Cantrell will find that there are quite a few posters in this
newsgroup who believe BOTH (1) that *most* New Age,
"alternative," etc., views of medicine are ignorance rampant, and
(2) that only the individuals concerned have adequate knowledge
of their values and assessment of risk to choose among medical
treatments.  I believe that the ethical physician informs, and
lets the patient choose.  I believe that the FDA and other
regulatory agencies go too far in forbidding, and move too slowly
in approving.

But understand how we have come to this situation.  People's
lives have been destroyed by experimental medical choices made in
the context of partial knowledge.  Protecting people from this
simultaneously limits their choices.  Expanding their choices
INEVITABLY leads to occassional catastrophe.  Risk, taken enough
times, WILL present its tragedies.

Russell
--
 Signature quotes are not just to show a famous person's agreement with one
 of the poster's opinions.  They can be a wise, joyful, sarcastic, humorous,
 or salacious idea well expressed, or a good (or evil) sentiment from an
 unexpected source.  Anything that entertains or edifies.  Give it a try.

As I pointed out before, studies can be expensive to carry out. And
some studies can take *decades* to carry out. Science may eventually
find all the answers; however I want to live healthily now.

This response does not address my main point:  namely, doctors do not
deserve to have a monopoly on most forms of medical treatment.

Donald Cantrell

As for the above, you are confusing random variation with bias.
What you had been talking about earlier was bias, and you cannot
form 95% confidence intervals around it.

As it happens, as Herman Rubin delights in pointing out, if the
null hypothesis is that substance x has "no effect", you can
generally be 100% certain that the null hypothesis is false, since
to some infinitesmally tiny degree everything can be expected to have
some effect.  But this is meaningless in the clinical realm where
not only do we like to have a measurable effect, but we also like
to know whether the effect is positive or negative.
--
David Rind

One reason its hard to grasp is because it is so rare that it ever
occurs. I can assure you, your keen physiological insight and self
diagnostic abilities represent a distinct minority.

Otherwise, you are absolutely correct in that medicine is not a science.
It is an art, or perhaps even a trade, that uses some scientific
principles, tools, and techniques.

H McCollister, MD
<http://uslink.net/~clmc/>

There is a wealth of objective information about the benefits of
weight loss, you can find it on MEDLINE or via the NIH.  

The best evidence comes from results from bariatric surgery, which
IMO provides the only long-term solution to people who basically
have an inbuilt desire to eat more energy than their body needs.  

Lower miscarriage rates, normalisation of {*filter*} pressure, improved
diabetes mellitus, lower rates of coronary heart disease, and
many, many others, but perhaps most importantly, better
performance indices on quality of life measures.

It's all there and well documented.

--

Mike Larvin
Leeds, England

There is absolutely no proof that permanent weight loss is even possible
in a healthy way for most fat people.

Remember, I am not talking about someone weighting 10 pounds over the
'accepted' weight range. I am talking about people 50 pounds or more over
this range.

I do not consider surgery acceptable.

Even very fat people have only about 5 years less to live (on average).  
(Norway study).

Both twin and adoption studies show that weight (or more accurately BMI)
is largely genetically influenced.

Many of the benefits of weight loss are based on the benefits of exercise and
healthy eating.

Comments, please?

Elly Jeurissen

Health and weight

I cannot comment on all these, but did you know that the Dutch Heart
Society just publish a report in which they mention several studies that show
increased risk of dieing of cardiovascular disease, and only one where this
risk was decreased, all with weight LOSS.

Elly Jeurissen

Health and weight

There are hordes of scientifically oriented clinical researchers
who back up your MD who you, and him/her possibly, cannot be aware
of right now.  Someone figured out Lithium many years ago for your
condition, but it took a "lousy" clinical trial or two to convince
the FDA/CSM(UK) to license actual use of this scientific advance.

Keep an open mind, tempered with scepticism.  A good science
trained MD will too.

--

Mike Larvin
Leeds, England

Medicine also has a volatile knowledge base.  Some theories are taught
as facts which later are proven false.  When new knowledge becomes
available and it contradicts the beliefs of older doctors who have
been pedantic and authoritarian they are forced to reevaluate their
practice of a lifetime.  Most people will not admit to being wrong all
their life, instead they "honour their profession" by being silent.

The knowledge taught by the profession is far from uniform.  When they
teach their applied, statistically based knowledge with considerable
false knowledge they also indoctrinate people into a belief system
that preserves a profession.  When people learn medicine from the
previous generation of doctors who lived in socially different times
you produce doctors with an attitude.  The "facts" taught are
frequently false by the time they graduate.

One doctor said that he worked in the auto industry before becoming a
doctor.  I am interested in whether he has a belief conflicts with
other doctors about the essential character of labour workers or
labour unions.

          CALL NUMBER: R/723/D57/1985 BMED
                TITLE: Dissent in medicine : nine doctors speak out / the New
                           Medical Foundation. --
            PUBLISHED: Chicago : Contemporary Books, c1985.

          CALL NUMBER: R/727/.3/P73 BMED
               AUTHOR: Preston, Thomas A., 1933-
                TITLE: The clay pedestal : a re-examination of the
                           doctor-patient relationship / Thomas Preston. --
            PUBLISHED: Seattle : Madrona Publishers, 1981.

Doctors choose to see all the suffering, horror and death in return
they demand the gratitude of their patients.  Doctors are part of a
powerful professional organization - more powerful than any labour
union - and lobby governments.  Now look at the patients in a doctors
care.  What happens when things go wrong, when mistakes are made.
Medicine's code of "ethics" has a conflict of interests.  Doctors are
told to "Honour their profession" and remain silent.  The patient has
little power.

A doctor and his patient see a red leafed tree in spring.  The patient
naively says "the tree is red".  The doctor says with authority "the
tree is green" and I can prove it!  Since more trees are green in the
spring the doctor is right most of the time.  The patient
unfortunately is left knowing the doctor is wrong but being powerless
as a patient to do anything about it.  Imagine a patient's self
awareness and self knowledge being contradicted by a doctors medical
training.  When the doctor later is found to be wrong the patient if
he is still around will find no allies to improve the resulting lost
quality of life.  Doctors who do handle exceptions are practicing non
standard medicine and lay themselves open to lawsuits and professional
sanctions.

So doctors are motivated not to handle exceptions.  High functioning
individuals are asked questions that are also culturally biased and
may be inappropriate.  Nevetheless decisions are made on this basis
and doctors hang together (honour their profession) when exceptions
occur.

Health care is driven by economics.  Economists know the economy does
not optimize the quality of life of a population.  This syllogism's
conclusion is obvious.

The direction of research is very political.  Why is North American
research taking a different direction to that in other parts of the
world?  Why is peer reviewed research from other parts of the globe
sneered at?

Expressions like auto-immune rather than environmentally triggered are
political.  A condition is called idiopathic often out of an inertia
that the profession has to accept an obvious causal link.

I have an axe to grind but it is very sharp.

Enough for now,

Craig

--

Unfortunately, Steve, alt.med will look pretty good by some outcomes
research criteria (patient satisfaction, quality of life, costs) for
many of the "walking well" ills that conventional docs do so badly
with and spend so much money to work up.

Some form of alt.med (which?  whose? how do we decide?) may very
well be the treatment of choice for SWOF (symptoms without findings)
patients.  We'll never know if the {*filter*} won't do any research . . .

--
nimno, Nimnos, NIMNOD

Science as we know it is based on population studies with the populations
numbering in the trillions (10 to the ninth) or greater. Anybody care to
remember what Avagadro's number is? With statistical samples that large, a
chemist can predict with accuracy what reaction will happen for a given
set of circumstances.

How many bacteria or viri exist in a vial of solution? A microbiologist
can formulate a hypothesis about what these organisms will do if the
enviroment is changed.

How many people have lived since the dawn of recorded history? Since the
Geneva Accords and the Nuremberg Trials have essentially removed the
civilized capacity to test human beings to destruction (Praise Be!), we
can not subject a human being to the same stringent test that we do a
bacterium when we are testing a new compound (eg root hog, or die!).

Therefore, Anthropology, Psychology, Medicine, and Sociology are all based
on limited studies (rarely more than a few thousand), which can include
substantial biases- statistical and otherwise.

The art comes in under the Appreticeship program that we use to pass on
our collective wisdom to our younger colleagues, where we hopefully have
someone to notice our errors of omission, commission and memory lapse.

  "We must All hang together, else we most assuradly will Hang separately"
               Benjamin Franklin, 1776
Charles S. Krin, DO FAAFP  

Re fat and health.  I have never seen any *controlled* evidence
that fat is, in and of itself, a health problem.  It can be
a symptom of an underlying health problem such as insulin
resistance, familial combined hyperlipidemia, or polycystic
ovaries, or hypothyroidism.  Saying that fat is the problem
in hypothyroidism is like saying that weight loss causes AIDS
instead of the reverse.

There may very well be direct health problems associated with
high body fat--maybe someone will do some controlled studies
someday.

I posted the following offer on soc.support.fat-acceptance
a while back.  It still stands, if anyone cares to respond.

-----------------------------------------------------------------
I am paying $25 per article for original articles about con-
trolled studies which demonstrate a causative link between any
health problem and fat.  ALL of the following conditions MUST be
met!  You must point out in a concurrently submitted written
document exactly how the research meets each condition.

1. Xeroxed copies of articles on original research only.  No re-
view articles, literature citations, newspaper or magazine articles, or other secondary references. Read the experimental protocol descriptions carefully!

2. Weight must actually be physically measured at intervals throughout the study.  The 27 year follow-up of Harvard alumni indicating significantly greater risk of heart disease among heavier men has been widely cited recently, but none of the secondary cita-tions have mentioned that weights were determined
by calling people up on the phone and asking them how much they weighed.  NOT ACCEPTABLE!

3. Body composition and changes thereto must be recorded, i.e.
the proportion of fat to lean body weight.  A tendency toward
high {*filter*} pressure, for instance, correlates more strongly with high lean body weight than with high body fat levels. ("The
weight/{*filter*} pressure association is due to components of body
mass other than body fat."  Stallones et al., Hypertension Vol
4, p483-386, 1982)  Lean body mass rather than fat also correl-
ates with {*filter*} cancer in some studies (DeWaard, Cancer Res-
earch Vol 35, p 3351-3356, 1975 and MacMahon, Cancer Research
Vol 35, p 3357-3358, 1975)  The point here is that you must
demonstrate that having high levels of fat tissue is the
problem.

4. In studies  purportedly linking increased weight with ill health, weight must be shown to be an INDEPENDENT variable, i.e. multivariate analysis of factors including family history of the medical condition, total cholesterol and HDL levels, {*filter*} pressure, etc. must be performed.

5. Conditions attributed to fat must be clearly distinguished
from conditions related to loss and regain of weight.  The lat-
ter is known to be associated with cardiovascular problems traditionally associated with fat.

6. Social variables distinguishing fat people from those of
average weight must be either specifically controlled for or acknowledged as sources of potential bias.  These include:

   a)Income differential.  Women in the heaviest 2% of the          population earn $6,700 a year less than women of average weight. Low income is itself a risk factor for poor health and earlier death.

   b)Lack of access to medical care.  Being fat commonly results
in ineligibility for health insurance.  When insurance is avail-able, prejudice on the part of medical practitioners keeps fat people from seeking needed medical treatment.

   c)Dangerous weight loss methods.  Use of amphetamines, taking thyroid hormone when no thyroid deficiency is present and overuse of diuretics are weight loss methods which also happen to be
linked to heart failure.  So is the loss and regain of large amounts of weight.

   d)Social isolation is more likely to be to case for fat people, and it is an independent risk factor for heart disease.

   e)Comparative lack of exercise.  The fact that feasible long term exercise programs typically make fat people weigh less with-out making them acceptably thin is a major disincentive for persisting with such programs.  Random abuse by total strangers
for exercising in public is also a discouragement not faced by people of average weight. (The gutsy Aztec pyramid climbers and
century riders posting to this list are, unfortunately, excep-
tions to this rule.  More typical is the office manager where
I work. Since our company health club offers prizes for those
who enroll new members, I have several times tried to get her to
join.  No dice--she says she'll join when I can guarantee that
there won't be any other people there when she works out.  She
is about my size.)

7. Articles claiming improvement in health conditions with weight loss must have controls that specifically exclude the DIRECT effects of exercise, long term nutritional improvements such as lowered dietary fat and more vegetables, and short term calorie restriction.  For instance, the fact that heart disease risk factors are ameliorated by exercise, which also commonly results
in some weight loss, does not establish that weight loss is the cause of the improvements.  Analogously, the fact that chemo-therapy often results in both hair loss and cancer remission does not demonstrate that shaving your head is a cancer cure.  

Health improvement variables and weight changes must be monitored often enough to establish that weight loss PRECEDES the specific improvement studied.  [Hint:  The most common health improvements attributed to weight loss are lowered {*filter*} pressure and improved {*filter*} sugar regulation.  It has already been established that a)  some people gain the benefits without losing weight and b) among people who do lose weight calorie restriction causes direct
(though short term) improvements in {*filter*} pressure and {*filter*}
sugar regulation BEFORE changes in body composition occur.]

To restate:  there are two possible models for the correlation of
weight loss with improved health.

A.  Changes in diet -->weight loss-->improved {*filter*} pressure,
    Changes in exercise              glucose tolerance, etc.

B.                        |--->weight loss
    Changes in diet       |
    Changes in exercise   |--->improved {*filter*} pressure, glucose
                               tolerance, etc.

Experimental controls MUST establish that Model A is the case.      

8. Psychological and other fuzzy non-quantifiable benefits don't count.  Recommending weight loss as a remedy for psychological abuse is like recommending that Asians have their eyes surgically altered, or that Africans straighten their hair and lighten their skin.

9. Factors affecting athletic performance don't count.  I am looking for information about general health benefits rather than improvement in highly specialized sports activities.  (A body fat level appropriate for a gymnast is not at all useful to a long distance swimmer.)

Send articles plus a postage stamp for reply (REQUIRED) to

Martha Koester
P.O. Box 47111
Seattle, WA  98146

Be patient.  My mail tends to pile up.  Hint:  the nurse study
fails conditions 2, 3, 4 and 6.  Don't send it.

--
Martha Koester         "Some mornings, it just isn't worth

                                      --Emo Phillips

If people knew the truth about hospitals (at least in America), they'd be
quite sobered about the institution of medicine.

No matter what the founding purpose of any institution, once established, the
primary goal becomes survival.  Status quo and the maintenance of an illusory
"elite" body of knowledge are the major tools of any professional organisation
in that struggle for survival.

Peace,
Dogman

Newsgroups: soc.support.fat-acceptance

Subject: Re: FIaFI & relative attention (was Re: FAT is a Feminist
Issue)

-----------------------------------------------------------------
I am paying $25 per article for original articles about con-
trolled studies which demonstrate a causative link between any
health problem and fat.  ALL of the following conditions MUST be
met!  You must point out in a concurrently submitted written
document exactly how the research meets each condition.

1. Xeroxed copies of articles on original research only.  No re-
view articles, literature citations, newspaper or magazine articles,
or other secondary references. Read the experimental protocol
descriptions carefully!

2. Weight must actually be physically measured at intervals throughout
the study.  The 27 year follow-up of Harvard alumni indicating
significantly greater risk of heart disease among heavier men has been
widely cited recently, but none of the secondary cita-tions have
mentioned that weights were determined
by calling people up on the phone and asking them how much they
weighed.  NOT ACCEPTABLE!

3. Body composition and changes thereto must be recorded, i.e.
the proportion of fat to lean body weight.  A tendency toward
high {*filter*} pressure, for instance, correlates more strongly with high
lean body weight than with high body fat levels. ("The
weight/{*filter*} pressure association is due to components of body
mass other than body fat."  Stallones et al., Hypertension Vol
4, p483-386, 1982)  Lean body mass rather than fat also correl-
ates with {*filter*} cancer in some studies (DeWaard, Cancer Res-
earch Vol 35, p 3351-3356, 1975 and MacMahon, Cancer Research
Vol 35, p 3357-3358, 1975)  The point here is that you must
demonstrate that having high levels of fat tissue is the
problem.

4. In studies  purportedly linking increased weight with ill health,
weight must be shown to be an INDEPENDENT variable, i.e. multivariate
analysis of factors including family history of the medical condition,
total cholesterol and HDL levels, {*filter*} pressure, etc. must be
performed.

5. Conditions attributed to fat must be clearly distinguished
from conditions related to loss and regain of weight.  The lat-
ter is known to be associated with cardiovascular problems
traditionally associated with fat.

6. Social variables distinguishing fat people from those of
average weight must be either specifically controlled for or
acknowledged as sources of potential bias.  These include:

   a)Income differential.  Women in the heaviest 2% of the
population earn $6,700 a year less than women of average weight. Low
income is itself a risk factor for poor health and earlier death.

   b)Lack of access to medical care.  Being fat commonly results
in ineligibility for health insurance.  When insurance is avail-able,
prejudice on the part of medical practitioners keeps fat people from
seeking needed medical treatment.

   c)Dangerous weight loss methods.  Use of amphetamines, taking
thyroid hormone when no thyroid deficiency is present and overuse of
diuretics are weight loss methods which also happen to be
linked to heart failure.  So is the loss and regain of large amounts
of weight.

   d)Social isolation is more likely to be to case for fat people, and
it is an independent risk factor for heart disease.

   e)Comparative lack of exercise.  The fact that feasible long term
exercise programs typically make fat people weigh less with-out making
them acceptably thin is a major disincentive for persisting with such
programs.  Random abuse by total strangers
for exercising in public is also a discouragement not faced by people
of average weight. (The gutsy Aztec pyramid climbers and
century riders posting to this list are, unfortunately, excep-
tions to this rule.  More typical is the office manager where
I work. Since our company health club offers prizes for those
who enroll new members, I have several times tried to get her to
join.  No dice--she says she'll join when I can guarantee that
there won't be any other people there when she works out.  She
is about my size.)

7. Articles claiming improvement in health conditions with weight loss
must have controls that specifically exclude the DIRECT effects of
exercise, long term nutritional improvements such as lowered dietary
fat and more vegetables, and short term calorie restriction.  For
instance, the fact that heart disease risk factors are ameliorated by
exercise, which also commonly results
in some weight loss, does not establish that weight loss is the cause
of the improvements.  Analogously, the fact that chemo-therapy often
results in both hair loss and cancer remission does not demonstrate
that shaving your head is a cancer cure.  

Health improvement variables and weight changes must be monitored
often enough to establish that weight loss PRECEDES the specific
improvement studied.  [Hint:  The most common health improvements
attributed to weight loss are lowered {*filter*} pressure and improved
{*filter*} sugar regulation.  It has already been established that a)  some
people gain the benefits without losing weight and b) among people who
do lose weight calorie restriction causes direct
(though short term) improvements in {*filter*} pressure and {*filter*}
sugar regulation BEFORE changes in body composition occur.]

To restate:  there are two possible models for the correlation of
weight loss with improved health.

A.  Changes in diet -->weight loss-->improved {*filter*} pressure,
    Changes in exercise              glucose tolerance, etc.

B.                        |--->weight loss
    Changes in diet       |
    Changes in exercise   |--->improved {*filter*} pressure, glucose
                               tolerance, etc.

Experimental controls MUST establish that Model A is the case.      

8. Psychological and other fuzzy non-quantifiable benefits don't
count.  Recommending weight loss as a remedy for psychological abuse
is like recommending that Asians have their eyes surgically altered,
or that Africans straighten their hair and lighten their skin.

9. Factors affecting athletic performance don't count.  I am looking
for information about general health benefits rather than improvement
in highly specialized sports activities.  (A body fat level
appropriate for a gymnast is not at all useful to a long distance
swimmer.)

Send articles plus a postage stamp for reply (REQUIRED) to

Martha Koester
P.O. Box 47111
Seattle, WA  98146

Be patient.  My mail tends to pile up.  Hint:  the nurse study
fails conditions 2, 3, 4 and 6.  Don't send it.

--
Martha Koester         "Some mornings, it just isn't worth

--

Obesity is clearly a risk factor for diabetes and hypercholesterolemia
which in turn are risk factors for coronary artery disease and strokes.
If you want to claim that this does not mean that obesity itself is
responsible for increased numbers of heart attacks and strokes because
it acts through something else (diabetes for instance) then I think
this is a somewhat intellectually disingenuous position.  This has
nothing to do with obesity rarely being a symptom of some other
underlying condition that has associated health problems.

I drive at high speeds in a small car.  No one has done a randomized
controlled trial proving that my risk of death would be lower if I
drove slower in a big car.  That doesn't mean I go around trying to
convince people that it is perfectly safe for me to drive the way I
do citing "lack of evidence."  We make choices and take chances.
Obesity increases the chances for various health problems.

--
David Rind

: Obesity is clearly a risk factor for diabetes and hypercholesterolemia
: which in turn are risk factors for coronary artery disease and strokes.

But it is not clear whether the obesity causes the insulin resistance of
Type II diabetes, or whether the insulin resistance causes the obesity.
Or whether they operate in some kind of vicious circle initiated by the
presence of abundant cooking.net">food resources. But at any rate, Type II diabetes is
genetic, and thus, not CAUSED by obesity, although obesity certainly DOES
exacerbate it. So people without the genes for it can get as fat as they
please, and they will not develop it. Obesity is a risk factor ONLY in
those people who are genetically predisposed.

And hypercholesterolemia also seems to be related to obesity only in
genetically susceptible people -- there are certainly fat people with
normal cholesterol and thin people with high cholesterol. So there must
be something else going on there, too.

I think this is what Martha is trying to say -- correct me if I'm wrong.

Sincerely

._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c-

Natalie A. Sera, with all her ducks in a row!!!!  
Proud mother of Josh, age 22                      

._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._(` ._c- ._c- ._c- ._c- ._c-

                                         Can YOU find the Ugly Duckling?