Uechi-Ryu.com

"Is the answer, then, to say we should have a free and open market for everything that is either beneficial and harmful? "

This is our policy for books, and it works well.

"I don't think you're implying that all substances should be legally available to anyone who wishes to try them and ruin their bodies with them, or that medicine should be completely unregulated. "

That's a nonsequitor--how about making MOST things available in a potentially HIGHLY regulated manner? Interdiction has certainly failed us in the arena of drug abuse. Everyone who wants it can get it. So why bother fighting that? The illegality of it only buys us the black market, drug turfs and wars, and crime. Makes more sense to me to make the substances SAFER to use (harm reduction) by at least providing clean needles, reliable dosing and purity, less contaminants, and spending all the money wasted on interdiction on therapy and edcation/prevention.

"Do you have a problem with government outlawing tobacco growing and selling but not criminalizing it for the user?"

Big problem. This would buy us crime over illegal tobacco distribution and another huge budget in fighting it. There are choice besides letting big tobacco "thrive" and criminalizing tobacco abuse--there's the route of high taxes on tobacco (not so high underground market develops) with strong warnings, education, and treatment strategies. Choice is preserved, gentle guidance is established. I don't think another prohibition like that which failed in the 20s is in the public interest (and it's impossible anyway). I should remind you that food is another government sponsored "mass death." I really don't want Big Brother looking over my shoulder at mealtime. There's no good way to distinguish these. Like I said before, butter is ALWAYS suboptimal food and the government could argue they should ALWAYS be between us and our brownies as a result.

"Perhaps you know the details re the professional standards of what constitutes justifiable risk for a medical procedure to be sanctioned"

Risk is irrelevant. I've seen people go for perfectly justified procedures with an 80% risk of death. Or worse. The matter is one of RISK vs BENEFIT balance. The higher the benefit (for example, only chance of survival) the more risk is tolerable. In the end the decision depends on the patient's values and the physician's guidance--and I don't do things to people I don't think constitute good medicine.

"Do you feel that the current practice of counselling and screening people for this procedure is adequate?"

I don't deal with it directly because I am not a surgeon. I know it is extensive and that hospital ethicists and lawyers are closely involved with the matter at our insitution at a minimum because of the high liability that can be entailed with taking a high surgical risk patient to the OR. So, I feel that with the various pressures on our surgeons to make wise decisions (many SELF imposed because they want to do right) at reputable places there should not be a problem.

The problem is the Twinkies.

Just a few days ago, Bill Cosby stunned an audience in a ceremony commemorating Brown vs. Board of Education.



Bill Cosby: Poor blacks can't speak English
NAACP leaders stunned by remarks of prominent comedian

Read the article. It shocked me, and I'm not African American.

What was Bill doing? Why was he able to get away with this? (Obvious answer here...) Is that kind of talk needed, and who should deliver it?

Bringing it back to the subject at hand...

* In the interest of being politically correct and protecting dignity/self-image, are we as a society enabling addictive behavior?

* Should doctors tell it like it is? You're fat! Stop eating so much or you'll die!

- Bill

It's also worth noting that Bill Cosby lost a son to violence.

IJ said: "Plus we should continue to educate kids and use vigorous antismoking education to prevent the companies from expanding their markets with children, which is what the profit motive has been making an absolute imperative for them."

Certainly true, but I'd also like to see more of an emphasis placed on educating kids about the relationship between obesity and the choices they make regarding nutrition, exercise, etc. While cigarette manufacturers do target marketing to kids, they don't have nearly as many outlets to do so as the makers of soda and junk foods, and kids are blitzed by advertisements for these products constantly. There needs to be at least as much emphasis on educating kids about the health risks of poor nutrition and lack of exercise as there is on the dangers of smoking, because the statistics I found stated that a little under 4 million kids smoke, while slightly less than 9 million kids are overweight.

I think that kids are aware of the health risks of smoking, but just don't have the maturity to consider the long-term consequences of doing so. I also think that, given that kids know smoking is harmful, the main reason that kids still do it is for the thrill of doing something they aren't supposed to. They probably also do it because they think they'll catch a buzz from it, but my impression is that the nicotine effect is usually sort of nauseating and headache-inducing for people who aren't used to it--nothing that in itself would keep people coming back after a first try.

So that always brings me back to the idea that if it were legal for teens to smoke, and thus there was no I'm-getting-away-with-something thrill to it, maybe they wouldn't. But I'm probably overestimating kids' reasoning abilities, and I'm sure that my own logic here is also flawed.

-Doug

Making patients responsible for their health has to be done carefully and it has to be individualized. We had this guy with AIDS who came in with pneumonia, got treated IV, and was sent home on oral antibiotics. He stopped taking them the first day, and bounced back sick again. Instead of repeating the process we told him, listen, this is BS. YOU are responsible for your health so make a decision either way--take the antibiotics when you go home, see a doctor, get on AIDS treatment, and get well. Or sign out now and go home with nothing, otherwise you're just wasting our time and your time. He was moved into action by the speech and in short, got better.

Of course other people hearing the same speech will vanish and never come back. If you look at fat advocacy sites you'll read complaints about how people go to the doctor with a rash or even a sore knee or diabetes (related things) and got told they were heavy and RESENTED it and vowed never to come back. We have to assess the individual's current state and see if they're ready to act. But I agree we should be candid with people that being obese is optional and how it affects health. There are very few people who face immediate life threatening health problems from it, though. Most just run a higher risk of several things, played out over years. And just like people with high blood pressure, or diabetes, or whatever, they may or may not care enough to do something. The overall rate of compliance (for medical professionals too) is low enough that I think efforts to reduce overweight should be geared at the societal level primarily, reversing tax breaks for high fructose corn syrup peddlers and using other financial incentives to make healthy eating clearly a financially rewarding proposition, such that less junk food enters the market.

I agree 200% that we should teach our kids about ovberweight. They actually DO lose weight with counseling unlike most adults, and the schools are quite complicit in feeding them crap, tolerating crap food, and giving pouring rights to regular sode providing beverage companies. However--it's quite hard to change the way a kid eats when mom 'n dad weigh 340 because of the junk they shove down their throats. Obesity is highly heritable, it's just not genetic (it's transmitted through eating habits).

Let's see how habits would change if a can of regular coke cost 25 cents more than the same can of diet coke (etc etc).