Classical Values, a regular read of mine, posted an excellent piece about a salon owner who’s been sued for failing to hire a burqa-wearing applicant.

Values sums it up well:

The owner here was placed in a classic damned-if-you-do, damned-if-you-don’t position. Had she hired this whining, covered woman, and had her trendy urban hipster customers felt uncomfortable about having their hair cut by a self-proclaimed prude, they’d have most likely not have complained, because trendiness is infected with political correctness.

But the thing is, a haircut is a personal service. A very personal service. If you’re in the least bit uncomfortable (as I have been with several haircutters), you won’t go back. No one wants a confrontation even under ordinary circumstances. But when you add PC to the mix, it becomes even less likely. So, had the owner hired her and watched her customer base dwindle, what then? Fire Bushra? She’d be sued for even more.

Now, I’m very troubled by legal jihad. When I lived in London back in 2004/2005, I saw firsthand what it had wrought. Advertisements for ham sandwiches resulted in fines. A bank’s promotion involving squeaky pig toys resulting in massive government and muslim backlash. Muslim riots in my part (Camden Town) over the failure of school cafeterias to offer properly halal meat in their meals. It stifled speech, it stifled free action, it caused enormous economic difficulties, and resulted in a culture of fear. As a Hindu, I could sympathize with the feelings of muslims to a degree. ‘Beef. It’s what’s for dinner’ ads cause an upraised eyebrow in a non-beef household. Failure of menus to mention the fact that a dish contains ground beef can cause headaches. And things like the new Mike Myers movie Love Guru kind of irk you just a little bit. But I couldn’t sympathize with their actions. It wouldn’t occur to me to start a religious riot over Apu in the Simpsons or a comedian mocking Indian customer service (I have to say though that the sound of their voices when you switch over to their mother tongue and harangue them until they put you in touch with someone who knows what they’re talking about is HILARIOUS). At the end of the day I just can’t understand how anyone could want to so limit the lives of someone else just because of such seriously minimal discomfort.

But that wasn’t the point of this post. You see, I’m going to be training as a psychiatrist very shortly. One with big plans that include physical health programs. A center of some kind incorporating rehabilitation, physical therapy, and personal training for the highly motivated patient with physical ailments. I and my employees will be selling a product. A product of health and wellness that these people may believe is out of their reach. As a psych guy, I’m very conscious of the importance of image in the therapeutic relationship and the importance of not only image in the patient, but the patient’s image of what they can be.

In the words of the owner:

“I sell image — it’s very important — and I would expect a hair stylist to display her hair because I need people to be drawn in off the street,” said Ms. Desrosiers. “If someone came in wearing a baseball hat or a cowboy hat I’d tell them to take it off while they’re working. To me, it’s absolutely basic that people should be able to see the stylist’s hair.”

I’ve very rarely met a nutritionist that was actually in shape. And how many gyms actually have personal trainers that look as good as you want to? Maybe 1 in 10 in this gym rat’s broad multinational experience. This is problematic, especially where my goals lie. Because I want to take someone who feels and is broken down, I want to show them that by working hard and training smart, they don’t have to look that way, they don’t have to feel that way. And the thing is, when you suffer from serious physical issues, the journey to health is 90% psychological. You are told by everyone around you that you cannot succeed, consciously and subconsciously. You don’t hear the stories of success because quite frankly the ones that succeed have done it on their own through sheer bloody-mindedness. You don’t see the stories of success because they can be hidden from you.

So one of the major goals of this center is to provide people with an image of success, an image of health, an image of working hard to surpass the physical obstacles placed before you. People who come in the door need to feel like they can conquer the world.

How is this going to be accomplished if their caregivers, trainers, and educators don’t look like they can. The professionals working at the center need to embody the concept of working toward results. They need to look like the finished endpoint of a lot of hard work. If an out of shape, slow-moving client comes in and sits down with a nutritionist who is the same way, why are they going to believe paying attention to diet will work? If their personal trainer is doughy and weak, why should they believe that following her training program will result in anything other than doughiness and weakness? Not only will this lead to my patients questioning the ability of their coaches to provide results, they will question the very ability of hard work to result in improvement.

Rehabilitation and physical change come from a desire to improve yourself. And especially when it occurs in the context of physical illness, attachment on a role model can offer a major boost in empowerment. This is one of the reasons Lance Armstrong is so beloved. “He’s gotten through major illness, so can I.” These stories tell us that change is possible, and when we’re guided by mentors that have had to change and understand the process of change we’re that much more likely to commit ourselves to their plan.

I can only imagine the PC climate is going to be worse in 6-10 years when I’m finished training and opening up practice than it is now. Will I be forced to hire an obese nutritionist or a weak strength coach? I sure hope not. Because as the salon owner pointed out, the service I will be offering is one of fitness and physical health, which is as much about image as anything. You don’t look at someone and say ‘I bet she can run a mile in 6 minutes’, or ‘he looks like he can squat 3 times his bodyweight’, you look at someone and say ‘They look strong.’ or ‘They look healthy.

But of course there’s more to it than just the patient’s perception. There’s also the employer’s. When you come to me asking to be employed in your capacity as a fitness professional, you are selling yourself. When your job is to teach someone how to eat healthy or lift strong, shouldn’t you be healthy or be strong yourself? I know myself, when I run into a problem and have to go to a medical specialist, I almost always try to find one who’s an athlete or at least athletic. Because I need someone who will understand my needs as a person with serious physical ailments who nevertheless pursues an athletic lifestyle, and more importantly because of that lifestyle, is able to do things most people with these issues cannot. I have to question a nutritionist’s ability to teach a healthy diet if they don’t look like they follow one. I have to question a strength coach’s knowledge if they are unable to put up decent numbers in the gym.

It’s not a question of judging someone by their looks, it’s a question of judging what their looks say about their ability to do the job. Can you be a good hair stylist if you don’t have a good hairstyle of your own or are unwilling to show it off? Possibly, but can you convince me or the clientele of that? Doubtful. And when it comes to something as psychological as chronic musculoskeletal problems, empowerment and belief have everything to do with it.

A person with major physical debility comes with the viewpoint that ‘life is suffering’. Even when people are understanding and empathic, they can end up furthering this limited viewpoint. “I understand your pain, I see why walking, playing with your grandchildren (or children), is so difficult for you.” It validates their suffering yes, but it also reinforces how their suffering affects the quality of their life. When Buddha said that three word utterance, it wasn’t out of pessimism, but out of optimism. That by understanding suffering and the root of our suffering we can get past it. But as ancient buddhist saints remarked, fewer than one in a thousand could find their way without a teacher. I doubt they had any statistics to back it up, but it’s a point I agree with. It’s why I’ve been the vast exception to the rule, in both my experience, and in the experience of healthcare professionals who’ve seen me. The thing about a good buddhist or hindu guru is that to be a teacher you had to be a doer. Transference was and is an important part of the process. The student had to have faith in their guru’s abilities in order to have faith that their guru could show them the way.

If my patients are to succeed, they need that kind of faith. Will I hire handicapped people? Oh my god yes. I would love to run a place filled with coaches and educators who are as or more crippled than I am and have succeeded at overcoming their physical debility. I would seriously consider giving up half of my gonadal mass for the possibility. But will I hire people who cannot bring out my patients’ faith in their abilities to transcend their disability? Hell no. It is impossible to run a hardcore rehab facility without hardcore coaches.

Americans spend more on healthcare than any other industrialized nation. With the election looming closer, it’s almost impossible to pay attention to current events without hearing it every single minute of every single day. Unfortunately, we never hear the two corollaries. 1) The quality of our medical interventions and management is superior in every single way. 2) The United States leads the world in living as unhealthily as possible. If our outcomes are worse, look to the latter. If our costs are higher, look to both.

Every day I hear pundit after talking head waxing poetic about what we can do to avert the healthcare crisis. Doctors get paid too much (really, how about you suspend your life, goals, and dreams until you’re AT LEAST 28 before you start doing what you’ve wanted to do all your life, with mountains of debt, paperwork, regulation, and other little nuisances looming over your head?). HMOs make too much money (true, in no small part to government regulation). Drug companies are after profits (well, yeah. That’s what corporations do. Physicians can accept some blame here for flawed studies, ever more pervasive medication guidelines, and NBT-ism*).

What I never hear from any of the people who supposedly have the answer to this, is the importance of the American public taking their health into their own hands. The simple truth is that the vast majority of the day-to-day costs of healthcare are rooted in our own lifestyles. Diabetes, heart disease, depression, anxiety, low back pain, arthritis, all of these things are if not 100% preventable, at least largely within our control. What we cannot prevent, we can alleviate and manage by living our lives as best as we can.

The philosophical model of the individual under which the majority of the public seems to operate under is that of a powerless pawn in the grip of fate. Diseases, conditions, and injuries happen to people. They aren’t expected, they aren’t incurred, and god forbid anyone even imply that how you live had anything to do with your current predicament.

It’s not surprising that this is what they want in healthcare coverage. Pay a yearly fee, go to the doctor, get tests, get medications, get interventions, without any further expenditure of time, effort, or money. They want as little an active role as possible in their own health care. This is not insurance folks, this is health maintenance.

What the public seems to want is for doctors, pharmaceutical companies, and the healthcare industry to manage every aspect of their health. And they seem shocked when as their health deteriorates and their demands grow greater, that costs grow.

I came to medical school with a different model in mind, a model that’s only been reinforced as my third year draws to a close. Something not so far off from what Edison voiced when he said that “The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease.” As a 10 year sufferer of Reflex Sympathetic Dystrophy and as someone who spends no small amount of time counseling informally, there is no value I hold higher than the Agency of the individual.

Whether the ailment be physical or psychological, the most important thing to me is to promote the individual’s sense of free will, their belief that they can effect a change in their own destiny by their own hand. In my one year on the wards, I’ve seen heart disease in 30 year olds with no family history, 70 year olds as thin as a rail telling me that their children have diabetes but they have no health problems themselves, and I’ve seen more sedentary, obese, low muscle-mass people with disability for low back pain than I can count. And I’m not even going to mention the rate of COPD in the great state of Oklahoma. This is not the picture of a world in which bad things occasionally happen to people. This is what it looks like when individuals fail to take the maintenance of their own health as seriously as they do Oprah and SportsCenter. This is the failure of the individual to recognize and accept responsibility for their own agency.

The nature of healthcare has changed dramatically in the past few decades, from one in which visits to the doctor were infrequent, pillboxes were tiny one-chambered affairs, and people with chronic conditions were few and overwhelmingly elderly, to one in which our doctors are on speed dial, personal organizers have sections for medication lists, and healthcare utilization has become a part of our everyday lives.

The only way out of this mess as I see it is to stop being Enablers. As the American public eats, sits, and poisons itself into oblivion, instead of allowing them to continue to ask “who’s going to clean up this mess?”, we need to ask them who made the mess in the first place. We need to follow Edison’s advice and return the patient to their position of power. We must act as advisers and educators first, stepping in to manage illness, trauma, and chronic conditions only as they lack the capacity and power to. But patient agency goes far beyond just taking an active role in one’s own health, but also in the decision-making process of paying for medical care. From what level of coverage to who they choose to carry it out. Anything else would be to only further the deteriorating healthcare situation.

One of my philosophical influences, Garret Hardin, wrote about The Tragedy of the Commons. In such a scenario, some see the benefits, while everyone pays the costs. In such a scenario, we are ill-motivated to curtail the costs we incur as we never feel them directly. Such is the situation of our current healthcare structure. Even though we continue to bemoan the increase in out of pocket expenses, premiums, and denial of coverage, the direct costs of our own personal health situations are still very much spread out, and even when not, can be heavily concealed from us.

Premiums have risen dramatically, as my meager pocketbook can attest to, and while much of this is due to graft and greed on the part of HMOs, a good deal of this is due to the fact that the average person and thus the average health insurance enrollee incurs greater costs. Frequent PCP visits for minor ailments, antidepressants, anti-reflux medication, BP medication, diabetes medication, pain intervention, specialist visits. All of these things have seen dramatically increased utilization over the years. More people utilizing more healthcare, of course insurance will go up. And yet nary a mention of this I’ve seen on the news our out of the mouths of politicians.

In such a situation, it would behoove the individual to have the ability to choose their level of coverage and who their provider would be. Two of the greatest disservices that have been done to health care consumers was the coupling of employment to health insurance, and the comprehensive health insurances mandates currently inundating the country. Your employer doesn’t ‘pay for’ your health insurance. You do. ‘Employer contribution’ for social security, unemployment, and healthcare are actually part of your pay, you just never take it home. But when you relinquish a part of your income to your employer for HMO purchasing, you run into an ugly little problem: Your employer may be legally bound to use your money to buy ‘comprehensive’ health insurance by law, but that only means they will try to find the cheapest coverage that satisfies legal requirements regardless of how well it actually takes care of you. This is pretty well evidenced by the fact that although I’m a medical student spending all day in the finest academic hospital in my state, we are offered the most pathetic health insurance known to man. Which is why I don’t purchase it.

More importantly, as mentioned earlier, when you buy health insurance, you are pooled with all the other people also enrolled at a similar level of coverage. What you pay isn’t based on what you spend or are likely to spend but what the group as a whole does. As this group continues to profligately waste away their health, substituting expensive medication and specialist visits for better living, you are forced to share costs with them. For some people, this is pretty sensible. Those with a family history of chronic conditions, those with young families, and those who simply don’t care to take their health into their own hands are pretty well served by the traditional model of health insurance. Yep the premiums are pretty high, but so is your healthcare utilization. As an example, there’s a guy I know in his late 40s who has well-managed diabetes, taking metformin, niacin, omacor, and one other diabetes drug. His family’s health insurance comes to about 7200 a year, but when you subtract all the expenditure for diabetes that would’ve otherwise come out of pocket, the balance is only about 1200 a year. That covers routine visits for his wife and kids, emergencies, and any further expenses he or they might incur. Including his wife’s recent expensive cervical fusion operation. Which is actually pretty reasonable when you think about it.

Contrast that with me a young 24 year old with no wife, no kids, and conditions beyond the RSD. I get an MRI every year to watch for further deterioration of a very ugly symptomatic herniated T8/T9 disc and some less ugly less symptomatic cervical discs (thanks to the RSD), the occasional specialist visit when there’s an issue I’m not able to manage on my own in the weight room, and 32 dollars worth of mobic and cyclobenzaprine a year (a lot of which ends up thrown away). Even with my condition, my expenditures are never more than 1500 dollars a year. How much sense would it make for me to enroll in the 3200 dollar school health plan that doesn’t cover the most important part (MRI) anyway? Not a whole heck of a lot when I could pay the much more modest sum for critical care insurance and drop the occasional dollar in a Health Savings Account. Especially given that, in the event that I do develop diabetes or heart disease (unlikely given my nonfasting total cholesterol of 150, perfect FBG, and 15 hrs a week in the gym) the critical care insurance will pay me a rather large lump sum right then and there.

The truth is that when you buy into comprehensive health insurance, you buy into a total package that involves healthcare as a part of your lifestyle, rather than something to be used in an emergency or disastrous situation. This is especially true in today’s environment as more and more people develop ‘chronic conditions’ through their own way of life. Those who choose to live right and live well simply do not need this level of coverage. Or at the very least should be able to take advantage of pricing contingent upon how they manage the risk factors under their control.

As Americans, we should be able to choose the level of coverage we desire in keeping with the way we live our lives and a rational assessment of our risks. We do so with our cars, choosing high deductible liability insurance on beaters and low deductible comprehensive insurance for our BMWs. Why not with our bodies? My car insurance offers a 10% discount for defensive driving classes, and lowers my rate every year I don’t have a speeding ticket. Why should I not be offered the option of cheaper health insurance that acknowledges my efforts with a discount for eating right and going to the gym, or that would first require I shed my omental fat before going on medication for mildly elevated blood pressure, or eat better and exercise more for low HDL/high LDL? That’s what insurance is all about? Assessment and reward for risk reduction.

Taking it a bit further, let’s say a 28 year old walks into your office at about 220lbs. He used to be a linebacker in high school and tried out for college ball but didn’t want to deal with the demands of daily practice. Now his idea of physical activity is keeping up with his alma mater on ESPN. Routine health visit reveals mildly elevated LDL, mildly decreased HDL, BP at 148/90 (x3, whatever, leave me alone), complaints of GERD, and mild somatic symptoms of depression suspicious for sleep apnea. Now, ’standard of care’ for this guy would be a low dose statin, a diuretic or maybe an ACEi/HCTZ combo, PPi, and CPAP and/or sleep study. That’s a fair amount of intervention right there. Now, I know that we give lip service to lifestyle and prevention, and he’d leave with a stack of pamphlets along with his scrips in real life, but what if we put our money where our moth was? What if we said “tell you what, I’ll schedule you to talk with a nutritionist, who can beat into your head the importance of essential fatty acids, reduced simple sugar intake, high quality protein intake, breakfast, and 4-6 smaller portioned meals a day. Then you can meet with a CSCS (certified strength and conditioning specialist) for another hour, who will explain to you how to jump on the stairstepper for 30 minutes 4 times a week on the ‘hill’ or ’strength’ or ‘fat burner’ program, and supplement that with weight training. You can come back in three months having lost 15 lbs and I’ll re-evaluate you then.” He comes back in three months with his BP problems remarkably having disappeared and his lipid profile drastically improved (although his LDL could use a little more work), and his sleep troubles dramatically alleviated. We start him on a PPi. Now let’s say he doesn’t take care of the factors in his control and comes back. “We’ll treat you. That’s what we do. But if you’re not going to put the time and effort into taking care of your body, you can pay a bit more of the costs of your medication.” Now, let’s say he DOES put in some effort, loses some weight, and seems to be committed to a healthy lifestyle, but the problems continue. “You’ve done your part. You should be proud of yourself. And I know it didn’t help with all of the problems you have, but believe me, it will pay dividends down the road. Here’s your scrips. It’s a pleasure having patients like you.”

Now let’s say a mildly overweight female in her mid forties comes into your office complaining of low back pain, fatigue, and has a webmd article with all her symptoms of fibromyalgia helpfully highlighted. Her obese husband’s come along because his knees ache something fierce these days. You notice that she stands ‘bonily’ (no official medical terminology for it), slouching and seeming to carry all of her weight on her bones and joints, not in her muscles. Guess what? Off they go to the nutrionist and exercise physiologist. Maybe a physical therapist as well in her case. And given the high comorbidity of CFS and fibromyalgia with depression, it might not be such a bad idea to have her see a psychiatrist for further evaluation. Send them off with some mobic and wish them the best of luck. See them back in three months before you pull out your list of orthopedists and pain specialists you refer to. Fibromyalgia, low back pain, and arthritis are expensive conditions and largely have to do with deconditioning of our postural and girdle muscles. Getting our muscles back in working order is the most effective intervention we can make with regard to these increasingly prevalent ailments. Depending on how much damage has already been done, we may not be able to avoid more costly and invasive procedures, but we may be able to delay them.

Rational decision-making is based on freedom of information and accurate assessment of costs and benefits. The current healthcare paradigm in which the individual costs of aspects of healthcare (actual cost of healthcare premiums–not just personal contribution, true cost of drugs, PCP visits, specialist visits, and procedures) are concealed from them and in which they are not allowed much choice in the degree of coverage they want. The healthcare equation is one of time, effort, and money. Choosing the level of coverage you would like needs to reflect your assessment of personal risk, as well as the degree of time and effort (and a little money), you are willing to invest in your own health. The more time and effort you are willing to invest in your own health, the less money you should have to pay for your healthcare coverage and co-pays. Conversely, the less you are willing to invest in yourself as the agent of your own health, the more you have to be willing to invest in the healthcare delivery system.

The true crisis in healthcare from where I’m standing isn’t the increasing load of diseases and conditions in our population, nor is it the increasing costs of healthcare. At the root of both of these things is the dereliction of duty to self that patient, doctor, industry, and government have been party to. I’ve said before that my goal as a physician is to be useless. I really detest preventable chronic disease. And I want to live in a world where as few of my patients have them as possible. I want to help my patients do everything in their own power to stay healthy, intervening only when it becomes necessary. The current rhetoric about healthcare, and the current structure of healthcare coverage and payment, is such that it only serves to reinforce the alternative view, one in which bad health is something that happens to people, rather than something we can in large part prevent and alleviate on our own. We must make lifestyle management a part of the healthcare cost equation. And we must allow patients to reap the benefits or bear the costs (at least in part) of their own discretions. Insurance is about taking care of the factors that are out of our control. This is why the concept of insurance was developed thousands of years ago and the concept that health insurance especially needs to return to. If anything is to be done about the healthcare problems facing us today, it must be done by returning to a patient-centered focus. A focus in which the American public is made the arbiter of its own destiny.

*NBTism - Next Big Thing Ism. Using a new drug just because it’s new. Even if older drugs in the class are just as effective with little or no increased incidence of ADRs. See PPIs, BP medication, antibiotics, and DM2 drugs.

…Actually measuring it accurately. This goes for research as well as in clinical practice.

This is a huge pet peeve of mine. Possibly because I was trained in a much more rigorous science before I started on my way in the medical profession (third year medical student). Also possibly because I’m kind of a healthy living nut. And equally as possibly because I’ve been ‘overweight’ my entire adult life despite wearing pants with a 32″ waist. Hard to say really.

The point is that obesity is a serious problem. Not just when it comes to major causes of mortality like heart disease, stroke, and even cancer and dementia, but also major morbidities–ones that often further predispose you to the above-mentioned mortality risks–like arthritis, spinal dysfunction, diabetes, peripheral vascular disease, and recurrent infection. There’s also little question that excess weight substantially reduces quality of life if nothing more than for the simple reason that it’s harder to move.

There is no doubt that fact, and the escalating proportion of the population that fits this definition is an even greater concern. But we actually don’t know and can’t know how serious a problem it is as long as we continue to use the BMI (actually an approximation thereof) as our method of categorization.

The Problem with BMI

BMI is a population-level measurement and has been proven time and time again to be of little to no validity when applied to the individual. Granted, if someone has a BMI of 17.5, they probably are substantially malnourished, but it still shouldn’t be the criterion we use to differentiate anorexia from bulimia, for instance. And if someone has a BMI of 40, chances are they are indeed carrying dangerous levels of body fat and have metabolic syndrome, if not overt diabetes and atherosclerosis. But in between the BMI is nothing if not lacking in precision.

The formula for the BMI is quite simple and is nothing more than our weight divided by our height squared. Yielding units of kg/m^2. And here we have the first problem. Any measurement system we use should be based on actual physical characteristics. The only physical characteristic that would naturally be expressed in terms of m^2 is our surface area. This would actually be a substantially more pertinent (although still limited) calculation. Body Surface Area is a pretty useful quality and finds application in everything from bioenergetics to exercise physiology to pharmacology. A measurement that used BSA and weight would give us an idea of body density, which is the basis for the more accurate body composition tests we have such as immersion. But since density at a given body fat percentage varies based on height (i.e. a 5′ tall person with 7% body fat will have a different density than a 6′ tall person with 7% body fat), a Bodymass Density Index (which Height/BSA would be), still wouldn’t be the most useful thing in the world.

The next problem with the body mass index is that it really doesn’t look at what kind of mass you’re carrying.

It’s a population level statistic and is more of an epiphenomenon of the fact that people are fatter today than they used to be than anything else. In other words, the only reason the BMI tends to work is because in society at large heavier people tend to be fatter. It’s an incidental finding. Amongst my gym buddies, Ken, a 230lb behemoth, sits at 6.5% body fat (based on statistically valid caliper testing). At 5′11″, he’s ‘obese’ according to BMI, yet just about anyone reading this should be envious of his low body fat content. At 5′11″ and 195, I’m only ‘overweight’, but I would bet any amount of money that I’m the one with a higher body fat percentage. And, even though my love handles have been my constant companion since I was about 14, I carry less body fat than most people who weigh 10lbs less than I do or more.

On the other end of the scale, researchers have had to coin the term ‘normal weight obesity‘ to identify those individuals who are not caught by the BMI screen and yet carry a substantial amount of body fat. Using a cutoff of 20% bodyfat for men and 30% for women, Mayo researchers found that over half of the sample of people with BMIs from 18.5-24.9 qualified as ‘normal weight’ obese. Metabolically, they appeared for all intents and purposes similar to those with a BMI over 30. The obesity problem thus isn’t restricted to those with a higher BMI, not by a longshot.

From a research standpoint, we can pretty much invalidate most of the ‘obesity’ research that has occurred thus far, at least as it relates to health risks and etiology. I haven’t been able to find a study looking at ‘normal body fat obesity’, but given that at 5′11″ a person can only weight 178 while still being considered ‘normal’ (which really isn’t very big), I suspect that a substantial proportion of people considered ‘overweight’ and even ‘obese’ by BMI are actually well within healthy limits for body fat. One bit of (slight) corroboration that I’m aware of is a study I found some years back indicating that increases in BMI among adolescent males were linked to decreasedbody fat and increased physical activity.

Current epidemiological and population-level research in obesity is thus lumping together disparate body types and compositions into its various categories. A full half of the ‘normal weight’ group carries an unhealthy amount of body fat, while a good-sized portion of the ‘overweight’ group is actually quite healthy. The major effect is to understate the health risks associated with unhealthy levels of body fat. Other potentially important factors with regard to chronic and major illness, morbidity, and mortality could easily be missed as well, such as whether llghter individuals with high body fat are at greater risk for health problems than heavier individuals with otherwise similar amounts of body fat (perhaps accounting for the occasionally mentioned ‘protective effects’ of body fat), or whether heavier individuals with low body fat are at increased or decreased risk for chronic medical conditions compared to lighter individuals of comparable body composition.

And, again (the third time I’m mentioning it I think), as BMI doesn’t hold for individuals anyway, we find ourselves hampered when it comes to translation of research into practice. It’s literally comparing apples to oranges. There is no way to put the information BMI-based research gives us into practice when it comes to screening and treatment.

The Answer?

Measure body fat. Recent attempts to popularize waist size instead of weight are a step in the right direction. But waist size is still an imperfect proxy. While unlike the BMI it is instantly translatable from research to practice, it still overlooks other possibly important body variables such as total lean body mass.

Well, immersion (hydrostatic) body composition tests are quite obviously impractical. The equipment, facilities, cost, staff training and expertise, and patient discomfort/inconvenience are prohibitive. But the 7-site skinfold method is accurate within 2% or so, training is easy, it’s fast, and it’s cheap. It might add a minute or two of time to patient/subject processing, but the dividends it pays will be tenfold.

Conclusion

Moving to skinfold tests to measure bodyfat in research and clinical practice is the wisest step we can take in understanding, preventing, and combatting the effects of obesity. It is the simplest solution to improved understanding of health and disease as well as more effective targetting of at-risk patients.

One benefit of body fat percentage testing which I’ll only touch on briefly is that it also provides us the ability to measure lean muscle mass. Muscle is an oft overlooked entity when it comes to medicine at large. We look at our patients’ bones, joints, visceral organs, endocrine systems, and brains, but nary a glance do we lend to one of the most amazing and adaptive tissues in the human body. Which is concerning, given that it makes up roughly half of our total mass.

Lean muscle mass is a pretty important variable unfortunately ignored for the most part in research and in practice. Exercise physiologists have known for decades the benefits of lean muscle mass and medicine has just started to take notice of its role in areas from prevention and alleviation of arthritis, to decreased spinal, neck, and back problems, to improved daily functioning in the elderly, to diabetes resistance, and lean body mass may even have a protective effect with regard to dementia–at the very least providing an improvement in symptoms and slow in the rate of cognitive decline.

Whatever the case, in order to properly understand, prevent, and treat obesity and obesity-related illness, we must be able to accurately assess its extent both within the population and in our individual patients. The body is too complex to be defined by a single number, be it BMI or simply weight. And in order to best understand the human body in sickness and in health we need to move away from such simplistic measurements.

Sun Tzu advises us that ‘If you know the enemy and know yourself, you need not fear the result of a hundred battles.” High BMI is not the enemy. And we are not our weight. The enemy is body fat, and body composition is ourselves.

Target weight or unhealthy BMI, either concept is wrong. Rather we should seek a target body and mind, and to such an end we should endeavor to use the most enlightening tools at our disposal, especially when the effort is so small and the reward so large.

It’s been a busy umm 15 months? Third year of medical school is winding down. I still haven’t revived my primatology career. The endless and painful process of rehabilitating myself and staying as functional as possible, as long as possible, while living with RSD is–well–endless and painful. And the spectre of residency applications and the match looms large in this very ambitious, and very freaked out future psychiatrist’s head. But the blogging itch has bit me again, and so blog I shall. Probably less politics, probably more medicine, probably more on health and fitness. Who the hell knows where this’ll take me. Anyway, if any of my old readers still have me on their RSS aggregators, the point is I’m back. Probably sporadically. Deal.

One of the best friends I’ll ever have died on October 31, 2006. Eric Shockley drowned in his own body fluids in a hospital bed, in his early 30’s. A couple years ago his aorta started to balloon. They were able to patch it and replace the damaged valve, but we always knew it was going to kill him. We just didn’t think it would be this soon. And I promised I’d say this at his funeral, but I didn’t find out he’d died until afterward. So here goes:

Eric had a heart of gold. Shame about the shitty aorta.

Our friendship started randomly, as all great ones do. On a ford focus discussion board of all places, debating politics. Eric was a dirty socialist. I was a hardcore conservative. But by the time he died we were both converging on a kind of conservation-centered pseudolibertarianism. The politics weren’t important, except that they were the way we met, and a microcosm of our entire friendship.

Sometimes, I still think it’s some kind of sick joke. That there’ll be a gigantic 300lb crate on my doorstep when I come home from school some random day. That upon prying the lid off, out will pop a heavyset 6′4 white guy with a stupid beard who’ll shout ‘Surprise’. I’ll scream and have a heart attack and then we’ll both have weak tickers and moronic facial hair.

Which is exactly the kind of thing Eric would do. But he probably wouldn’t let me stew this long. At least I don’t think he was that much of a bastard.

Anyway, the point is, Eric and I were like brothers. We fought constantly, usually because one or the other was being pigheaded about some opinion or another. And then we’d make up. Heck, we were worse than brothers. If you’re a Scrubs fan as I am, you probably find great humor in the pseudo-homosexual relationship between JD and Turk, epitomized by the touching and beautiful song, Guy Love. That’s about where we were.

I’m known for my gay jokes around school, but Eric definitely holds the title for ‘gayest thing ever said by a straight man’ when he in all seriousness told me that the only time he ever smiled anymore was when we talked. But that was one of the great things about our friendship. Self consciousness was never an issue. We were ourselves.

People have a lot of layers. Some more than others. Myself? I collect layers as a sort of hobby, not to mention as a defense mechanism. I can’t say that too many people know the real me. Eric did. Hell, without Eric I don’t think I would know the real me.

In a post I made about a week before he died, I all but named him specifically. And I’m glad he commented, because it would turn out to be our last interaction. Around Eric, and perhaps a couple others, Nick came out. Not the jock, not the clown, not the nerd. Just the guy.
————————————————————–

You know how all 5 year olds have that annoying ability to ask you ‘How Come?’ until you’re blue in the face with frustration and are starting to contemplate just how far you can hurl 40lbs of annoying kindergartener? That kind of doggedness was Eric’s greatest gift to me. He forced me to push my understanding of the world and myself. And whenever I’d get to a ‘Just because, dammit!’, he’d force me through it and out the other side into deeper understanding. I’d like to think I pushed him too, which is probably why he was slightly less of a hippy by the time he died. And why I’m slightly more of one.

We have a concept in hinduism known as maya–the veil of illusion. The thing about reality is that we will always have trouble perceiving it. It’s concealed from us by our imperfect sense, by our prejudices and our preconceptions. But if we’re aware of these imperfections in ourselves and in our view of the world, we can come closer to finding reality.

In science we develop models of the world, and these models are based on certain assumptions. A model is only as true to the world as its assumptions are. The more accurate the assumptions, the more accurate the model.

Eric wasn’t a hindu or a scientist, but more than any scripture (and I’ve read them all), or any science book (and I’ve read thousands), he was the most instrumental in helping me to acknowledge the veil, and start to lift it. Because of Eric, I’ve pushed back the boundaries of simple belief and replaced it with knowledgeable understanding.

And that’s why even though I’ll never be lucky enough to see that giant crate on my doorstep, will never again hear him say something so gay that even JD and Turk would be embarassed, I know that Eric isn’t dead.

Eric’s gift is still with me, pushing me, demanding more of me. Like that 5 year old, his memory tugs on my pant leg, asking why? I’ve still got my ‘Just because’s but today it’s a much different, much smaller set of them than it was before I met him. And I keep pushing through, finding explanations for things I’d taken for granted. Changing my opinions, seeking to find not internal consistency, not some assumption upon which to build a castle in the clouds, but the truth. And it’ll never stop. I owe that much to Eric.

Eric was larger than life. And he was taken long before his time. But I take solace in the fact that everything I do, he does. That whatever I manage to do with my life is in no small part his doing. That if I can push people the way he pushed me, to find themselves and in so doing find each other, that if I accomplish nothing else, it’ll still be a life well spent.

So in memory of Eric, I’ll ask you. Where does your understanding end, and your blind belief begin?

the only people for me are the mad ones, the ones who are mad to live, mad to talk, mad to be saved, desirous of everything at the same time, the ones who never yawn or say a commonplace things, but burn like fabulous roman candles exploding like spiders across the stars and in the middle you see the blue center light pop and everybody goes “AWWW!”
–Jack Kerouac

I’ve been arguing with anti-gunnies for a few years now. And the one thing that strikes me about these people is they have no fear of being violently attacked. Whether or not this fear is rational is beside the point. The thing is that they are unable to understand why others don’t feel that way. But more importantly they see no need for others to have a means of self defense.

I’ve made the confession several times before that carrying is not one of my top priorities. Because like those anti-gunnies with their heads in the clouds, I too have almost no fear of being attacked. The closest I ever came was while in England, fearing not being mugged, but the legal and criminal repercussions of defending myself against the mugger. Like the silver spoon leftists I went to school with, I live in a very nice area almost devoid of any crime. Which no doubt contributes. But I do go to school and spend much of my time in as close to a ghetto as Oklahoma City has. And that’s where my youthful arrogance and over-reliance on size comes in. One of the funniest examples of not understanding the need for firearms in self defense I ever encountered was in a Canadian bouncer. The guy was close to 250lbs, and paid to be able to beat people up, of course he saw much less need for a gun than others. I’m a dark, well built guy with a little training in boxing, grappling, and tae kwan do. While I’d likely get my butt kicked by any similar-sized guy with even a moderate amount of more disciplined training, I’m simply not that worried about your average mugger. I’ve taken them down before, and would not be surprised if I had to do it again.

Like I’ve said since the beginning, I’m far more obsessed with the right than doing so myself. In Men Like Me I talked about my schizoid tendencies just a bit. And maybe that’s why I’m able to put myself in others’ shoes. I’ve known guys with my strength and intelligence who lacked a moral code; and the results were uniformly ugly. Sometimes a friend will make a joke or hassle me a bit and I’ll say “I could end you right here, right now.” And they’ll laugh, and I’ll laugh, and someone will probably say “You’re harmless” or “Nick, you’re just a great big teddy bear”. But I know my capabilities, and I’ve seen the results when I got just a bit too into it when I was sparring with a buddy, or when someone threatened a friend. And it isn’t that far from the truth.

I think about what it would take to stop someone like me, if he was determined. A tazer? Probably not. Mace? Hardly. A wooden bat? If swung right, perhaps. A gun? Every time. Tazers and other deterrents like mace rely on luck and an easily discouraged–rather than easily enraged–perp. Bats, batons, etc still pit the potential victim against the criminal in a contest of strength and fighting ability. Not to mention that many of those are banned in the same places that ban the carry of firearms for self defense. A gun is literally the only thing that completely negates an attacker’s size and ability. And if a loved one had to go up against a guy like me, I damn well hope they’re armed with one.

The silver spoon kids are unable to put themselves in circumstances where self defense may be necessary, where you’re outweighed, outnumbered, outmatched. Where a gun might make the difference between your life, your virtue, and your property, or the rape and theft of what and who you are. So they say things like “Well, there’s martial arts” or “That’s the police’s job.” What if I were like them? What if I said “Well I don’t really need it, so no one else should either.” What if I were so selfish, so childish, as to condemn people to suffer a horrible fate at the hands of a violent criminal, simply because I was unlikely to be one of those victims?

With the growing popularity of concealed carry licenses has also come a ballooning number of establishments that prohibit firearms upon their premises.

Employee and customer alike must obey these dictates. And–often angrily–they wonder why their ‘right to bear arms’ doesn’t extend to these places of business. The answer of course is that this is the essence of the right to own property. What good is owning something if you have no control over it? Much like the 1st amendment, you can criticize their position, but not their right to hold said position.

And just as entertainers and celebrities often pay a price for opening their mouths a bit too wide, these proprietors may pay a price for the positions they take. A guy on Kim du Toit’s forum shared a letter to the editor in American Handgunner with us that illustrate’s this point perfectly:

Thought this may be of interest to Handgunner readers. Today I received the following letter:

”Dear Mr. *****, Today, while in the bank, you were noticed wearing at your side a pistol. Unless you have some specific duty or reason to enter the bank with your pistol, we appreciate your leaving all firearms in your vehicle.
Thank you for your understanding and cooperation in this matter.

Sincerely John Parker
Vice President & Branch Manager
Troy Bank & Trust Company
Troy, AL 36081”

After receiving this letter, I immediately called the bank president and asked if he knew of the letter and agreed with it’s content. He assured me he did, saying there is not much crime in Troy and we don’t thin you need to be carrying a pistol. After a few words advising him of my position on the issue, and the fact Alabama has open carry, I proceeded to seek out local banks who would recognize my right to self protection and the exercising of my second amendment rights. Wachovia advised they would not permit any armed individuals in their bank. Colonial Bank never got back to me.
Regions Bank advised they would be happy to recognize my carry rights, my status as a retired LEO and would welcome my money. By close of business that day, I had closed several accounts at Troy Bank & Trust, with several more to go, and deposited over $480,000 in the Regions Bank. You just got to do what you feel is right. Oh, by the way, I’m also getting much better interest at the new bank.
Thought this would be of interest in so far as gun owners need to know where the gun friendly banks are.

Name withheld by request
Via email

This is pretty much a classic example of how things that are neither bought nor sold still have value. This man chose to make a statement about how important it is to him to be able to carry. And perhaps what he thought of a place of business whose idea of ’safety’ was to disarm the people who follow the rules, yet do little to make sure rule-breakers weren’t armed. Works for me, and maybe got the bank to think for a second or two. Certainly if a substantial portion of the 2nd amendment supporters in Troy followed suit anyway.

Not all second amendment supporters are classical liberals, but I certainly am. And the essence of our philosophy is that we should be free to act as we wish so long as we do not interfere with the freedom of others. Demanding that we have a ‘right’ to carry our firearms on someone else’s property is imposing our will upon them. But we can always make our displeasure known, as this gentleman did.

My first contribution at the Liberty Papers in months

The essence of the post has been seen on this blog a hundred times before. Intellectimpure will soon be complaining that I’m not saying anything new. Which is true.

But liberty papers now gets more readers than I do. So I thought I’d say it anyway lol.

anyway, quick snippet

In today’s political climate, Kennedy’s famous quote has been reversed. It is now not about what you can do for your country, but what your country can do for you. In this climate, freedom has been redefined as comfort. Into this environment you invite millions of people who through no fault of their own better qualify as ‘have-nots’ than ‘haves’. And as the ‘have nots’–together with the cultural elite–have shown themselves all to willing to do, they will vote from others’ pocketbooks. And they will vote for other egregious restrictions and legalized discrimination.

Like leftists, many libertarians seem to suffer from what I can only call perfectworlditis. The major difference being that while libertarians’ idea of what the perfect world is, probably is the platonic form of our own world. Whereas what leftists think the perfect world is doesn’t make sense at any level.

I have no illusions of how perfect the world is and more importantly I understand something called the Tragedy of the Commons. Which is one of the reasons I’m a hardcore conservationist (although I don’t think global warming has been proven, deforestation and other environmental destruction due to man certainly have). And why I support some kind of government regulation/funding in education. Unlike many of my fellow classical liberals and libertarians. But much like plenty of them.

It’s something I’ve seen time and time again with people looking for philosophical and logical consistency while failing to anchor themselves against real world concerns:

“I’m more internally consistent than you!”
“Not going to deny it. But as the surgeon said to the patient with gangrene, ‘would you rather die with two legs or live with one?’”
“Yeah, well, you’re right. But I’m still more internally consistent.”
“And I’m still breathing. Later”

Post on perfectworlditis tommorrow.

Amazingly enough within a couple of hours of writing yesterday’s post and heading to school, I was assaulted by yet another piece on the horrors of debt. This one in the OU student newspaper.

Apparently ’some students don’t realize future implications of frequent credit card use.’ Not going to deny that. But yet again I’m amazed by the tone of the article. If I were to write the article, it’d very much have a tone of “Quit screwing up you idiots!” Sovereign individuals over the age of majority are making bad choices. They need to stop making them.

Instead of course the article is fairly typical in its pleas for sympathy and understanding.

Moyer, a National Merit Scholarship finalist and letters major, applied for his first credit card at 18 with a credit card company set up on campus at UTD.

He did not understand the problems he was going to face.

OU gives full rides to national merit finalists. I think UTD does too. So unlike a good chunk of this country, this kid’s tuition and general living expenses were heavily subsidized. If a National Merit Finalist isn’t smart enough to understand how debt works, who is? And even more problematic, if people of above-average intellect can’t even be expected to manage their own finances who can?

“He didn’t know how he got into all of this debt and didn’t know how to get out,” she said. “He felt like a failure.”

He didn’t know how he got into all of this debt? He did it by ignoring the consequences of his actions.

Since Moyer’s death, his mother has become an advocate for groups working to change the way people get credit cards.

She has joined the advocacy group, Americans for Fairness in Lending (AFFIL). The group is pushing Congress for change.

“We are asking for credit cards to be based on how much you make and how much you owe,” she said. “I don’t understand how all of these companies can give credit cards to someone making $5.15 an hour.”

Mother loses son. Mother wants to blame someone for son’s death. Mother then seeks to change the law and restrict freedom to somehow honor her son’s death or find purpose in it. Nope, never seen that happen.

Here’s an excellent quote from a kid with a good head on his shoulders in the same article though:

Although he is stuck repaying every dollar of his loans, he said he doesn’t regret what he is doing with the money.

“It is definitely worth it,” McCroan said. “People take out 30 or 40 thousand dollar loans to buy a car. I’m getting an education with the money. In our society, education is expensive, but it is worth it.”

Course, McCroan does whine a bit about the cost of education, but then again so does everyone. I definitely bitch and moan about the 60,000 i’ve amassed for just two years of med school. But like McCroan I grin and bear it.

I know I’m beating a dead horse here but I really don’t like ‘consumer protection laws’. And I really don’t like the intimation that we’re too stupid to make decisions for ourselves. But more importantly if we are too stupid to be masters of our own lives, what business do we have telling others how to live? Democrat, Republican, and yes even Libertarian. All of us support the right to vote and some degree of social coercion through government and law. But along with the right to vote comes the responsibility to choose wisely. To pick the right leaders who will take us down the right path. And if we can’t be responsible for ourselves how can we possibly be responsible for a whole nation?

Headline News had a little spiel about how more people are cutting back on holiday spending and are worried about credit card debt than this time last year. They blame the usual culprit: cost of living. What they didn’t ask was what level people are living at.

What I’d like to see would be a longitudinal study of income vs. ownership rates of 20k+ cars, 1k+ TVs, size/expense of movie collections, number of times people eat out at sit-down restaurants, stuff like that. Because anecdotal evidence tells me that the actual cost of living hasn’t really increased: I pay the same for Old Navy jeans as I did back in high school, bean burritos are the same price, and the only grocery I’ve seen increase are those damnably addictive Clementine Oranges. And I know for a fact that medical residents live much more luxuriously these days than they did in the mid 1980s. Same for college students.

Inflation has occurred, I’m not denying it. When I was a 1st grader taco bell burritos were 59 cents. Now they’re 79! And 20oz sodas were .75 out of the vending machine back in junior high. But then again so have paychecks. I’ve only worked entry level jobs. And I’ve never been paid minimum wage. Still during these sporadic periods of employment I’ve seen a significant rise in pay uncorrelated with the degree of skill or effort the jobs involved. But have increases in wages kept pace with inflation? Apparently, yes.

There are certain costs that are outpacing inflation. But for the vast majority of people worried about credit card debt and cutting back on their spending I wouldn’t be surprised if the reason for this fiscal bind could be traced back to the fact that these people are choosing to spend more on frivolous expenses, or simply spending more than they have to on necessary purchases.

The undertone of the pseudo-factual hit pieces we’re bombarded by about ‘making ends meet’ is that it shouldn’t be this way, that people shouldn’t be in this position. It amuses me then that the people of the self-proclaimed ‘Party of Science’ consistently fail to even remark upon what is in all likelihood a prominent factor in the rising debt of our nation’s people.

For just about any other kind of health problem, we talk about how lifestyle (diet, exercise, etc.) plays a huge role in the etiology of disease. Lifestyle changes can prevent disease, they can slow its progression, and in some cases even reverse it, depending on what we’re talking about.

Diabetes, cancer, heart disease…all are illnesses that affect a substantial portion of the population. And in each of these cases, a significant amount of time, effort, and money is allocated toward learning how to reduce the risks of developing such debilitating conditions. Furthermore, as a quick perusal of the ADA and AHA websites show, lifestyle modification is a crucial part of the strategy for managing these health problems. Indeed, as time goes on, doctors are emphasizing the fact that all the drugs in the world cannot make patients healthy if they make unhealthy decisions.

They claim that 47% of adults will suffer from a diagnosable mental illness during their lifetime. I take issue with the label ‘illness’ as that implies a degree of severity and irreversibility that simply isn’t the case. They also claim that 23% of us will suffer from clinical depression. By contrast, only 10% of the population aged 20 or older has diabetes.

Psychiatric problems (illness or not) can be just as deadly and debilitating as any other medical issue. Why then is there little or nothing in the way of preventive education? Why then do primary care physicians prescribe antidepressants and psychostimulants often without so much as a referral to a therapist?

We are surrounded by messages telling us how we know if we ‘have depression’ or ‘have ADHD’, and what drugs to ask our doctor for. But have we ever been told how to prevent ourselves from becoming clinically depressed? Have we ever been shown how to deal with depression, ameliorate our anxiety, or learn how to focus better?

I find it hard to believe that unlike diabetes, unlike heart disease, unlike cancer there is nothing we can do to prevent ourselves from suffering from mental health problems. Indeed, the fact that some people appear far more resistant to depression and anxiety than others in similar circumstances, combined with the relatively weak heredity of such psychiatric problems, would seem to indicate that mindset and worldview play a substantial role in resistance to mental health problems. And, even more convincingly, depression is on the rise in this country. Which would point to something we are doing rather than something inside of us being the culprit.

Relapse rates for those treated with antidepressants alone are considerably higher than for those who received combination therapy or only psychotherapy; in fact, only about 1/3 of those who take anti-depressants alone see a full resolution of their symptoms while 1/3 don’t respond at all. Da Vinci, Michaelangelo, Edison, and countless other accomplished people fit the textbook definition of ADHD, yet never took a pill for their ‘condition’.

Simple logic dictates that if systemic disease can be prevented or at the very least mitigated by behavioral modification, then certainly mental health problems would too. Scientific evidence backs this idea up quite firmly. And yet it would seem that they’re far more interested in telling us we have a psychiatric illness, then telling us what we can do to prevent being so labeled or how to fix it.

Rosie O’Donnell made a comment today about how we shouldn’t fear the terrorists:

Faith or fear, that’s your choice. You can walk through life believing in the goodness of the world, or walk through life afraid of anyone who thinks different than you and trying to convert them to your way of thinking.

I figure most people are going to key in on the ‘we shouldn’t fear the terrorists’ line. Whatever. It’s expected from her. What I personally find noteworthy is how in one short sentence she has exposed both the hypocrisy and the innate instability of the leftist worldview.

“You can walk through life believing in the goodness of the world…” is the choice she wishes us to believe she has made. ‘Faith’ in her fellow man. I consider myself a freethinker. And a tireless seeker of the truth. Are people fundamentally good? Every day in the news they shows us otherwise; rather, greed, anger, and pettiness seem to be innate characteristics. Are people fundamentally evil? Thousands of acts of kindness both large and small–many going largely unrecognized and unrewarded–would seem to belie this assertion. I submit instead that people are neutral. Neither good nor bad until we make that choice.

To have faith in the goodness of the world is to invite yourself to become a victim. Should girls at college parties get drop dead drunk assuming that all men are perfect gentlemen? Should the elderly couple entrust their life savings to a shyster? Should a person walk down the streets of Camden Town at 2 am assuming that no one will assault them?

To do so is not only the height of stupidity, but if Ms. O’Donnell truly behaved in such a fashion and truly lived in the real world, she would quickly be disabused of such lofty and inane notions.

…or walk through life afraid of anyone who thinks different than you and trying to convert them to your way of thinking. Here Ms. O’Donnell seems to be talking about the Right, religious and otherwise. But what about herself and her own politics? She rails against firearms, yet if people were truly good, she would have nothing to fear would she? She bangs her meaty fist upon her desk screaming at the camera about the need for social welfare. Yet if people were truly good, would we have need for such things? Ms. O’Donnell compares Christians to the Taliban and tells us that Christianity is if not evil, at least a danger to be carefully guarded against.

She openly derides those who seek limited government, and seeks to impose her leftist will upon us through government. She campaigns for the erosion of freedoms that could be used to cause harm and demands that government force us to be charitable.

Rosie and her ilk have no faith in the goodness of people or they wouldn’t campaign so hard to limit our freedoms and coerce us into making the social choices they want us to make. They have no respect for opposing viewpoints or they wouldn’t work so hard to silence voices like mine. Or, at best, compel us to act as they would wish through the use of government fiat, making us unwilling cogs in their machine.

What is it they fear? The evil that lies in the hearts of men. The pettiness. The greed. Just as everyone else does. This is why they fight tirelessly to control how we behave. They fear that a morally neutral tool would inevitably be used against them. They see the freedom of others as innately threatening. They fear that left alone, we would let others starve as we pad our own pockets. They fear that we have no capacity for goodwill toward others. If they do not fear such things, why do they work so hard to legislate them?

What is it they have faith in? It’s clearly not the people, or they wouldn’t try so hard to direct our every move. Yet, feeling as they do about our capacity for evil, they willingly give power to government to control us. They find little to be apprehensive about in this granting of enormous power because it will be ‘used for good’.

And yet when non-leftists are in control they briefly don the anti-establishment cloak that never leaves the shoulders of liberty-minded individuals, wearing for a time the mask of someone who sees the implicit danger of concentrated power. Faith in big government by fellow leftists, but not in big government by those other than themselves. What is this but fear of others that believe differently from you. We are left to the inescapable conclusion that what the leftist elite have faith in is in their own ability to justly preside over others.

I choose neither faith nor fear, but simple rationality. People are neither good nor bad, but will act in either fashion as their own self-interest dictates. Unlike the leftists, I do not fear others to the point I wish to control them. But neither do I have faith in them to always act in a goodly manner. More importantly, whereas the leftist has faith in ‘the right people’ and their ability to rule over us, I have faith in no one to do so. I am not an elitist, believing I operate on a level of righteousness unparalleled by ‘the common people’. I have within me the same capacity for evil as they do. And so I wouldn’t trust myself with such power, nor anyone else of a like mind. I do not hold myself above others, as the leftist elite seems to.

We were talking about The 300 on the med school discussion board. Of course, a couple of the meatheads mentioned that we would’ve loved to be born in such a time. Which incited me to mention that the Velamas today are a far cry from our warrior past, namely engineers, doctors, and mid-level managers. Someone said that stereotyping isn’t ok, even if you’re stereotyping your own people. Which, umm prompted a response. Here it is.

Stereotyping isn’t bad. The human brain (all higher mammal brains really) is designed for the express purpose of pattern recognition and categorization. All a stereotype is is a generalization concerning a given category. Many of these generalizations have considerable statistical validity. NOT acknowledging a statistically valid stereotype is irrational. Creation of stereotypes is essential to any kind of job or task that involves dealing with variability in your subjects. Without stereotypes we would be paralyzed by uncertainty. We couldn’t make assumptions. We couldn’t move forward. Because you can never be 100% sure of anything.

Stereotyping only becomes wrong when you make the mistake of assuming that everyone within a category fits the stereotype. For instance, BMI works well at the population level. As a population, people with a BMI higher than 25 tend to be fatter, have a higher risk of heart disease, diabetes, etc. At an individual level, BMI fails to accurately predict such things. Use of BMI is a stereotype. The BMI in and of itself doesn’t measure anything medically valid. It just happens to correlate well to something that is (namely body fat percentage and metabolic indicators).

A public health researcher can say “Oklahoma’s average BMI is on the rise. This is bad because this means that our incidence of heart disease, diabetes, etc will also see a corresponding rise.” Valid. Yet it’s a stereotype.

Misuse of a stereotype would be what would happen when I went to the doctor while I was still an athlete. I had a BMI of over 30. I also had a 31″ waist size. The doctor still told me I needed to lose weight because my high BMI was a health risk. BMI as I said is a population level phenomenon. And as long as it is used as such, no problem. But you can have fat people with a BMI under 25 (I’ve seen many) and people with BMI’s over 40 without an ounce of fat on them.

Or here’s another example. You’re walking from the BSEB to your car the night before a test at 3am and you see a 210lb dark guy in a black hoody walking directly at you at a fast pace. Do you make the stereotype of assuming this guy might mean you ill? If you’re smart, you do. Because at 3 am in a bad neighborhood, there’s a high likelihood that such a guy has a high possibility of being a criminal. If on the other hand you say “That guy right there is a violent criminal”, then you’ve taken it too far.

Can’t wait to see the fuss I cause this time. I’m honestly surprised the discussion board hasn’t gotten me into serious trouble yet…

Last week, I saw a totally thugged out guy with the whole huge jacket, saggy pants, and silver chains thing going on walking around my neighborhood. I thought to myself “that dude doesn’t belong here. He’s probably up to something.” I parked my car in the garage and left the family beater outside instead. And sure enough around midnight that guy and his buddies broke into several cars on our street. I live in an upper-middle class white neighborhood. And I do mean white. We are one of two minority families in the entire square mile.

I’m stereotyped the same way that guy is all the time. Back in London, after midnight people would cross the road to the other sidewalk when I was walking by. It doesn’t really bother me. Heck, I take advantage of it and am probably safer for it.

It really befuddles me that the self-proclaimed ‘Defenders of Science’ ™ are unable to understand basic logic and statistics. That they tell us we shouldn’t use the most basic element of animal intelligence when we deal with day to day life.

But what’s even weirder than that is that they go ahead and make racial stereotypes themselves with affirmative action.

It was a point I made to the new President of Cornell back in 2003. Lehman was notorious for the affirmative action supreme court case and I decided to bust his balls a bit when he had an open mic q&a situation on the quad. So I asked him why he’s such an ardent supporter of affirmative action when using income instead of race would be far more valid. I asked him how he could look at a black applicant and assume that their parents were low income and uneducated, then turn around and look at a white applicant and assume that they were privileged.

I have rarely been more popular with white people than I was that day.

Yeah, limited blogging until at least the end of this week. Possibly forever. *shrug*

Anyway, I heard an Orlando Magic fan had his season ticket revoked because he called Dikembe Mitumbo a monkey. Apparently that’s racist. I’ve had a lot of racial slurs thrown at me over the years, including pretty much everything you could call a muslim or a black person (which is funny, because I’m neither), but I’d never even heard of monkey being used as a racial epithet.

In fact, my nickname all through highschool and college was monkey. This might be because I’m an extremely gangly bastard and can touch my knees without bending over.

I’m not much of a sports fan, but one thing I know about Mitumbo is that he’s pretty much known for one thing: blocked shots. He’s not a bad rebounder either. Blocking shots and rebounding are two of the only basketball skills I’m mediocre instead of miserable at. One thing we have in common is being gangly bastards. It’s conceivable that he was called ‘monkey’ because of that.

Why I mention this is because it’s an example of how special protection laws erode the basic liberties we hold so dear. Whether it’s muslims in europe or minorities and gays here the end result is a limitation of the 1st amendment. Which I find rather strange given that it seems to be the only one leftists–the ones often behind such legislation–seem to remember exists.

This fan of an opposing team hurled an insult at a particular player. To my understanding, this is a regular occurrence. I would suspect that very few of us think insults should be illegal. Is calling someone a monkey somehow worse than calling him a loser or a moron? What if this fan had called Dirk Nowitski (also gangly) a monkey? Would he have been in the wrong then? No?

Strange. So insulting a white guy by calling him a monkey ain’t a big deal, but insulting a black guy by calling him one is? Seems odd to me. The black guy wasn’t hurt, his reputation wasn’t tarnished. I fail to see a crime. And even if there was one, how was it worse than if the player had been white?

Furthermore, they’ve managed to give this word a power it didn’t have before they made such a fuss. They’ve managed to turn a simple allusion, a simple comparison, into something hurtful. I wonder how many people like me would never have even thought monkey was racist before they heard the term.

I’m not a fan of special protection laws (such as ’sexual harassment’ or ‘age discrimination’ laws) as they take all objectivity out of the equation. It’s no longer important what actually happened but rather how someone interpreted it. Calling Nick a monkey wasn’t racist, because Nick didn’t interpret it that way. Calling Mitumbo one was, because he did. I realize moral relativism is ascendant in the children in adult bodies who are quickly claiming this world as its own, but is it really so hard to see the untenability in a justice system where the definition of crime is so capricious?

So. This is an ugly time in our Nation’s history. Far uglier than the Civil War and Reconstruction. Much worse than the Depression–although the seeds of today were planted by FDR, his four freedoms, and even moreso his massive ego.

Claire Wolfe puts it succinctly in the opening lines of 101 Things To Do ’til The Revolution when she says:

“America is at that awkward stage. It’s too late to work within the system, but too early to shoot the bastards.”

That is exactly the situation we’re in. At this point it is all but impossible for one to vote for a party that supports the essential American ideal of liberty. The Libertarians who perhaps come closest still fail to acknowledge the basic pragmatism espoused by the founding fathers and which common sense when applied to classical liberal theory would suggest.

A vote for the Democrats is the same as a vote for Old Europe. Also known as the road to serfdom, socialist collapse, and totalitarianism. To vote for the Republicans is to vote for a strange combination of plutocracy, social authoritarianism, and a brand of big government all their own. Democrats fail to understand that if it requires coercion to maintain, then it can’t really be freedom. They also strangely see no problem with giving Government control of our economic lives, all the while whining about the problems faced by those without it. Republicans are unable to separate their personal moral views from their political stances. And neither party is able to understand the difference between political and economic capitalism.

Both parties are broken. The left irretrievably so seeing as the very definitions of important words like ‘freedom’ and ‘rights’ they operate under are flawed. Castles in the sand and all that. Democrats’ minds inhabit a world in which physics, biology, and basic mathematics do not obey the rules of the physical universe. They live in a world where ’socialism is a good idea in theory’. Despite the fact that it’s at the theoretic level that socialism is most flawed, failing to take into account the basic self interest inherent in all animals.

Republicans? I’d give them slightly better odds but not much better. This might be a personal bias though. Like most minarchists I’m more sympathetic to conservatism than neosocialism since although we push for legalization of many things conservatives stand staunchly against, many or most of us willingly choose not to partake in such activities. Firmly wedded to personal responsibility as we are, the liberties of excess are not objectives we are likely to pursue.

So what do we do with one of the few tools left to us? Our vote? Well, we’ve all heard the basic arguments, which basically boil down to two:

1) The Republicans are still better than the Democrats, so we should vote for them.

2) The Republicans need to be sent a message so we should…

2a. Vote Libertarian
2b. Vote Democrat

3) The political machine is completely broken so we should refuse to vote at all.

4) Give the Democrats some power so they can hang themselves with their own rope.

I think Michael Savage has taken option 3 (if you can overlook his egotism, he’s actually fun to listen to). Boortz has rejected option 1, but I don’t know if he’s committed to anything else.
Personally I’ll be using option 2a and 3 depending on availability and palatability.

Just a couple days ago I reminded people that this is not an either/or proposition. And that’s what we need to keep in mind. This isn’t about choosing between Republicans and Democrats but architecting the birth of a new party or three. About changing things from the top to the bottom. Perhaps the new parties will keep the old names, perhaps they won’t. The fact that the Democrats can call themselves the ‘Party of Jefferson’ proves that names are as ephemeral and irrelevant as can be imagined.

Not everyone will choose the same option. Not everyone should choose the same option. I will say that Option 4 is just plain stupid. The thing about government power is that once granted it is almost impossible to revoke. Bush, like the past 70 years of presidents, is operating under the ‘emergency powers’ that FDR bequeathed upon himself. His Rural Electrification Administration is still in operation. Which is strange. I’ve lived in West Texas, Oklahoma, North Dakota, and rural New York state, and have never had a problem with access to electricity. It’s just possible that that particular branch of government has outlived its always dubious usefulness.

Choosing Option 4 in other words is to accept that revolution–a true revolution–will be the only recourse. Whether it could be avoided in any case is doubtful. Still, as a young man who hopes to raise children as soon as he finds a worthy vessel, I’d like to at least try for a peaceful solution.

The other options boil down to a combination of geography, the individual candidate, and personal principle. I refuse to vote for a Republican. I can do this because I live in what was the Reddest state in the union back in the 2004 election. I’m also lucky enough to call Porkbusting Senator Tom Coburn my own. I get to have my cake and eat it too. Were I to live in a borderline state like Ohio or Wisconsin, my personal convictions might have some negative side effects.

My vote isn’t meaningless, but it is futile. Even if the libertarian party presented me a candidate who’s head wasn’t in the clouds, a candidate with a strong and popular following, some Republican who displayed ‘Christian Family Values’ would still win. But like I said, my vote isn’t meaningless. Voting for an LP official would send a message. 5% of the vote this cycle, 10% next cycle. It would remind the people at large that there could be a viable alternative. And it would remind the Republicans that they aren’t the only option for non-socialists. And there is a certain comfort in knowing that even though I’d be ‘throwing my vote away’, at least I wouldn’t be abetting a Democrat in gaining a seat.

In a similar way, the same goes for those living in California, New York, or any of the other neosocialist bastions. They similarly have little chance of changing the tides. They are free to vote for an alternative candidate with a clear conscience. And that is what they ought to be doing without a doubt.

Borderline states, it’s you who have the real dilemma. When elections hang on margins that measure in the low thousands, your vote does make a measurable difference. Not voting for a Republican could change the election. Then again, voting for a Republican doesn’t quite convey your disapproval of the GOP. And then there’s the danger of the message being interpreted wrongly. The GOP could always take your decision not to vote for them as a signal that they need to turn even farther left. All I can tell you is that just remember that Dems in power means yet more liberty all but irretrievably lost.

Maverick candidates offer the best of both worlds. Republican candidates who support the FairTax plan, are more socially liberal, or firmly stand against the growth in the Executive Branch are people we can give our full support to. Unfortunately they’re an all too rare breed.

Nope, I don’t have an all encompassing solution to this quagmire. And there is no one-size-fits-all voting strategy. Human power struggles are far too messy. Which is probably why the Founders sought to limit the power of government so much when they created the law of the land. Sadly, we forgot their lesson. And this is the mess we’ve inherited.

All I can hope for is that we tread carefully and prudently. Whether we merely prolong the seemingly inevitable or somehow manage to revive our ailing nation, either would be better than hastening its demise.

Ben Folds Five - Philosophy

Go ahead you can
Laugh all you want
I got my philosophy
Keeps my feet on the ground
And I trust it like the ground
And thats why my philosophy
It keeps me walking when Im falling down
I see that there is evil
And I know that there is good
And the inbetweens
I never understood
Wont you look at me
Im crazy
But I get the job done
Yeah Im crazy
But I get the job done

I find it hard to function without philosophy. Not that I always think things through on a metaphysical level before I do them. But that I can’t help but reflect upon the things I see and do in that way. It just kind of…happens.

“Just because,” the favorite explanation of everyone between the ages of 5 and 10–and seemingly the majority of adults–simply doesn’t work for me. “Because [authority figure] said so” is scarcely any more satisfying. “It shouldn’t have to be that way,” a favorite justification of the left (and you thought I couldn’t bring politics into this), is similarly without value unless it’s explained why.

I’m often half-jokingly asked if I was a philosophy major. Which is flattering because believe me this ego loves to be stroked. But it’s also disheartening. I’m saddened that in the circles I run in, people find the depth to which I take politics, science, even hobbies to be something unique. I don’t want it to be unique. I don’t want to be singled out for it. I’d much rather it be the initiation or the continuation of an ongoing friendly debate. Something that’s as much take as give.

For me, I’m nothing without philosophy. It’s what helps me stand alone. It’s how I know I’m my own man, not beholden to the indoctrination of culture, peers, ancestors, or society. Because under the layers, under everything those outside see, is a core I know to be my own. Take away the clothing, the degrees, the resume. Forget about the way people describe you, from those who’ve just met you to those who’ve known you for years. Take away the words of others who taught you what to do and how to do it. What’s left?

Sadly, it would seem that the answer is at best that most people simply don’t care what makes them tick.

Perhaps it’s because I romanticize, well, the romantic period, the enlightenment, and the renaissance. Perhaps it’s because for all my cynicism and anger, I’m really an optimist when it comes to the capabilities of humanity. Couldn’t say. I just think that people are capable of understanding themselves and the world to a much greater degree than they ever try to. And when they do put in that effort, not only do they grow larger in the making, but so does the