Sex and drugs and pharmacies

Over at Junkfood Science, Sandy Szwarc had an excellent post today on the rather incredible prevalence of prescription drugs in America today and the financial motives behind such large-scale prescribing.

Full disclosure: I'm in favor of meds for those who need them. Actually, I often wish SSRIs had been around when I was a teenager. I often wonder who I might have become had I not had to deal with the continuous panic attacks that started around age 11. Living in constant terror shaped me, body and soul. For better or worse.

Still. Some of the statistics Szwarc quotes are staggering: More than half of all insured Americans take some kind of prescription for a chronic condition. (Note that it's 50 percent plus of insured Americans.) Nearly half of all young women in this country now take ongoing meds. Likewise one in three children.

As Szwarc points out, pharmacy benefit managers stand to gain big bucks from the rise in chronic prescriptions. But most doctors don't benefit directly from prescriptions. They have patients' best interests at heart. The trouble is in how one defines best interests.

Case in point: The women in my family tend to have high cholesterol. My mother has it. My grandmother had it. And I've got it. When my cholesterol level first turned the wrong way, my (former) doctor encouraged me to "eat right and exercise." I did, and I do. I'm no fitness queen, but I try to walk or bike for 45 minutes every day, and I try to be active in other ways too. I eat a wide variety of foods, including plenty of fruits and vegetables. None of this affected the cholesterol numbers, which continued to inch upward. Then my doc started trying to convince me to go on statins. Every time I saw her she suggested I give them a try. After about two years of this she sat me down and said, "If you were my sister I'd put you on these right now." She went on to scare the living crap out of me with accounts of young people who'd had heart attacks and strokes. Statins, she said, would prevent all that.

Never mind the fact that there's pretty much no history of heart disease or stroke in my family. None of us are thin. Few of us die early. I've got grandparents and great-grandparents on both sides of the family who lived into their upper 90s.

Still. I was scared. I went on a statin. I felt like crap, but I kept taking it. I never developed the full-blown myopathy that some people get from taking statins, but I did get increasingly depressed and never felt good. Two years later, I got a new doctor, and at our first appointment she asked about the statins. I told her how I felt--scared and crappy--and she took a thorough family and personal history. She told me my risk of having a heart attack or stroke were less than .5 percent, at least at this point, and took me off the statins. Within a couple of weeks I felt great again.

Back when Doctor #1 prescribed the statins, I asked her if she really thought a relatively healthy woman in her early 40s needed to be on cholesterol-lowering drugs for the rest of her life. She looked at me like I was nuts.

I'm sure she believed she was doing the right thing. And I'm just as sure that she wasn't. I guess time will tell.

The obesity paradox, redux

In the category of why-is-this-so-hard-to-believe, Reuters reports that the effects of the so-called "obesity paradox" have prevailed in yet another study, this one on people with heart disease and high blood pressure.

The results substantiate earlier results showing the now-famous J-shaped mortality curve described by Dr. Katherine Flegal, wherein overall mortality rates are highest at either end of the spectrum and lowest in those in the "overweight" category. What's significant about this study is that it concentrated on people with heart disease--who are, if you listen to the media at all on this subject, in imminent danger of death if they carry even a couple of "extra" pounds.

This study of 22,576 people with high blood pressure and coronary artery disease found that

compared to normal-weight subjects with a BMI between 20 and 25, the risk of death, heart attack, or stroke was lower in subjects who were overweight (BMI 25 to 30), and in those with class I obesity (BMI 30 to 35) and class II-III obesity (BMI 35 or greater).

The article is accompanied by--what else?--the obligatory shot of headless fatties. And its wrap-up leaves something to be desired:

In a commentary, Dr. Carl J. Lavie and colleagues of the Ochsner Medical Center, New Orleans caution that while improved outcomes appear to be consistently associated with increased BMI, "one should not conclude that weight reduction is detrimental in overweight populations."

I'm not sure what we should be concluding then, except that the media coverage on this subject is, as usual, beyond biased.

Finally, we're talking about eating (rather than weight)

Amid the usual hysterical news stories about the so-called obesity epidemic I was pleased to come across an item about new research out of Penn State looking at eating competence as a risk factor in heart disease.

Using an eating competence scale developed by Ellyn Satter, researchers found that--surprise, surprise--people at risk for heart disease fared better when they were "confident, comfortable, and flexible with their eating habits."

Being comfortable with your eating seems to mitigate other risk factors, including elevated LDL cholesterol. It's process over product, holistic health over health-by-the-numbers. It's the act of eating rather than the rigidly controlled carbs and calories approach.

Now we know the truth: fear of food is bad for your health. Mangia va bene!

Why dieting is the ultimate health risk

Big kudos to Sandy Szwarc, whose most recent post looks at how the American Heart Association's "heart-healthy" diet recommendations don't actually add up to better health or longer lives for women.

Eating healthy, in other words, doesn't protect you from heart disease. (We're talking about women who aren't sick; the statistics are different for those who already have heart disease.) And eating "not-healthy" doesn't put you at higher risk--at least, no studies have been able to show a cause and effect relationship.

In fact, all "eating healthy" (read: dieting) does, as we know, is make you fatter by messing up your metabolism with the deprivation-and-binge cycle. So dieting itself is a risk factor for obesity.

Obesity, it turns out, is a risk factor for diabetes, but not much else. Fat people actually do better after heart attacks than thin people. Older people who are fat live longer than their skinny peers.

Another thing dieting does is trigger eating disorders in those who are susceptible. Once more, dieting itself is a risk factor for anorexia, a serious illness that kills up to 20% of those who suffer from it.

Oh yeah, it does one more thing: Make money for the multi-billion-dollar weight loss industry, for the bariatric surgeons, and for the obesity researchers. Cui bono, baby?

So forget the war on obesity, which is as ill-conceived and well-funded as the war in Iraq. I think we need a war on dieting.

**This post is dedicated to the memory of my dear friend Marilyn "Mimi" Orner, who founded the Anti-Anorexia/Bulimia/Dieting Project. She was an advocate of size acceptance, a survivor of anorexia, and a powerful inspiration to a generation of young women. She died of ovarian cancer in 2000 but has not been forgotten. You still rock, Mimi!

Fat kills. Except when it doesn't.

Deaths from coronary artery disease in the U.S. went down by half between 1980 and 2000, and researchers at the University of Liverpool attribute this to positive lifestyle changes and better treatments.

Now for the bad news: Those same researchers go on to say, on no cited evidence, that the number of deaths would have been reduced even further had it not been for the rise in obesity and diabetes.

How do they know this? Well, they don't, actually. One researcher is quoted as saying, "The increase in obesity and diabetes are a wakeup call. They reflect the increasing consumption of large helpings of junk food."

Hmmm. So deaths from heart disease have decreased during the same time that rate of obesity have increased, yet obesity is still to blame. That's what I call having it both ways.

An epidemiologist could look at the same information and come to the opposite conclusion: That obesity has a protective effect when it comes to death from heart disease.

Seems like more of the same fat-is-evil ranting to me, liberally laced with assumptions and a heaping helping of bias. Mmm, mmm.

Good food, bad food

Sound familiar? I've often wondered where the good food/bad food dichtomy originates. Why is it that carrot sticks carry with them an aura of smug virtue, while chocolate cake bears the stigma of sin?

Of course I know the answer: It's all about the calories, stupid. But there's got to be attitude behind those calories. And there is. Turns out reseachers from Yale and elsewhere did a study several years ago (which I just came across) looking at the stigma associated with obesity. Get this: They quizzed obesity specialists--doctors, researchers, psychologists--and discovered that even people who have devoted their lives to the subject associate "blameworthy behvioral characteristics" with obesity.

These are folks who understand the genetic and environmental factors implicated in obesity. Who know that fat people aren't fat because they watch TV and eat bon-bons all day.

Geez, if you can't trust these people to understand, who can you trust?

This sense of judgment extends beyond food to any part of our lives that our related to fat and overweight. We fatties are told that we bring all kinds of bad things on ourselves, from diabetes to lower pay to heart disease.

If your heart were, I don't know, a sewage pump (which in some ways isn't such a bad comparison), and it got clogged, would you feel a sense of moral failure? Or would you just call the plumber to have the pipes cleaned out? So why the strong sense of self-blame and guilt over being fat?

Stigma equals shame. Shame equals a sense of moral dichotomy, good and bad. People with anorexia take this good/bad food thing to obsessive extremes. But I bet most of us do it on some level.

Pay attention to your feelings about the next plate of food you sit down to. See if it's true for you. Then practice moral blindness when it comes to food. Repeat after me: There is no such thing as bad food, only badly cooked, badly prepared, or bad-tasting food.

Bon appetit.