Notes Towards Day 7: What is Health?

Notes towards Day 7 of Food for Thought:
What is Health?

I. Coursekeeping
naming: who's game to go all the way 'round?

what did we learn from our field trip/finale to Section I of the course?
(post this on-line by Thursday-->thinking also about the environmental costs of what you learned)

What did you learn from your last set of papers, re: BMC dining services?

Reading two papers, w/ a focus on audience

Don't forget last week's lesson in this week's paper:
how about that "open" ending....?

II. Turning now to next section of the course,
about how science selects its data

for Thursday:
read Lisa Belkin's "02 NYTimes essay on coincidence--
like today's readings, about the tendency of all of us
to look for patterns where there may be none

writing for Friday:
3-pp. paper describing one of the health choices (besides eating--we're "done" with that!) you have made since you have been living on your own, @ college: what are your sleeping/exercising/working habits? How have you made these choices? What information did you rely on to make this decision? What was its source (intuition, family and friends, "expert" advice....)? Why do you believe what you do--and act as you are? How does your behavior appear to you, now that you've read (Zugar's account) of Halder's debunking of "most medical truths"?

As w/ the last sequence: start w/ your experience; plus....

set it in a larger framework; this is not just about you; you are addressing a range of larger theoretical questions, such as "what is health"? what are its sources, and what the obstacles to reaching them?

be thoughtful in selecting your focus, because you'll be stuck w/ it for the next 3 weeks; i.e.
for the next paper you'll do research reporting on current studies done on your health choice:
how are most college students handling the choice you are confronting?

and for the one after, right before break, you'll do some local data-collection
(your floor? your sports team? your work team? this class?):
on how this group of women is handling the choice you are confronting...

III. Reading for today: Taub's report (and commentary; and Zugar's footnote)

what did you learn/unlearn from these articles?

reading notes:
Taub on elusive search for truth in medicine
rhythm of science: observation--> hypothesis--> tested--> odds are it fails
if supported by epidemiology--> transformed into public-health recommendations
perception runs far ahead of reality: difficult to establish reliable knowledge
prospective/cohort study: monitor disease rates and lifestyle factors
in large populations-->infer conclusions about causes
dangerous game re: presumption of preventive medicine
fundamental limitation of observational studies:
distinguish associations, not causation
hypothesis-generating evidence is only circumstantial
definitive testing requires randomized-controlled trial/experiment
discordance between observational studies and experimental ones
incidence of diseases differs greatly in different populations
judgements based on "totality of the data"

fault with the press: not the epidemiology,
but the way it is interpreted for the public:
any single study has many limitations, is just a piece of the puzzle
epidemiologic studies are probabilistic statements; they "estimate the truth"
are uncertainties too great to draw useful conclusions from data?
placebo-controlled, double-blind trials gold standard for establishing reliable knowledge
but clinical trials rarely used to study suspected harmful effects; don't enroll typical people
lowering standard of evidence to save lives: caution dictates action; err on side of prudence

healthy-user bias: ppl. who engage in good activities are fund'ly different:
give appearance of cause&effect
wealth=better health; misfortunes "cluster"
even more subtle: compliance or adherer effect
cfing incomparable types of ppl.: girl scouts vs. others
prescriber effect another complication, combined w/ eager-patient effect

whole point of science is self-doubt: asking for another explanation
3 explanations for discrepancy between clinical trials and observational studies:
healthy-user and prescriber effects
measurement problem: difficulty of reliably assessing what's being studied
were asking different questions (the "timing" hypothesis)
can't correct for what you can't measure
observational epidemiology: doubt everything
several guiding principles:
assume first report is meaningless: be skeptical
doubt small association, even if consistent
question validity if it involves human behavior (which makes reliable interpretation impossible)
exception: unexpected harm
keep in mind the law of unintended consequences;
til then, remain skeptical

Letters:
epidemiology has improved health
don't expect certainty
important aspect of story is influence of drug-company marketing

Zugar: cfing Snyderman & Hadler 's diametrically opposite advice re: wellness
Snyderman recapitulates standard wisdom
Hadler uses statistics to debunk most medical truths: short on benefits, high on risk:
"You are not what you eat!"

serious question: what does it mean to be well?
freedom from discomfort, or ability to cope w/ it?
what are costs of conflating the two?
health beliefs are so deeply ingrated that data won't dissuade us from believing what we want

III. Get into pairs (with someone you don't know well):
write together one paragraph that gives, as best you can at the moment,
what you think is a clear and useful definition of "health." Based on that
definition, how would you go about teaching a health class @ your high school?

Reporting back: are our models medical (focused on fixing a problem) or
biological/neurobiological/cultural (focused on individual's capacity to shape their own lives?)
How much are our definitions of health dependent on a definition of disease/illhealth?

Cf. Culture as Disability

Recognizing

* the inevitability of risk in a random (unknowable? unpredictable?) universe

* the necessity of risktaking, for intellectuals whose job (and predilection?)
is to make new knowledge.

On its inevitability:
Nassim Taleb's book The Black Swan:
A Black Swan is
*an outlier (unpredicted/unpredictable),
*with extreme impact,
*made explainable and predictable after the fact.

Taleb uses it to illustrate
*the limits of learning from our experience
*the limits of our ability to predict
*our excessive focus on the precise and the "Platonic"
(privileging models over messier structures)
*our blindness regarding randomness.

On its unavoidability:
if we understand the business of intellectuals as the generation of new understandings
...fundamental not only to good teaching but to ...scholarship....It's our business to take
intellectual risks...to perpetually question current...understandings