20th October 2005

Yet more epidemiology

To paraphrase Jonathan Schwarz, I know only two things, and one of them is that the American medical industry does a fantastic job. Day after day, doctors, hospitals, and drug companies succeed spectacularly in doing what they are supposed to do, which is to make piles and piles of money.

One way they do this, as Saurabh notes below, is to classify everyday life as a disease, and to then offer pharmaceutical — rather than social — cures for our discomfort. If you’re 7 years old and can’t sit still, you should be considered “normal.” Instead you are a medicable pariah. If you are a couch potato who gets fat, here’s some surgery. If your days in desk chairs and car seats leave you with short hamstrings and a tight lower back, here’s some surgery for that, too.

And then there are the lifestyle diseases that wouldn’t even exist if it weren’t for medicine. This graph shows the change over time in the rate of triplets and “higher-order multiple births” per 100,000 live births. The change is attributable entirely to the growth in fertility treatments. Multiple births take place in 1 out of 50 untreated births and about 1 in 2 births with fertility treatment. And that in itself can easily fit into the new improved definition of an illness — pregnancy can be a pain, and pregnancy with quadruplets can be an even bigger pain. It’s almost certainly worse than PMS, which is also now considered an illness.

posted by hedgehog in Uncategorized | 2 Comments

20th October 2005

Obesity rant #7

It’s been a long time since I went on a rant about obesity, which I used to do far more frequently back in the day. One of those foregoing rants was about the Department of Health and Human Services’ decision to specify obesity as a disease. Included therein was the startling recommendation that gastric bypass surgery be included as an accepted, and even primary, treatment.

This seems unwise even to the ill-informed and conjures up the disquieting phrase “unnecessary surgery”. Now a pair of recently-released studies provide some good statistcs to bolster that disquietude. Check out the horrifying graph to the right. Even more disturbing is the fact that the number of people electing to have this sort of surgery is galloping upwards, from 13,000 in 1998 to 103,000 in 2003.

I don’t mean to imply that gastric bypass surgery should never happen. Nevertheless, I do find it to be an extreme reaction to something we know to be a problem of lifestyle and nutrition. There’s simply no reason why our government should be responding to it as a disease.

Fifty years ago when lung cancer rates started shooting up, few people had any idea that cigarettes were to blame. When that correlation was established, the public health imperative was abundantly clear: stop smoking. Stop smoking, and you will stop lung cancer. In this case, we can say just as certainly that obesity has a lifestyle cause. It isn’t as concentrated or obvious as cigarettes, but it’s probably far more reversible. It’s the responsibility of public health officials to push healthy lifestyle changes first, especially when treatment is a dangerous and undesirable option.

posted by saurabh in Uncategorized | 3 Comments

20th October 2005

I didn’t know that…

Sometimes colossal ignorance itself can be educational.

For example, recently events have underscored the fact that I’m stupendously ignorant of what goes on in Japan. Mostly I think my knowledge is on par with the average American – a few vague tidbits about samurai, a post-war obsession with the bomb and some really bizarre cartoons.

The other day most of Asia was in uproar because the Japanese prime minster (and the following day, 200 Japanese MPs) paid a visit to a Japanese shrine that paid respect to their war dead. What’s this all about?

Let’s review some history: in 1994, when I was in high school, we learned about World War II. As everyone knows, World War II started with Hitler’s invasion of Poland, which was followed by their capture of France and bombing of London. Then, in 1941, following the insidious bombing of Pearl Harbor by the Japanese, the Americans entered the war, kicking ass, taking names, and chewing their newly-minted Bazooka brand chewing-gum. Eventually we got close enough to Japan that we could firebomb Tokyo and nuke a few cities, which convinced the recalcitrant Japanese to stop their human wave attacks and surrender like reasonable people, and had absolutely nothing to do with any Russians whatsoever.

Meanwhile, back in the real world, “World War II” was actually well underway long before 1939. In 1937, two years before Hitler invaded Poland, Japan was cutting their way through China on their way to Nanjing, which was, at the time, the capital of the Republic. Once there, they commenced an orgy of blood and violence that earned the subsequent six-week period the lovely moniker “the Rape of Nanjing”, or more diffidently, “the Nanjing Massacre.”

Or more diffidently still, “the Nanjing Incident.”

See, the other part they neglected to review in my world history class, aside from what is arguably one of the worst atrocities in the history of the world, was any of the post-war history of Japan. Until 1952 when they regained formal sovereignty, Japan was effectively ruled by General Douglas MacArthur, and he was not idle during that period. He was heavy-handed in his reforms of Japanese society, including the basic structure of government, the separation of Shinto religion and the state, educational systems, the disbanding of the armed forces, and the breakup of the large commercial conglomerates that ran the economy.

And, as the Cold War began to get underway, the U.S. naturally used its influence to push Japan in an anti-communist direction. Part of this meant encouraging Japanese nationalism, including resurrecting the Japanese army as a ‘self-defense force’, despite the protests of Japanese progressives. It also meant encouraging the growth of historical revisionism, notably with respect to the Communists in China.

This bore fruit in 1971, when a huge hoopla started out over the censoring of certain Japanese textbooks. The position of many Japanese nationalists, contrary to the prevailing historical understanding, was that the Nanjing massacre had never happened. Sure, some people had been killed, but only soldiers, and there were dead on both sides. The number of dead the Chinese government was suggesting (300,000) was just propaganda, and passing it on denigrated the Japanese national character.

Naturally, this irked the Chinese, for whom, by this point, Nanjing was a signal memory and a symbol of Japanese wartime atrocities. It also irked the author of the textbook, Saburo Ienaga, who sued to have the history of Nanjing preserved as he intended. His desires were upheld in court, and eventually Nanjing made its way back into textbooks.

But nationalism and its historical revisionist currents didn’t vanish, and in fact during this period there was plenty of back-and-forth on the subject of Nanjing. Revisionist attempts to whitewash Japanese wartime history resulted in a spate of new journalism on the subject, notably Katsuichi Honda in the newspaper Asahi, who published a series of widely praised and despised articles detailing the atrocities at Nanjing (including a famous account of a macabre death-count competition between two lieutenants).

The essential issue remains alive to this day, however. This, I did learn about in high school, although the source was the dark, sotto voce mutters of my Chinese classmates about the damnable Japanese. Japan has not, to date, issued any formal apology for its war crimes, a subject of frequent dispute. And revisionism is not gone, either; in April of this year, the Japanese Ministry of Education once more announced its intent to adopt textbooks that minimized Nanjing, labeling it only an “incident”. Probably you remember the protests that produced, although if you are like me, you were a bit taken aback by their vehemence.

A full account of the complaints made against Japan and the full measure of what they refuse to do would take more space than I’m accustomed to consuming. Here’s a Wikipedia page with a fair bit on the subject.

The most recent bit is over the Yasukuni Shrine, a war memorial which commemorates 2.5 million Japanese war dead. Included therein are 14 Japanese convicted “class A” war criminals, (i.e., the top top, like Tojo) and over 1,000 other Japanese war criminals. Yasukuni is very much a nationalist shrine; it celebrates the dead and is not apologetic about the war. The literature published by the shrine denies many atrocities (e.g. forced prostitution) and defends those “wrongly convicted” as war criminals.

So when Prime Minister Koizumi pays a visit to this shrine, this is no meaningless statement. When he apologizes and then proceeds to repeat his visits five times, despite the fact that his visits have been ruled unconstitutional, despite the outrage it raises in Korea and China every time he does, you begin to wonder what he’s about. When nearly HALF the Japanese Diet visits the shrine, things really start to seem tweaked to you.

In a fashion American ignorance on this subject is understandable because we’re outsiders to this conflict, which more or less happened without American interference. But frankly I’m appalled at the notion that human events should be ignored, that human history isn’t shared, especially pain of this magnitude. Most Americans are probably just as oblivious to the recent Congo Civil War, which produced something like 4 million dead. And this was practically yesterday. Part of the project of overturning nationalism should involve moving away from ‘national histories’ told from the point of view of a single nation-state protagonist. Going from “this had nothing to do with us,” to “this was a tremendous tragedy for us” takes an important step: it broadens the meaning of us.

posted by saurabh in Uncategorized | 2 Comments

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