John P. Ioannidis and Reading the Latest Dispatches From the World of Science, Featuring Jonah Lehrer

In 1905 - stop me if you've heard this one - a young Swiss patent clerk published three papers that have shaken the world of physics ever since. We have not thought about little things like matter, space and time the same way since Einstein published in Annalen der Physic, in his Wunderjahr 1905, papers that proved to be paradigm-shattering and which addressed puzzling anomalies surrounding the photoelectric effect and Brownian Motion. Then Einstein added a little something called special relativity.

In 2005, an epidemiologist and medical statistician published two papers that had a similar effect in medical research. His name? John P. Ioannidis. (Say "yo-NEE-deez") He was a math prodigy and, after studying rare diseases, became interested in the problem of solid research that backed almost all of the taken-for-granted truths that your doctor and most medical researchers were working with. At first he thought he would take the rather paltry and shoddy studies that formed the basis of sound medical practice, then perform his speciality: a critical analysis of the founding papers, do a meta-analysis, and shore up and legitimize what had been a bit non-rigorous and sloppy for a body of practice that was so basic to our understandings of the best modes of treatment.

And...just...oh boy...

This was in the 1990s. Ioannidis, in his research, found that about 90% of what doctors believe and what they tell their patients, what drugs they prescribe, was seriously flawed. The research that supposedly legitimized the dogma in most of our doctors' heads was riddled with mistakes.

                             John P. Ioannidis, hero of this blog-spew, underrated thinker?

Brief Digression
I admit it: I read probably 100 articles a week on little scientific findings that sound..."interesting." I love Science Daily! There are about six or eight other science sites I read regularly, and I'm interested in  physics, chemistry, cosmology, medical findings, neurobiology, social psychology, genetics, archaeology, evolutionary studies, on and on, und so weiter. And I link to those in the OG, as for instance, earlier articles on the obesity problem, which is serious to me. But there's reason to believe, given what John P. Ioannidis has found, to read those studies with far more than a grain of salt. Rather read with something in mind between a dull news article about some crime that was committed...and fiction. Why? Read on.

Ioannidis and His Two Papers of 2005
One was published in PLoS and had a wonderfully provocative title: "Why Most Published Research Findings Are False," and was a rigorous mathematical proof that, summarized by David H. Freedman, who wrote the best journalistic piece I've seen on Ioannidis (HERE, and highly recommended you read it three times over the course of a year), as "Simply put, if you're attracted to ideas that have a good chance of being wrong, and if you're motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you'll probably succeed in proving wrong theories right." This applies to medical research, but many researchers in other fields have taken note.

Another way of summarizing Ioannidis's meta-research here (the PLoS paper their most downloaded one ever, and heavily cited by others) could be like this:
1. Assume modest levels of researcher bias and add to that:
2. typically imperfect research techniques, and then add to that:
3. the human tendency (well-known) to focus on exciting rather than highly plausible theories, and it all adds up to:
4. VOILA!: researchers will come up with wrong findings most of the time

Isn't this sorta galling, freaky stuff? Or is it just me?

[I consider David H. Freedman one of our very best Expertologists, and I just now remembered that I wrote about him and his book HERE.]

Also in 2005, Ioannidis published, in Journal of the American Medical Association (JAMA), a paper that tested the idea that, sure, there's a lot of bad studies, but the larger social world of doctors and medical researchers will read these flawed studies and be able to identify them; the flawed stuff will get weeded out. As you may have guessed, this was not found to be true.

Ioannidis picked 49 of the most highly regarded research findings over the previous 13 years. These were the most widely cited articles in the best peer-reviewed journals. These papers had to do with hormone replacement therapy for menopausal women, vitamin E to stave off heart disease, the use of coronary stents, and daily low-dose aspirin for keeping the arteries unclogged, etc.

41% of these studies were shown to have major flaws. Physicians and researchers do not know how to see through dubious research findings. Or there's a herd mentality among medical professionals. Or some would rather not know. Or possibly all of the above and Something Else.

A Few Upshots From All of This
Ioannidis shows there are routinely problems at any and every step of the research process, and they have to do with conception and hypotheses, research techniques and other methodological problems, conclusions, conflicts of interest, the human desire to make a breakthrough, the human desire to publish to gain academic standing, the need to feel part of a larger research group by supporting their findings, and the politics of peer-review and how journals decide to accept or reject certain papers. Among other things. Like the common obsession of winning a big research grant, often from Big Pharma.

On top of all that, the field seems resistant to change what it already "knows." Sorta like the tuberculosis out there now, that's resistant to antibiotics because those antibiotics were too over-prescribed? (Hold on, that may be a Bad Analogy...)

Regarding obesity studies, Ioannidis says "ignore them all." Why? Because they're seriously flawed. Some studies found fat people live longer than expected, and were just as healthy as the non-fat. Why? The problem of bio-markers: they tell us something, but not the entire picture, and they don't take into account very many other interactions within the body. We may be spending far too much in the wrong places. What about using Vitamins A, D, and E? Forget those studies also, says Ioannidis. What about whether we should eat more fat or carbs? Forget it, says John P. Read the David Freedman article from The Atlantic that I linked to above for Ioannidis' reasons why these studies are to be ignored.

Then...then...then...if there's so much bad research done in the medical field, what about our health, as a society? Ioannidis answers: "That we're not routinely made seriously ill by this shortfall [of truly evidence-based medicine] he argues, 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 healthy."

Ioannidis says bad ideas spread like an epidemic, "They're spreading it to other researchers through journals," says Ioannidis, who Freedman says looks "like Giancarlo Giannini with a bit of Mr. Bean."

How were Ioannidis's two bombshell papers received by the medical community? Very well. People seemed relieved. He was attacking general mistakes, and so every researcher could say to himself, maybe something like, "Yep, this stuff goes on a lot, and it's a problem. My colleagues need to be very careful..." It's not you who conducts bad research; it's other people.

Interestingly, in 1989, two Economists, Kevin Lang and Brad DeLong, published a meta-study of economic dogma and research and what they found was very much like what Ioannidis found: basic assumptions that formed the working models of almost all economists were found to be seriously flawed. However, the field of Economics has not embraced their research. There seems to be a profound lot of significance here about who we are, but I will leave that to my Dear Readers.

Here's Jonah Lehrer on video, for 30 seconds, explaining why he became a journalist:

Jonah Lehrer on This Stuff
Although I consider David H. Freedman's piece on Ioannidis most excellent journalism, Jonah Lehrer published a pretty terrific piece around the same time as Freedman, and about roughly similar problems in epistemology and scientific methodology, but for The New Yorker. It's HERE, and I was enchanted by the many examples of fascinating research Lehrer strings together. It's very entertaining, or at least I thought it was/is. Lehrer is trying to tease out a problem in science: that "the truth wears off," the name of his piece. The idea of verbal overshadowing and how it related to J.B. Rhine's studies in ESP was fascinating. One researcher's term, "cosmic habituation," reminded me of a fascinating outlaw biologist, Rupert Sheldrake, whose outre ideas about morphogenetic fields has not exactly been embraced by the larger Biology community.

Jonah quotes Ioannidis here, and many others. Irony-lovers: note the last paragraph of Lehrer's piece, where he writes, "Because these ideas seem true..." But I don't want to jump on Jonah here. He's gotta be reeling right now, the 31 year old fallen genius who fucked up royally. I am not one of those given to schadenfreude in this instance.

But read Lehrer's piece. Are you suspect of his research, now that you know he'd been outed as a fabricator of some sort? I find that I mostly believe what he's writing here. I particularly like what Jonah has to say about the "decline effect" in science, and I'll quote him here before giving Ioannidis the last say:

Jonah Lehrer: "The decline effect is troubling because it reminds us how difficult it is to prove anything. We like to pretend that our experiments define the truth for us. But that's often not the case. Just because an idea is true doesn't mean it can be proved. And just because an idea can be proved doesn't mean it's true. When experiments are done, we still have to choose what to believe."

Or, as Paul Feyerabend might've said, "Anything goes." Keep delving into the inner machinations of scientific research and it looks more and more like anarchy to us (well, I'll speak for myself and Feyerabend), and a lot less like the way Francis Bacon envisioned it.

I leave us with this quote from Ioannidis, which I find very poignant, hard-nosed, and revelatory of how rare and truly special the findings in any scientific field have been that have truly worked to provide major breakthroughs, research - like Einstein's - that led to a new paradigm:

"Science is a noble endeavor, but it's also a low-yield endeavor. I'm not sure that more than a small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be comfortable with this fact."

Here's Jonah Lehrer on Charlie Rose, talking about Bob Dylan and creativity. 2 mins:

Here's a 15 minute video in response to Ioannidis's "Most Published Research Findings Are False," and I think it's pretty good in explaining the statistical methodology for determining good research. The narrator - who, to me, sounds very erudite and funny about this stuff - seems to want to stave off the possible reactionaries who already have problems with "science," or as he says, "on the road to science denialism." Sorry for taking so much of your time!

Spitballin' Over A New (To Me) Public Health Scare

What's that old saying that (maybe?) was concocted during the rise of totalitarian states? "That which is not forbidden is compulsory."? Or is it "If it's not compulsory, it's forbidden."? Kafka seems to have taken this notion a smidgen further in some of his immortal werks, giving us the impression that you can't even know what's forbidden or compulsory: you wait for the State to knock on your door and they tell you. That Kafka! Such an imagination!

For hypochondriacs like myself, reading about health issues - even and especially health issues of more urgent concern for others - over an extended time can lead me down a similar one-way, no-exit blind alley, and recently I ran up against a doozy.

Sitting Can Kill: It's Like Smoking
Yep. Plug in "sitting down and smoking health risk" into your favorite search engine and sit back...I mean stand up...and drink it all in. Sitting is a hot topic among some researchers, and sometimes I suspect they're having us on. Get this: according to one study, and another one, sitting for more than six hours a day - in any form (at work, watching TV, in a car, etc) - is linked to heart disease, diabetes, cancer, obesity (surprise!), chronic back pain, muscle weakness, posture problems, and early death.

                         Who knew this poor dear pretty thing is slowly inching toward death,
                         AKA, The Big Dirt Nap? It's tough to look at. Avert your eyes! It's 
                         just so...sad!

Now, there are a lot of studies on sitting, and as I read them - all in the midst of a good, long day of sitting on my ass reading books and some articles on my MacBook - I tended to lose track of who did which study; the anxiety and absurdity of it all - that I have spent most of my life, slowly committing suicide all the while thinking I was enjoying a languid life of modernity...it was too much.

All those hours I've sat! I think it was the Institute for Medicine and Public Health, but the anxiety had built so much by then, my ears were ringing, I think I was having palpitations - and I was sitting while reading this schtuff! - The Institute said that, of 6300 people polled, most people spent around 56 hours a week sitting. Lemme see. There's seven days in a week. Seven goes into 56...carry the nine...damn I wish I was better at math...do you need to divide by pi? I forget...Let's just say we spend around eight (8) hours a day sitting, in one way or another. Let's face it: that's a lot of ass-time, folks.

Some of my favorite times of my life were spent sitting. I remember when I first saw Citizen Kane. I sat through it all, oblivious that I was killing myself. There was a time I attended a semi-formal sit-down dinner with many sexy, witty people. We were such fools! We were so totally unsuspecting!

American College of Cardiology: more bringers of bad news for those of us who sit. 54% of people who sit more than six hours a day are likely to die of a heart attack...within 15 years of the moment you read this, or something like that. If I seem something less than the Ideal Reporter here, it's 'cuz this whole sitting story has me dizzy, and I should go lie down, if only because it's better than sitting. I already spend 1/3 of my life there anyway (lying down).

Prof. Marc Hamilton, a physiologist at a biomedical research lab in Louisiana, wrote in the journal Diabetes in November, 2007, "The dire concern for the future may rest with growing numbers unaware of the potential insidious dangers of sitting too much." It's been almost five years since Prof. Hamilton wrote that, and even though I think of myself as someone who "reads everything," I'm only now becoming aware of the insidious dangers. How many more of us are sitting...as you read this!!!

                            Not a pic of me, but a graphic representation of the inner turmoil
                            I feel upon learning of the dangers of sitting, and I'm sitting now!

Another quote from Prof. Hamilton, gleaned from this ABC News article (with video) that shows a bunch of office worker-saps at their nadir - trying to get the corporate work done for Massa by standing at something called a "standing desk" and walking on treadmills - the Hamilton quote: "Smoking and sitting too much have some striking parallels. Decades ago smoking was so common that everyone perceived that...not only was it acceptable behavior, but that there was safety in numbers."

Not much more one can add to that!

What Happens When We Just Sit There
Well, we know that breathing - respiration - causes oxidation. We "rust" inside. No amount of antioxidants is gonna win that battle. Breathing is simply insidious, I tells ya. May as well be sitting while enjoying a few tall, cool, breaths. No one - except Ray Kurzweil - lives forever. I figure, what the hell? Enjoy ourselves while we're here. Have a smoke, maybe? A drink? What's your poison? Have a seat!

So the Dangers of Sitting: as soon as you sit your body goes into "storage mode." We inherited this from our ancestors, who had a tough time remembering when you asked them, "When was the last time you sat?" These ancestors - chances are very good you're related to 'em - were always out working all day, hunting game for the tribe, or farming. They had bodies like gods, or they were starving to death. Sometimes both within a period of 18 months. When they relaxed and pulled up a chair, their bodies really needed to go into storage mode. Ours? Not so much. Immediately, the leg muscles get their electrical current shut off. We go into hibernation mode, and, sitting, burn a whopping one (1) calorie per minute. I assume two or three per minute if you're sitting and fidgeting unnerved with worry because you just found out that sitting kills.

An enzyme that burns fat - lipase - drops in effectiveness by 90%. Pretty much as soon as you plop down and "take a load off." And we are a load, lemme tell you...But I'd rather not. Okay: One in three Unistatians is overweight, many of those ones obese, morbidly obese, and even Reality TV Show Obese.

What To Do?
It came quick. We never saw it coming, in a way. So maybe we're relatively blameless. For 99.99% of our time as hominids, Life Was Hard. Not much to sit for. Then, just a few seconds ago in the longue duree of Epochs, we got TV, La-Z-Boys, beanbag chairs, stereophonic sound, Internet, and scads of other things of comfort to muscles. Absence of toil. A surrealistically easy access to fat and sugar. And BLAMMO: we're a buncha lardasses, sitting and smoking, eating french fries while enjoying a marathon of Mad Men. I say we're blameless. Our paleolithic forebears would've done the same!

We just got capital ell Lucky in the History Sweepstakes.

Allow your imagination, distributed throughout your nervous system, based in your brain, housed in your cranium, bathed in warm, nutrient-rich cerebrospinal fluids and oxygenated blood...allow that imagination to relax unencumbered by basic biological needs. It's all there, on the tray in front of you. Just sit and read, or watch amazing shows. Enjoy the dip. Do you like cookies? Have one! Entertainment! Even our early paleo ancestors sought to modulate their inner states. Hence that Olde Time Religion: sex and drugs, drinking and dancing, drumming. Then, later: Gee Oh Dee...but we still had fun in our off-hours nonetheless.

                   This poor sap will never see it comin.' Will you tell him he's killing himself?
                   I sure won't. He'll find out soon enough. I wonder if he has Sitter's Insurance?

So, what are we to make of this new health scare? I feel we're doomed. Oh, sure, one study shows that people who sit for three hours or less per day lived an average of two years longer, but fer crissakes: how could all that gawdawful standing and pacing and running-around be worth the extra two years when there's such a kaleidoscope of joys to be had, sitting and eating and watching shows. And reading and talking and daydreaming, all while sitting. Do you daydream while lying down? I don't. If you do, fine. When I lie down, I tend to sleep, or doze, or do other things delightfully primal. But no daydreaming.

Hey, I love to walk and ride my bike. I do yoga and it's greatly rewarding. It feels good. But I also sit for at least six hours a day (not that I've begun counting), so I'm doomed. But I'll be going out in style. A heart-attack or cancer? Probably. But am I going to give up Turner Classic Movies? Sitting and reading James Joyce, Thomas Pynchon, Robert Anton Wilson, science fiction, and phenomenological sociology? Sitting for hours engaged herbivorously with friends, quaffing ales and laffing? Nooo way! I'd rather be dead than give any of that up! Sitting is my birth-right! I'll sit until they carry me out - reclining - in a pine box. (Am I over-reacting?)

Ladies and germs, we start 'em off young, in high-chairs. They think it's "normal" by age seven! I guess what all this has been leading up to is: Good lawd! Who will tell the children?

We're all hopelessly addicted. These news stories about the dangers of sitting are too much, and I won't take them lying down. I'll take them square on the chin, as I sit here, grinning in the face of death, a bit of chocolate syrup having escaped the corner of my mouth, dribbling down into my beanbag. Take THAT!..."reality"?

As one who laffs in the face of Death, I humbly submit to my Dear Readers that I wrote this entire spew while SITTING! My extremities barely moved for about 75 minutes, the blood pooling up ominously near my mid-thorax, no electrical current flowing through any of the networks of nerves forming the off-ramps of my tibia. And you know what? I couldn't care less! (If you don't see another OG post for seven days or more, I've probably died of a heart attack worrying about sitting too much.) If I were not to be cremated (my wish), I would have these words put on my headstone, and the OG readers would know its deeper meaning:

                                    He Could Stand No More

Some Sources:
Is Sitting A Lethal Activity?
Sitting May Lower Life Expectancy, But It's So Comfortable
Is Sitting As Dangerous As Smoking?
The Dangers of Sitting At Work - And Standing

Obesity, OR: "Does Our Butt Look Big In That?" (Pt. 3)

A lyricist named Bernie Taupin once wrote this line in a song called "The Bitch Is Back," sung by Elton John:

"Times are changin' now the poor get fat."

And if anyone wants to know why or how this historical turn of events took place, it's easy to find out that  our ingenious modern era with its manipulation of science and technology has produced food at a level to mock Malthus, and cheaply, too. (In the rich countries.) Evolutionarily, for 99% of the time we've been homo sapiens it's been a real slog to capture enough calories and eat a diet with enough protein, fat, and carbs to keep us going, and the average life expectancy rose to the unheard-of high of 38 years old in Unistat by 1850. Evolutionarily, we were pretty much programmed to die by 40. Why sit around as old people and use up the precious tribe's resources? Just for your stories and wisdom? Write that shit down, grandpa, and die already. You're taking up space and it's been at least five years since you used the plow worth a damn.

Sir Thomas Malthus was a catastrophist. If you were around when he was doing his version of what Sir Martin Rees is doing now, and you were prone, let's say, to "pessimistic thinking," you might have thought him a prophet. Basically he said we humans reproduce at an exponential rate, while the rate of food production is arithmetical. It was only a matter of time before famines became common and quite widespread. Malthus was a Man of God, too...No wonder his outlook was so prone to bleakness...(I tend to listen worriedly to Sir Martin Rees, though, truth be told, but that's for another blogspew.)

                                    Reverend Malthus, 1766-1834. Sociologist, economist,
                                                         pessimist.

All too human, Malthus did his futurology and prognostications while living in what Nassim Nicholas Taleb calls Mediocristan: he was using far too simple mathematics and couldn't factor in something totally unknowable but fairly Black Swan-ish: we were able to harness mind-power to produce more and more food in smaller and smaller areas, and quicker and quicker, and then transport got better and faster, and refrigeration came into its own...another futurologist proven wrong. (Temporarily?)

But in the ultra-short period of, say, 125 years, this easy access to sugar (which was always hard to find for 99% of our existence), fat, and carbs - all delightful, life-enriching and acting on dopamine levels in the brain (AKA the "reward system") - threw us a curve. We didn't know how to handle it. And then other sciences and technologies combined forces and made our lives comfier and comfier, to the point where, very very suddenly, on our evolutionary scale, we sit around all day long, every day, and eat rich, fatty food. Meanwhile, our bodies are basically the same ones we had a million years ago. No wonder we're fat!

Now we are so rich we've extended the average lifespan to double what it was in 1850, and we're dying of degenerative diseases. Now the game is not predicting when the food will run out, but when we'll learn how to handle the food. And maybe our analytical tools are more sophisticated than Malthus's.

We saw in my last entry that the NCHS/CDC say the stats showed the obesity epidemic is leveling off already. A recent mega-research paper predicted 42% of the Unistat public would have a Body Mass Index of 30% or higher by 2030, but we have reasons to doubt that. The CDC in 2003 predicted that by 2010 40% of the public would be clinically obese (BMI above 30%); the number turned out to be 35.7%

The British Dept of Health predicted in 1999 that by 2010 25% of Brits would be obese. They updated this prediction in 2006 to 33%. By 2010 the number was 26.1%. Fudge factors? Yes, all sorts of them. First off, of course, many who responded by admitting they were eating fudge as they spoke. Then again...

Some numbers were obtained by phone surveys, asking people how much they weighed, and people tend to prevaricate in that situation. Nonetheless, the numbers are probably pretty close. They have turned out to not be as bad as our best predictors predicted. Do the predictors have a vested interest in their High Numbers? Yes, probably. More money gets thrown at Public Health and obesity-related problems, and some of that money sticks to the predictors and their colleagues. But still: we have a long road to hoe, and it's not going to be easy.

                                Chicago-style deep-dish pizza: now qualifies as a "vegetable"
                                in Unistat schools, thanks to the Goliath food and beverage 
                                industry and their lobbyists. Man, this looks good right about 
                                                       now! Eh?

Why will it be difficult? Well, that too is a very complex problem, but if we look at the Goliath-like Food and Beverage Industry and what it can afford in lobbying Congress, versus the public interest groups that want to educate and restrict massive amounts of sugar and fat in schools, or curb advertising aimed at children, well, David gets stomped to death by Goliath like an ant. In the last three years, four government agencies sought to reduce sugar, salt and fat in food marketed to kids: Congress killed it. The Center For Science in the Public Interest - a bunch of do-gooders who object to 9 year olds who weigh 170 pounds already - spent $70,000 last year lobbying Congress. The Food and Beverage Industry spends that every 13 hours. Pizza is now classified as a "vegetable" in schools. According to this article from Reuters, the food/bev industry has never lost  a significant political battle, and their tactics are the same as what the tobacco industry's were: we're just giving people what they want in a free society. There's no real proof our food and drink is making people sick. They need to moderate their own intake, and exercise more. If you made a hefty paycheck working as a lobbyist for big Food and Bev, wouldn't you say that too?

Note that Ol' Captain Buzzkill William Dietz makes an appearance in the above-cited article: "This may be the first generation of children that has a lower life span than their parents."

Here are two classic takes on why we're fat, from different points of view. First, check out Professor Richard McKenzie, who may be getting some of that sweet Food and Bev money alongside his emeritus professor dough. Yes, we're fatter. On average, Unistatians are 26 lbs heavier than they were in 1960. SUVs were made for fatties. Gurnies have had to be reinforced, stadium seats widened. Because we're on average 26 pounds fatter than 1960, we use an extra two billion gallons of gasoline and jet fuel. We create much more greenhouse gas and our medical costs have skyrocketed. But, as he argues in his book Heavy: The Surprising Reasons America Is the Land of the Free and Home of the Fat, it's all due to lowered tariffs, cheap imports, and "our growing economic freedoms," which go with political freedoms. No reason to change any of the freedom stuff! (I'll let you mull this one over on your own.)

I think it's a classic, valid libertarian view. There's much to say for it. I'm not completely sold on how we're economically freer now, though. But the freedom argument holds some appreciable weight (sorry!) with me. What I object to is the ultra-monied Food/Bev lobby and their louder bullhorns. They don't want frank education about food and what it's doing to us. For guys like McKenzie, money equals freedom, but I'd like more "freedom" for the educators.

                                     Jonah Lehrer, brilliant popularizer of neuroscience, 
                                     the latest psychology, and very creative science writer,
                                                born in 1981.

From Wired, here's a typically smart article from Jonah Lehrer. Why do people eat too much? Well, we're really bad at recognizing when we're full. (That long legacy of hungry homo saps.) Also, restauranteurs think we expect huge portions, and we probably do. So plates have gotten bigger and bigger. Serving sizes are up, Lehrer says, 40% over the last 25 years. We're prone to mimicking the behaviors of those around us. And yes, Big is Good. But why? Lehrer links this to primate status-seeking, which I find fascinating. The problem is: seeking high status by getting the big serving, we get obese, which lowers status. Talk about a vicious circle!

As always, Lehrer suggests a way our of the predicament: if we become mindful of the power/powerlessness module in our primate brain that links Big Food to High Status and therefore, Power, we realize the folly. Mindfulness. It's a big theme in much of Lehrer's writings on neuroscience. But it's easier said than done.

In closing, I suggest we meditate - or ruminate? - a bit on the epigraph Jonah Lehrer uses at the beginning of his article, the quote from M.F.K. Fisher. Is it true? If so, how much do you think it explains about our obesity problem? Do you think some subconscious part of our brain tends to equate food with security, security with love, love with food?

Obesity: More Observations (Pt. 2)

When I was a pre-teen I was like a lot of kids today: obsessed with the Guinness Book of World Records. (Some elementary school teachers I'm friends with say old Guinness Books found at garage sales for a dime each will keep quite a lot of 4th graders in thrall, even today. Books? Today? Anyway...)

A very old one I received one Christmas was very entertaining, and among the wonders first encountered there were palindromes, which have nothing to do with Sarah Palin. Palindromes are words or sentences or a sequence of sentences that read the same backwards as forwards, exempli gratis: "Madam, I'm Adam."

Apparently there were certain types of geeks who were obsessed with finding the world's longest palindromes, and as I recall there were some crazy doozies in there, but the one that stuck in my mind, the one I was able to remember and entertain grandma with, was this one:

"Doc, note: I dissent. A fast never prevents a fatness. I diet on cod."

I thought this one just sounded funny: a guy calling a doctor out on his purported expertise? It sounded forced, but I guess it would have to. A long, eloquent palindrome seems too much to ask. I thought the dissenter was probably wrong anyway: a fast does make you lose weight. Or so I thought around age 12.

But now, from the current dietary and nutritional data that I think holds sway along these lines, a fast usually results in a rebound and gaining your weight back. Most starvation diets do. And they're probably not all that good for the overall body's biochemistry and its astonishing intelligence and search for homeostatis. And cod appears to be quite the non-fatty fish, high in protein and Omega 3s. The smart-aleck in the palindrome was right in calling out doc!

Lesson for the dieters: sometimes palindromes contain uncommon wisdom. Read every palindrome with the intensity of a Talmudic scholar! And if you're going to make cod a major part of your diet: you're gonna want to use seasonings, or really just anything to add a little TASTE to your meals. Plain cooked whitefish like cod tends to be beastly dull. Good luck!

                                     Cod, that old staple. Needs broccoli and potatoes?

Obesity: A Huge Deal These Days
Earlier this month a group of Experts (ut-oh!), who'd made a grand study of the obesity epidemic in Unistat, advocated a "major overhaul" of American life. I'm not making this up. Their report - which was 400 pages of fat itself - says around 67% of Unistatians are too fat, and Something Must Be Done in virtually every facet of life to "reverse trends," or we will sink under the weight of...oh, these "fat" puns are too easy and probably too boring for The Reader so I will try to steer clear.

Anyway, the good folks at the Institute of Medicine cram their study - or so I've read about - with "synergies" and how if we do this and that it will "empower" the overweight and we need to take a "systems approach," all of which sounds dandy. We also note how, when reading these reports, there's a whiff of social engineering lurking between the words. Let us not be totally naive idiots and just say it: the Food and Beverage lobbies have everyone cowed with this one: social engineering is code for brainwashing, or at least "Nanny State," right?

Right?

Let those who cower in fear at the looming ever-present threat of the Nanny State relax a little. I will explain why in a bit. (Actually, tomorrow. - ed.) For now let's just say your guys have the money.

So this Major Study says we spend $190.2 billion a year due to the ravages of obesity. That's a lot. Let's not ask about their statistical model right now. It sounds bad. Makes us maybe feel like foregoing that second helping of waffles staring us in the face.

Here's a problem they point out, and every other study done I've seen in the past five years that wasn't funded by the Food and Beverage folks: poor people (that's more and more of us) tend to not have access to affordable, healthy, decent nutrition. We can afford Taco Bell and Mickey D's. Also, and less persuasive in all of these studies: the poor - who are prone to the ravages of obesity at a higher rate than the better-off - need time and space to exercise. I can see poor kids in urban concrete canyons not having adequate space to do the exercise they want to do, but what about walking? Is it too dangerous to walk around the 'hood? There's probably something I'm missing with the exercise space issue, and I guess if you're working a crappy 40-50 hour per week job that barely pays a living wage, you will find it exceedingly difficult to find the time for exercise, the lack of space being but one of your problems.

This study also has 17% of school kids obese, which has tripled in 30 years. Separate research predicts 42% of all adults in Unistat obese by 2030, and 11% "severely obese" by then, up from the 5% now.

And according to some right wingers, we already have too much of a "Nanny State." I wonder how fat we'd be without Nanny hovering around us? Or would the Invisible Hand be guiding all of us to our correct, thin and healthy weights? I'm not seeing the Nanny lately. Haven't seen her for good long time, but people say she's lookin' good. I'd like to see Her myself. I bet she couldn't keep me from the Oreos! I'm too sly...Hey Nanny: bring it on, baby!

(Whenever I hear "Nanny State" I picture a 7-foot-tall beautiful black woman, like some African goddess. She's wearing an apron and a long, flowing blue dress with little white checks all over it. She's got a thin waist and big breasts. I find her very sexy. She's always catching me staring at her boobs and she tells me to go finish writing "that thing you're always yakkin' on about." I have no chance with her. She's not "Nanny State" for just any old reason. But that's me...)

                                 My personal Nanny State figure looks a lot like Erica Badu,
                                 Queen of Neo-Soul. She tells me when to put back the 
                                 Chips Ahoy, and I know she's right. Personification can 
                                  be a whole helluva lotta fun, friends!

Another Big Study: Time: Recently
Along with Experts at the CDC, Research Triangle Institute, International and other do-gooders, Duke University's Global Health Institute says recently that we need to try to keep obesity rates level so we can save $550 billion over the next 20 years.

Hold on. I know stats problems mount up quickly - for many independently variable reasons - but if the above study says we spend $190.2 billion a year now due to obesity...times ten years...double that for a second ten years...and I get a number quite a bit higher than $550 billion. Obviously, all sorts of differing criteria and shenanigans (<-----great name for a sports bar that sells Guinness, by the way) will yield different numbers. I know the folks at Duke used the Bureau of Labor Statistics and factored in the likely unemployment rate and how that affects obesity, and also fast food, alcohol and fuel prices.

When we boil any one of these studies down, all discrepancies aside, we're fat, and the Situation looks dire, and we really need to do some major league "slimming," as the Brits call it, a term I first encountered in that same Guinness Book. Here's a brief story a Slimmer of the Year, who, spurred on by a nasty comment from his daughter's friend, lost 12 stone, 10 lbs, or 178 pounds. Unistat Experts consider being over 100 pounds overweight as "severely obese."

Dr. William Dietz of the Centers for Disease Control (CDC) is often quoted in articles on long term effects of obesity. He says here that - you guessed it - healthier choices must be made more accessible and affordable.

                                                   Dr. William Dietz of the CDC
                                                   He cares about our collective girth.
                                                   That's his job. He looks serious to me.
                                                   He cannot compete with Erica Badu,
                                                          though.

Some Good News!
Okay, enough with the prognostications from the researchers at the Institute of Fat Studies saying we'll all look like Fat Bastard by 2030, while the Experts at the Dom DeLuise School For the Study of the Zaftig say we'll all be "plumper" by an average of 13.7% per capita compared to today's numbers and blah blah flabbedy-flah blah. Two lovely women, one from the CDC and one from the National Center For Health Statistics (NCHS) point out that, pretty much, Unistatians' ballooning obesity rates may have leveled off already. That's something to jump up and down about until we start wheezing and have to sit down in a beanbag, right? Dig:

Recall that we have decided a rather crass way to determine obesity called Body Mass Index (BMI): take your height and weight and you get number. If you're below the normal range, you need to get into the kitchen, STAT! There's the normal range, and then if your BMI is 30 or over, you're "obese." The stats from this analysis has obesity rates stable from 1960 to 1980. From 1976 to 1980 we spiked 8%. They measure obesity every two years. Between 1988 and 1994 another spike of around 8%. (Why?) Between 1994 and 2000 a rise, but between 1999 and 2008, a leveling off. Around 2000, women in Unistat were fatter than men, but in the ten years since then, women have gotten thinner, men fatter. We're about equal now.

Enter good ol' William Dietz again, who takes the long view and compares public health education and individual consciousness to cigarette smoking. The knowledge that smoking was bad for you started to be broadcasted regularly in the mid-1950s, and between 1950- 1965 we see very little in the way of people quitting smoking. These things need time to percolate into mass consciousness before people start to get tough with themselves (with a little help from the State). By the 1980s, we began to see a steep decline in cigarette smoking, and Dietz thinks the obesity "epidemic" will see roughly the same trajectory. So we may have already leveled off.

We may have.

It could be that all the "by 2050 everyone will be built like a planet" warnings from experts are all wrong.

Maybe. This is part of why this subject is so fascinating to me: the complex of dynamic adaptive characteristics of the problem make it an intriguing thing to try and get a handle on. And the problem is so close to all of our homes. We're all in this. There are many steps to be taken, pun intended. And with the scope of the problem I think it's safe to say we have enough on our plates to....ooops! Sorry! One too many for today.

NEXT: the elephant in the room, AND: some Big Thinkers on why we're fat.

Obesity: Some Observations, Part One

I've been wanting to write about a complex problem from many different viewpoints. There appeared to be numerous topics in the physical sciences and the humanities, but I've chosen to tackle the obesity "epidemic" (note how our language has largely adopted the "medical model" over the last 30 years) for the emotional freight it carries. Fat jokes are everywhere. (I recently heard a comedienne say she greets her female friends with, "What up, fat-ass?" as a phrase of affection.) It's one of the most-cliched tropes in mainstream media: cite a new study that shows how we're getting fatter, then show anonymous shots of 300 pounders meandering in the streets. For me, there's something not only garish about this aspect of the spectacle, but maybe a bit of the sadomasochism of everyday life.

Hey! There's a commonality between many thin left-liberals and right-conservatives: they love to cluck tongues over the fatties. Then there are different levels of acceptance towards the obese. I once acted as a chauffeur for an old man who was one of the kindest people I'd ever known. He was 80 or so, and never had a bad thing to say about anyone. He was quite thin, and as I remember he volunteered to me, socially liberal but conservative about economics and his own personal finances. The worst thing I ever heard him say about anyone else was when we were in a parking lot and a very obese woman was in the midst. He leaned over and quasi-whispered to me, "Can you imagine letting yourself go like that? It must be...so...difficult!" That really was the most "negative" thing I ever heard him utter about anyone else. After studying obesity and our attitudes towards it, I now see him as in the avant-garde.

Last night I had dinner with a dear friend who was agonizing that she'd gained 20 pounds in two years, and she's over 50, has stepped up her exercising, went into too-minute detail about self-imposed dietary restrictions that hadn't worked, and of course, the emotional turmoil. The thing is: she's still relatively thin. She looks good. But she worries, puzzles over loss of control. It seems common to think we can stay the same weight throughout life. As a fact, most of us cannot. And we can't control that as we think we ought.

                              Hippocrates, who over 2400 years ago knew we all had different 

                              metabolisms and body types, and that different foods were more 

                              more liable to make us fat than others, knew we should eat less

                              and exercise more. But he also thought we should vomit to control

                              our weight: "Fat individuals should vomit in the middle of the day,

                              after a running or marching exercise and before taking any food."

I think that's maybe the most insidious thing, aside from the very real human misery and health costs related to true obesity: loss of control. Wanting to be in control in this ever-accelerating world. And you can't even keep your own weight down! 

How many times I've had to listen to my female friends wax vexingly about their perceived issues around weight! I have male friends who are overweight, but they seem relatively more accepting. Maybe they just don't want to talk about it? But I think the pressure to be thin and beautiful in this heavily mediated world is quite the recipe for depression and self-loathing. And let's face it, it's not all that interesting a kvetch, as kvetches go...

I am not fully conscious about why I have zero weight issues. (To those with perceived too much adipose tissue, take heart: I'm a too-nerdy neurotic asthmatic, who, despite thinness, is genetically predisposed to high LDL cholesterol. Also: I have not been scanned, and there's a chance I'm a "tofi"and wouldn't THAT put me in my place! The "thin outside, fat inside" finding is just one of many weird, counterintuitive things I found when reading on obesity.)

I've always been able to eat as much as I wanted and I have always been thin. In my late teens I took up weightlifting and protein shakes in order to gain as much weight as I could, with limited success: lots of muscle on bone. Even though I've reached 50, I still can't get over 170 pounds on my 6-foot frame. Why? I don't know, but there's plenty of reasons to chalk most of it up to genes. Because I don't feel "proud" of my genes (which reminds me of the avowed racists I read who say they're "proud to be white": how about taking pride in something you accomplished?), I can't summon much opprobrium for the obese. 

                                   Nietzsche had read - of course! - the famous The Art of Living Long,

                                   by the Renaissance Venetian Luigi Cornaro, who said he'd eaten 

                                   like a pig in his younger days, but now ate very little, and what he

                                   did eat was bland and virtually tasteless.  Cornaro seems to 

                                   prefigure some of the annoying tofu-addicted food-scolds
                                    I see around Berkeley. Fred N has this to say about Cornaro: 
                                  "A scholar in our time, with his rapid consumption of nervous energy, 
                                   would simply destroy himself on Cornaro's diet. Crede experto -  

                                                  believe me - I've tried."

Of course, there are those who seem the very picture of gluttony, but the news out of various corners of neuroscience and genetics and other lines of thought mucks this picture up too much for me. I will give plenty of credence to the "fat and sugar act as drug-like rewards in the brain" line; or the "food as drug-addiction" rhetoric, which I find very persuasive. And addiction is not, in my eyes, a conservative Republican's simple moral issue of self-discipline. I think we'd see even more of this cant from conservatives, but too many of them are obese themselves. (Which doesn't stop them from railing about addicts of other drugs.)

And there's plenty of reasons why those the government would classify as "overweight" (Body Mass Index over 25), obese (BMI of 30+), or "severely obese" (BMI over 40, or 100 lbs overweight) feel bad about themselves. Well, not all, but probably most: the non-obese culture tends to look down on the  corpulent for reasons that seem not to do with concerns about human health and happiness, but, as Louise Foxcroft writes in her history of obesity, Calories and Corsets, from "aesthetic distaste." 

In reading a couple hundred articles on obesity, and about it in many books recently, I'm not at all sure we have as much agency as the popular culture would assign to us and our fatness. More of it seems out of our hands than meets the eye.

                                      Lord Byron, archetypal progenitor of gorgeous movie 

                                      and rock stars, binged and purged. Is there

                                        nothing new under the sun?

My study of obesity met my needs for something personal (friends and fellow citizens) and urgent (the spiraling costs of health care). It was also filled with enough complexities that I felt sufficiently "whelmed": not over- or under- . The study impinges on biochemistry, economics, public policy, environmental interactions, all-too real politick, evolutionary psychology, social perception, sex, genetics and epigenetics, neuroscience, aesthetics, rhetoric, history of diets, creative solutions and counterintuitive studies, futurology, delusions and depravity, and lies, damned lies, and statistics.

I hope to not bore The Reader and instead impart a sense of optimism that we can, if not solve, greatly ameliorate the suffering of obesity. I also hope to encourage a more nuanced understanding than is usually found in the mainstream press. As I alluded to earlier, I think the notion of personal agency is much more difficult than is generally appreciated. 

Fatness is a touchy subject, and fraught with emotion, and I know that if I write, "If this bothers you, why don't you put down that box of lard, get off the couch, and wheeze around the block, you tub of goo!," I might be misunderstood, as the Internet is filled with Missing Information; you cannot know that I would be saying this ironically, and that I care deeply about us and this weighty problem. Our problem. I also abhor Political Correctness. When a subject becomes almost taboo to talk about, I am one of those who will talk or write about it with reckless abandon. So: a sense of humor, please? Or do you think that, because I'm personally not obese - or have at least presented myself as such - I have no "right" to joke? (Rail in the comments, please!)