Friday, May 06, 2005

WSJ.com - Wonder Land

Perfectly said.

The money quote:
Science, of its nature, is always confusing. Medicine is uncertain. But public-policy formation in the U.S., especially as concerns health policy or the environment, whether obesity or the melting of the polar ice caps, admits to very little confusion. We claim to know. But in fact we usually don't know.

Full text in Comments


From Spin City to Fat City
May 6, 2005; Page A14

On the same day that Bill Clinton announced in New York this week that he would head a campaign to reduce childhood obesity, a restaurant in Pennsylvania set a record by outputting a 15-pound cheeseburger -- 10-1/2 pounds of chopped beef and 25 slices of dripping American. A case of the planets aligning?

We are gathered today to discuss America's fat people and their new best friends -- the federal government, researchers who specialize in fat people, businesses that sell stuff to fat people and now, Bill Clinton.

This is a case study in how public policy gets formulated in a highly advanced, highly educated and not least, highly neurotic society.

Until recently a lot of Americans thought they were living fat and happy. Some of our best friends are big boys who will point cheerfully at their beautifully sloped pot bellies and proclaim, "I gotta ton invested in this baby!" You can put a fork in it, bubba. Those days are gone.

The day the munching died is March 9, 2004, when the Journal of the American Medical Association gave its imprimatur to a study by the U.S. Centers for Disease Control, announcing that "obesity" had caused 400,000 deaths in 2000, a whopping 33% increase from 1990. The AP's first paragraph wrote the script for what followed: "Americans are sitting around and eating themselves to death, with obesity closing in on tobacco as the nation's No. 1 underlying preventable killer." The key phrase there is "preventable killer."

In America, "preventable" is the high C of a public-policy bugle, calling forth an army of professional preventers. Conservatives like to believe that the preventer brigades are invariably liberal. This is not true. The prevention compulsion is bipartisan, and I am inclined to suggest someone should do a study of what's in the sparkling water in Washington.

The day the CDC released its killer-obesity study, George Bush's HHS Secretary, Tommy Thompson, said: "We're just too darn fat, ladies and gentlemen, and we're going to do something about it." He added elsewhere: "It's a difficult fight but we all have to partake in it." We all? Say bye-bye to those backyard picnics of burgers and dogs washed down with five Buds, Melvin; you're in the anti-fat army now. Within months, HHS said it might let Medicare pay for "anti-obesity interventions," suggesting obesity was now officially an illness, which in turn would pressure all insurers to pay for weight-loss "interventions."

Back in March, the great American campaign to control obesity was no longer an issue. It was a done deal. The government was onboard. The medical community was onboard. And of course the food industry and plaintiffs lawyers had launched parallel campaigns to cash in on fat people. But in November obesity suddenly reverted to issue status, that is, you could have a conversation about it again.

It turned out that the CDC's arithmetic had "methodological flaws." After recombing the data dump, the CDC announced last month that the new number of obesity-related deaths annually is not 400,000 but . . . 26,000. Most intriguingly, though, the new study found that 86,000 "overweight" people lived longer than people of normal weight.

This is confusing -- and that's the point. Science, of its nature, is always confusing. Medicine is uncertain. But public-policy formation in the U.S., especially as concerns health policy or the environment, whether obesity or the melting of the polar ice caps, admits to very little confusion. We claim to know. But in fact we usually don't know.

The CDC's conclusions about mortality weren't based on anyone's science, but like hundreds of "studies" reported each week on what has been discovered to be good for us or not good for us, it was based almost wholly on statistical associations.

But until the CDC's correction, "obesity" was about to become a well-financed public and private industry forced upon a bewildered population ("we all have to partake") -- by obesity researchers, politicians, drug companies, philanthropies, the insurance industry, ectomorphic health freaks and email spammers.

None of this is to suggest that gross obesity is not a medical concern. Make no mistake, if you are hypertensive, diabetic or arthritic and also extremely overweight, then the hand you've been dealt suggests you're at risk of buying the ranch and should lose weight.

But we are fortunate that obesity has returned to earth as a discussable issue, rather than rumbling across America as a quasi-religious crusade. There is much we don't know about the complexities of body weight, illness and mortality.

Most fundamentally, one of the mysteries of science is why sustaining weight loss over time is so very difficult. Whether programmatic weight loss indeed benefits healthy overweight people is also not clear. One obesity study found that weight-related risks decline with age, and disappear at 74. And might the obesity issue really be a red herring for the broader problem of an increasingly sedentary, artery-clogged population? One more confounding fact: Since 1990, life expectancy in the U.S. has risen -- to 77.4 years from 75.2 years. That is a phenomenal gain. Most of it is likely explained in three words -- Mevacor, Zocor and Lipitor.

Public officials will always ride in the slipstream of an evident crisis. But there is a cautionary tale here. The informational world we inhabit has become a volatile mixture of news, rumor and often incomplete science. This or that threat, need or cause comes at us constantly. But there may be a limit to how often politicians can lower a bucket into the well of public credibility, asking people to alter their behavior and pay handsomely for the privilege -- as here, or climate change or fuel alternatives. There might not be much left when the authorities most clearly must ask people, for example, to prepare for an avian flu pandemic before it arrives from Asia.

When the 400,000-dead obesity study unraveled, the CDC's director called it a "lesson in humility." In a world that is evermore complex, busy and costly, it would be a good thing if the people in Washington with the power to impose solutions to the problems of life on all of us made their new watchword "humility." Fat chance.

Write to henninger@wsj.com.
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