Let Us Shun the Obese This Holiday Season

DrRich | December 20th, 2011 - 7:54 am

Podcast:

In the tradition of “Yes, Virginia, &c.,” DrRich once again reprises his classic holiday message.

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‘Tis once again that time of year when we Americans gather together with our extended families and friends to celebrate the Season. It is a time for catching up – renewing acquaintances and making new ones, sharing in good news and commiserating in bad, welcoming our new arrivals and mourning our losses. It is a time for giving thanks, counting our blessings, and putting our sundry individual problems into perspective. Indeed, it is perhaps most importantly a time for each of us to remind ourselves that – despite the trials and tribulations that may cause us to become relatively self-absorbed in our daily lives – we are all part of something much greater than ourselves.

So, in a way, it’s a shame we must now cull out our obese relatives and friends, and disinvite them from these joyful and fortifying reunions.

It’s not something we should do lightly, as the obese are people, too. They enjoy the holiday gatherings as much as anyone else (more, some would say, given the abundance of sugary foodstuffs which are typically provided there). But alas, excluding the obese is now something we must do – for our own sake, of course, but more importantly, for the sake of our social networks, and indeed, for America itself. For, to allow the obese to continue participating in our traditional seasonal gatherings is something we now know (as DrRich will shortly explain) to be simply too dangerous and too counterproductive to our collective interests. We can no longer permit it.

Before demonstrating why, DrRich ought to digress for just a moment to address the burning question many of his kindly and generous readers must already be asking, namely, What about Diversity?

On the surface at least, it would seem that the exulted goals of Diversity – the uber virtue, from which all the other, more subsidiary virtues must necessarily spring – would be well-served by our including the entire panoply of body types in our holiday celebrations, from the very thin to the very fat. Must we really exclude from our table our obese family and friends, whom we know and may love, while at the same time, in the name of Diversity, welcome into our collective bosom, say, self-declared Islamist terrorists who openly aim to kill us?

In a word, yes.

For the terrorist, as much a danger to our persons as he or she may pose, is merely a fervent adherent to a minority (and therefore oppressed) religious sect, whose fundamental beliefs (though they center around the utter destruction of Western Civilization) we may not legitimately place ourselves in a position to judge, and therefore, whose tolerance by us, and proximity to us, greatly enriches our appreciation of the wondrous diversity of the human experience.

In contrast, obese people are just fat.

They have no redeeming qualities whatsoever which ought to merit their protection under the beneficent umbrella of Diversity. In this way, fat people resemble Sarah-Palin-lovers, global warming skeptics, tea party fanatics (at least 40% of whom, by the way, are overweight or obese, judging from photos of their rallies), and other groups of narrow-minded or otherwise inferior people the benign tolerance of whom would quite obviously do material harm to the true goals of Diversity. But the obese pose a greater threat to us than even these other unworthies do.

And unfortunately, as we approach that charitable season in which our natural inclination would be to temporarily overlook the sins of our obese friends and relatives, to allow ourselves to fraternize with these individuals – even if only for a few brief hours during this one time of year – is to place ourselves, our non-obese loved ones, and our nation itself, in immediate and immeasurable peril.

This sad fact came to light just a few years ago when a landmark study was published in the New England Journal of Medicine proving that obesity is contagious. Merely having fat friends (and not necessarily living with or near them, or even interacting with them regularly, but merely enumerating them among your friends at a distance) can make you fat as well.

The study came from the studios of the famous Drs. Christakis and Fowler, who have embraced a software package, comprehensible only to themselves, that churns out complex images of “social networks,” from which they can derive all manner of heretofore unimagined associations. These academic stars have turned their shop into a veritable factory of peer-reviewed publications, thereby solidifying their scholarly reputations and (doubtless, now that they have done so much good for the anti-obesity movement) their ability to secure NIH grants, and other favors from government agencies.

Using data from the venerable Framingham database, these pioneers combed through old records for information about the body weight, relatives, and social contacts of individuals who were enrolled in this famous study. They then used their esoteric computer modeling software to create various “animations” depicting the evolving social relationships of the subjects, and the development of obesity, over time.

To summarize their findings: A person is 57% more likely to be come obese if a friend becomes obese, even if that friend lives hundreds of miles away. (This finding is really quite remarkable, considering that the only other natural force that acts on bodies instantaneously and at a distance is gravity. This newly discovered force that produces obesity at a distance – shall we call it “obevity?” – will have to be incorporated, with great difficulty no doubt, into the Grand Unification Theory now being sought by physicists everywhere.) The same effect was not seen when close neighbors became obese, or even (to such a great extent) when family members became obese. Furthermore, if the friendship is mutual (that is, if the fat person considers you a friend in addition to you considering the fat person a friend), the odds of your becoming obese triples. And even worse, this study shows that, even if you wisely avoid the company of fat people yourself (in an attempt to remain acceptably svelte), fat people who are acquainted with your acquaintances may still have an impact on your BMI. That is, obesity is a contagion that tends to spread throughout the social network.

So clearly, if anyone within a given social network associates with fat people, then ultimately nobody in that network is safe.

(Here is an animation the authors have provided, to show a time-lapsed view of how obesity spreads. If this doesn’t convince you, nothing will.)

Now, to be sure, there have been critics of this study – individuals, DrRich thinks, who are nearly as dangerous as the obese themselves. Since this issue is so critically important, please allow DrRich a few brief paragraphs to debunk the debunkers.

Some have complained about this landmark study because the list of “friends” employed by the authors was determined decades after the fact, from administrative records that had been used in the Framingham study for follow-up purposes, in which subjects had been asked to list relatives and a “close friend” who would know their whereabouts at all times. Critics claim that somebody who can reliably provide your contact information may be a good friend; but perhaps not. Perhaps subjects were simply more inclined to give the name of a fat person as a round-the-clock contact. After all, it’s always easier to get ahold of an obese person who, being slothful, is likely to be parked in front of his TV, popping chocolates and munching chips, than it is to contact somebody who’s thin, and is likely to be out and about, probably jogging. The researchers, in other words, were not operating from a list of BFFs, but instead from a list of acquaintences judged by the subjects at the time to be most likely available by telephone. (The subjects, remember, had been enrolled long before the era of cell phones.) So, critics insist, the baseline assumption made in this study – that the researchers actually knew who the subjects’ close friends were – is highly suspect.

To which DrRich replies: These critics likely have fat friends, and are probably even fat themselves, and thus their complaints can be dismissed with a definitive, “Bunk!”

Moving on, critics have also complained because the kind of computer modeling used in this study is not for mere mortals to understand, and therefore amounts to a black box. And indeed, DrRich must admit that the authors’ description of their statistical maneuverings is enough to make your head spin – replete as they are with the running of numerous simulations, using differing assumptions along with a quite unembarrassed manipulation of all the variables (almost as if they were seeking the “right” combination of factors to yield the desired answer, reminiscent of the scientific techniques revealed in the emails of those global warming experts). Critics go on to complain that there are only a handful of humans who claim to understand this kind of complex computer modeling, the results of which, therefore, resemble “received knowledge,” akin to what the medieval clergy used to dole out to the unwashed masses, when most people were illiterate and there were no Bibles in the vernacular.

Bunk again, says DrRich. While the computer modeling used here is indeed unfamiliar to physicians, it is very familiar to a few theoretical economists, who have used similar modelings for years in the attempt to predict the behavior of markets within social networks. DrRich even found a formal critique of the Christakis/Fowler analysis, written by two such economists (Ethan Cohen-Cole from the Federal Reserve Bank of Boston, and Jason M. Fletcher of Yale University). And while this pair of economists, in fact, concluded that Christakis/Fowler bollixed-up their analysis of obesity to such a great extent that their conclusions are completely illegitimate, DrRich counters with this query to said economists: If you know so much about computer models, how’d your investments do during the big crash in ’08? Eh?

Finally, critics say, all the reports appearing in the popular media (which often have included provocative quotes provided by Christakis and/or Fowler themselves), seem to have exaggerated the conclusions of the study way beyond what the published study actually says. For instance, all media reports stress the general contagious nature of obesity. But when one reads the study itself, one finds that the highly-publicized ability of obesity to “spread” from friend to friend actually did not hold up for the following combinations of friends: man-woman, woman-man, and woman-woman. It only reached statistical significance when both friends were men. So while the results of this study have been mercilessly generalized, in fact only one real finding was actually suggested by this data. If either you are a woman or your friend is a woman, then your friend’s obesity is not contagious to you – even if you buy the results of this study.

To this criticism DrRich responds thusly: Having fat friends makes you fat, OK? So get over it. If you choose to believe only the details of the study, instead of its spirit (as clearly expressed by the media and by the public utterances of its authors), then go ahead and enjoy your obese female friends, and see where that gets you.

The real beauty of this study is that, since it comes from a completely unique database that will never be duplicated, the data we have is the only data we’re ever going to get. So, the quibbling of the critics aside, the very best study ever conducted or that ever will be conducted on this issue shows definitively – to the satisfaction of the people that matter – that obesity is contagious.

Since the obese are rapidly becoming the witches of the 21st century, we are obligated to do everything in our power to stop them while we can. (DrRich points out that burning witches is an evil act only if you don’t believe that witches are real. If you, supported by all the respected authorities of the day, believe that real witches are present in the community, and that they indeed are capable of producing extreme harm to innocent individuals, surreptitiously and at a great distance – kind of like the obese – then burning them is at least reasonable, if not the only responsible thing to do.)

DrRich of course is not advocating burning fat people at the stake. He is already on record as saying that committing such an act would be a crime against the environment, just based on the carbon emissions alone.

But, my goodness, why would you befriend a fat person – let alone invite one into your home for a holiday supper – when doing so will put you and your family, all the way down to the second-and-even-third-degree acquaintances in your social network, at grave risk? Until the day comes when our leaders develop the courage to do what needs to be done about the menace of obesity – perhaps gathering up all the fat people and concentrating them, say, in special camps – we must do our bit to keep them from contaminating our own social networks.

As our President says, our new healthcare reforms, to be successful, will rely utterly on the straightforward and unprejudiced application of the very best medical science available, rather than on emotions, on biased opinions, or on unsupported traditions.

Until our leaders grow the teabags to begin following their own advice, let us regular folks do what needs to be done in our own homes, especially during this very special holiday season.

May God bless you and keep you – thin.

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DrRich wishes his readers a Merry Christmas and Happy New Year – whatever their BMIs – and will return here to the CRB shortly after the holidays.

An Abject Apology

DrRich | October 4th, 2011 - 6:30 am

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DrRich deeply, humbly, sorrowfully and most abjectly apologizes.

When one fancies himself an ironist, a satirist, one must be very, very careful. The ironist attempts to illustrate the limitations of a point of view with which he or she strongly disagrees, by purporting to adopt that point of view, and then taking it to its logical and outlandish extremes, in order to demonstrate how absurd it is at its root. But the irony only works when the people who actually hold that absurd point of view would somehow be brought up short, or embarrassed, or angered by it.

“That’s not what we’re saying at all!” is the response the ironist hopes to elicit. Because once the opponents make that response, it then becomes their obligation to attempt to explain  exactly how their point of view does not logically lead one to such absurd, counterproductive, or stupid conclusions. And, if the ironist is correct, his opponents will be unable to do so, and will be left with name-calling, labeling, and vituperation – which, by any objective measure, is a form of capitulation.

And judging by the names he has been called, the labels that have been hung upon him, and the vituperations with which he has been pasted, DrRich has generally been quite satisfied with the results of his occasional attempts at irony and satire.

But his most recent effort has failed, and failed badly, and for this he is most grievously regretful.

For, no sooner had DrRich penned his most recent post patiently explaining why Governor Christie is simply too fat to run for president, than sundry Progressives (the very target of DrRich’s badly misjudged piece) began publishing exactly the same opinion, using the same arguments which DrRich had considered to be the fruits of irony. In fact, one or two of them actually predated DrRich’s publication date. (Had he known this, he would have aborted his effort altogether.)

Regular readers will know that DrRich has long railed against the demonization of obesity, and has liberally employed irony to do so. By ostensibly supporting those who would cast the spirits of fat people into herds of swine, DrRich has (until now, he thought) effectively shown the moral bankruptcy of the anti-obesity movement.

The anti-obesity movement, DrRich thinks, is like many of the crusades which have been taken up by Progressives (for instance, the environmental movement and the deification of “diversity”), in that it takes what at its root is a good idea (in this case, the unhealthfulness of extreme obesity), and converts it into a sledgehammer with which to beat the populace into compliance with top-down, expert-driven controls over individual freedoms.

It is an unavoidable result of publicly funded healthcare that any behavior of any individual which increases the likelihood they will need “extra” healthcare services, will potentially rob those of us who do not choose such unhealthful behaviors of medical services which might otherwise be available to us. Therefore, when healthcare is entirely publicly funded, it is inevitable that individual behaviors will need to be controlled by some Central Authority.

The obese are the chosen first target for asserting such controls. To render those controls publicly acceptable, it is necessary to reduce obese individuals to a state in which limiting their individual freedom of action is widely considered acceptable. That is, they need to be demonized.

So we ignore that gross obesity is almost always genetically mediated, greatly enhanced by environmental factors largely out of an individual’s control. We choose to blame obesity entirely on a lack of self-discipline, on a fundamental failure of the individual himself, and we behave as if this failure renders fat people beneath contempt. We do not do this with smokers, or drug abusers, and even seem reluctant to do it with child molesters. But fat people are fair game.

So when DrRich said that Governor Christie is just too damned fat to be a candidate for president, because fat people are lazy, slothful, lethargic, and self-indulgent; and because allowing a fatty to aspire to such a high position would create the false impression that obese people are worthy of any consideration whatsoever, and would make people think that the obese ought to have the same individual freedoms as the rest of us; and when DrRich concluded that Christie’s candidacy would therefore be a serious setback to the Progressive program (which is to say, controlling individual behaviors for the great benefit of the collective); and when he therefore urged the Governor to stay in New Jersey, except perhaps to occasionally cross the state line just long enough to stock up on Philly cheesesteaks; he thought he had taken the thing to the outlandish extremes customary to a master of irony.

So imagine DrRich’s dismay when, just after publishing his diatribe, he saw Michael Kinsley’s article on Bloomberg also declaring Christie too fat to be president. The reason? Because “a presidential candidate should be judged on behavior and character, not just on policies.” Fat people, Kinsley elaborates, are a “perfect symbol of our country at the moment, with appetites out of control and discipline near zilch.” In other words, fat people have shown themselves, by their very obesity, to be entirely unworthy characters, and being unworthy, should not aspire to the presidency  – or presumably, to any other position of importance.

Then there’s Eugene Robinson of the Washington Post, who agrees that Christie’s weight should prevent him from running, but does so for kinder reasons than Kinsley’s. Robinson is worried about the Governor’s health. That’s kind of him, but he also can’t help remarking that the “obesity epidemic” is costing the government a lot of money, and indeed, he implies that people like Governor Christie are responsible for the massive federal deficit. Since Christie is likely to remain fat whether or not he runs for president, when one parses Robinsons’ sentences one can only conclude that his real argument is that it would simply be wrong for a person whose behavior is costing us so much money, and is thus endangering the future of the nation, to aspire to the presidency.

So there you have it. Actual Progressives are making the very same arguments for Christie to stay out of the race that DrRich made, in what he thought was a brilliantly ironic blog post.

DrRich’s description of how the obese are regarded is no longer an outlandish extrapolation of prior statements and policies. It’s now official. The party line on obesity is this: Fat people have chosen to become fat, and by so doing, have overtly displayed, for everyone to see, their utter lack of discipline, self-control, self-regard, and concern for their fellow citizens. So the obese have no reason to expect the same rights, privileges, freedoms and considerations enjoyed by us thinner (or at least, less fat) citizens.

DrRich unwisely tried to satirize the Progressive position on obesity, without realizing that this position had already “progressed” well beyond irony. His readers ought to expect more from him than this, and so he abjectly apologizes.

DrRich only asks his readers to please take into account, when you consider the Progressives’ actual behavior and their own words, how very difficult it is becoming to satirize them. DrRich may soon be reduced to straight reporting.

Why Governor Christie Must Not Run

DrRich | September 30th, 2011 - 12:15 pm

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From all appearances, Republican voters are desperate for New Jersey Governor Chris Christie to throw his hat into the ring, and announce that he’s running for the Republican nomination for President. And, while the governor has made dozens of absolutely definitive statements utterly denying that he is going to run, he nonetheless seems quite happy to continue relentlessly teasing his supporters with the possibility. (Just the other night he gave a speech at the Reagan Library in which he discussed foreign policy and other topics not notably relevant to running his state. What’s up with that?)

There are several good reasons Governor Christie gives for not running. He promised the voters of New Jersey that he would stay in office and do everything he could to fix the fiscal disaster that his predecessors created there. He notes that he doesn’t have the fire in the belly which, apparently, one must have for this sort of contest. He does not have very much experience with governance, and has said repeatedly he does not feel ready to become the leader of the free world.

None of these reasons, of course, are dispositive, and all of them could be dispensed with very quickly. Governor Christie is pissing off so many people in New Jersey so quickly that it is not inconceivable that, if he asked them politely, the majority would soon give him a pass on all his promises, and bid him Godspeed in his new endeavors. Fires in the belly, it is said, come and go, and one might just show up at any time. And as for feeling ready to become the leader of the free world, well, the bar there has been lowered so much in the past couple of years that even DrRich – who balked at the responsibility of becoming secretary of his book club – would no longer be intimidated at the prospect. I mean, what the heck?

And so, despite all his denials and all the reasons he gives for staying out, it remains entirely possible that Governor Christie may still get in the race.

DrRich is alarmed by this possibility. And so should we all be, as Governor Christie’s potential candidacy poses a very great threat to us all.

You see, dear reader, the governor is just too damned fat.

Our leaders have just spent nearly three years demonizing the obese, and convincing we the people that fat people, by virtue of their unsightly and self-induced rotundity, are a grave threat to the well-being of each of us.

Here is what we have been taught: Aside from the obvious negative characteristics of fat people (their sloth, gluttony, laziness, selfishness, &c.), and the fact that they are unpleasant to behold and inconvenient to encounter (they are slow, they take up too much space in the grocery aisles and on buses, and they sweat more than you and me), and the fact that obesity is contagious so that fat people should be isolated and shunned, and the fact that the obese probably account for global warming, and thus will ultimately be responsible for untold death and destruction; aside from all these undeniable truths, the obese consume far more than their rightful allotment of healthcare resources, which, per force, leaves much less healthcare available to us holier persons. They are, in fact, trying to kill us.

Demonizing the obese is critically important to the program we have embarked upon in America. Obamacare may give the Central Authority the legal standing to control the personal behaviors and personal choices of individual Americans, but it does not give them the moral authority to do so, nor the ability to actually enforce that control. Americans, despite 50 years of indoctrination to the contrary, still value their individualism, and will still balk – or worse – when they perceive their personal freedoms are being taken away.

The obese are supplying our leaders the vehicle they need for breaking down this last barrier. For, if everyone can agree that obesity is evil, and so are the people who allow themselves to become fat (despite all the “help” they get from expensive public service announcements, calorie counts posted in restaurants, and lectures from First Ladies), then how can we object when our leaders are forced to take stronger measures to “encourage” better behavior, or, if necessary, to punish their behavior?

By virtue of their now-universally-accepted state of sinfulness, the obese are fair game for whatever actions the Central Authority deems necessary to cause them to either lose weight or pay for their sins. From appearances, such measures are likely to begin with taxing soft drinks and Twinkies and whatever other foodstuffs the experts (in their wisdom) deem to be illegitimate sources of calories. But really, the sky’s the limit. For instance, under the undeniable proposition that it costs more energy to move a fat person from point A to point B, whatever the mode of transportation, the obese could be subjected to a special carbon tax, based on their BMI. The periodic mandatory “weigh-ins” such a tax would require would serve the useful purpose of public humiliation, an important incentive to weight loss.

Further humiliations could be visited upon the fat by designating special isolated areas in the workplace (ideally, an area fully exposed to the elements) for fat people to consume their calories. This latter strategy, of course, is derived from the same restrictions placed on smokers, and can be legitimized by the same sort of logic. That is, the authorities can invoke the prospect of second-hand obesity* to induce fear and loathing of the fat, and cause them to become socially isolated.
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*The “scientific” conclusion that obesity is contagious, i.e., that those who associate with the obese are more likely to become obese themselves, has been proffered by academics employing the same kind of statistical legerdemain used to blame global warming on fat people. Clearly, obesity has now become so toxic to the survival of mankind that any paper submitted to a medical journal which offers some new reason to despise the fat – no matter how absurd – will be cheerfully accepted by the editors, and published with great fanfare.
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It goes almost without saying that the ultimate censure would simply be to withhold healthcare services from fat people. This is a strategy that is already being employed by the British healthcare system,  a system we are urged by many of our leaders, such as Dr. Berwick, to employ as a model.

The great benefit of taking the demonization of the obese to its logical conclusion, of course, is that by doing so, the Central Authority will have established the very important precedent of selectively enforcing certain rules, based on a person’s behavioral habits*, in order to achieve Social Justice.

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*While demonizing the obese is considered legitimate by many because fat people “choose” to become fat through their selfish behavior, it is nonetheless true that becoming truly obese (as opposed to becoming merely overweight) is almost always strongly mediated by genetic and metabolic factors. Blessed with the same genes and metabolisms, many of us svelter, more holy individuals would also have become fatties.
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This is a truly critical precedent to set. This precedent will ultimately allow our Central Authorities to restrict, control and tax virtually any human behavior they can claim may lead to an increased risk of healthcare expenditures. Such behaviors may include (in addition to obvious things like smoking and alcohol consumption), one’s choice of occupation, participation in sports, hobbies, hours spent or miles traveled on the highways, and how well you follow the lifestyle changes prescribed by your PCP in your annual, very-strongly-encouraged, “free” wellness checks. Indeed, it is difficult to conceive of any choice one makes in daily living that does not, in some manner, impact on one’s likelihood of requiring medical services, and which thus would not be subject to central control.

All this will become possible because Americans are willing to accede to the demonization of their obese neighbors.

So now we see why Governor Christie must not run. Think of the damage he could do!

The prospect of a fat man campaigning for President – an endeavor which everyone admits takes an incredible amount of initiative, intelligence, energy, and a robust constitution – would itself undermine important “truths” about fat people upon which we base much of our (hard won) hatred of them. Worse yet, if Governor Christie actually managed to secure the Republican nomination, there’s an excellent chance that a majority of voters would actually cast their ballots for him! And he might actually become President!

What would that say about the general acceptability of obese people in our society?

Governor Christie’s candidacy would do untold damage to the critically important obesity paradigm which our leaders have painstakingly established over the past few years, and thus, would seriously damage their entire program.

And it is for this reason that Governor Christie must not run.

Note: DrRich now realizes that he has made a major mistake by writing this post, and here offers an apology and a weak explanation for his error.

 

It Is Your Duty To Maintain Wellness

DrRich | August 15th, 2011 - 7:26 am

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DrRich considers it his responsibility to point out to his readers certain truths related to modern American healthcare which may not be obvious to everyone, and which the fine people in the mainstream press choose not to mention.

Be honest. If it weren’t for DrRich, would you be aware that the only reason Obamacare became the law of the land is that the private insurance companies needed it in order to have any hope of long term survival?  Would you understand that the Progressive healthcare system to which we are now legally committed inherently requires all of the following things (while loudly proclaiming the opposite): ending the classic doctor-patient relationship; preventing individuals from spending their own money on their own healthcare; killing off the practice of primary care medicine; to the furthest extent possible, limiting preventive medicine; and stifling medical innovation?

One thinks not.

And so, DrRich hopes you will pay attention as he reveals yet another poorly-appreciated truth about our new healthcare system. Namely, it has become the case that maintaining your own wellness is not merely something which would be desirable, something you ought to do, or at least something you ought to want to do. It is now your duty.

You owe it to society to maintain your wellness, to take every step at your disposal to keep yourself from needing to consume healthcare resources. You owe it because healthcare is now a collective responsibility. And if your chosen actions (or inactions) cause you to become unwell, and if your unwellness causes you to consume healthcare resources which otherwise might have been available to individuals who (unlike yourself) became ill through no fault of their own, and if such faultless individuals subsequently suffered or died as a consequence of your failure to honor your duty, well then – that would make you no different from any other common criminal whose selfish actions produce harm to their innocent victims.

Maintaining your wellness is not a nice-to-have; it is your non-negotiable obligation.

You have been told that your wellness is very important to the caring people who will run our new healthcare system. And indeed, it is. So you will, by law, be “entitled” to annual, detailed “wellness checks,” provided by a dedicated team of healthcare workers, who will assess (and record) your efforts to maintain your own wellness, and then will give you all the instruction you need to alter whatever suboptimal behaviors you are displaying. The results of these annual wellness checks will be entered into a federally-approved universal electronic medical record, so that any healthcare provider, anywhere, at any time, will have a complete record of the trajectory of your state of wellness over the years – and of the degree of your compliance with the instructions you have received for maintaining that wellness.

Of course, if you elect to forgo the annual wellness checks to which you are entitled, that information (i.e. that you cared so little for your wellness that you couldn’t be bothered to do anything about it) will also be maintained in the universal electronic records.

Then, when you become ill 10 or 20 years from now, your records can be consulted to decide to what extent your illness can be considered self-induced. For, when resources are scarce, the only moral thing to do is to distribute them according to who is the most deserving.

Most readers are now thinking that DrRich is paranoid. Guilty as charged. However, DrRich’s paranoia, regarding the kinds of behaviors of which our Central Authority is capable, is based on hard experience. Indeed, it is evidence-based.

Still, DrRich is enough of a realist to understand that it is unreasonable to ask his readers to just trust him here. Instead, let’s examine patterns of behavior, regarding supposedly self-induced disease, which our society is already displaying. The best example, one which DrRich has written about extensively, is obesity.

We are witnessing a sustained and ongoing campaign to demonize the obese. Consider: While we are universally urged to stifle any impulsive speech or sentiments which, by any stretch of the daintiest of sensibilities, might make any member of any group (however you choose to define a group) the least bit uncomfortable, it is perfectly OK to castigate the obese, loudly and often. We can say about the obese anything we like.  Screw their feelings. It is perfectly fine to insist that it is the obese – gluttonous, lazy, self-indulgent, slothful fat people – who are driving our healthcare spending off a cliff. It is acceptable to publish ridiculously flawed papers in respected scientific journals proving that global warming is caused by the obese (thus pinning upon them the responsibility for upcoming catastrophes of unimagined proportions), and demonstrating that obesity is a contagious disease (which will justify any actions we may choose to take to concentrate the obese into special camps).

A person’s choice to allow themselves to get fat already justifies more than mere words of castigation. Under the British Health Service (the model to which Dr. Berwick and other of our current healthcare heroes openly aspire), the obese (along with smokers, another group of selfish sub-humans who use an unfair share of healthcare) are now being removed from the waiting lists for medical services.* By virtue of their obesity (and the lack of social responsibility their obesity indicates), fat people have forfeited their equal access to healthcare.

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*Removing the fat from the waiting lists has at least two beneficial effects. It punishes them, of course, for their selfish refusal to maintain their own wellness. But it also reduces the long waiting lists that exist in Britain for medical services, closer to the target waiting times which the government has been promising its citizens for decades.
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Demonizing the obese has many advantages. Chief among these is that the obese are easy to spot. In contrast to the Jews of Nazi Germany, one does not have to sew a Star of David to their jackets to know which individuals are wrecking the culture. By just walking down the street (not that fat people do all that much walking, lazy SOBs) they reveal themselves, by their unsightly corpulence, to be one of those people who are ruining the healthcare system for the rest of us. And we svelter, more worthy citizens can look upon them with the scorn they deserve.

Especially now that we have so many programs and policies aimed at preventing obesity – putting apple slices in Happy Meals, publishing calorie counts in restaurants, being lectured at by First Ladies and skinny movie stars, &c., – anyone who still chooses to remain obese despite all this abundant assistance must be especially contemptible.

Perhaps most useful of all, in the long run, is the fact that real, honest-to-goodness, health-threatening obesity almost always has a strong genetic component. When we learn to demonize the obese, we are learning that wellness is a duty even if your genes (or some other force that is largely beyond your control) mitigates against it.

The obese, therefore, are the perfect target. Thanks to them, we are teaching ourselves that it is right and proper to disdain individuals who are leading less than exemplary lives.

Once we have learned this lesson well, it should be relatively easy for us to apply the same kind of disdain to others who who fail to honor their duty to maintain their own wellness. Most of these scurrilous individuals will not be so obvious to spot as fat people.  But at the end of the day, they will reveal themselves in the ultimate manner – they eventually will fall sick. And by their diseases we shall know them.

For the past several years, our healthcare experts have been busy declaring more and more illnesses to be “preventable.” And if an illness is preventable, and an individual fails to prevent it – well, what more do you need? That person has obviously failed to perform their sacred duty to society, and has forfeited any claim to the healthcare we more deserving people can expect.

The list of illnesses which are officially preventable now includes coronary artery disease, heart failure, kidney failure, diabetes, stroke and many kinds of cancer. And just a week or two ago, Alzheimer’s disease was added to the list.

It is possible that in a decade or so, if you acquire an illness from this growing list of “preventable” medical disorders – especially if your annual wellness checks reveal that you have gained weight since college, or you habitually fail to exercise at least 90 minutes per day, or that you imbibe less than one or greater than two alcoholic beverages per day – you may be triaged to Tier B healthcare. Tier A will be reserved for people who obviously care more than you do about wellness, and about their duty to society. Just as obesity does today, the state of your health will demonstrate your true commitment to the perfect society to which we all aspire.

For, when it is your duty to maintain wellness, your illness reveals a grave dereliction.

How the Obesity Crisis Is Like the Mortgage Crisis

DrRich | November 10th, 2010 - 12:32 pm

Podcast:

Q. What’s the difference between a public health expert and an incompetent doctor?
A. An incompetent doctor tends to kill only one person at a time.

The deep recession and jobless “recovery” which we have enjoyed in the U.S. for going on three years now was triggered by the bursting of the housing bubble. The housing bubble was created by lending practices that awarded “subprime” mortgages to people with bad credit ratings, and offered to people with good credit ratings adjustable-rate mortgages (ARMs) that enticed them to purchase more expensive homes than they could afford.

Traditionally, banks were always reluctant to award mortgages, of any flavor, to people who obviously could not afford them, since doing so would wreck their businesses. The reason the banks began making bad loans in the 1990s is that new government policies, chiefly the Community Reinvestment Act, strongly “encouraged” them to.

The banks, being businesses, reacted logically to the new regulatory climate, to threats by ACORN and other activist groups, and to the escape hatch opened for them by the government which allowed them to turn over their toxic mortgages immediately to Fanny and Freddie.  Banks quickly began turning out as many questionable mortgages as they could write, to as many uncreditworthy individuals as they could find.

Fannie and Freddie, in turn, securitized all those bad loans into complex investment instruments, which they released into the general worldwide marketplace. Investors around the world were happy to take these questionable new instruments since Fannie and Freddie, tacitly at least, were backed by the United States government.

And so, when the unqualified homeowners, who never had any prayer of making long-term payments on their mortgages to begin with, proceeded (at the very first and gentlest whiff of a recession) to default on their loans, the whole structure rapidly collapsed, nearly causing a global financial Armageddon.

Thank goodness us U.S taxpayers “volunteered” to clean up the whole mess with our taxes and those of our children and grandchildren.

There’s plenty of blame to go around for causing the mortgage crisis. We can blame all those people agreeing to mortgages they could not afford, the banks pushing mortgage deals on people who clearly did not understand what they were getting into, and Fannie and Freddie infecting the worldwide investment structure with toxic instruments. But the root cause was bad government policy.

Establishing policies that compelled banks to award mortgages to people who could not afford them (in order to advance the noble goal of creating a nation of homeowners) may seem like a compassionate thing to do. But the laws of economics are like the laws of nature. You can’t change them by government fiat. All you can do by fiat is to get people to behave in new and possibly unpredictable ways. And when those irreducible economic laws finally come around to assert themselves, you will be surprised, and likely dismayed, by the result.

As it turns out, setting health policy can have much the same kind of result. If you fail to pay sufficient attention to certain irreducible laws of nature – such as the laws of human behavior, and the laws of human physiology – you may not get the effect you are looking for (or, at least, not the effect you say you are looking for).

And this brings us to the obesity crisis.

Whether or not you agree that obesity is a “crisis” in the U.S., or even that mild to moderate obesity is the medical disaster it’s often painted to be, you’ve got to admit that Americans have gotten substantially fatter over the past few decades. And whether or not our increased corpulence is a grave threat to life and limb, it is creating an opportunity for the government to seize control over our individual freedoms – so it is, in fact, an important phenomenon.

DrRich is not the first to suggest that the public health policies of that very government substantially contributed to our obesity crisis. But as we enter a new era of Progressive healthcare, in which medicine is going to be practiced by policy fiats instead of by individual decision-making, it serves us to remind ourselves just how much the obesity crisis is tied to the great push, instigated by government policies dating back to the 1970s, for everyone to eat low-fat diets.

An association between dietary fats and coronary artery disease was first noted in the 1950s. In 1957, the American Heart Association (AHA) published its first, tentative recommendations for limiting the consumption of saturated fat. The recommendations were specifically aimed only at people who had strong genetic predisposition to heart attacks or strokes, or who already had heart disease. An accompanying editorial by Herbert Pollack, in the August, 1957 issue of Circulation, specifically warned against the widespread application of the recommendation to avoid saturated fat:

“Altering the dietary habits of a large population group is fraught with a great many dangers. Our knowledge of nutrition is not sufficient at this time to anticipate what ultimate results would happen if the public were encouraged to alter radically their basic dietary patterns.”

The AHA’s recommendations regarding saturated fat in the diet received sparse attention for 20 years. Then in 1977 (during arguably the second most Progressive administration in our history), the Senate’s Select Committee on Nutrition and Human Needs, chaired by George McGovern, nationalized the question of fat avoidance. After holding a series of hearings which tied fat consumption to heart disease, the Committee published the first “Dietary Goals in the United States,” advising all Americans to cut back on fat consumption. With this report, the US government officially supported low-fat diets for everyone.  (The public then was judged to be just as stupid as we are judged to be today, so any real effort to distinguish between unhealthy fats and healthy fats was quickly set aside. “Fat is bad” is a message you can sell even to gun-toting Bible-thumpers.)

The anti-fat boulder got a great big push down the hill in 1983, when the Framingham study published a landmark paper tagging obesity as an important risk factor for cardiac disease. Because eating a diet high in fat obviously caused obesity, it seemed self-evident that low-fat diets would prevent heart disease both directly, and indirectly (by preventing obesity).

Accordingly, in 1984 the NIH issued a Consensus Statement entitled “Lowering Blood Cholesterol to Prevent Heart Disease,” which amounted to an all-out attack on dietary fat. Many scientists pointed out that there really was a lack of convincing evidence demonstrating that low-fat diets would be healthful. But the majority, seeing an epidemic of heart disease which must surely be due to fatty diets, outnumbered the reticent ones, and the Consensus Statement was voted into publication. Then, when the AHA abandoned its earlier caution and endorsed this Consensus Statement, the scientific backing for the government’s public policy encouraging low-fat diets for everyone was fully in place.

This action finally ignited the great low-fat diet era. Spurred on by government policy, prestigious medical organizations and others began a campaign of public service announcements and media blitzes. Influential magazines (that is, magazines read by women) began a prolonged onslaught of low-fat diet tips, articles, and human interest stories emphasizing the deadly nature of dietary fat. The food industry, which was at first very skeptical (like the banks when subprime mortgages were initially foisted upon them), finally jumped in with both feet. A massive new product line of low-fat and no-fat snack foods were invented which were just packed with carbohydrates, and often with supposedly “healthy” man-made trans fats. (This major shift in food production has been referred to as the “Snackwell phenomenon.”) The AHA found a lucrative new revenue source officially certifying such low-fat, high-carb products (including Frosted Flakes and Pop-Tarts) as being “Heart Healthy.”

Americans, being filled with the milk of human nature, largely ignored the ubiquitous pleas to abandon their burgers, pizza and tacos in favor of broiled, skinless, sauceless, saltless chicken breasts and broccoli. But they did begin scarfing up the new-age low-fat snack foods in massive quantities, having been assured that, as long as the snacks contained no fat, they could eat as much as they wanted.

There are a few physiological facts about dietary carbohydrates that were largely ignored during the low-fat era. First, the body greedily converts dietary carbohydrates into massive stores of adipose tissue, so indeed you can readily become fat by eating carbs. Second, gorging on the refined carbohydrates found in these new “healthy snacks” causes huge spikes in insulin levels (insulin being a key factor in converting excess carbohydrates to fat).  When the insulin levels suddenly drop a couple of hours later, that drop produces insatiable hunger. So, two or three hours after enjoying a fat-free Pop-Tart or a Snackwell cupcake, one is ripping the cubboards open to find another carbohydrate fix. By thus inducing a continuous-snacking mode, the new high-carb snack foods increased overall caloric intake far beyond the calories listed on their labels.  Third, diets high in refined carbohydrates increase triglyceride levels, reduce HDL cholesterol (“good cholesterol) levels, and in general create lipid profiles that are quite damaging to the arteries.

So, while few people actually stuck to a strict low-fat diet, many, many people became addicted to refined carbohydrates, and as a result became fat.

It has only been in the past five or six years that the low-fat dogma has begun to moderate, largely thanks to the (now mercifully faded) low-carb craze that struck at that time.  We now hear somewhat more reasonable advice about good fats and bad fats, and good carbs and bad carbs. But much of the damage has been done, and at least partially because of the major push for low-fat diets, we Americans are fatter and less healthy than we used to be.

By the way, to this day it has never been shown that low-fat diets applied across the population would reduce the incidence of heart disease.

The low-fat diet policy amounted to a massive public health experiment, with the research subjects being us. Our government and our scientific organizations have yet to apologize for subjecting all of us to this travesty.  Indeed, like the outcome of the great experiment in subprime mortgages, the outcome of the low-fat experiment is not particularly chastening to our Central Authorities. In fact, it works to their advantage.

To see why, consider the final way in which the obesity crisis is like the mortgage crisis. To prevent another mortgage crisis, our government, in its wisdom, did not promise to avoid promulgating any more counterproductive economic policies that will force businesses and individuals to act in harmful ways. (In fact, government policy continues to coerce lending to unqualified individuals.) Rather, they passed massive new “financial reform” legislation aimed at preventing banks and other financial institutions from behaving logically in response to bad government policies. The cure for bad regulation is more bad regulation. And when the results of its own bad regulations created an opportunity to grab even more control over the marketplace, our government lept at the chance.

Similarly, having (probably inadvertently) made policies that resulted in a fatter, less healthy populace, our government is now poised to take advantage of that opportunity, to turn the purportedly grave danger posed to the nation by the obesity crisis into a mandate for assuming powerful controls over the prerogatives of individual Americans.

And now, having learned that, like bad economic policy, bad public health policy can get them to where they want to go, our Progressive leaders are turning their attention to the next great public health initiative. Far from apologizing to us for the damage they caused with their low-fat experiment, they are plotting the next great experiment in public health which they will perform upon the population.

It appears it will have to do with salt.

Major Victories In the War Against The Obese

DrRich | November 5th, 2010 - 8:24 am

Podcast:

DrRich has expended a fair amount of effort explaining to his readers why it is so critically important for Obamacare (and for the Progressive program in general) to conduct a vigorous war against the obese. For the benefit of readers who may be new to DrRich’s thinking on this subject, please note the proper emphasis: This is not a war against obesity, but against the obese.

A central tenet of this war is the assertion (sometimes overt, sometimes tacit) that the obese are fat by choice, that is, as a matter of willfulness and recalcitrance. Their unsightly adiposity is a condition of their own choosing, a direct result of their having settled upon gluttony and sloth as central  life-principles. It is because of their self-indulgence that the obese have allowed themselves to become a threat to humanity, and most especially, a threat to the fiscal stability of our healthcare system and therefore our nation. They have, by their own volition, made themselves fair game for whatever actions our Central Authority may deem necessary to protect the legitimate interests of the collective against their corrosive corpulence.

When we who are thinner (and purer) go along with, and even encourage, official actions against the freedoms of fat people, we will have allowed an important precedent to become established. It will be a precedent under which our ever-wise leaders may legitimately restrict, control and tax virtually any human behavior they can claim may lead to an increased risk of healthcare expenditures.

DrRich’s hypothesis is that the real point of this war is to set this very precedent. And hence, the actual war is against the obese, and not obesity.

Any hypothesis, of course, is useful only if it helps to explain certain interesting phenomena that otherwise would be difficult to explain. And this hypothesis (as do all of DrRich’s hypotheses) does just that.

For instance, consider several recent decisions the U.S. Food and Drug Administration has made removing from the market, or preventing from entering the market, certain drugs aimed at treating obesity.

Pharmaceutical companies, in recent years, have steered hundreds of millions of dollars toward the development of drugs for the treatment of obesity. They made these investments in confident reliance on a particular premise, a premise that has been explicitly and passionately expressed in a thousand ways by physicians, government agencies, beloved public figures, the popular media, academics, public health experts, and (chances are) yo’ mama.

The Obesity Premise

This, of course, is the Obesity Premise. According to the Obesity Premise we are now engaged in a great war against obesity. Obesity, this premise holds, is perhaps the greatest threat to the health of our nation. Obesity imparts tremendous risk to the individual by causing vascular dysfunction, hypertension and insulin resistance, leading to heart attacks, strokes, peripheral vascular disease, aortic aneurysms, kidney failure, arthritis, depression, disability, and death.

It has been asserted that it would be better to receive a diagnosis of many types of cancer than it would to be obese. It has been asserted, in well-organized public service campaigns that allowing oneself to become obese is the equivalent of committing suicide (again, emphasizing the central tenet that obesity is voluntary). Because the scourge of obesity is such a grave threat to individuals and to our society, the Obesity Premise concludes, extraordinary measures are justified in fighting it.

Accordingly, our drug companies have invested many years and vast amounts of money (time and money they could have invested in banishing wrinkles, say, or creating fine and durable erections upon demand), to develop drugs for treating obesity. They have invested in this way completely assured that their efforts, if reasonably successful, would be richly rewarded in the marketplace. Thus has been the promise of the Obesity Premise.

But today, drug company executives, if they are at all astute, must surely agree with DrRich that the great premise upon which their massive efforts have relied is, in fact, not actually operational. Not even close.

Consider what has befallen drug companies just in recent weeks when they relied on the Obesity Premise:

Item 1. The August 14, 2010 issue of Lancet published the obituary for the once-sure-blockbuster anti-obesity drug rimonabant (Sanofi-Aventis). Through years and years of development efforts, and through several clinical trials, rimonabant looked very promising. It proved effective not only in producing significant weight loss, but also in significantly aiding in smoking cessation, and in improving blood lipids. It won marketing approval in Europe, and was on the verge of being approved by the FDA. But in the end, the FDA declined to approve the drug – and in 2008 the Europeans withdrew it from the market – because of strong “signals” seen in clinical trials, indicating an excess of significant depression and even suicide* among patients taking rimonabant. As a result, Sanofi-Aventis abandoned all further development efforts for rimonabant.

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* The relationship between obesity and suicide is surprising and intriguing, but has received relatively little public attention. Because this relationship could possibly be useful to the Progressives in their war against the obese, DrRich may soon write a post to help them along in their efforts.
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The recent Lancet article on rimonabant describes the results of the once-anxiously-awaited CRESCENDO study, a study designed to evaluate rimonabant’s effect on long-term mortality and morbidity. The study was ended prematurely (when rimonabant was withdrawn from the market), so only 14 months of follow-up were able to be reported. Out of over 9000 patients randomized to rimonabant, there were 4 suicides, as compared to 1 suicide in the 9000 patients receiving placebo. An accompanying editorial laments that investigators were compelled to stop the study early, since the potential cardiovascular benefit that might have been realized from the impressive reduction in risk factors among patients taking rimonabant, given another year or two of follow-up, might well have outweighed the small (and statistically non-significant) increase in suicides. The editoralists go on to observe, “However, any mortality associated with cardiovascular preventive therapy is generally viewed as unacceptable. The preventive approach is fundamentally different from curative therapy for a potentially lethal illness.”

Item 2. In October, 2010, the FDA withdrew the weight-loss drug sibutramine (Meridia, Abbott) from the market, when the post-marketing SCOUT study showed a 16% increase in serious cardiovascular events in patients taking the drug. The FDA advisory panel was split as to whether the drug should be withdrawn, but the FDA concluded that the drug was too unsafe to remain on the market. (It was originally approved in 1997.)

What most in the general media failed to report, however, was that the SCOUT study specifically enrolled patients who had preexisting cardiovascular disease, and for whom sibutramine had never been approved in the first place. In other words, it was a study designed to test whether the usage of the drug could be safely expanded to fat patients who already had heart disease. An appropriate conclusion, from the SCOUT data, would have been that usage of the drug should not be expanded to those patients. There was no apparent objective reason to take the drug away from obese patients who had no preexisting cardiac disease, and who had had access to the drug for 13 years.

Item 3. Also in October, the FDA rejected approval for the obesity drug lorcaserin (Arena Pharmaceuticals). They rejected the drug because preclinical studies showed a “signal” for an increase in breast tumors in rats.

Item 4. Again in October (truly a landmark month for anti-obesity drugs), the FDA rejected approval, for the second time, of the anti-obesity drug Qnexa (a combination of phentermine and topiramate, developed by Vivus). The drug was rated as moderately effective for weight loss, but was rejected because of concerns about cognitive disorders, metabolic problems, increased heart rate, and (most especially) birth defects.

While these are truly legitimate concerns, topiramate (the component to which most of the concerns with Qnexa are due) has been widely used for seizures, and especially for migraine headaches. While the FDA expressed special concern over the possibility of birth defects if topiramate were used in obese women of childbearing age, most migraine sufferers who take the drug are women of childbearing age.

What is the best explanation for these recent FDA decisions?

Please understand, Dear Reader, that DrRich is not necessarily saying that the FDA was flat-out wrong in rendering these decisions on any of these four anti-obesity drugs. All of these drugs posed at least the possibility of serious side effects in at least some patients, and none produced more than moderate average weight loss (though, to be sure, individual patients achieved remarkable results with each of these drugs).

Rather, DrRich is saying that the FDA’s decisions in each of these four cases were inconsistent with the Obestiy Premise, and therefore that the Obesity Premise is operationally false. That is, when it comes to actually taking action, the Central Authority entirely discounts the Obesity Premise.

The severely obese, in point of fact, do indeed have a remarkably elevated risk of developing premature, severe, disabling, expensive and lethal medical problems. Many of these individuals, in truth, would indeed be better off having many types of cancer. This aspect of the Obesity Premise is scientifically correct.*

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*There is much less evidence that people who are only moderately overweight – the vast majority of Americans said to be in grave danger due to their weight – are at markedly elevated risk because of weight alone. Indeed, DrRich has discussed evidence for the “Obesity Paradox,” whereby those who are moderately overweight appear to have improved survival compared to those of low or normal weight.
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So, at least for people who are very obese, a drug that produced weight loss but carried a small risk of potentially dangerous side effects might be justifiable, just as a treatment for cancer or heart disease might be justifiable despite a risk of serious side effects.  But this is clearly not how the authorities are treating weight loss drugs. It appears plain that in order for an obesity drug to be approved, that drug will have to display virtually no side effects. Operationally, therefore, obesity is treated as a low-risk medical condition whose treatment does not warrant any measurable risk. Indeed, obese patients are not to be allowed even the option of choosing such a drug, even after being fully informed of the potential risks and benefits.

If the Obesity Premise were operational, the authorities would have permitted studies with rimonabant – by far the most promising anti-obesity drug yet developed – to continue, in order to measure whether the long-term benefits of weight loss, smoking cessation, and lipid control outweighed what now appears to be a very small risk of excess suicide – a risk which could almost certainly be reduced even further with appropriate psychiatric screening.

If the Obesity Premise were operational, the authorities would not have withdrawn sibutramine from healthy obese patients (who had had access to the drug for over a decade) on the basis of a study which evaluated the drug in people with serious pre-existing cardiac conditions, and for whom the drug had never been approved.

If the Obesity Premise were operational, the authorities would not have banned lorcaserin for the sole reason of a tumor signal of uncertain significance seen in rats.

And if the Obesity Premise were operational, the authorities would not have denied topiramate to obese patients, when they allow the widespread use of the same drug in patients with migraines.

Undeniably, the actions of the Central Authority (as opposed to its words) entirely discount the Obesity Premise. Its actions reveal that the Obesity Premise is for public consumption – that is, for propaganda – only, and that its main purpose is to justify extraordinary measures.

The actions of the Central Authority do, on the other hand, comport with DrRich’s hypothesis – that we’re fighting a war against the obese, and not against obesity. In a war against the obese, a cure for obesity would preclude the need for strong central controls, and so would be counterproductive.

Therefore, while it goes about whipping our population into a frenzy about the scourge of obesity, the Central Authority is simultaneously doing whatever it can to stifle novel therapies that begin to attack obesity. True, none of these four drugs “cures” obesity, and none is risk-free. But the cure for any significant medical problem rarely occurs in a single step, or is accomplished without the possibility of side effects.

The Central Authority has sent a very clear message to the pharmaceutical industry: “When it comes to treating obesity, only perfection will be allowed; we insist on remarkable efficacy, and virtually no side effects. Without such a result all your efforts will come to nought.”

DrRich believes that in the last month the drug industry has heard this message loud and clear, and that it will be a very long time indeed before any more investments are made toward developing drugs to treat obesity.

By the same actions, the Central Authority has also sent a very clear message to the obese: “Do not expect any help from medical science, you self-indulgent, lazy, gluttonous budget-busters, you wreckers of society, you fattys. You did this to yourselves, by your own willful actions, and by your own actions have brought the rest of us to the brink. You deserve no more quarter than other sociopaths who undermine civil society – the bank robbers, the child snatchers, the Tea Party marchers. Because your individual choices have brought you to this juncture, prepare to be constrained in your individual choices.”

And so, in just the past few weeks, the war against the obese has seen significant victories, and has advanced ever closer to its ultimate goal.

Why This Election is A Yawner

DrRich | October 29th, 2010 - 11:39 am

Podcast:

DrRich is amazed at all the attention being paid to the impending mid-term election.

Breathless commentators speculate endlessly whether Republicans will take over the House and Senate, or just the House; and small-time operatives who in the heat of battle blurt out words like “whore,” or “bitch” (it truly is the Year of the Woman!), or inflammatory phrases like “punishing our enemies,” are subjected to endless public psychoanalysis. The angst is palpable.

For those of us interested in healthcare reform the coming election is an interesting sideshow, but it will not substantially change the cascade of events that has been set in motion by a) history, b) the election of Mr. Obama and his dogged persistence in passing his healthcare legislation by whatever means necessary, and c) the implications of the election of New Jersey Governor Christie a year ago.

As DrRich has said to his readers countless times, the real meaning of Obamacare is that the job of covertly rationing America’s healthcare is being formally transferred from the insurance companies (which have had quite enough, and which did everything they could to see that Obamacare became law), to the government. That transfer of the responsibility for covert rationing to the government is merely the natural culmination of 50 years of history. And the fortuitous election of Mr. Obama is merely the particular event (like the dropping of a crystal into a supersaturated solution) that finally brought a historical inevitability to fruition.

But the election of Governor Christie – now that was a real Wild Card. Christie’s election revealed (to DrRich, at least) that the government’s takeover of covert rationing (which, obviously, requires a government takeover of healthcare) may not be the end of the story.

At this point, some of DrRich’s readers undoubtedly think he is referring to Christie’s conservative economic outlook; his willingness to take on public employees, teachers, and others whose unions, over the years, coerced and/or bribed corrupt politicians into awarding them unsustainable entitlements that are incompatible with a stable society. They think DrRich is referring to the fact that, if even the people of very-blue New Jersey are willing to elect such a conservative Republican, then the Progressive agenda (and hence Obamacare) must actually be in real trouble.

While there may indeed be something to this argument, it’s not at all what DrRich is referring to.

Rather, DrRich is referring to the fact that the voters of New Jersey, at a time when Mr. Obama’s popularity was still quite high, chose to violate a pattern they had established over the manifold generations, chose to knock the stars out of alignment, chose not to return to office Mr. Corzine, the incumbent Democrat in a strongly Democratic state, who was strongly supported by President Obama himself, and instead chose to break with all of history, with all tradition, with their primeval instinct, and with their common sense, and elect instead – a fat guy.

Electing a fat man, DrRich must point out, was not incidental. Corzine cagily made it a campaign issue by running campaign ads reminding New Jersey voters that Mr. Christie was obese, and that he was not. Mr. Christie himself was driven by this tactic into a public admission that he indeed was quite overweight (and offered the lame suggestion that his obesity was irrelevant to the job he was seeking).

Any voter pulling the lever was necessarily thinking, “fat guy, or skinny guy?” And they, with malice aforethought, picked the fat one.

This was absolutely stunning. The implications are too far-reaching to exaggerate.

For a long time now – but especially since the beginning of the Obama Presidency – a concerted and sophisticated campaign to begin “culling out” the obese has taken place. This campaign has been conducted with great energy by everyone who matters – the government, academia, various covertly-funded consumer groups, and numerous industries and enterprises whose success depends on lots of fat people becoming desperate to lose weight. We have been assured that the obese are fat by choice, and that as a result, by their own volition they have allowed themselves to become a threat to humanity (by, among other things, increasing global warming), and most especially, a threat to the fiscal stability of our healthcare system and therefore our nation.

The message is clear: If we don’t get the obesity epidemic under control we are lost as a people. (Historians may find it interesting to note that this epidemic was greatly accelerated in 1998, when the NIH changed the definitions of “overweight” and “obese” from a BMI of 28 and 32, respectively, to a BMI of 25 and 30. The very next morning, tens of millions of previously healthy Americans woke up to find themselves fat. Even more than most epidemics, this one developed with the speed of a tsunami.)

Obamacare – which places the control of the healthcare system into the beneficent hands of our political leaders – finally provides the tools to eliminate this scourge. It will take some tough love. But for the good of America (and, who knows? possibly for the good of the obese themselves) we’ve got to do it.

Central to our efforts to save our country is the conviction that the obese are different, and while they may be potentially salvageable as worthy humans, in their present state (posing as they do such an existential threat to the rest of us), they need to be (at the very least) ostracized.

Perhaps the most telling example of just how far we had come in this regard occurred in July, 2009, when President Obama named Dr. Regina Benjamin as Surgeon General. When it appeared from certain pictures and television images that Dr. Benjamin may be somewhat overweight, critics pounced immediately. How can one become the epaulet-wearing Head Doctor of All America, in the middle of a life-threatening obesity epidemic no less, and be fat? No fat person should ever rise to any position of prominence (where he or she could potentially become a role model for young Americans) – much less this particular position.

It must have brought a tear of joy to the anti-obesity crowd to learn that being obese now so demonstrably trumped being: a) an African American, b) a woman, c) a hero who dedicated herself to providing medical care to the Katrina-ravaged poor, and d) strongly supported by President Obama himself.

But all this progress (and all this hope) was dashed just a few months later by the voters of New Jersey, when they chose to elect a fatty.

When an obese Republican can be elevated to such a position of prominence and responsibility, and by a Democratic electorate to boot, the anti-obesity campaign has been set back by decades. That a rotund candidate could emerge victorious despite such an onslaught – and not, as the breathless conjectures of our professional punditry suggest, a Republican resurgence – is the real threat to healthcare reform.

A government-run healthcare system permits – nay, demands! – that we declare to the obese that their unsightly physiques are no longer a matter of personal choice, but are now a matter of legitimate public concern. The choices they are making – that is, their gluttony, sloth and all other manner of self-indulgence – are placing unwanted and unsustainable demands on us purer, svelter, fellow-citizens.

More importantly, ostracizing the obese sets an important precedent for our wise leaders to restrict, control and tax virtually any human behavior they can claim may lead to an increased risk of healthcare expenditures – which, really, encompasses virtually any human behavior you can think of. Furthermore, successfully dehumanizing the obese will establish that our society may, whenever it needs to, discriminate against the lower economic classes (since these classes are well known to indulge in becoming overweight). And finally, since obesity (despite our decision to blame it on personal failings) is largely determined by genetic predisposition, our success in dehumanizing the obese will give us a useful tool which we can later employ to withhold healthcare expenditures for other genetically-mediated medical conditions.

It is clear that successfully demonizing the obese is a vital pillar of Obamacare.

Now perhaps, Dear Reader, you can see why the election of Christie in New Jersey was such a potential catastrophe. It is his obesity, rather than his Republicanism, that poses such a threat to healthcare reform and thus to the Obama administration.

It was the result of the New Jersey election a year ago, and not the results of the impending mid-term election (which will merely add an exclamation point to New Jersey’s declarative statement) that changed the landscape. Clearly, the anti-obesity movement, despite concentrated, coordinated and sustained efforts to make overweight Americans feel subhuman, has failed. The election of Christie – wherein the electorate of a Democratic state has raised up to prominence a fat guy, despite the damage that does to the long-term prospects of Obamacare – was the real blow.

For if We the People (even that part of “We” who are Democrats) refuse to follow the dictates of the Central Authority as it attempts to educate us on Right Thinking, then the passage of Obamacare cannot actually represent the culmination of Progressive history. It means that the final chapter has not yet been written, and real hope remains for those of us who do not buy into the Progressive program.

And this is true whatever the results of Tuesday’s election. Thank you, New Jersey.

Defending the Demonization of Obesity – Part 2

DrRich | August 26th, 2010 - 7:49 am

Podcast:

Fighting the Obesity Paradox With A New Obesity Creed

In Part I of this important and insightful meditation, we saw the many reasons why it is so critically important for anyone who supports Obamacare to stand foursquare behind the demonization of the obese.

But unfortunately, the vitally important anti-obesity platform of Obamacare is under assault. The fat-is-bad firmament – created by the concentrated exertions of the American College of Cardiology, the American Heart Association, the National Institutes of Health, the fashion and beauty industries, sundry weight-loss conglomerates, the popular media, and countless other engines of public opinion – is threatened by a growing body of evidence, created by a few misguided scientists, which suggests that obesity may not be quite as bad a thing as we are all led to believe. Like an expanding pool of molten rock hidden just beneath an apparently placid landscape, this expanding evidence poses a threat to the anti-obesity movement, and therefore to Obamacare. It must be dealt with.

And we need to deal with this threat now, while it is still relatively hidden, and before it bursts through to the surface where it would do much damage. Fortunately – in contrast to an actual volcano – we have the tools to tamp the threat down before it becomes manifest.

Before DrRich explains how this can be accomplished, let us take a brief look at some of that counterproductive evidence itself, to illustrate the seriousness of the problem. The evidence that not all obesity is bad for the health, when one begins to look for it, is disturbingly broad and consistent. DrRich will not attempt a comprehensive review of that evidence here, but instead will offer a brief and selective survey, just enough to impart a sense of the threat we are dealing with:

1) We must begin by noting that a substantial part of the “obesity epidemic” that has become manifest over the past decade can be accounted for by a change in the definition of obesity. When the CDC changed that definition in 1997, as many as 30 million Americans who had been of normal weight suddenly found themselves to be obese, or at least overweight, and all without gaining a pound. Enemies of the anti-obesity movement will not be above exploiting this inconvenient truth to their own ends.

2) In 2002, a report in the Journal of the American College of Cardiology examined almost 10,000 consecutive patients who had angioplasty and/or stenting for coronary artery disease, and found that those who were overweight or obese had fewer complications and a lower 1-year mortality than those who were thin or of normal weight. Several more recent studies claim to have shown the same thing.

3) A 2007 report in the Journal of the American Medical Association showed that overweight people who were physically fit had a lower risk of death than normal-weight people who were sedentary.

4) A 2007 report by the National Bureau of Economic Research noted that while Americans were growing fatter, other changes in health behavior (such as reduced smoking and better management of cholesterol and hypertension) more than offset any increase in health risk posed by the population’s increase in obesity.

5) In 2009, a meta-analysis in the Journal of the American College of Cardiology concluded that while obesity itself increases the risk of heart disease, obese people who develop that heart disease have significantly better survival than thin or normal-weight people who develop the same kind of heart disease.

Some cardiologists have already termed this growing line of evidence, i.e., the general observation that at least in some situations obese cardiac patients fare better than thin ones, as “The Obesity Paradox.” Anyone who understands the importance of the anti-obesity movement to Obamacare should be alarmed.

Just on the face of it, we can see that while such evidence could easily be painted by our enemies as “a little fat is OK,” the opposite is actually true. As we all know, the chief aim of healthcare reform (despite all the palaver about providing universal access and improving quality) is to reduce costs. So what could be worse than a condition like obesity, which a) increases the incidence of heart disease, but b) once heart disease develops, prevents an early (and relatively inexpensive) demise. The actual incidence of a disease, of course, is pretty neutral to our goal of reducing healthcare costs. What is important is the expense and duration of the disease once it develops. (Indeed, to reduce long-term healthcare costs, a very prevalent disease that kills very quickly would be just about ideal.) Since few medical conditions are more expensive to manage chronically than heart disease, the best thing for our healthcare system and our society would be for those who develop heart disease to just go ahead and make a rapid departure from the scene. So in this light, what this recent evidence shows is that obesity – because it increases the incidence of non-fatal (i.e., chronic) heart disease – is much worse than we believed.

Beyond these obvious cost implications of the “Obesity Paradox” (the general idea that obesity may not be as dangerous as we have thought), is the much deeper problem that any new science that undermines the anti-obesity movement threatens to undermine a major pillar of Obamacare. DrRich described this important aspect of the anti-obesity movement at length in his prior post, but to summarize: Successful anathematization of the obese will establish an important precedent that is needed by our central authorities as they set out to restrict, control and tax the human behaviors they decide may cause an increase in healthcare expenditures (which is to say, nearly all other human behaviors). While establishing this precedent would certainly be possible with some group other than the obese, so much effort and time has been invested in dehumanizing fat people that it would be more than a shame to have to abandon that huge investment, and start all over to demonize some other subset of our population.

Thus, what is needed is a means of suppressing a more general awareness of the Obesity Paradox. It is fortunate, therefore, that we have at hand a very serviceable model for achieving this end.

That model, as DrRich has pointed out, is Man-Made Global Warming. By the simple expediency of issuing a formal declaration that Man-Made Global Warming is real and is too important to argue about, all further debate over global warming (whether it is occurring, and more importantly, whether it is man-made) has been cut off; those who persist in challenging it have been decreed as outliers, heretics and kooks. To so effectively stifle further scientific scrutiny, a great council of hand-picked environmental scientists was assembled to review the body of admitted evidence on global warming, and to formally divide that evidence into orthodoxy and heresy, and to declare the era of scientific revelation on the matter to be ended, and the science settled.  And while the extensive document that council produced itself contains much that would make one question the actual magnitude of global warming, and especially whether it is actually man-made, the Executive Summary (a sort of catechism produced for general consumption by the Global Warming hierarchy) nicely provides us with what we really need to know, and accordingly is the only part of the document that is ever reported or discussed publicly or in polite company. In this manner, and with the full cooperation of the media, Man-Made Global Warming has been rendered a done deal.

DrRich merely points out that if further scientific exposition and debate of global warming can be officially cut off, apparently (and remarkably) with the blessing of the scientists themselves, then the same can certainly be accomplished with obesity.

It would be a simple matter to assemble another great, Council-of-Nicaea-like body of respected and unassailable experts on obesity and preventive medicine – from government, academia, sympathetic consumer groups, and the numerous industries whose success depends on the existence of lots of fat people desperately wanting to lose weight – to ruminate over all the evidence, and produce their own sacred document declaring, once and for all, that obesity is very, very bad (and so is anyone who says otherwise); and further, that it is morally wrong to waste any more time or money studying whether obesity is a health hazard, and hereafter the only permissible research will be aimed at studying how to prevent and treat it.

That should do it.

Selling such an Obesity Creed should be even easier than selling global warming. Fat people, unlike the ostensibly rising seas and melting ice caps, are all around us, and are readily visible to everyone. Many times each day our encounters with them will induce real and visceral reactions – our pity over their personal health plights, our disgust over their manifest inability to exhibit any self control whatsoever, and our indignation that their obvious gluttony and sloth is costing us so much money. Obesity as a threat to humanity will be a much more concrete, much less abstract, tool for focusing a general righteous anger than global warming can ever be.

So how to combat the growing problem of the Obesity Paradox is not the issue – we can combat it by promulgating an Obesity Creed. The issue is to recognize that there is indeed a threat to the anti-obesity movement, that the threat comes in the form of an expanding body of scientific evidence, and that time is of the essence. If we are to have the Obamacare our leaders visualize for us, we need to recognize the threat and deal with it now, while it is still in its early stages, and before it enters the general public consciousness.

DrRich is very pleased to have been able to assist in this matter, and at this critical juncture, to help eliminate a grave threat to Obamacare. But heck, that’s what DrRich is here for.

Defending the Demonization of Obesity – Part 1

DrRich | August 24th, 2010 - 7:42 am

Podcast:

Why Demonizing Obesity Is So Important

As regular readers will know, DrRich thinks President Obama’s healthcare reform is very bad for America, and in particular, that it threatens the Great American Experiment. At the same time, DrRich is fundamentally an optimist, and finds in Obamacare a thin thread by which some good might result. That thread goes like this:

In practice, Obamacare will become a government-run system of covert healthcare rationing. And DrRich is reasonably confident that in the government’s hands the covert rationing will become so amazingly ham-fisted and inept that even us Americans, distracted as we are by Lady GaGa, performance-enhancing drugs in baseball players, and Shark Week, will finally be forced to notice that there’s actually a whole lot of healthcare rationing going on. And once we are all forced to acknowledge the rationing, perhaps we will insist on trying to figure out how to do it as fairly, efficiently, and effectively as possible. In other words, DrRich clings to the hope that the Obamacare might end up being the cataclysm that precipitates a public discussion of healthcare rationing. And a public discussion of healthcare rationing is critical, since continuing to conduct the rationing covertly will destroy us.

It’s a slim thread, to be sure. But, especially in a new era of hope, one must embrace what hope one can.

Accordingly, DrRich feels obligated to do his part in supporting some of the main pillars of Obamacare (as odious as Obamacare itself may be), whenever they come under attack. And one of those pillars is the proposition that obesity is a scourge on our civilization, and for the good of the whole, those who are guilty of it must be reformed or stamped out.

Obesity, we are assured, is a main cause of heart disease, hypertension, stroke, arthritis, diabetes, (and even, some insist, cancer), and so is largely responsible for the runaway cost of our healthcare. This simple fact alone allows us to – indeed, demands that we – use every public and private intervention at our disposal to fight this great scourge.

The fact of publicly funded healthcare permits us to say to the obese: “Your unsightly obesity is no longer a matter of your individual choice; rather, it is now placed squarely within the realm of legitimate public concern. Since everyone else has to pay for your heart attacks and knee replacements, all those donuts and double cheeseburgers you insist on shoveling into your mouth are no longer your business. All your protestations to the effect that you can’t help it are revealed by simple math (i.e., calories gained = calories consumed minus calories burned) to be sad prevarications. Indeed that same simple formula reveals the true cause of obesity – gluttony and sloth. Like other heretics of an earlier time, you deserve no sympathy nor special considerations, but only a firm – though ultimately compassionate – hand to push you toward the right path, or alternately, toward the just punishment you have brought upon yourselves.”

So clearly, the obese are now become fair game for whatever manipulations our government can devise to cause them to either lose weight, or pay for their sins. The authorities can begin with simple maneuvers – taxing soft drinks and Twinkies, and whatever other foodstuffs they (in their wisdom) deem to be illegitimate sources of calories – but the sky’s the limit. For instance, under the undeniable proposition that it costs more energy to move a fat person from point A to point B, whatever the mode of transportation, the obese could be subjected to a special carbon tax, based on their BMI. The periodic mandatory “weigh-ins” such a tax would require would serve the useful purpose of public humiliation, an important incentive to weight loss.

Further humiliations could be visited upon the fat by designating special isolated areas in the workplace (ideally, an area fully exposed to the elements) for fat people to consume their calories. This latter strategy, of course, is derived from the same restrictions placed on smokers, and can be legitimized by the same sort of logic. That is, the authorities can invoke the prospect of second-hand obesity to induce fear and loathing of the fat, and cause them to become socially isolated. (The “scientific” conclusion that obesity is contagious, i.e., that those who associate with the obese are more likely to become obese themselves, has been proffered by academics employing the same kind of statistical legerdemain used to blame global warming on fat people. It appears to DrRich that obesity has now become so toxic that any paper submitted to medical journals offering a new reason to despise the fat – no matter how absurd – will be cheerfully accepted by the editors, and published with fanfare. These editors, one can only presume, must also be great supporters of Obamacare.) And finally, it goes without saying that the ultimate censure would be simply to withhold healthcare services for medical problems which can be associated with having allowed oneself to become too fat – a strategy that has already been employed by the British healthcare system, which we are urged by Dr. Berwick to employ as a model.

Demonizing the obese and subjecting them to such restrictions, of course, carries with it implications that go far beyond merely inducing the obese to lose weight or causing them to pay more in taxes. It sets an important precedent that will finally allow our central authorities to restrict, control and tax virtually any human behavior they can claim may lead to an increased risk of healthcare expenditures. Such behaviors may include (in addition to obvious things like smoking and alcohol consumption), one’s choice of occupation, participation in sports, hobbies, hours spent or miles traveled on the highways, etc. Indeed, it is difficult to conceive of any choice one makes in daily living that does not, in some manner, impact on one’s likelihood of requiring medical services.

Furthermore, successfully demonizing the obese will establish that our society may, whenever it needs to, discriminate against the lower economic classes – which will prove a useful tool when setting future behavioral standards to reduce healthcare spending. (Obesity, rather than starvation, is the chief nutritional problem of the poor in America. This is the the direct result of plentiful and cheap foods that are often loaded with empty calories. Making such foods more expensive – by imposing punitive taxes on them – will disproportionately affect the poor, who still won’t be able to afford the highly nutritious stuff, especially since the price of that good stuff will go much higher as a result. Rendering it permissible to inflict such pain on the poor, in the name of the greater good, will be an immeasurably important precedent to establish.)

In terms of providing strategies for controlling healthcare costs, it is clear that our response to obesity is key. Fighting obesity is a vital pillar of Obamacare.

Accordingly, DrRich is very sorry to report that this anti-obesity pillar may not be nearly as robust as we might hope. Certain clueless medical researchers – ones who have apparently not received the official memo – have been reporting that obesity might not be quite as bad a thing as we have all been saying. So, in the spirit of advancing Obamacare, DrRich will address in his next post some of this counterproductive new research on obesity, and will show how it can be marginalized.

Don’t Sweat the Obesity Dividend

DrRich | August 11th, 2010 - 7:25 am

Podcast:

DrRich has pointed out several times that it is very important to our new healthcare system, as a matter of principle, to be able to discriminate against the obese.

The obese are being carefully groomed as a prototype, as a group whose characteristics (ostensibly, their lack of self-discipline, or their sloth, or their selfishness, or whatever other characteristics we can attribute to them to explain how their unsightly enormity differentiates them from us), will justify “special treatment” in order to serve the overriding good of the whole.

The obese are a useful target for two reasons. First, their sins against humanity are painfully obvious just by looking at them, so it is impossible for them to escape public scorn by blending in to the population, unlike some less obvious sinners such as (say) closet smokers, or pedophiles. And second, since true morbid obesity almost always has a strong genetic component, successfully demonizing the obese eventually will open the door to the demonization of individuals with any one of a host of other genetically mediated medical conditions.

Readers who wonder why this is a big deal need to go back and study the original Progressives, for whom some form of genetic purification was an indispensable step toward achieving societal perfection. This was true not only for notorious eugenicists such as Woodrow Wilson, H. G. Wells, George Bernard Shaw, and Margaret Sanger, but also for the kinder, gentler Progressives we generally revere even today, such as Theodore Roosevelt, Winston Churchill, and even Mohandas Gandhi.

This sort of thinking fell out of vogue, for obvious reasons, after World War II. So it is no longer cool to talk openly about genetic cleansing.

But discriminating against people who have genetic health disorders (in the name of achieving an optimally efficient healthcare system for the purpose of cost saving) would be a start. And the obese have been selected as the most acceptable prototype for such treatment.

In this light, a recent article in the Public Library of Science Medicine Journal has created something of a problem for the anti-obesity movement. This article compared the lifetime cost of healthcare (beginning at age 20) for obese individuals and for smokers to the lifetime cost for non-smokers who maintained a healthy weight. Naturally, the study concludes that the healthy individuals can expect to live longer than the obese and the smokers (84 years vs. 80 and 77 years, respectively). However, the healthy young people will consume $400,000 in lifetime healthcare costs, vs. only $365,000 for fat people and $321,000 for smokers. (The cost savings in the obese and the smokers arise from their relatively premature deaths.) Therefore, healthy people, over their lifetime, are a bigger drain on the healthcare system than the obese and the smokers.

The reason this study presents a problem  is that it appears to contradict a central axiom of our present program. Specifically, it places in some peril our deeply held conviction that the obesity epidemic is one of the major threats to the stability of our healthcare system.

The added costs which the obesity epidemic poses to our healthcare system has become a touchstone, to the extent that it has become acceptable even in polite circles to openly discriminate against, if not overtly disdain and humiliate, the obese. Mississippi is considering legislation to prevent the obese from eating in restaurants. And in Britain, whose healthcare system has been held up as a model for Americans, doctors themselves are saying that obese patients should be barred from receiving medical services. (Though, in defense of his physician colleagues, DrRich wishes to point out that these same medical humanitarians are also calling for the withholding of medical care from the elderly and smokers – so perhaps they are not being unusually unkind to the fat.)

In light of this, what are we to do with this new study which says that obesity saves money for the healthcare system? Do we reverse course, and embrace this “obesity dividend?” Do we encourage supersizing, and, far from refusing to serve them, offer the overweight free second portions? Do we give them deeply discounted heavy-duty suspensions? Better yet, do we give away free Marlboro starter packs to the fat? (Just think how much money we’d save with obese smokers.)

Thankfully, no.

DrRich has pointed out innumerable times the absurdities we find ourselves promoting when the chief purpose of the healthcare system becomes avoiding costs rather than maximizing health, that is, when its chief job is covert rationing. It is therefore gratifying to say that this is one of those cases where we don’t have to engage in such absurdities. Let’s be plain about it: We don’t need to reevaluate our current vilification of obesity (and smoking) just because people who have these conditions may save us money in the long term.

The reason? We don’t care about the long term.

Who cares that, in 50 or 60 years, today’s healthy 20-year-olds are going to cost us a lot of money? They’re likely to be entirely free to our healthcare system for at least several decades. In contrast, today’s obese and today’s smokers, what with their chronic diabetes, heart disease, kidney disease, joint replacements, strokes, lung disease, &c., are costing us a lot of money right now.

If we actually cared about the long term, we’d be doing something about the Social Security and Medicare entitlements we’ve already signed up for, which in a little more than 20 years will require confiscating more than 50% of each American paycheck, just in payroll deductions. (Never mind income tax.) Heck, just looking at their pay stubs will probably cause most of today’s healthy 20-year-olds to die of apoplexy by the time they’re 40. In any case, the entitlements we’re obligated to provide will threaten societal disintegration long before today’s healthy young adults ever need elder care. Consoling yourself with the idea of projected long-term savings when you’re facing such a fiscal catastrophe is like consoling yourself with the idea of beautiful spring alpine flowers when you’re directly in the path of an onrushing avalanche. Projected long-term savings are completely irrelevant.

The obesity dividend is just smoke, and can be safely ignored. For the greater good of our social welfare, we’re far better off doing what we’re doing today – castigating and humiliating the obese into right actions, and if that fails, then (following the example provided by the British healthcare system which Dr. Berwick and others urge us to use as a model) discriminating against them when they need healthcare. Once we’ve established this useful prototype, we can apply it to whatever additional groups we can identify as targets of our collective indignation.

Whatever it takes to avoid confronting the rationing issue head on.