Monday, December 26, 2011

WHAT’S THIS ALL ABOUT, ANYWAY?

Writing a blog is easy. You just say whatever’s on your mind du jour. You don’t have to be 100% sure of what you’re writing because if you don’t get it exact enough, you can correct it tomorrow. But books, especially paper ones, last longer so are more difficult to set straight. These days, then, as I massage this blog into a book, I need to think more carefully about what I’m writing.

I’ve described here how illness changed during the past half-century. When I was a kid, medical visits were principally for bacterial and viral infections. Now they’re mainly for conditions deriving from pathogenic (disease-causing) lifestyles, including horrendous diet, inadequate exercise, poor stress management, dysfunctional relationships, negative self-image, and exposure to literally a million toxins and carcinogens in our food, air, water, building materials, home products, cosmetics, and even medications. These behaviors predictably lead to obesity, type two diabetes, and much of cancer, hypertension and cardiovascular disease. This notion—that we cause most of our diseases—can be a hard fact to swallow. If you don’t believe it, ask your doctor.

Thinking about this shift critically, I’ve come to realize that pathogenic behavior isn’t intentionally self-destructive. On the contrary, it’s usually an attempt to cope with social demands, some of which can be frankly insane. My friends who began to smoke in their late teens and early twenties did so for peer acceptance; they lit up because their friends did, attracted by cigaret ads touting savoir faire. Alcoholics drink not to bring on cirrhosis, but to anesthetise the pain in their life. A teen doesn’t disappear into the couch-potato video game world aiming to flab his body, but to visit a place where he can win for a change. The compulsive eater doesn’t put away a quart of Ben & Jerry’s in response to a lipid deficit, but because she senses an internal emptiness, a feeling of literal unfulfillment. The employee or spouse who puts up with abuse does so because the prospect of responding to it honestly is even more threatening.


In other words, much current illness arises in unhappiness. Every culture's values inevitably dictate much of its constituents’ behavior. Our culture, leaning massively toward materialism, consumption, and individualism, ultimately breeds feelings of inadequacy, competition and separation. Little wonder, then, that we train our physicians to examine and treat individuals, virtually ignoring the context in which they live. Thus we docs wait in our offices and clinics for patients to show up with the diseases that have finally bloomed from their various unhappinesses, and we repair them enough to return them to their pathogenic lives.


This cycle is obviously ineffectual, not to mention ridiculously costly, but even worse, our treatments perpetuate misery by simply turning down its amplitude. Our patches, our tranquilizers and antidepressants, our BP meds and stents and stomach staplings do little more than numb the pain people have unconsciously chosen to live with. In the most honest light, much of our intervention can be seen as enabling neurotic behavior.


Certainly we should treat the longterm smoker's emphysema and the type two diabetes of the obese, since healthcare without compassion is only engineering. But while we perform those treatments, we need also to exercise commensurate skills in educating, encouraging, and supporting our patients in genuine prevention. Colonoscopies and mammograms have their place, but people need also to awake to the possibility of higher-quality lives, styles that honor their personal value and don’t just clear the lowest bar society offers.

Wednesday, December 14, 2011

SUFFICIENT ATTENTION SYNDROME: The Subtle Crippler

The article below was lifted from the current issue of the Journal of Possible Disorders.

In mid-November of this year, Dr. Kevin Bland of the University of Cleveland School of Medicine described a disorder long thought to exist but never before identified, Sufficient Attention Syndrome.

“SAS may be part of the autism range,” said Dr. Bland. “Its sufferers were previously ignored because they tended to avoid online social networks. They’re identifiable, though, by their requirement of unusually long periods to assess their surroundings. They pause in conversations, evidently to think about what was said and what to say themselves. They are employment-challenged by their inability to multitask; in fact, they often seem proud of being monotaskers. Continually dissatisfied with news headlines, they insist on knowing details, too. They don’t watch television because rapid scene changes nauseate them. They’re often shunned because they’re considered too curious and intense.”

Fortunately, treatments are promising. According to Dr. Bland, “Avarice Pharmaceuticals has developed a new drug, Distractin, designed to scramble neural circuits back to normal. We expect in the near future to welcome SAS patients back into fast-track society.”

Tuesday, December 6, 2011

CONSUMPTION

We’d do well to ask why obesity is so rampant. I mentioned yesterday that healthcare costs resulting from it exceed those associated with both smoking and drinking. Funny: all these pathogenic behaviors involve the mouth.

Hardly anyone would dispute that we’re a nation of consumers. We were once a nation of creators, inventors, initiators, but now we just sit ourselves down and ingest. The trope’s even pervaded healthcare: during the last thirty or forty years, as our model of healthcare shifted from a service to a commercial transaction, patients and doctors became “consumers” and “providers.” When I hear myself referred to as a provider, I’d like to provide the speaker with a sound drubbing. And the term “consumer” conjures for me the image of those train-sized omnivorous worms in Frank Herbert’s Dune.



Why are we such obligate consumers?

I suspect we aim to fill a void we sense in our core, a feeling that we’re existentially empty. I’ve quoted eating-disorder guru Geneen Roth here more than once: “You can’t get enough of what you don’t need.” The emptiness we feel isn’t material. It’s spiritual, a currency in which our society is painfully poor. Oh, yeah, there’s plenty of religion around, but much of that, it seems to me, is plain old creed, pious language betrayed by actual behavior. As a popular country/western song goes,

I’ve driven my whole life on empty
Still, I think I done pretty good
I got two SUVs and a Hummer,
And a home in a walled neighborhood
Got a boat with a thousand-horse outboard
My TV screen takes up a whole wall
I got lots of stuff, but it’s never enough
‘Cause no one sells love at the mall

I bought me an RV to travel
And seek what might comfort my soul
I yearned to be more than a food tube,
An unfillable, bottomless hole
I parked in the lot of a Wal-Mart
And in high hopes I entered the store
Bought an iPod and a drill and a George Foreman grill
But left as empty as I was before.
‘Cause no one sells love at the mall
They don’t deal with affection at all
True love, you can’t get it for cash, check or credit
‘Cause no one sells love at the mall

Consumerism presumes that nothing of much value exists inherently within us. Maybe this is an extension of the western notion of original sin. Until we sit and get quiet and finally see the wondrous beings that we are, we’ll continue consuming without satisfaction.

Monday, December 5, 2011

NO CHILD LEFT WITHOUT A BEHIND

The first article I ever published, in Co-Evolution Quarterly in 1980, was entitled “Insurance and the Abandonment of Responsibility.” It pointed out that all else equal, those who take better care of themselves will subsidize, through medical insurance premiums and taxes, the healthcare of those who don’t. Nothing has changed since then.

A major reason healthcare is so expensive is that we simply use too much of it. Americans engage in a number of pathogenic (disease-causing) behaviors until florid disease erupts, and then ask physicians to repair them. We harbor the notion, reinforced by incessant marketing, that medical science can correct just about anything. I can mistreat my heart all I like because when it finally caves in, I can get a new one.

Arguably our most common pathogenic behavior involves diet, obesity being alarmingly endemic. Three-quarters of Americans are overweight or obese, but what’s more distressing is the kid rate, now estimated to be 15-25%. Obesity leads to type II diabetes, cardiovascular disease and hypertension, not to mention disability associated with carrying around all the extra baggage. It’s estimated that obesity costs our society $117 billion annually, exceeding the healthcare costs associated with both smoking and drinking.  

Obesity’s become part of our accepted social landscape. Clothing catalogs standardly offer women “plus” sizes, and men, “big and tall.” Airlines debate installing larger seats, or charging passengers double if their bulk flows over the armrest. A man recently sued a burger chain because its seats wedged him in too tightly.

Last week I encountered evidence that obesity is no passing fad. Visiting another town where a new hospital is being constructed, we learned its special obesity ward will feature a ceiling fitted with a mechanical lift system since a good number of patients are now too heavy to hoist without industrial machinery; in addition, too many of the hospital staff themselves can barely carry their own estimable bulk, let alone their patients'.

Someone’s bound to cavil that some obesity is genetically programmed. Right: that proportion is about one in five hundred people. The rest comes from what’s eaten, period. Many pathogenic diets are a product of poverty. Try feeding your family a healthy diet on a minimum wage income. Unable to afford fresh organic groceries, you’ll opt instead for processed foods notoriously richer in preservatives than nutrition. These imitations are cheaper than the real thing, by the way, thanks to government subsidies their manufacturers wangled. Consuming these empty calories, you’ll plump out without being nourished. If people mattered as much as corporate profit does, we’d help them find their way to genuine food.

Too many families who can afford decent nutrition opt for the convenience of prepared foods, and children in these families grow up learning no alternative. If you’d like a shock, watch this video,  http://www.youtube.com/watch?v=bGYs4KS_djg&feature=results_video&playnext=1&list=PL35762311C5A7EF37, in which chef Randy Oliver asks a second-grade classroom to identify tomatoes. The poor kids haven't a clue. Maybe they've seen a sliced tomato on a McGutbuster, but never a whole tomato.

I recently related in this blog a report by a prestigious medical board (http://www.nhlbi.nih.gov/guidelines/cvd_ped/summary.htm) about American childhood obesity. The board recommended testing kids for serum cholesterol levels beginning at age nine. It also recommended, between page after page of pharmaceutical interventions, “intense lifestyle management” without spelling out what that might be. Of course, everyone suggests behavioral change along with medications, but in practice that amounts to meds alone. Testing kids and putting them on “corrective” drugs will, of course, keep the wheels of commerce spinning (especially since kids will need additional drugs to deal with side effects), but it won’t do a thing to increase the national health. As a certified curmudgeon, I’m amazed, astonished, and appalled that we evince such impressive expertise in chemical engineering, but are so little interested in a national program to promote personal health responsibility.