Tag Archives: healthy lifestyles

Nutritionism and the glycemic index

3-levels-of-glycemic-index

Let me begin by quoting a paragraph from Gyorgy Scrinis, a lecturer in food and nutrition politics and policy at the University of Melbourne. This is from a chapter called ‘Nutritionism and Functional Foods,’ which he contributed to the book The Philosophy of Food. Scrinis went on to publish an entire book on this subject, Nutritionism: The science & politics of dietary advice.

Just prior to the following paragraph, Scrinis has been discussing the dietary advice, from the 1960s to the 1990s, that it was better to eat margarine than butter. (Added emphasis in this and the following quotations is mine.)

The “mistake” of inadvertently promoting transfat-laden margarine is one of several mistakes, revisions, and backflips in scientific knowledge and dietary advice over the past century. Other cases include advice regarding dietary cholesterol, eggs, low-fat diets, and vitamin B. Yet these revisions do not seem to have tempered the sustained and confident discourse of precision and control that continues to pervade nutrition science, nor the willingness to translate limited and partial scientific insights into definitive population-wide dietary advice. I refer to this nutritional hubris as the myth of nutritional precision, as it involves an exaggerated representation of scientists’ understanding of the relationship between nutrients, foods, and the body and a failure to acknowledge the limits of the nutrient-level perspective. At the same time, the disagreements and uncertainties that exist within the scientific community with respect to particular nutritional theories tend to be concealed from, or misrepresented to, the lay public.

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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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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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A culture of health needs a market for health

Determinants of healthThis feels encouraging: Two Viewpoint articles in a recent issue of JAMA (The Journal of the American Medical Association) on improving population health (both behind a paywall, unfortunately).

Population health

What is population health? Apparently it depends on who you ask. If you ask those with a financial stake in the health care delivery system, population health means improving the health of patients who currently use (i.e., pay for) the system. You get a different answer if you ask those involved in public health, community development, or social services. They believe “population” should include everyone in the entire geographic community, whether or not those individuals are able to use or benefit from health care services. They also believe “health” should include quality of life and economic well-being – measures that prevent disease in the first place – and not just conditions addressed by the medical model of disease.

What I especially liked about Stephen Shortell’s article – Bridging the Divide between Health and Health Care – was its economic realism. I dearly wish that those with a financial interest in the health care industry, as well as politicians who control health policy, would acknowledge that the way to improve health is to address its social determinants. But trying to change the hearts and minds of stakeholders is like pushing against the tide. 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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The duty to be happy

Pascal Bbruckner Perpetual EuphoriaThe French intellectual Pascal Bruckner casts a critical eye on happiness in his newly translated book, Perpetual Euphoria: On the Duty to Be Happy. Much of what he has to say about happiness applies equally to health.

In the first post on this blog I asked: How did health, which used to be something we were born with, become something we believe we can personally control. Today most people in developed countries assume they can avoid certain diseases and prolong their lives by practicing a “healthy lifestyle.” How did this happen? When did the change occur? What does it mean that – unlike earlier generations — we’re so preoccupied with our health?

Attitudes towards both health and happiness changed in the sixties. In an interview in The Guardian, Bruckner comments: (emphasis added)

After the 60s, there is no more distance between one’s happiness and oneself. … One becomes one’s own main obstacle. To overcome this obstacle a huge market opened: medicine to modify your mood, surgery to modify your body, and it also includes the spread of therapy and new or reformed religions. So Jesus is no longer this transcendent God, but a life coach who helps you overcome addiction and so on. …

We should wonder why depression has become a disease. It is a disease of a society that is looking desperately for happiness, which we cannot catch. And so people collapse into themselves. …

[P]eople are very unhappy when they try hard and fail. We have a lot of power in our lives but not the power to be happy. Happiness is more like a moment of grace.

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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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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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Buffness and beauty are arbitrary fashions

Exercising at the gymA nice essay in the New York Times on the cult of physical fitness, past and present, occasioned by the death of Jack LaLanne. (emphasis added)

That sense of failure you feel when you haven’t exercised in days? That conviction that if you could pull off better push-ups, you’d be a better person through and through? These, too, are his [LaLanne’s] doing, at least in part. What he left behind when he died last week, at the toned old age of 96, was not only a sweaty culture of relentless crunching and spinning but also the notion that fitness equals character, and that self-actualization begins with the self-discipline to get and stay in shape. In the post-LaLanne landscape, it’s not the eyes but the abdominals that are windows to the soul. …

There’s a bullying strain to the modern fitness ethos, a blurred line between cheerleading and hectoring. And it’s hard not to wonder whether that kind of intimidation — in addition to the social and economic realities of diet and exercise — helps explain the paradox that for all the newfangled aerobic machines and reduced-rate January gym memberships, Americans aren’t noticeably haler and healthier.

When exercise comes wrapped in value judgments, does it wind up entangled in an anxiety that threatens the very resolve to get fit? As Mr. LaLanne was siring new methods for shaping up, he was fathering something else, too: a potent, and in some cases immobilizing, strain of contemporary guilt.

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Fla judge rules against health care bill (& broccoli)

Broccoli and the univeral mandateA conservative federal judge in a conservative area of the conservative state of Florida ruled today on the health care reform act. Not only did he rule that the individual mandate – the requirement that everyone have insurance – was unconstitutional, which was expected. He declared the entire bill unconstitutional.

Judge Vinson acknowledged that this was a bit unusual.

This conclusion [that the entire bill is unconstitutional] is reached with full appreciation for the “normal rule” that reviewing courts should ordinarily refrain from invalidating more than the unconstitutional part of a statute, but non-severability is required based on the unique facts of this case and the particular aspects of the Act.

Why does the individual mandate raise a constitutional issue when other government health care programs – Medicare, Medicaid, health care for veterans – did not? An article in the The New England Journal of Medicine (NEJM) explains. (emphasis added) 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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The problem is you

The problem is youA post I wrote earlier this month — Character, personality, and cosmetic surgery — reminds me very much of something I wrote 30 years ago. It was a chapter called “The Problem Is You” in a book I published in 1981. Today I write about personal responsibility for health. In the 1980s my phrase to identify that emerging phenomenon was “the problem is you.”

The 1980s saw significant shifts in medicine and health care, among them a shift away from focused attention on disease and chronic illness to an emphasis on individual risk factors, the need for greater self-surveillance, and the promotion of personal responsibility for health.

Health includes psychological well being, and one of the areas where blaming yourself was most apparent was the self-help industry. What I wrote 30 years ago was prompted by Wayne Dyer’s book, Your Erroneous Zones, first published in 1976 and now available from Amazon in 17 different formats. Dyer’s message: responsibility for emotional dissatisfaction lies with the individual. The problem is you.

The dark side of positivity

The message from the self-help industry (you control your own destiny and have no one to blame but yourself) was also popular in the business community (successful positive thinking is essential if you want to impress employers, customers, and co-workers). It was eventually adopted by the health care industry (you are personally responsible for living a healthy lifestyle).

There is a dark side to positive thinking, however, as Barbara Ehrenreich describes in her recent book Bright-sided: How the Relentless Promotion of Positive Thinking Has Undermined America. Read more

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Can Congress Force You to Be Healthy?

Doctor patient police The individualmandateLaw professor Jason Mazzone asks this question in a recent NY Times op-ed piece. His remarks were prompted by the recent Virginia ruling on the health care law’s individual mandate provision, the requirement that everyone must either be insured or pay a penalty.

To ask if health care legislation forces you to be healthy is misleading. Neither the government, the medical profession, or nor anyone else should force you to be healthy. A civilized nation, however, should make affordable health care available to all its citizens. These two are not the same thing.

Be personally responsible for your health or else

Governments want people to be healthy because this creates a productive workforce. Governments should support policies that create healthy environments in which its citizens can live and work. But no one wants Congress to force people to be healthy. What we want is not to go bankrupt when we get sick. We’re all going to die, and most of us will get sick or be in an accident before we die. We shouldn’t have to die prematurely simply because we can’t afford insurance. Read more

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Character, personality, and cosmetic surgery

IntegrityI am not a blogger. I know what Andrew Sullivan and the Huffington Post people say about how one should blog: Think of it as a conversation and just write what you would say to a friend. I can do that in a comment, but not in a post. It doesn’t suit my “personality” – and personality is a topic in this post.

But … I wrote a comment that got so long, it seemed like it should be a post. It’s a reply to something Roberta said in a comment on Wang Bei and cosmetic surgery.

[T]here is a personality or psychological need within some people that drives them to have plastic surgery to fill a hole inside them. I think people who seek fame and want to go into the entertainment industry, like Wang Bei, by and large have a certain personality type. And it is largely based on a need for constantly being in the spotlight, and a need for constant applause or approval. The roots of these needs would be many and complex, but could include genetics and parenting style.

Here’s my reply. Read more

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Healthy lifestyles serve political interests

Runner healthy lifestylesUltimately, decisions about a country’s health are not a matter of science, medicine, research, or scholarship. They are essentially political choices. When the US leans right, the solution to the health care crisis is to emphasize personal responsibility (aka prevention through healthy lifestyles). When the country leans left, there’s increased interest in the “negative externalities” of advanced market capitalism (pollution, climate change, ethnic inequities). Neither one is exclusively right or wrong. But when the political climate puts the spotlight on patients who are guilty of unhealthy lifestyles, the focus goes dim on those “fundamental mechanisms leading to disease” that have nothing to do with lifestyle. We lose sight of the genuine solutions that an increased focus on those mechanisms could provide. 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 health care. 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 … the idea that patients should be coerced into being healthy. Read more

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“Tyranny of health” on KevinMD

Cat in windowThat we’re not routinely made seriously ill by this shortfall … is due largely to the fact that most medical interventions and advice don’t address life-and-death situations, but rather aim to leave us marginally healthier or less unhealthy, so we usually neither gain nor risk all that much. Read more

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The tyranny of health

Chocolate cakeA recent commentary in the Journal of the American Medical Association asks: If individuals don’t use preventive services, “what kind of penalty … would be ethically and morally acceptable?” The question wasn’t “How do we account for unhealthy behavior,” but what punishment would be sufficient either to change that behavior or at least to save money by denying these people health care. Read more

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Blogging: Time to get over it

The blogging catWhen 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. Read more

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