Why is Health Advice Only Puritanical?

[Marat]

When the government gives health advice to its citizens, you would expect that that advice would be purely scientific and objective. But in fact it is not, and instead, citizens are advised only to do those things to benefit their health which will also force them to curtail their spontaneous pleasures. So all scientific health advice has to pass through a filter of Puritanism before it reaches the public.

 

One example is that a large body of data now demonstrates that cigarette smoking powerfully protects people against Alzheimer's Disease. If government health information were objective rather than Puritanical, every cigarette packet would display the notice that tobacco use can cause cancer and cardiovascular disease, which is true, and also that it has the benefit of protecting people against Alzheimer's Disease, which is also true.

 

Another example is that people who are underweight have a life expectancy which is just as much shortened as the life expectancy of people who are overweight. So a purely scientific government health service would advise us to pig out on food if we are underweight, but you never hear that message, since people naturally enjoy eating, but instead all you hear is the Puritanical message that people must lose weight.

[Cap'n Refsmmat]

One example is that a large body of data now demonstrates that cigarette smoking powerfully protects people against Alzheimer's Disease. If government health information were objective rather than Puritanical, every cigarette packet would display the notice that tobacco use can cause cancer and cardiovascular disease, which is true, and also that it has the benefit of protecting people against Alzheimer's Disease, which is also true.

Does that benefit outweigh the probability that you'll die of lung cancer long before you get Alzheimer's?

 

Another example is that people who are underweight have a life expectancy which is just as much shortened as the life expectancy of people who are overweight. So a purely scientific government health service would advise us to pig out on food if we are underweight, but you never hear that message, since people naturally enjoy eating, but instead all you hear is the Puritanical message that people must lose weight.

Probably because we have a much larger problem with obesity than with underweight people. There's a big anti-anorexia campaign too, of course. It's just targeted to younger people.

[Marat]

While overweight may be a more significant population problem than underweight, why not at least inform people about both problems? If cigarette smoking prevents Alzheimer's Disease, why not at least tell people about it along with the information about the harm of cigarette smoking, so they can make their own cost-benefit analysis. Perhaps someone comes from a family where Alzheimer's Disease is much more rampant at an earlier age than cardiovascular disease or cancer, so it would make sense for them at least to know their options. Interestingly, although you constantly hear on the news now all the panic bulletins about childhood obesity leading inevitably to an increase in type 2 diabetes, the NHANES study failed to find any connection.

 

I wonder if all these moral panics about self-indulgence leading inevitably to health problems are like the old myth that masturbation will make you impotent, blind, and cause hair to grow on the palms of your hands? The prude or the Puritan seeks support for his repressive beliefs in objectivity, since he knows he cannot convince people to imprison themselves by just communicating to them his own terror of pleasure.

[CharonY]

In addition to what Cap mentioned: The link between Alzheimer's and smoking is not as clear as the OP suggests. There were a number of (epi-)studies in the 90s that indeed there may be an inverse relationship between smoking and Alzheimer onset. However meta-analyses of larger data set later on indicated the reverse. If experts are not able to satisfactory extract a mechanistic dependence, how is the layman suppose to make an informed choice? (Hey, maybe I should let the kids inhale more smoke to prevent Alzheimer's).

 

 

You can add alcohol to the mix. Small amounts of red wine are supposed to have antioxidant properties and may have a bit of a benefit. However, these benefits may be offset by the alcohol consumed at the same time and large amount of alcohol consumption are definitely unhealthy.

 

Finally, how about the suggestion to eat more fruit. Is that puritan? Incidentally I love fruit.

[Ophiolite]

If cigarette smoking prevents Alzheimer's Disease, why not at least tell people about it along with the information about the harm of cigarette smoking, so they can make their own cost-benefit analysis.

Perhaps because the government fully understands that smokers would instantly use this as an excuse to continue smoking, rather than trying to discontinue.

 

The average citizen does not do cost benefit analyses. If they did they would not have elected the governments they elect.

[CharonY]

Good point. Also most people are really bad at it. Otherwise people wouldn't have to think too hard about wearing seat belts. Actually the tobacco example is a perfect example for that.

 

It compares the very uncertain decreased risk of Alzheimer's to the well-known effect of cardiovascular diseases (major outcome of smoking) and cancer.

 

Even if we concentrate only on the cancer rates (and the impact on cardiovascular health is even higher) roughly five times of people die of lung cancer per year compared to Alzheimer's (also disregarding the high false positive detection of Alzheimer, as it is often confused with other forms of dementia).

 

Adding that together the potential benefits are vanishing. However, presenting both as viable alternatives will skew the perception.

 

It is kind of like suggesting throwing kids down stairs as the repeated bruising could strengthen bone and muscles. Also learning how to fall correctly will benefit them later on. One should make an informed decision based on that info whether one would like to incorporate that into PE classes.

[Mr Skeptic]

You're pretty much right: people don't need to be told to do pleasant things, so for the most part they're told to do the unpleasant things. Same applies to government, parents, bosses, etc.

 

As for informing things of both positive and negative aspects of something, this sort of advice is mostly disregarded. People won't do a cost-benefit analysis, they will use any potential benefits as an excuse and disregard the drawbacks. And then there's the fact that when it comes to certain things like tobacco, research in that field can't really be trusted since tobacco companies have made a lot of it up. To do a proper cost-benefit analysis would require people to sum up all the probabilities that the effects are in fact correct, the degree to which the effect occurs, and the probability that they would suffer/benefit from the effect, and do this without their personal preference biasing their judgment. Not many could do that.

 

Consider the above a cost-benefit of providing a more accurate versus a more unified suggestion.

[Marat]

In Canada there was a huge television advertising campaign a few years ago to discourage smoking by asserting that it causes men to develop erectile dysfunction. Well, it may have an extremely slight effect in that direction insofar as it promotes cardiovascular disease, but the main causes of impotence are diabetes and various forms of neuropathy, and cigarette smoking is nearly non-existent as an epidemiological factor for erectile dysfunction. Similarly unrealistic are the exaggered public warnings about the dangers of second-hand smoking, which generates what is in fact a minimal health risk, though it is an excellent scare tactic to make smoking mothers think they are significantly injuring their children by smoking.

 

Many 'health' warnings are just exercises in social control. Every society needs some sort of social glue, a shared value and belief system, to hold it together, and with the drastic decline of religious belief as the standard device to fill the role over the past thirty years, there has had to be a corresponding increase in social control systems people do believe in, such as maintaining a healthy lifestyle. So now some companies refuse promotion to employees who are overweight or who have high cholesterol, just as in 1890 they might have refused promotion to employees who were not 'good, church-going men.'

 

The new merging of morality and health is evident in the utterly unscientific pretense that health problems are avoidable if only we live a healthy lifestyle and devote our efforts to 'taking responsibility for our own health' by preventative rather than curative measures. But the diseases that really have a significant impact on morbidity and mortality -- half of all types of cancer, many cases of diabetes, all instances of lupus, other autoimmune conditions, cystic fibrosis, multiple sclerosis, muscular dystrophy, many cases of cerebral palsy, many cases of spina bifida, half of all cases of heart disease, and half of all cases of endstage nephropathy -- are not lifestyle diseases at all and are not preventable by any known means, but are genetically conditioned or caused by unknown environmental factors.

[CharonY]

I see goalposts moved a lot around here.

[Cap'n Refsmmat]

But the diseases that really have a significant impact on morbidity and mortality -- half of all types of cancer, many cases of diabetes, all instances of lupus, other autoimmune conditions, cystic fibrosis, multiple sclerosis, muscular dystrophy, many cases of cerebral palsy, many cases of spina bifida, half of all cases of heart disease, and half of all cases of endstage nephropathy -- are not lifestyle diseases at all and are not preventable by any known means, but are genetically conditioned or caused by unknown environmental factors.

 

The other half of heart disease cases -- the preventable half -- still makes up a huge portion of the deaths in Western societies, simply because heart disease is so prevalent.

 

But then, I thought you were arguing that the advice we receive is "puritanical" in nature, not that there's no need to give advice at all. Earlier you were arguing that being underweight is a significant problem.

[Marat]

I stated the more general part of my thesis after the more specific. That is, given the increasing overlap between morality and medicine as 'good health' is conscripted into the role once played by 'good religious observance,' it is only to be anticipated that much of the public health advice given will resonate with older moral values, which the new health police pick up and augment with the newer morality of 'taking control of your own health.' So broken pieces of the old value system, such as gluttony being a sin, sensuality being evil, laziness being sinful sloth, etc., are swept up into the new religion of fitness and health, with all disease being imagined to be necessarily preventable, so that only those who sinned against the idol of fitness are punished.

[Cap'n Refsmmat]

I dunno about sensuality being evil. Most of the health advice I see says that sex is important. Also, see the following article:

 

http://health.usnews.com/usnews/health/articles/070731/31dance.htm

[Marat]

I meant sensuality in its widest sense, so as to include the delight in smearing bread with butter, lying on the couch rather than exercising, and indulging a sweet tooth or a taste for salt. Because commercial interests now recognize that sex sells, even medicine cannot successfully adopt a Puritanical attitude toward sex any more. But in a less commercialized age it used to. For example, Kellog of the cereal fame originally developed products so anti-nutritious as to dull the sexual urge, and this was in the prudish standards of the time a selling point. Graham Crackers were orginally sold as part of a diet to control sexual desire in teenagers. The majority of medical students surveyed in America in 1959 thought that masturbation was harmful, and in this they were reflecting the merging of prudery and medical 'science' of the age.

[joshuam168]

One example is that a large body of data now demonstrates that cigarette smoking powerfully protects people against Alzheimer's Disease. If government health information were objective rather than Puritanical, every cigarette packet would display the notice that tobacco use can cause cancer and cardiovascular disease, which is true, and also that it has the benefit of protecting people against Alzheimer's Disease, which is also true.

Please share where this came from. As of now doctors cannot diagnose alzheimers without a brain tissue analysis, which would cause death. So this analysis is done only after death. Meaning that alzheimers cannot be diagnosed before death. They now use the term dementia for diagnoses that would have previously been called alzheimers. So cigarettes cannot help with alzheimers, since you must be dead to be properly diagnose with alzheimers;) Though that is semantics lol.

Cigarettes are used in mental health facilities, as they can help control symptoms of mental health, not cure or prevent. Possibly this is what you meant. I would like to see this study for myself.

Cigarettes used to be said to have health benefits, and be good for you to smoke. Why are you not calling this puritanical?

And health advice is far from puritanical. Hell, we give advice to people about how they can have a bowel movement regularly. Puritanically it is unclean to have a bowel movement and therefore you want to do it as little as possible. In nursing homes we regularly shower people, and try to keep them clean. Puritanically, in the dark ages, it was unclean to shower so you did it as little as possible, henceforth, perfume was invented.

Your argument falls apart on the basis of gross generalizations, which in all science is always a mistake. And also on your not having a full grasp on medicine. We do not claim to have a full grasp on the human body's functioning, what is completely healthy and what is not. We give advice on what we have learned so far is healthy and good for you, and what has more benefits than risks. In ten years things we thought healthy now will probably be looked at as horrible, and we will mock ourselves for thinking it healthy, just like cigarettes. What you understand to be puritanicism is merely ongoing learning.

Edited July 21, 2010 by joshuam168

[CharonY]

joshuam168, as you surmised correctly there is no mechanistic data. As I mentioned above, there were some epi-studies. However, the results were conflicting at best. Heck there was even a reports with a correlation between religiosity and dementia.

In fact, a metastudy surmised that much of it can be explained by selection bias in the different studies.

 

See e.g.:

Cigarette Smoking and Dementia: Potential Selection Bias in the Elderly

Hernán, Miguel A.a; Alonso, Alvarob; Logroscino, Giancarloa

EPIDEMIOLOGY Volume: 19 Issue: 3 Pages: 448-450 Published: MAY 2008

 

In contrast, for smoking a number of toxicity pathways have been detected that add to the evidence of e.g. adverse birth outcome, cardiac diseases caused by smoking.

[Marat]

While all of this discussion about the ultimate significance of the early epidemiological studies suggesting that smoking helped prevent Alzheimer's is scientifically interesting, what is significant for the point of my original comment is that even at the earliest stages of the research, when it seemed that there might be a good case for saying that smoking helped prevent Alzheimer's, this information was suppressed. But on the contrary, data which promote a puritanical ideology, such as smoking causing impotence (the effect is miniscule but the advertising campaign was gigantic and gave no indication of how small the effect actually was), are seized on instantly and promulgated widely. There should really be a public information campaign to let people know that being under normal weight is harmful to health, or that the U.S. government's NHANES study found no evidence that weight increases among young people could explain the rise of type 2 diabetes among children, but you will never hear about these studies, since they do not reinforce the Puritanical message that self-restriction, self-denial, and self-punishment is good for you.

[CharonY]

And surely you have references that demonstrate that the info was actively suppressed instead of the fact that most initial associations studies are unreliable and normally do not lead to a policy change? Which NHANES study are you referring to? These are a series of studies with different methodologies. Note that it is a survey study that alone does not necessarily result in the assessment of all risk factors.

Nonetheless in NHANES III and NHANES 1999-2002 already found a close association between obesity and diabetes in different populations.

 

 

However subsequent studies using the data sets elaborate on that, including

 

National Task Force on the Prevention and Treatment of Obesity (2000), Overweight, obesity, and health risk, Arch Intern Med 160, 898-904

Colditz, GA et al, (1990) Weight as a risk factor for clinical diabetes in women AM J Epedemiol. 132, 501-513

Colditz, GA, et al, (1995) Weight gain as a risk factor for clinical diabetes mellitus in women Ann Intern Med, 122, 481-486

Malnick SD, Knobler H. The medical complications of obesity. QJM. 2006;99(9):565-579

 

One surprising find from the NHANES data was the identification of a population that was both overweight and fit, though further sampling indicated that they in the US that particular groups is very small (i.e. if overweight one is more likely to belong to a risk group for hypertension, etc. rather than being in the fit group).

 

Nonetheless there is mounting evidence for a link between obesity and diabetes. As usual it is not a direct mechanistical one, though several have been proposed. Of course not every child will have the same risk, due to physiological differences, however stating that there is no evidence for it is ignoring a huge body of evidence.

Edited July 25, 2010 by CharonY

[PhDwannabe]

While all of this discussion about the ultimate significance of the early epidemiological studies suggesting that smoking helped prevent Alzheimer's is scientifically interesting, what is significant for the point of my original comment is that even at the earliest stages of the research, when it seemed that there might be a good case for saying that smoking helped prevent Alzheimer's, this information was suppressed. But on the contrary, data which promote a puritanical ideology, such as smoking causing impotence (the effect is miniscule but the advertising campaign was gigantic and gave no indication of how small the effect actually was), are seized on instantly and promulgated widely. There should really be a public information campaign to let people know that being under normal weight is harmful to health, or that the U.S. government's NHANES study found no evidence that weight increases among young people could explain the rise of type 2 diabetes among children, but you will never hear about these studies, since they do not reinforce the Puritanical message that self-restriction, self-denial, and self-punishment is good for you.

 

 

I'm going to let the inner Hobbesian come rolling out here, but, uhhh, maybe it's because people are sort of dumb, generally incapable of handling nuance and context, and need to be told what to do? I don't trust the common man to read TV Guide correctly, let alone make informed decisions which bear strongly on the public health. I mean, have you seen interviews of people at political rallies lately?

 

And on a more serious (or at least, rigorous) note, can you really operationalize "puritanism" in a way that you can detect it in all varieties of communique from the federal government? Really? Do they feed us nothing but self-restriction, self-denial, and self-punishment? What about Bush's constant entreaties for us to spend money and go on vacation? What about structures of subsidy which help pay for every manner of wasteful, selfish lifestyle: highway driving, suburban living, beef consumption? Why does the federal government promote condom use? Fund methadone clinics? Why do state governments do everything they can to encourage spending and partying in their own states? Why are community or alternative courts replacing criminal courts for so many offenses? Doesn't sound like they're being very good puritans at all! Look, man, I'm not even a conservative--I'm not even against these things. But it does very much seem like you've got one big hammer, and you're seeing a whole lot of nails.

[Guest Girish]

...you mean like Hester Prynne?