Wednesday, September 19, 2012


According to the Robert Wood Johnson Foundation, more than half of Americans could be obese by 2030. The result will surpass simply living with excess bulk. We’ll see millions of new cases of diabetes, coronary artery disease, and stroke—a constellation of illness that could cost the United States up to $66 billion in treatment and over $500 billion in lost economic productivity.

According to the national Centers for Disease Control and Prevention, a third of American adults are obese today. “Overweight” and “obese” are technical terms. If you’d like to know where you fit in, divide your weight in pounds by the square of your height in inches, and multiply the result by 703. For example, if you weigh 140 pounds and are five feet six inches (that is, sixty-six inches) tall, your calculation would be

 140     x 703 = 22.59
  66 x 66

The result, here 22.59, is your “body mass index,” or BMI. If your BMI is between 25 and 30, you’re overweight, and above 30, obese.

What are we going to do about this? New York City’s recent strategy, limiting sugar-rich drinks to sixteen ounces, has been met with outraged cries of “Nanny state!” It's not only widely opposed, but ineffective, as a determined customer can buy two sixteen-ounce drinks. Or four.

I’m disappointed that we respond to this menace by debating what the government can or should do about it. What can citizens themselves do? Why have so many of us lost touch with our own bodies? Why aren’t we more concerned about our ballooning kids? Our problem is less obesity than failure of consciousness. What does it take to wake us up?

Tuesday, September 18, 2012


According to a Reuters report (, a Mayo Clinic study has found that a program focused on improving quality of life can help people being treated for advanced cancer. Patients who attended the sessions—a combination of physical and talk therapy, along with relaxation techniques and spiritual discussions—reported a stable quality of life during treatment, while patients who didn't get the extra help declined on those measures.

People who have had cancer or any other serious illness won’t be surprised by that finding. They know in their bones that cancer’s more than a tumor. Its accompanying emotions grossly abrade one’s life. Attending to quality, then, not only makes a difference, but ought to be a standard part of cancer treatment.

As a matter of fact, attending to quality ought to be a lifelong function. Why wait for cancer? Most of us tolerate some degree of unhealthy diet, inadequate exercise, toxic exposure, adverse self-image, poor stress management, unfulfilling work, deficient support, or dysfunctional relationships. Do we need that? Can we do better?

Preventive medicine means more than getting regular checkups. Ultimately it means living one’s ideal life. When we consider what that might look like, we entertain images of cruising around in a shiny convertible, tippling champagne, partying, going for the gusto. Thus we compile “bucket lists” that include skydiving, bunji jumping, and other extremes. These images find their way into us via pop culture marketing; they’re not necessarily us. What exactly would your perfect life be like, moment-to-moment, day-to-day? It might not depart significantly from what you’re doing now, or you might sense major challenges to confront.

One of Freud’s disciples, Alfred Adler, routinely asked his patients, “If you were cured, how would you behave?” They’d think about it, finally answer, and then Adler would say, “Then why don’t you do that now?”

Thursday, September 6, 2012


A new procedure, bronchial thermoplasty, is becoming available to people who suffer severe asthma. It consists of introducing a tube called a bronchoscope into the airway and then heating the lungs, lobe by lobe, to 149 degrees Fahrenheit. This apparently reverses the smooth muscle swelling characteristic of asthma. Post-treatment studies indicate fewer attacks and fewer hospital visits. It costs around twenty thousand dollars.

Understandably, insurers are reluctant to cover it, their rationale being that it’s still “experimental.” So some—or maybe most—asthma sufferers will go without bronchial thermoplasty. This seems a shame, say many, since the multiple hospital visits and treatments that the procedure might obviate will cost far more than twenty thousand dollars.

This exemplifies healthcare’s predicament. New and possibly effective technologies are constantly coming down the pike. What they have in common is breathtaking cost: high-tech is inarguably expensive. Someone needs to pay for it, and it will inevitably be end-users, either through taxes or higher insurance premiums. The more optimistic view is that high cost in a single treatment is possibly cheaper than dozens of hospitalizations. I find it hard to take sides on that, but it makes me recall the observation a friend from Mumbai offered me: “You Americans have a lot of know-how; what you seem to lack is know-why.”

That is, we could ask ourselves why there’s so much asthma these days. In our little rural county, asthma incidence has increased along with constant rise in ozone, a known cause. Now one of every six of our kids is asthmatic. Our ozone isn't created here, but drifts here from population centers, where it’s generated by internal combustion exhaust.

We treat asthma—and a host of other preventable illnesses—only after it’s gotten to the emergency department level. We could choose to prevent much of it by providing ourselves cleaner air. By the same token, we could prevent much of cancer by questioning the presence of thousands of chemicals added to our foods and other products, and much of cardiovascular disease with personal habit changes. 

But our political system is gridlocked, and our healthcare system limits its jurisdiction to flagrant disease. Insisting on overt disease development instead of sensible prevention, we’ll be faced with dilemmas such as the efficacy versus cost of high-tech procedures like bronchial thermoplasty. A genuine “breakthrough” in American healthcare will be to address illness far earlier in its development. That would require a sharp increase in personal responsibility and civic participation. Are you willing?