Stop that Bug!

Colleague and WBP supporter Art Caplan explains that the 1918 offers some lessons for us today and that all of us have a responsibility to keep swine flu from spreading:

When faced with the threat of disease, the impulse of most Americans is to think about medical technology and miracle drugs. These are not likely to be much help in the battle against swine flu — but the history books might.

As history has proven, the best way to halt a deadly virus is to keep infected people away from others. In 1918, an influenza pandemic caused by a strain of flu similar to the one identified in Mexico killed more people than died in all of World War I. Up to 50 million people died worldwide. The greatest number of deaths occurred among young adults between the ages of 15 and 35.

At the time, young American men were being mustered into military camps from all corners of the country to prepare for the war. A few brought to those cramped quarters a new strain of flu. They quickly infected one another at an astonishing rate. As they were ordered to ship out, the epidemic spread along the train lines they used, with the flu jumping into the civilian population at every stop, right up to the harbors and port cities where they departed. Many experts think the flu followed these troops on their convoys into Europe, causing millions more to die.

We risk making that same fatal mistake this time around.

The Obama administration has developed plans to send National Guard troops from all over the U.S. to the Mexican border to help contain the violence from the bloody drug war raging there. I hope that by now the White House has realized this is a really, really bad idea. Sending the Guard right now to battle drug war lords could accelerate the spread of the swine flu among a high-risk group while giving the virus a free pass to travel all over the United States as the troops rotate home.

The 1918 pandemic offers additional stark lessons. While an effective vaccine may be found against this rare strain of swine flu, it will take many months to produce in large amounts. The best weapons we have right now are not glamorous and have little to do with doctors, drugs and hospitals: They are isolation, hygiene and controlling large gatherings of people.

New Zealand just quarantined a group of students who had flown back from Mexico. We may need to do the same thing.

Americans are not used to giving up individual liberty in the name of the common good. But that attitude is exactly what diseases such as the swine flu virus thrive on.

Heading out to church, the movies, restaurants, subways, supermarkets, day care centers, schools and other places where large numbers of people gather is a recipe for spreading the virus. What if infected people and those who have close contact with them won’t stay home? What if people with symptoms slog in to work anyway? Will we intrude on their basic rights and make them stay home? Are we willing to cancel public events and close schools, museums and churches until the infection passes, no matter how loud the protests?

Good hygiene — washing your hands frequently; wearing a filtering mask; keeping doorknobs and surfaces clean; being careful about sneezing, spitting and coughing — is helpful in controlling the spread of nearly all infectious diseases, swine flu included.

Each of us needs to take responsibility for stopping the spread of the flu.

What the nation needs is not to send an army to sit in the path of a deadly virus. Instead, we need to prepare for a short period of time when individual rights to go where we want, spend time with who we want and assemble as we want yield to the necessity of protecting the common good.

Reprinted from MSNBC website, original article can be found here.

Obesity in the News, part two (or 'Can Fat Be Fit?')

In light of Kelly's earlier post about the media's obsession with obesity being more epidemic than obesity itself, I thought it was timely that this article just came out in Scientific American:

"Can Fat Be Fit?

A well-publicized study and a spate of popular books raise questions about the ill effects of being overweight. Their conclusions are probably wrong.

By Paul Raeburn

Two years ago Katherine M. Flegal, a re­search­er at the Centers for Disease Control and Prevention, did a new statistical analysis of national survey data on obesity and came to a startling conclusion: mildly overweight adults had a lower risk of dying than those at so-called healthy weights..."[Full text here]

The article goes on to explain that the states are high in this debate...that a "major thrust of the nation’s disease prevention efforts are aimed at ending what orthodox researchers say is an epidemic of obesity." And if obesity is not the primary cause of heart disease and other serious illnesses, then efforts to trim American waistlines are entirely misplaced.

Language does matter -- I've heard it said that obesity is the last bastion of socially acceptable bigotry. I recently overheard some young women in Europe, standing outside a hotel having a cigarette break, saying that the reason they smoke is so that they don't 'get fat'. But there are worse than being 'fat' -- likely being sedentary. Or dead from lung cancer.

One the things that so many of the articles fail to mention is the importance of regular physical activity -- that the fitness that results from regular exercise confers a variety of health-related benefits in obese patients even if they lose no weight. It seems to me that regular exercise is a far more reliable indicator of health than simple body mass -- based on BMI alone, Brad Pitt, Keanu Reeves, and Michael Jordan are all overweight. And George Clooney and Matt LeBlanc are obese. In fact, a quick review of literature revealed this gem of a study, by Warburton, Nicol, and Bredin: "We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death." All that, with barely a mention of BMI.

To which I say, let's do a celebratory jig.

Obesity in the News (or, Why Language Matters)

Obesity research is all over the news today:

From the BBC, obesity is linked to birth defects and health risks: a large scale study in the journal Archives of Pediatrics and Adolescent Medicine says that women who are obese when they conceive are more likely to have chronic diseases, fertility problems, miscarriages and complications during pregnancy, as well as birth defects including missing limbs and malformed hearts.

Then there's a study reported in Cell, which suggests that the skeleton is part of the endocrine system, specifically helping with the regulation of osteocalcin, which in addition to regulating mineralization appears to regulate glucose and deposits of body fat. This likely explains, at least in part, the connection between obesity and type two diabetes; researchers will move forward to look more closely at this link, next.

Following that, a study out of UPenn says that obese kids are more absent from school than others, and in fact suggests that obesity is more an indication for how much school a child will miss than any other factor, including race, gender, or socioeconomic status. The lead researcher is pretty succinct about why this is, too: the kids don't want to be teased or bullied over their weight.

According to a report at an American Physiological Society meeting, estrogen loss leads to weight gain, as well as hypertension, suggesting that estrogen treatment is beneficial for both the heart and the body.

And finally, it looks like people overeat due to another hormone-gone-wonky. People who don't manufacture leptin tend to overeat, becoming chronically obese. People who are deficient in leptin have the same areas of their brain react, at the sight of food, that react to rewarding emotions/desires.

So what's the point to all the fat talk? For some people, fatness, being overweight, obesity, is simply a medical issue. You are overweight for a reason, be it medical or psychological, it is bad for you, you should work on not being overweight, which is good for you. There are clear concepts of good and bad tied to this model of viewing weight, and it tends to be a part of the general medicalization of weight we see - to be thin (but not too thin) is healthy, to be fat is to be unhealthy. And within healthy/unhealthy there are specific moral and value-laden beliefs that tie into good and bad; to be healthy is to be good, to be fat is to be bad.

But there are people out there, often people who are overweight, that reject this sometimes value-laden, binary attitude towards weight. They are comfortable with their weight, and don't appreciate being "bullied" by society to adhere to an ideal they don't believe is accurate. These folks often espouse the motto "healthy regardless of weight", placing an emphasis on health outside of weight. After all, the reasoning goes, if someone is 65 lbs overweight, but perfectly healthy otherwise, what business is it of anyone just what that weight is? People come in all sizes, and as long as the individual is healthy, what that size is shouldn't matter to anyone. While this group, often known as fat activists, embrace the notion of being healthy, they reject the idea that healthy is thin is good, and unhealthy is fat is bad.

How news reports discussing obesity are received tends to depend on how they are written. If they are written, as most are, in the medicalized and moralized language of the first model, a group of people - perhaps the group of people most affected by the research being reported on - are alienated from the outset by the language, and judgment, being used. People are sensitive to the language being used to describe them, and very few people respond positively to being preached at.

A healthy body is a goal that is hard to argue with, and if we communicated consistently in such a manner, we might very well discover that many of the medicalized concerns about the overweight/obese would be addressed to everyone's satisfaction.