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Setting up straw men.

And knocking them down, to the detriment of everyone's health. Right on the heels of the subject of my last "Message from the Editor" comes another widely publicized anti-health message. The previous message, an article by John Cloud titled "Why Exercise Won't Make You Thin," was the cover story of Time magazine on August 9, 2009. He set up a two-legged straw man and then easily knocked him down. The two legs were: a) regular exercise is the principal modality for achieving weight loss and b) most regular exercisers do it principally for weight management. In my retort in the AMAA Journal, I pointed out that a professional who is knowledgeable about weight loss would never recommend regular exercise as the principal modality for achieving it and that most regular exercisers don't do it for weight management or any other direct morbidity/mortality-related reason. As the readers of this publication know well, we do it primarily because it makes us feel good and feel good about ourselves.

The most recent anti-health message comes from Dr. Susan M. Love, a surgeon, who has been referred to in a New York Times article as "one of the country's most respected women's health specialists." (1) Dr. Love offers a new rule: "Stop worrying about your health." Why? Because, according to her, "perfect health" is unobtainable. She says that "perfect health is a myth and that most of us are living far more healthful lives than we realize." This message, of course, is yet another straw man. I don't know any respected authority on health and wellness who proposes "perfect health" as a goal to achieve. In fact, I don't know of any such authority who would claim to know what "perfect health" is for an individual or population, or how to reach such a nirvana if it existed. But then again, Dr. Love is not an authority on health and wellness. She is a clinical professor of surgery which may account for her point of view.

Surgeons are trained to aim for perfection in their surgical procedures. Or at least they were when I took my surgical clerkships many moons ago at the Peter Bent Brigham and Massachusetts General Hospitals. If perfection is not attainable then they strive to achieve the very best possible outcome in a given patient that would be "perfect" for that particular person. Of course, if you are going under a surgeon's knife that is exactly the outcome you would want. You certainly would not want an indeterminate outcome and would never want to hear "Let's do the best we can," or "If it doesn't work now let's come back and try it again in six months." You would prefer to have certainty when undergoing surgery and if that is not possible, as much certainty as possible.

Health and wellness do not deal with certainty. They deal with uncertainty. As I have told medical students and preventive medicine residents for the 40 years or so I have worked in the specialty, the only thing that can be guaranteed from leading a healthy lifestyle is reduction of risk. If an appendix is removed correctly, it can be guaranteed that you will never have appendicitis again. If a fibular fracture is set properly in an otherwise healthy person, you can virtually guarantee a fully healed bone. On the other hand, if you engage in a program of regular exercise, the only guarantee you'll receive is that your risk of incurring a variety of diseases and illnesses will be reduced. You will also most likely feel better.

Even the title of Dr. Love's book sets up a straw man: Live a Little! Breaking the Rules Won't Break Your Health. She makes it sounds as if health and wellness proponents are next to sturmbahnfuhrers. First of all, healthy health and wellness proponents don't set up "rules." We offer recommendations. Second, we know that what works for one person doesn't necessarily work for the next. Third, we know that health is a state of being that in each person varies over time, while wellness is a process of being. It is a process that has its rises and falls and changes over time in response to a wide variety of personal and environmental considerations. Just as disease has a natural history, so does health.

In my view, people like Dr. Love are detrimental to both the individual and population as a whole, which is becoming less healthy every day. A recent paper in The New England Journal of Medicine concluded: "If past obesity trends continue unchecked, the negative effects on the health of the U.S. population will increasingly outweigh the positive effects gained from declining smoking rates."(2) I wonder if Dr. Love has the same attitude toward smoking as she has toward weight loss: "Don't worry about it, just go ahead and smoke. Not everyone who does will eventually come under the knife." Books, such as that written by Dr. Love, flame out fairly quickly when most people realize the message is not in their best interests. But they do garner publicity up front and that publicity does initially sell books, even if they do have an unhealthy message.

Respectfully yours, Steven Jonas


(1.) Parker-Pope T. New health rule: quit worrying about your health. New York Times. Jan 5, 2010.

(2.) Stewart ST, et al. Forecasting the effects of obesity and smoking on U.S. life expectancy. N Engl J Med. 2009; 361:2252-2260.
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Author:Jonas, Steven
Publication:AMAA Journal
Article Type:Editorial
Geographic Code:1USA
Date:Jan 1, 2010
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