The Obesity Myth: Why America’s Obsession with Weight is Hazardous to Your Health

I have been busy reading my research topic and have been very interested in what it has to say about the current epidemic. Some of the key messages I have come across are:
• Weight is a poor predictor of health
• “Fat” people have better health then “thin” people
• “Fat” active people have half the mortality rate of “thin” sedentary people
• A person’s level of physical activity is a far better predictor of health than body mass.

The whole issue of obesity seems to be highly political. We are forced to conform to the most powerful institutions (medical profession) ideals of what a body should look like. The media is supporting this and telling us we need to lose more weight, when in fact this is highly hazardous to our health. Instead of trying to lose weight we should be focusing on exercising more and having a healthy lifestyle (no binging, starving or dieting).

Witches, Floods and Wonder Drugs: Historical Perspectives on Risk Management

Clark states, “Risk is a people problem” (287). After reading Clarks article and comparing it with Tufte’s work I completely agree with this statement. It seems to me that as humans, we have a difficult time removing ourselves from our fears. There is a lack of independence so to speak. Our fears start to dictate us. Be it taking out “insurance” through joining the Inquisition as to not be named a witch, or having extensive pre-release testing on drugs which is inefficient but guards us against litigation. Even when we have the facts in front of us, we still cannot make the right decision. (Think NASA launching Challenger when advised not to.) Perhaps, not only is it our fears that rule us, but the current discourses and institutions in power. Only when we can change our current ways of thinking and reduce the pull of conforming to these notorious intuitions will risk management become rational.

Cost Benefit Analysis: Measuring costs

I have been reading the chapter called Cost Effectiveness and Cost Benefit Research in our latest reading (the one with the coffee stain). Something that sparked an interest in me was the difficulty in measuring direct costs of health care. The article states that “accountants have a difficult time figuring out how to allocate substantial overhead costs...” (p.87). After finishing my accounting degree I know this to be true. What we do is estimate the overhead as a percentage then allocate it out to the cost object. For example say the overhead is supervisors wages, we would give say 30% to emergency rooms, 35% to maternity, 15% to paediatrics, 10% to psychiatric, and 10% to geriatrics. These percentages could further be broken down into actual operations or treatments under each ward. Although this is a very crude explanation it points out that accountants rely on estimates. We will never know the correct amount to allocate; it will only ever be an estimate. Also, the reality is the accountant probably has little knowledge in what goes on in each ward, making it hard for them to determine the estimate in the first place. Both these factors result in a very arbitrary amount of so called direct costs. Accounting can be very easily manipulated within the rules. Once we factor in indirect costs (time lost from work, inconveniences) and opportunity costs, the final amounts of total costs can be completely different to the real total cost. This is important as a procedure that has a cost exceeding its benefit may not be implemented into Government health care spending. The first step in cost benefit analysis is to determine the costs, the most seemingly obvious being direct costs. But as mentioned above the direct cost is impossible to determine correctly. Therefore, if the easiest aspect of cost benefit analysis is in a way impossible, what hope is there for accurately determining the other costs and benefits?

Chlorpromazine and the revolution in psychiatry

Despite vast amounts of research they do not know what is happening to the brains of the mentally ill. Over 50 years ago some drugs that were effective in relieving the symptoms of mental illness were discovered by accident. However, how these drugs work, the nature of the abnormal changes in the brain they correct and the causes of psychiatric illness remain a mystery.
Before these effective drugs were used, doctors relied on custodial care and sedation e.g. insulin comas, electric shock therapy and cutting the brains of patients. They hoped that the trauma would correct the brains malfunctioning.
→ Huge problems of using such methods (personality change, epilepsy)
→No improvement in patient’s conditions despite treatment lasting years. Emperor’s new clothes!

1953
Through non related experimentation came across chlorpromazine. The drug was used on patients with schizophrenia who after a few weeks on medication became symptom free.
Later over the next four years other major drugs were found applicable to the whole spectrum of psychiatric illness. (Lithium for manic depression, Antidepressants for depression and Benzodiazepines for anxiety.) All drugs were found by chance and doctors still have no idea how or why they work.
Chlorpromazine is not a cure for schizophrenia; the essence of the ‘euphoric quietude’ lessens the agitation making the patient more manageable and lessens the intensity of the distress of systems helping recovery. – “like a pain relief”
“The history of psychiatry in the post war years shows in a very dramatic form, how the growth of the possibilities of treating illness, could occur in the absence of any substantial understandings of the nature of the problem being treated or indeed why the treatment worked.” (p.71)
Post war psychiatry has been a ‘smashing success’, we don’t understand how the drugs work. The drugs were discovered accidentally and completely independently of any intellectual understanding of mental illness- However, they have huge benefits for those affected.

Economics
It is a real stab in the dark when trying to find a cure. The costs of R&D are substantial and with a small probability of success. Cost > Benefit???
However, it would be more costly not to increase our knowledge of mental illness. (Just look at what 50 years knowledge achieved.)
What incentives would a government, business or research institution have to discover more about mental illness? The patent rights of discovering a cure may be a large enough incentive.
If experimentation will be carried out on finding a cure for other health problems (large fixed costs), then there would be only a small variable cost attached to testing the new discoveries on mental illness

Hi everyone, this will be my blog for ECON337