing the document Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention in 1979. The response in European countries — caught in the same bind of greater demand, increasing costs, and the financial consequences of a deteriorating economic landscape – was similar.

The common thread in these new perspectives on health was the assertion that health could be improved — without increasing health care costs — if we concentrated on such things as the work environment (occupational health), the physical environment (air and water pollution, pesticides and other carcinogens in food), genetics, and healthy lifestyles. The approach was broad: the environment was considered at least as important as the promotion of healthy lifestyles. Read more

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Healthy lifestyles: The antecedents

Healthy lifestyles yoga poseIn the 1970s, public health policies began to promote the idea that individuals are responsible for their health and therefore have an obligation to adopt healthy lifestyles. Over the ensuing decades, health became both an extremely popular topic for media coverage and a lucrative market for vendors of health-related products and services. What followed was a substantial increase in health consciousness and greater anxiety about all things that concern the body.

Do healthy lifestyles actually produce better health? That they should may seem like common sense, which is one reason it’s been so easy to promote the idea that they do. The question is difficult to answer with absolute certainty, however. For one thing, the behavior that counts towards a healthy lifestyle does not readily lend itself to the objective measurements required for reliable scientific evidence. Defining health is also tricky. Lifespan is often used to compare the ‘health’ of different nations, but this fails to capture the subjective sense of health that is meaningful to individuals. Perhaps most important, while in theory a healthy lifestyle might improve health, that does little good if – as is now obvious – it’s extremely difficult to maintain behaviors that require things like changing what we eat and how often we exercise.

A related question would be: Did the promotion of healthy lifestyles reduce health care costs? This too seems like a sensible assumption, and the assertion is quite popular, especially among politicians. Health care costs have increased to hand-wringing levels. Promoting healthy lifestyles costs governments next to nothing, while the cost of health care is all too easily quantified. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (4) The abnormal part

Abnormal psychologyContinued from parts one, two, and three.

A year ago, when I decided to call my declining rate of blogging a ‘sabbatical,’ I wrote down some questions to explore while I took time off to read.

How did we find our way into the dissatisfactions of the present – the commercialization of medicine, the corporatization of health care, the commodification of health? Does understanding the path we followed offer any insight into finding a better direction? Was the increasingly impersonal nature of the doctor-patient relationship inevitable once medicine became a science? Or was it only inevitable once health care emphasized profits over patients and the common good?

At the time I thought I would read primarily in the history of medicine, and that was how I started. Appreciating the historical context of medicine is important for understanding both how medicine ended up where it is today and what medicine could become. “The texture and context of the medical past provide perspective, allowing us to formulate questions about what we can realistically and ideally expect from medicine in our own time,” I wrote.

Now that I’ve become more familiar with the social determinants of health, I’m less optimistic about the future. The problem is not simply that the corporatization of health care has increased dissatisfaction among both doctors and patients. The problem is that our focus is so narrowly limited to health care systems that we fail to see the larger issue. As one metaphor puts it, doctors are so busy pulling diseased patients out of the river, there’s no time to look upstream and ask who’s throwing the bodies into the water. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (3) Connections

Continued from parts one and two, where I defined the terms used in the following diagram of my blogging interests. Click on the graphic for a larger image.

Blog topics and their connections

If I had written the previous two posts a year ago, I would have realized how much my interests were intertwined. I guess I wasn’t ready to do that. Anyway, in this post I catalog some of the connections.

Healthism

~ Healthism and psychological and physical conformity: Healthy lifestyle campaigns promote an ideal way of life that encourages individuals to alter their behavior and appearance. Although it’s true that we would all be better off if we didn’t smoke, that doesn’t make anti-smoking laws any less authoritarian, i.e., requiring conformity (see the section on anti-authority healthism in this post). The fitness aspect of healthy lifestyles promotes the desirability for both men and women of acquiring (i.e., conforming to) specific body images.

“Self-help is the psychiatric equivalent of healthism.” That’s a slogan I made up. I’m not sure yet if it will stand up to scrutiny. Certainly the self-help industry encourages self-criticism, which leads to a preoccupation with those aspects of personality currently considered undesirable. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (2) Economics & the socio-political

Continued from part one, where I discussed the first three of my six interests: healthism, medicalization, and psychological and physical conformity. Click on the graphic below to see a larger image.

Blog topics and their connections

The social determinants of health

Social determinants of health (often abbreviated SDOH) refers to unequally distributed social and economic conditions that correlate with unequal and inequitable distributions of health and disease. Presumably there is a causal relationship between the two, not merely a correlation. Definitively identifying the causal mechanisms, however, is difficult. A great many things influence our health (including things we’re not even aware of yet), and it can be difficult to isolate and scientifically study some of the ones we strongly suspect, like poverty, isolation, or a sense of being socially inferior.

The medical model is the preferred framework in modern westernized societies for explaining the distribution of health and disease. It emphasizes risk behavior (smoking, diet), clinical risk factors (blood pressure, blood sugar, cholesterol levels), genetics, health care access and quality, behavioral change, and patient education. One common characteristic of the medical model’s explanation of health and disease is that causes are located in the individual (behavior, genes), not in the individual’s economic and social environment. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (1) Bodies, minds & medicine

It’s always hard to be sure about these things, but I think the reason I decided to take a ‘sabbatical’ from blogging last July was that I was interested in too many seemingly unrelated topics. Writing about all of them left me feeling like I never got to the ‘meat’ of any one of them. And I couldn’t convince myself to focus on just one or two things, since that would mean abandoning the others, which I was unwilling to do.

Now that I’ve taken the past year to read and reflect, I find – duh! – that my interests are not as unrelated as I’d assumed. In hindsight, I should have realized this long ago, but, alas, I did not. I’m writing this post to clarify to myself what I now see as the common threads that connect my interests.

Here is a diagram that groups my interests into six categories. (Click on the graphic to see a larger image.)

Blog topics and their connections

Four of the six categories relate to all five of the others. The two outliers (neoliberalism and medicalization) are not as directly related as I feel the others are. Read more

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What is healthism? (part two)

Apple and stethoscopeIn part one of this post I explained the most common meaning of healthism (an excessive preoccupation with healthy lifestyles and feeling personally responsible for our health) and described an authoritarian sense of the term. Here I discuss healthism as an appeal to moral sentiments and as a source of anxiety. I also note an unusual definition of the term as the desire to be healthy, which leads me to end with a personal disclaimer.

Moral healthism

The directive to be personally responsible for our health – whether it comes from a government health policy, the medical profession, or an advertisement – is often fraught with unacknowledged moral overtones. People who practice healthy lifestyles (daily exercise, a Mediterranean diet) and dutifully follow prevention guidelines (annual cancer screenings, pharmaceuticals to maintain surrogate endpoints for risk reduction) are overtly or implicitly encouraged to feel morally superior to those who do not. This includes the right to feel superior to those who ‘choose’ to be unhealthy – after all, isn’t smoking a morally indefensible choice? The implication is that those who fail to take responsibility for their health are undeserving of our sympathy or assistance (especially financial).

This quality of healthism – like the anti-authority healthism discussed in part one – is possibly more common in the US than elsewhere. It’s unfortunate but true that in the US there’s a tendency to blame the poor and disadvantaged for not being able to pull themselves up by their bootstraps. There is a decided unwillingness to acknowledge that differences in wealth and social class during childhood have lifelong effects on behavior and health. Read more

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What is healthism? (part one)

Apple and stethoscopeThroughout history there’s been an understandable desire to find connections between our behavior and our health. Human beings have practiced health regimens involving diet, exercise and hygiene since antiquity. When medicine was based on the humoral theory of disease, for example, individuals were advised to purge the body in the spring and, in the summer, avoid foods or activities that caused heat. Bathing in ice water was recommended in the 19th century. Mark Twain quoted the advice: “the only way to keep your health is to eat what you don’t want, drink what you don’t like, and do what you’d druther not.”

In the second half of the 20th century many Americans adopted the idea that a ‘healthy lifestyle’ (diet, exercise, not smoking, etc.) was a good way to prevent disease and live longer. This particular attitude was a product of popular perceptions about health (a surge of interest in holistic/alternative practices, self-care movements such as Our Bodies, Ourselves) and prevailing social attitudes (such as desirable body images). Perhaps more so than in previous centuries, the growth of media consumption and the effectiveness of modern advertising allowed commercial interests (books, magazines, fitness merchandise, vitamins and supplements, weight loss pills, diet and energy foods, …) to exert considerable influence on health behavior.

Also at work was extensive media coverage of a presumed link between preventive lifestyles and risk factors for disease (conflicting opinions about salt and which type of fats to eat are good examples). Unlike the vague aphorisms of previous generations, this more modern source of health advice had the scientific backing of epidemiology, if not the proof that comes from randomly controlled trials.

One of the terms used to describe the enormous increase in health consciousness is ‘healthism.’ Judging from how I’ve seen the word used, it means different things in different contexts to different people. I’m going to describe a few of those meanings.

This post grew rather long, so I’ve divided it into two parts. In part one I discuss an anti-authority sense of healthism as well as healthism’s most common meaning: a sense of personal responsibility for health accompanied by an excessive preoccupation with fitness, appearance, and the fear of disease. Part two discusses the moralistic and anxiety-inducing qualities of the term, plus an odd use where healthism becomes another word for health itself. Read more

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Guest post: Guilt-edged

Bananas with the Globe and MailToday was in need of humor. Here is another guest post from Kate Gilderdale (the original can be found here), who blogs at The Jaundiced View.

I found a website that lists (in a most unfortunate typeface) 29 types of humor. I’d say Kate’s writing combines – not always in the same post — wit, irony, understatement, repartee, satire, and that je ne sais quoi that can only be acquired by growing up in the British Isles. The word urbane also comes to mind. At any rate, I find that Kate’s posts brighten my days.

Guilt-edged

I know you can have Catholic guilt and Jewish guilt but you really don’t need religion to make you feel that whatever goes wrong is somehow your fault.

I feel guilty when I go through customs even though I am scrupulous about not bringing in anything illegal. I feel guilty when I go the dentist in case I haven’t flossed in the approved manner. I feel guilty when I try to defend my decision not to be tested for a disease I haven’t got, or don’t know I’ve got, or might have because at some point I’ll have to die of something – simply because I’d rather not know.

Now The Globe and Mail Life section reveals I could be guilty of hastening my demise by eating fruit. See The New Enemy in today’s paper, which warns that bananas are the arch enemy of the serious dieter and “that the high fructose content makes grapes and cherries as unhealthy as a plate of cookies.” Or not. Depending on which ‘experts’ you believe. Read more

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Guest post: A sound mind in a disintegrating body

Mens sana in corpore sanoIn an attempt to balance my very serious attitude towards the subject of healthism – the idea that individuals should be held personally responsible for their health; an idea promoted at a time of rising health care costs in the “Great Society” seventies, appealing to residual American sentiments of self-reliance and individualism, conveniently distracting attention from social and environmental determinants of health …

I could go on, but as I was saying, in an attempt to provide balance, I offer this guest post by Kate Gilderdale, a writer who valiantly resists healthism propaganda and whose approach to any subject is always liberally laced with humor. Kate blogs at The Jaundiced View (where this post first appeared), and I highly recommend a daily visit (laughter being the best medicine and all).

Mens sana in corpore sano is today’s mantra for many people, but a lot of us only manage to fulfil half the equation at best.

In order to attain the corpore sano required by today’s fanatical health and hotness community you have to devote two or three hours a day to honing the body beautiful so that it contains no lumps, bra overhang or bits that have to be sucked in when you walk past a mirror. This involves lunges, squats, curls, lat pulldowns, pushups, bench presses and eventual death from exhaustion unless you are of that rare elite who are truly in The Zone.

The rest of us get by by avoiding spandex and investing in Spanx, whilst using those three hours not spent at the gym to fill our brains with stuff that we hope will make us appear erudite without being unforgivably elitist.

When it comes to physical exertion, Joan Rivers said it best. “I don’t exercise. If God wanted me to bend over, he would have put diamonds on the floor.”

Any deviations from Americanized spelling (“fulfil”) may be attributed to Kate’s proper British education.

Kitten with barbell

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From healthism to overdiagnosis

H Gilbert Welch OverdiagnosedIn his new book, Overdiagnosed: Making People Sick in the Pursuit of Health, Dr. H. Gilbert Welch enumerates how the cutoff points that determine whether a patient should be treated for a disease – diseases such as high blood pressure, diabetes, osteoporosis — have been creeping inexorably lower over the years.

Take diabetes. The cutoff point used to be a fasting blood sugar level of greater than 140. In 1997, the number was lowered to 126. This immediately created 1.7 million new diabetes patients.

In a highly publicized study that began in 2003, one group of patients with type 2 diabetes received “intensive therapy” to make their blood sugar “normal.” The control group – the other half of over 10,000 patients – received treatment to lower their blood sugar, but not to the new normal level. The trial was stopped in 2008 when it became clear that there was about a 25% increased risk of dying for the intensive therapy group.

Dr. Welch’s comment on this: “If it’s not good to make diabetics have near normal blood sugars, then it’s not good to label those with near normal blood sugar diabetics. Why? Because doctors will treat them. People with mild blood sugar elevations are the least likely to gain from treatment – and arguably the most likely to be harmed.”

High blood pressure (hypertension) was also redefined in 1997. Instead of the cutoff points being 160 systolic over 100 diastolic, the numbers dropped to 140 over 90. This created 13.5 million new patients.

The definition of high cholesterol (hyperlipidemia) changed following a 1998 clinical trial. The definition of “abnormal” total cholesterol fell from 240 to 200. This created 42.6 million new patients, an increase of 86% over the previous number of patients.

It’s the same with the definition of osteoporosis. A bone mineral density X-ray produces a T score. It’s a way to compare an individual’s bone density to what’s considered “normal.” For women, normal is defined as the bone density of an average white woman aged 20 to 29 (a T score of zero.) If your T score is less than zero, it’s assumed you have an increased risk of fracture.

In 2003 the definition of osteoporosis changed from having a T score less than -2.5 to less than -2.0 (i.e., closer to normal). This created 6.8 million new patients, an 85% increase in those now eligible for treatment with drugs that turned out to have significant side effects – as virtually all drugs do. Read more

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Guest post: A fat lot of good

Slow bicycleToday’s post is a guest column by writer and editor Kate Gilderdale. It’s on a subject close to my heart – the promotion of personal responsibility for healthy lifestyles. Unlike me, Kate has a highly developed sense of humor, and I really enjoyed what she had to say.

Kate lives in Stouffville, Ontario (a suburb of Toronto), where she is an editor of the Stouffville Free Press. The Canadian Lalonde report of 1974 was one of the first government documents to emphasize lifestyles and the role of individual behavior in health. So I’m not surprised that Canadians are subjected to the same health injunctions as Americans. Other columns by Kate are available here, and she blogs at The Jaundiced View. Read more

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Old age and the limitations of a healthy lifestyle

Old age and Alzheimer'sA nice op-ed in the NY Times touches on our belief that living a healthy lifestyle guarantees a long and able-bodied life. The author, Susan Jacoby, speaks specifically to the issue of dementia and Alzheimer’s.

Members of the “forever young” generation — who, unless a social catastrophe intervenes, will live even longer than their parents — prefer to think about aging as a controllable experience. …

Contrary to what the baby boom generation prefers to believe, there is almost no scientifically reliable evidence that “living right” — whether that means exercising, eating a nutritious diet or continuing to work hard — significantly delays or prevents Alzheimer’s. …

Good health habits and strenuous intellectual effort are beneficial in themselves, but they will not protect us from a silent, genetically influenced disaster that might already be unfolding in our brains.

Jacoby cites a review of knowledge about Alzheimer’s sponsored by the National Institute of Health. (emphasis added) Read more

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Healthy lifestyles serve political interests

Runner healthy lifestylesThe practice of western medicine remained virtually unchanged from the time of the ancient Greeks to the mid-19th century. This is a testament to medicine’s basically conservative nature: Let’s not risk human life with something brand new.

Dramatic changes occurred, however, once medicine became a science. By the mid-20th century, medicine was experiencing a Golden Age: Life-saving drugs, miraculous medical breakthroughs, new diagnostic technologies, and a profession held in high public regard.

By the 1970s the Golden Age had ended. Medicine, along with other professions and institutions, fell victim to the anti-establishment sentiments of the 1960s. It was criticized harshly by consumers, journalists, and scholars. Medicine — it was alleged — was no longer concerned with the needs of patients, but with the ambitions of doctors.

The advent of Medicare and Medicaid in the 1960s not only brought government into the health care equation. The American Medical Association’s strenuous opposition to this legislation led the public to associate doctors with small businessmen — avaricious and probably dishonest. The practice of medicine changed from a healing relationship between doctor and patient to a profit-driven business enterprise. Read more

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The politics behind personal responsibility for health

Reagan and Thatcher danceConsumers of cell phones – actually, consumers of any product or service that isn’t essential for health or survival — clearly benefit from the competitive, market-driven economies of today’s modern world.

There are certain goods and services, however, that are essential for the public’s welfare: Drinking water, city sewage systems, financial support in old age, and the administration of things like prisons, schools, and health care. These “public goods” benefit from government influence. That’s because the profit motive needs some restraint in matters essential for basic survival. (Schools are not technically essential, but they’re important for a successful, prosperous society.)

This is only my opinion, of course. Conservatives, libertarians, free market fundamentalists, and members of the Tea Party would disagree vigorously.

Privatization

Privatization is the transfer of responsibility for public interests to the private sector. The PR argument for privatization is that the private sector is more efficient than government. The more basic, underlying motive, however, is that privatization has great potential for private profits. (See my recent post on the privatization of water as the investment opportunity of a lifetime.)

The downside of privatizing public services is that corporations are answerable only to their shareholders, not to the public they serve. We saw this quite clearly during the health care debate, as the dirty linen of the health insurance industry was aired in Congress. Read more

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The tyranny of health then and now

No socialism freedom vs tyrannyWhen we hear the words “tyranny of health” these days, it’s usually a reference to the tyranny of a government imposing unwanted health care on its citizens. It brings to mind images of protesters carrying signs that denounce the “socialism” of Obamacare.

As recently as 1994, however, the tyranny of health had a different meaning. That’s when Dr. Faith T. Fitzgerald published an article in The New England Journal of Medicine with that very title. What tyranny of health referred to – and what Dr. Fitzgerald’s readers readily understood at the time – was the idea that doctors should coerce their patients into being healthy. She objected to this increasingly prevalent attitude that expected the medical profession to be a combination of nanny and big brother.

Healthy lifestyles and the definition of health

The article begins with a reference to the recent emphasis on promoting healthy lifestyles: “Once upon a time people did not have lifestyles; they had lives.” (In 2010, it’s easy to forget that we did not always have “lifestyles.”) Dr. Fitzgerald then reminds readers of the 1946 definition of health from the World Health Organization (WHO): “A state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity.” Read more

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“Tyranny of health” on KevinMD

One my recent posts — The Tyranny of Health — was a guest post today on KevinMD. Comments are available here.

The original “Tyranny of Health” article that I wrote about – published by Dr. Faith Fitzgerald in The New England Journal of Medicine in 1994 — is no longer available online in its entirety without a subscription. I plan to discuss it in more detail in the next post.

Update 10/18/10:

Here’s a rather lengthy response I wrote in reply to someone at KevinMD who asked: “In what way did the state turn over its responsibility of individual health to the individuals?” I’ve said these things before, both on this blog and elsewhere. It seems to be one of my pet topics. Read more

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The tyranny of health

Chocolate cakeSomething happened to the public perception of health and medicine in the 1970s. People began to adopt — and financial interests and the media began to profit from – “healthy lifestyles.”

This was not without consequences.

• Americans became increasingly preoccupied with diet, exercise, and health habits.

• There was a big uptick in the use of alternative “medicine” and stress reduction practices – acupuncture, chiropractic, herbalism, naturopathy, nutritional therapies, yoga, massage, biofeedback.

• The increase in news and advice columns on health and wellness made people more anxious about their health.

• The public sought medical care much more frequently for symptoms that would have been considered insignificant in the past.

Was “healthy lifestyles” a medical idea?

Health awareness and anxiety are nothing new. Throughout history people have been concerned about threats to their health. Bubonic plague killed 200 million people. The death rate for women who gave birth in the 19th century was 400 per 100,000 births, compared to 10 per 100,000 today.

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Blogging: Time to get over it

The blogging catDr. Lisa Marcucci, a trauma surgeon and Associate Professor of Surgery, recently did an interview with me for her very successful blog Inside Surgery. It was an opportunity for me to think about why I blog, among many other things. I talked much more freely about myself than I ever do on my own blog.

The interview is quite long and will be posted in three parts. Here’s an excerpt from Part 1, where Dr. Marcucci asks about the mission of my blog.

I started blogging because I wanted to understand something that changed medicine and ideas about health in the 1970s. Prior to that time, the policies of the Kennedy and Johnson administrations had assumed the state should be responsible for the health of its citizens. When political and economic thinking became more conservative in the 1970s and 1980s, governments began to promote the idea that individuals were personally responsible for their health and should practice healthy lifestyles.

A large segment of the population – mainly the educated and economically secure – welcomed these ideas. Feeling personally responsible for one’s health and practicing healthy lifestyles gives one the reassuring illusion of control. In particular, it’s a good distraction from the things that are beyond individual control, like salmonella in our peanut butter and the superbug MRSA at the gym.

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Health insurance industry to consumers: You’re financially responsible for your behavior

Scott Harrington is a professor at Wharton and “adjunct scholar” at the conservative American Enterprise Institute. Two weeks ago he wrote a Wall Street Journal opinion piece that gave the standard Republican argument against a public option: It will inevitably lead to a single-payer system.

“Private health plans have a strong incentive to spend a dollar as long as the expected savings in payments is at least a dollar,’ he said in that article, justifying the profit motive of private insurance companies. Yes, and we all know how insurance companies save dollars: By finding an excuse to cancel the insurance of patients who become ill and by exorbitantly raising the premiums for small businesses. (See Health insurance insider speaks out.)
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Sanjay Gupta a victim of obesity myths?

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… Read more

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