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Sunday, August 7, 2016

Would you like a side of Baconator Fries with your "Culture of Health"?

Interesting article over the weekend. Particularly in light of my prior posts on Ann Neumann's moving work on death and dying, here, and here (and my least favorite person in the nation as well).
Trump’s suicide mission: He’s not trying to destroy his own campaign — the destructive urge he represents is much bigger than that
Is Trump sabotaging himself? Wrong question — he's channeling a deep-seated American urge toward self-destruction

...America is experiencing a health crisis on an enormous scale — a crisis that is simultaneously physical, psychological and spiritual and is hardly ever understood in holistic terms. If Trump is the most prominent symptom of this systemic disorder at the moment, he is not its cause or even its leading indicator. For starters, this crisis encompasses epidemic rates of obesity and epidemic rates of suicide, dramatic evidence of a wealthy country that is literally killing itself. It’s about a nation of worsening social isolation and individualized info-bubbles and pathological delusion, a nation that spends more per capita on healthcare than any other major Western power to achieve worse outcomes, and where Baconator Fries are $1.99 at Wendy’s.

More than one-third of American adults are obese, and close to 70 percent are overweight. Rates of obesity and associated ailments are highest among Americans with lower incomes and less education...


But, wait! There's more!
For all our understandable horror at mass shootings, police shootings and gang-related violence, most gun deaths in the United States are suicides. In 2014, there were more than twice as many gun suicides in as gun homicides. Suicide rates have reached their highest level in nearly 30 years, while murder rates remain near historic lows. Although suicide, like obesity, has increased across all socioeconomic and gender-ethnic categories, about 70 percent of the Americans who kill themselves are white men. Middle-aged white men with lower incomes are at particular risk — the group most likely to support Trump, and to express the incoherent racial and societal grievances he has channeled so expertly. (For reasons that are not entirely clear, blacks and Latinos are much less likely than whites to commit suicide.)

Some researchers have identified a troubling spike in preventable and more or less self-inflicted death among lower-income white people in America, the group that provides nearly all Trump’s support. This phenomenon includes suicide, alcohol poisoning, liver disease and drug overdoses, closely related to the waves of prescription-drug abuse and heroin addiction now visible in virtually every suburban or exurban community across North America...

...[T]he precarious mental state and multiple ailments of downscale white America have found a symbolic outlet in Trump, who offers imaginary remedies to real problems, vainglorious bluster masquerading as thought and hateful nihilism pretending to be hope.

I’m saying that the state of borderline psychosis produced by electronic consumer society leads to OxyContin addiction and Baconator Fries and a suicide epidemic and Donald Trump. Those things are not all the same, but they are interconnected. I’m saying that the landscape I just saw in west central Florida, whose inhabitants crawl mollusk-like from fast-food outlets to convenience stores to healthcare providers to office parks, in their SUVs and pickup trucks with tinted windows, is a landscape of cognitive dissonance and collective delusion. It’s the landscape of madness in general, and the flavor of madness provided by Donald Trump in particular...
No doubt the Democrats presented a much more inclusive and dynamic vision of America at their convention than the Trumpified Republicans did at theirs, and no doubt it’s better for my children and yours if Hillary Clinton wins the election. But Democratic cluelessness troubles me greatly. I’m not sure the Clinton-Obama-Clinton leadership of the Democratic Party has the slightest understanding of the physical and psychological dislocation of so much of America, the loneliness and desperation that has found its voice, for the moment, in Donald Trump. Why would they, since they are every bit as complicit in the political economy that made all this possible as the Republicans are?

Donald Trump is not the problem with America, and Donald Trump is not consciously trying to sabotage his own campaign. Maybe we should be grateful to Trump for what he has shown us. He is no more (or less) than the demonic personification of the central conflict in America, a nation torn by endless self-glorification, an insatiable hunger for Baconator Fries and the urge to put a bullet in its own head.

Tough stuff. Not everyone will agree. Some will no doubt see in it one more episode of the snooty rantings of "liberal elites."

One of my most favorite peeps in the nation is the Notorious Underachiever Mike Painter, MD, JD, Chief Program Officer at the Robert Wood Johnson Foundation and tireless advocate for a beneficent "Culture of Health." Be interested in his take on the foregoing.

One of my shots of Mike last year during the first day of the 2015 Health 2.0 Conference in Santa Clara. See also my coverage of Mike here: #Data4Health San Francisco listening session. See too my prior posts When it comes to health, your zip code matters more than your genetic code and "The ultimate population health "Upstream" issue?"

"Baconator Fries," ugh.

All of this stuff also brings to mind points made in another of my recent reads.

...Economic forces are also factors. On the one hand, market systems have made possible many forms of progress that allow more people in the developed world to live longer, healthier lives than their grandparents did. However, not all capitalism has been beneficial for the human body, because marketers and manufacturers prey on people’s urges and ignorance. For example, deceptive advertising of “fat-free” food entices people to buy calorically dense products rich in sugar and simple carbohydrates that actually make the consumer fatter. Paradoxically, it now requires more effort and money to consume food that has fewer calories. A quick glance tells me that the seemingly healthy and modest 15-ounce bottle of cranberry juice in my refrigerator contains 120 calories, but closer perusal reveals that the bottle is improbably considered to have two servings. So you actually ingest 240 calories when you drink it, as much as a 20-ounce bottle of Coca-Cola. We have also filled our environments willingly with cars, chairs, escalators, remote controls, and other devices that decrease our physical activity levels, calorie by calorie. Our environment is needlessly obesogenic. And at the same time, the pharmacological industry has developed a stunning array of drugs, some extremely effective, to treat the symptoms of these diseases. These drugs and other products save lives and reduce disability, but they can also be permissive and enabling. All in all, we have created an environment that makes people sick through a surfeit of energy and then keeps them alive without having to turn down the energy flow.

What do we do? The obvious, fundamental solution is to help more people eat a healthier diet and to exercise more, but this is one of the greatest challenges our species faces (and the subject of chapter 13). The other key solution is to focus more intelligently and rationally on the causes rather than the symptoms of these diseases. Having too much fat, especially visceral fat, is a health risk for many diseases and a symptom of energy imbalance, but being overweight or obese are not diseases. Most people who are overweight or obese are justifiably fed up with those who focus on weight rather than health and who stigmatize or blame obese people for being obese. The same despicable logic leads to blaming poor people for being poor. In fact, such condemnations are often linked because obesity is strongly correlated with poverty.

Widespread obsession with the obesity “epidemic” has led to an understandable backlash. Some wonder if alarmists have exaggerated the problem. According to this view, we not only stigmatize people unnecessarily, we also waste billions of dollars to fight an invented crisis. To some extent, the anti-alarmists have a point. Exceeding a recommended body weight is not necessarily unhealthy, as is evident from the many overweight individuals who live long and reasonably healthy lives. About one-third of people who are overweight show no sign of metabolic disturbance, perhaps because they have genes that adapt them to being heavy. But as this chapter has repeatedly stressed, what matters most for health is not fat per se. Even more important predictors of health and longevity are where you store your body fat, what you eat, and how physically active you are. One landmark study, which followed nearly 22,000 men of all weights, sizes, and ages for eight years, found that lean men who did not exercise had twice the risk of dying as obese men who engaged in regular physical activity (after adjusting for other factors, such as smoking, alcohol, and age). Being fit can mitigate the negative effects of being fat. Therefore, a sizeable percentage of fit but overweight and even mildly obese individuals do not have a greater risk of premature death...

Lieberman, Daniel (2013-10-01). The Story of the Human Body: Evolution, Health, and Disease (pp. 290-292). Knopf Doubleday Publishing Group. Kindle Edition.
Another highly recommended book. Cited it previously here. Love this:
"...lean men who did not exercise had twice the risk of dying as obese men who engaged in regular physical activity ... Being fit can mitigate the negative effects of being fat."
That's personally encouraging. I am by no means "fat," but I'm carrying about 15 lbs more than my high school weight, and it's long bugged me. But, I'm now back in the gym again (after about a 6 year hiatus) pumping iron and pursuing my absurd hoops Jones.

About a month ago, with my grandson Keenan, right after he graduated from St. Olaf. We lit 'em up pretty good that day, my bad back, Wax Museum Defense, and 6-inch hops notwithstanding.

PS- Oh, yeah, back to The Donald. What is "The Trump campaign health care policy position"?


LOL. from the New York Times:
Donald Trump’s Diet: He’ll Have Fries With That 

President Obama is so disciplined that his wife has teased that he eats precisely seven lightly salted almonds each night.

George W. Bush was an exercise buff, obsessed with staying trim by mountain biking and clearing brush at his ranch in Crawford, Tex.

But Donald J. Trump is taking a different approach: A junk food aficionado, he is hoping to become the nation’s fast food president.

“A ‘fish delight,’ sometimes, right?” Mr. Trump told Anderson Cooper at a CNN town-hall-style meeting in February, extolling the virtues of McDonald’s. “The Big Macs are great. The Quarter Pounder. It’s great stuff.”

Mr. Trump’s presidential campaign is improvised, undisciplined, rushed and self-indulgent.

And so is his diet...
The jokes just write themselves. Maybe he can lend his "$3 billion Brand" to the product.



In light of my reviews of Ann Neumann's fine book "The Good Death" (here and here), see this at STATnews:
Talk more about dying. Make doctors get MBAs. How to reform medical school

4. Talk about nutrition, and dying

Today’s doctors are woefully ill-equipped to answer their patients’ questions about nutrition or food access. Without this vital understanding, disease prevention is left to the wayside while treating the symptoms of chronic disease (type 2 diabetes, for example) becomes the norm. Classes in nutrition education, agriculture and food systems studies, food policy, and health justice would enrich a stale med school curriculum and better aid medical students in considering food and diet as a part of health care. (profession not specified)

We must teach physicians-in-training (from early in medical school) that death is not always a treatment failure. The current medical establishment feels compelled to provide invasive, aggressive care to all patients regardless of whether it will benefit them in the end. … We need more physicians who can look at the big picture to provide care to patients that fits their goals and values for how they want to live. (medical educator, physician)

5. Digital health and medical records

Make digital health a crucial component of curriculum. (physician)

Incorporate electronic medical record training into the curriculum, since that largely dictates how doctors practice and residents function in the hospital. Today, it is learned on the job, by asking others for tips, leading to gaps in training depending on who is around you, with deficits masking an otherwise medically intelligent trainee. For better or worse, people who know the computer program the best are seen as the best physicians (medical student)...
Given my long tenure around Health IT, I obviously agree with point #5, but it also behooves us to take credible critics seriously. See, e.g., "Are structured data the enemy of health care quality?"

More to come...

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