Month: December 2013

A reader writes:

I read with some consternation the reaction of one of your readers to the admonition by a physician that there is no “healthy obesity”.  It is worth pointing out that contrary to your reader’s unsupported assertion, clinical data does not support the idea that obesity in the absence of metabolic abnormalities (high blood pressure, high cholesterol, diabetes, etc.) is as safe as being normal weight.  Specifically, a recent systematic review and meta-analysis (that is, an analysis that looked to combine data from multiple independent studies) appeared in the Annals of Internal Medicine (here is the link to the abstract). The study combined eight studies that looked at 61,386 people in all and found that otherwise healthy obese individuals had about a 25% increased risk for death or cardiovascular events (heart attacks and strokes) compared to healthy normal weight individuals.  To quote the conclusion: ” Compared with metabolically healthy normal-weight individuals, obese persons are at increased risk for adverse long-term outcomes even in the absence of metabolic abnormalities, suggesting that there is no healthy pattern of increased weight.” [emphasis mine] Here‘s a NYT blog entry on the study.

I am very sympathetic to your reader’s assertion that eating healthily and exercising regularly doesn’t always result in weight loss, and the reader is certainly correct that doing those things will result in health independent of whether it affects weight loss.  I also cringed at the way the physician reader’s tone.  But he is also correct; all else being equal, an obese person is at increased risk for bad health outcomes.

Another reader is much more blunt:

That obesity is tied to many terrible and debilitating physical aliments is not merely opinion, and to point to the very few healthy exceptions to this norm is not an argument worth a damn.  And unfortunately, too few doctors even bother to make the recommendation to lose weight to their patients anymore, opting instead to prescribe drugs like statins or insulin, or surgical therapies, like gastric bypasses.  Why some overweight people think taking a palmful of drugs with potentially dangerous or even deadly side-effects or having part of their guts chopped out is more desirable than losing some weight through managing their eating habits and exercising regularly is mind-boggling.  Weight loss is not a complicated process, but it does mean the dieter cannot continue to eat like a spoiled child.  It means denying oneself everything one wants to eat, yes, okay, so suck it up or accept the fact that you are making a trade off: chose self-indulgent eating or health, mobility, and extended lifespan.

But I sigh because for anyone to claim obesity doesn’t matter or isn’t the health burden it actually is is ludicrous.  My own health has been greatly improved through weight maintenance and regular exercise.  I have been able to reverse my strong family history of heart disease – my father, who did not exercise or watch his weight, had a triple bypass by my age whereas my current risk of heart disease is rated extremely low.  Meanwhile, one of my siblings who disregarded proper weight management and regular exercise has also had a triple bypass. Sorry, but obesity and sloth make a huge negative impact on one’s health and anyone who argues otherwise is just nuts.

Another looks beyond health problems:

People who are obese may not have the issues that are often correlated with it, but there’s something to be said about the social impact and your ability to be mobile. I’ve lost 120lbs in about two years so far and I’ve seen both sides of this issue. The fact was, I was getting winded going up two flights of stairs. People wouldn’t sit next to me on the bus. Jokes were made at my expense. I could barely sit in seats and booths at restaurants. So if I didn’t have diabetes, heart disease, or high blood pressure, all of this would be okay?

After my weight loss I’m seeing doors open up to me. I’m getting solicited by men, and at my job I am getting more recognition for my hard work. They’re even talking about letting me travel; something they’ve never brought up to me before my weight loss.

Whether this is right or not is certainly a discussion, but at this moment it is the reality. Why artificially limit yourself in these ways because you want to convince yourself being obese is healthy somehow? It sounds like surrender.

In today’s video, Rick outlines the assorted dangers of psychedelic drug use:

In a followup video, Rick explains why he doesn’t think a history of mental illness should exclude someone from the potential benefits of psychedelic therapy:

Rick’s previous videos are here. From his bio:

Rick Doblin, Ph.D., is the founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS). He received his doctorate in Public Policy from Harvard’s Kennedy School of Government, where he wrote his dissertation on the regulation of the medical uses of psychedelics and marijuana and his Master’s thesis on a survey of oncologists about smoked marijuana vs. the oral THC pill in nausea control for cancer patients. His undergraduate thesis at New College of Florida was a 25-year follow-up to the classic Good Friday Experiment, which evaluated the potential of psychedelic drugs to catalyze religious experiences.

His professional goal is to help develop legal contexts for the beneficial uses of psychedelics and marijuana, primarily as prescription medicines but also for personal growth for otherwise healthy people, and eventually to become a legally licensed psychedelic therapist. He founded MAPS in 1986, and currently resides in Boston with his wife and three children.

Our extensive coverage of the spiritual and therapeutic benefits of psychedelics is here (or, in chronological order, here). Our full Ask Anything archive is here.

The FDA wants to curb the use of antibiotics on livestock. The drugs are heavily used because they increase animal growth for reasons not fully understood. McArdle supports the move:

Antibiotic resistance is a growing problem that endangers many of the medical miracles we now take for granted. Antibiotics are effectively a scarce resource; we should be husbanding them to cure disease, not to make our steak 15 percent cheaper. That said, don’t think that this solves the problem. When I wrote a piece about antibiotic resistance for the Atlantic, I expected to get easy quotes from experts on the scurrilous waste of feeding penicillin to pigs. But none of the experts I talked to were willing to say that this was a huge part of the antibiotic-resistance problem. Most resistance isn’t evolving on farms, where very few of us spend any time; to be sure, we eat meat from those farms, but cooking should kill off most of the resistant bacteria. Most cases of antibiotic-resistant bacteria come from hospitals, people who have been in hospitals, or tuberculosis patients who stop taking their drugs as soon as they feel better.

Kent Sepkowitz makes related points:

Though admirable, the FDA’s action should not distract from the larger issue at hand: yes, we are giving too much antibiotic to pigs, but the real issue is that humans have been so piggish about prescribing and requesting and gobbling antibiotics—in hospitals and doctor’s offices and drive-through urgi-centers and through the mail. We are addicted as a nation not just to opiates but to antibiotics—and as with other addictions, sooner than later, the party always ends.

Maryn McKenna notes that the FDA’s announcement has no teeth:

This plan is not legislation, nor a regulation; it is entirely voluntary. (Hence the “shoulds” above rather than “musts.”) If you look at the Guidance document itself, it is prominently labeled “Contains Nonbinding Recommendations,” and also says: “This guidance … does not create or confer any rights for or on any person and does not operate to bind FDA or the public.” Companies have 90 days to signal to the FDA whether they agree to follow this plan. Could they defy the agency and continue to sell their products for growth promotion? Probably they could; but the FDA has promised to make transparent which companies sign up and don’t, apparently counting on public pressure to get companies to move.

Dina Fine Maron is pessimistic about compliance:

The bigger news today is that FDA also issued a proposed rule that would force animal producers to obtain veterinary oversight to use certain antibiotics. Essentially, farms would need a prescription to use these drugs in animal feed. It would be a step in the right direction – if it survives the comment period intact.

Tom Philpott weighs in:

[T]here’s little distinction between giving animals small daily doses of antibiotics to prevent disease and giving them small daily doses to make them put on weight. The industry can simply claim it’s using antibiotics “preventively,” continuing to reap the benefits of growth promotion and continue to generate resistant bacteria. That’s the loophole.

But the document released Wednesday delivers five pretty specific guidelines on how “prevention” should be defined, including that antibiotics prescribed preventively should be “targeted to animals at risk of developing a specific disease,” i.e., not given willy-nilly to “prevent” the theoretical possibility of some hypothetical disease. It adds: “FDA would not consider the administration of a drug to apparently healthy animals in the absence of any information that such animals were at risk of a specific disease to be judicious.” That’s the strongest statement I’ve seen from the FDA on the prevention loophole.

(Photo  by Jeroen Bennink)

Responding to the on-air rant by Megyn Kelly insisting that both Santa Claus and Jesus Christ were “white men,” Aisha Harris points out that “Santa isn’t real”:

Santa is loosely based on Saint Nicholas, a fourth-century Greek bishop known for secret gift-giving. But while the names “St. Nicholas” and “Santa Claus” are often used interchangeably, modern-day Santa hardly resembles his supposed inspiration, who was depicted as tall and thin and, you know, Greek. He did not have a workshop in the North Pole nor eight faithful reindeer. Santa as we know him today is the result of wild imaginations and creative input from many people across centuries, including, as I noted in my piece, Washington Irving and Clement Clark Moore. He’s utterly divorced from his religious and historical roots.

Alyssa provides more history:

Santa Claus is frequently depicted as a white guy today precisely because of what Kelly said we absolutely must not do: “revise it in the middle of the legacy of the story.”

As part of the long process of formalizing a celebration of the birth of Christ–which includes shifting the purported date of Jesus’ arrival in the world to midwinter to coopt pagan observances and then suppressing said observances–Saint Nicholas gets mashed up with other figures. These include Sinterklass, who may be a variation of the Norse god Odin, and who’s part of holiday observances in places as varied as the Netherlands and Greece. Father Christmas, the British character, has analogues in South America, most European countries, and the Caucuses. And this isn’t even including characters like Zwarte Piet, who’s part of Christmas folklore in Netherlands, Luxembourg and Belgium, who is, wait for it, of African origin.

In the United States, many people and organizations have contributed to our modern conception of Santa Claus’ physical appearance, including the the political cartoonist and muckracker Thomas Nast, the White Rock Beverage company which used him to sell mineral water, and Haddon Sundblom, who drew Santa Claus for Coca-Cola’s famous 1930s advertising campaign.

Poniewozik’s take:

Relying on the historical argument to prove or disprove whether Santa is white is essentially insane. Because, and I’m going to go out on a limb here, but I will argue that once you give the guy a workshop of magical elves, eight tiny flying reindeer, and the ability to distend his corpulent body down a billion chimneys in a night, historical verisimilitude no longer obtains. Santa–avert your eyes, kids–is a fictional character, and as such, can plausibly be represented and colored any damn way you want him. (Or her! Yeah, I said it.) To say that he “is just white” because that’s the way fictional pictures of him have mostly appeared is to say that your pictures and traditions are solely legitimate, authentic, the cultural default. (A message that seems aimed not so much at the kids as at an audience of adult viewers terrified of cultural change in Obama’s America.)

(Painting of Saint Nicholas via Wikimedia Commons)

Cillizza ponders Boehner’s dressing down of Tea Party PACs:

While many within the Republican establishment will applaud Boehner, McConnell and Ryan for their willingness to take on the tea party, the fight is not without potential negative consequences for them. While the tea party is not as popular — even among Republicans — as it once was, in low turnout GOP primaries it remains a force to be reckoned with. And, with seven of the 12 Republican incumbents in the Senate set to face a primary challenge from their right, there will ample opportunity for groups like the Club For Growth, Heritage, Americans for Prosperity and the Senate Conservatives Fund to prove that crossing them is a very bad idea.

Look to the May 20 primary fight between McConnell and businessman Matt Bevin and the June 3 race between Mississippi Sen. Thad Cochran and state Sen. Chris McDaniel to see whether the new confront-the-conservative-groups strategy can work.

Sargent’s perspective:

There are all kinds of reasons why this has happened. As Danny Vinink points out, Boehner now has incentives for refusing to bow to the Tea Party, from the fact that Paul Ryan is now on his side, to the need to prevent chaos governing from taking the focus off Obamacare. (Here’s a case where absolute GOP certainty that the health law will fail over time and shower the GOP with nonstop riches has produced positive results.) Meanwhile, Brian Beutler argues persuasively that, by refusing to budge in the last shutdown and forcing a GOP cave, Obama finally drove home to House Republicans the limits of what sabotage governing can accomplish, leaving Boehner with little choice but to tell the sabotage governing brigade to take a hike.

Allahpundit is somewhat surprised:

I did not expect that this lame budget deal would be Boehner’s red line for tea-party criticism. But maybe it had to be that way. If he’d slammed them in October, when Cruz and Lee had galvanized the base against the bete noire of O-Care, it might have cost him his gavel. The stakes are lower now — he proved he was willing to shut down the government for a conservative cause, everyone understands that any budget deal with Democrats will vary only in shades of badness, and enough people have tuned out of the news in December that there won’t be any grand revolt against him. If he wants to throw down the gauntlet to groups like the Club for Growth and FreedomWorks, now’s as good a time as any.

Weigel joins the conversation:

The only question is whether Boehner is running a wonderful distraction or whether this really does represent a move to make the Professional Right less relevant. The reason Paul Ryan had to flog this deal, and Boehner couldn’t, was that the right stopped respecting Boehner years ago. In the summer of 2011, in December 2012, when he tried to save his party some face and pass big spending bills without Democratic votes, a rump of his members refused to get him across the 217-vote line. Over time this emboldened more members, who philosophically agreed with the easily lampooned right-wingers, and Boehner was denied dozens of Republican votes on his measures.

First Read’s take on Boehner’s comments:

This is the aspect that frustrates so many non-Tea Party Republicans. They have the Democrats agreeing to the premise of “what should we cut,” not “what should we spend.” Sure, conservatives think Democrats aren’t as fervent about cutting spending as they are, duh! But the fact they have Democrats agreeing to look for spending cuts is a fundamental philosophical chance right now. The conservative movement just doesn’t know how to declare victory; it’s akin to caring more about the margin of victory in a football game than simply the victory itself.