Archive for the 'Medicine' Category

Please post your apology here, Dr.

I have mentioned before the long-standing medical trope of first blaming the victim of an illness before identifying  its real causes.      To cholera (blamed on loose morals), drug addictions (blamed on weakness of will), stomach ulcers (blamed on a personal inability to handle stress), chronic fatigue syndrome (blamed on laziness), and repetitive strain injury (blamed on deception, or even self-deception), we may soon be able to add obesity and schizophrenia.

The contemporary developed world obesity epidemic has always struck me as being too widespread and occurring too fast to be due simply to a lack of self-discipline by lots of individuals.   Current medical advice is for individuals to eat less and exercise more, advice given despite the experimental evidence showing that increasing exercise actually may increase weight (on average), rather than reducing it.    And advice given despite the fact – known for at least 150 years, since the work of Claude Bertrand – that our bodies are complex adaptive systems, whose properties do not conform to simple linear models; for example, eating less may lead the body to retain more of the nutrients of the food ingested, because of a body-weight set-point effect, and thus not lead to much weight loss at all.   We already have evidence that appetite may have  genetic determinants.  Now, it seems that the obesity epidemic may have environmental or social causes, since as well as humans in the developed world putting on weight, so too have animals.  The animal species studied include not only pets and zoo animals (whose diets may have been influenced directly by human feeding), but also wild animals living near humans.

And schizophrenia, which once was blamed on poor parenting by the mothers of patients, and later on the patient’s genes (and who, Mothers, gave them those?), may in fact be caused by a virus – a retrovirus, present in our and our ancestors’ DNA for some 60 million years.  It turns out this is the same retrovirus that is believed by some scientists to cause Multiple Sclerosis.  A virus as cause could explain why there is a persistent, and statistically significant, effect on the incidence of schizophrenia arising from the season of birth of the patient.  Neither genes nor a mother’s parenting style would be expected to be influenced by the season of birth, but virus lifecycles, activations, durations and diffusions, certainly are.

The standard line initially of the medical panjandrums on RSI was that this medical condition only seemed to affect office workers, and not others who worked a lot with their hands, such as musicians.    The implication of such a statement was that the causes of RSI could not be some objective condition, outside of the patient, and so must be internal, either psychosomatic or actually knowingly invented.  Yet, musicians for at least a couple of centuries have been suffering from RSI (or closely-related conditions), as anyone who asked them would know.

When the medical profession is ready to apologize to us all for wrongly accusing us of moral failings, weakness of will, or malfeasance, I’ll be here ready and waiting.  I’m not, however, holding my breath.




Can the obese now expect an apology from the medical profession?

Western medicine has a long history of blaming the victims of illness for their illness, attributing moral and character defects to the ill – eg, those suffering from cholera (before the mid 19th century), from physical addictions (until the mid 20th century), and from stomach ulcers (until the discovery of Helicobacter Pylori in 1982).   The most recent morality campaign waged by the medical profession has been against the obese, who are assumed by many medical practitioners to be lazy, weak-willed, or worse.  The medical professions urge the over-weight to diet and to exercise, and they even restrict treatment in some cases to people who are not obese.  Never mind that the scientific evidence for the relationship between regular exercise and appetite is weak, and suggests in any case that the former increases the latter: so that, if anything, more exercise is likely to lead to increased weight, not to reduce it.  

Now, science tells us that appetite – and hence obesity – may also be a function of one’s genes, as this article in tomorrow’s SMH reports

SOME of the children were so fat they had been listed on the British social services ”at risk” register because it was assumed their parents were abusing them with deliberate overfeeding.

”In one case, one of the children had been taken into care,” said Stephen O’Rahilly, a world expert on the genetics of obesity at the University of Cambridge.

But then his research team discovered the problem. The obese children had a section of DNA missing in their genetic code – a fault that produced a very strong drive to eat.

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