Saturday, August 08, 2009

Weighing America and Finding It Wanting

David Kessler's anti-obesity crusade. He blames his own obesity on the "food industry". It'd be funny if he weren't such a menace

David A. Kessler is a man of science--former dean of the medical school at Yale and a physician himself--but he is also a man of pudge, so not long ago he decided to combine the two interests in an experiment. "I walked into a bakery," he writes in his new book, The End of Overeating, "and asked for two semi-sweet chocolate-chip cookies." He took them home and looked upon them. And Kessler saw that they were good. Better than good. "They were thick and gooey--chunks of chocolate filled the craters of the cookies and rose into peaks."

He placed them on his work table, an arm's length away. "I was fixated on those cookies," he writes. Without noticing, he inched his right hand closer to the cookies, just within reach of the overbrimming craters, the peaks rising chocolaty to the sky.

He went upstairs. "But even from that safe distance, I could not fully shake the image of the cookies." Yet he didn't eat them! He left the house, "and I felt triumphant." Then he went to a coffee shop and ordered "an orange-chocolate cookie and ate it at once." There his experiment ended.

As rigorous scientific research goes, this isn't Louis Pasteur. Kessler the author moves on, and the reader can't be quite sure what the experiment was meant to illustrate. Even if you concede that Americans are fat--and you'll get no argument from me--and that this widespread (heh) and chronic obesity qualifies as an "epidemic," it's not clear what David Kessler's individual powerlessness before a cookie has to do with anything beyond David Kessler. But that, it turns out, is just the point. Kessler has said in interviews that his weight yo-yos between 160 and 230 pounds.

Now he is intent on making his difficulties our own, so that the means of overcoming them will apply not only to himself but to the rest of us too. For in addition to being a man of science and a man of calories, Kessler is also a man of government, an activist and believer in public policy's limitless capacity to improve mankind.

Though his most prominent public role was in the 1990s, as director of the Food and Drug Administration under George H.W. Bush and Bill Clinton, he is a figure more suited to the present moment. The tobacco bill that President Obama signed in June, to cite one example, is mostly a collection of measures that Kessler tried but failed to enact during his years at the FDA. The legislation doubles--triples! quadruples!--the agency's regulatory power, greatly restricting the range of permissible activity for tobacco companies and their sales outlets, and making life even more difficult than it already is for smokers who want to smoke.

The tobacco bill was vintage Kessler not only in its programs but in its premise: that dark forces of commerce are getting rich off a citizenry powerless to resist their sophisticated manipulations. The same view shapes most of the current administration's efforts to reform the everyday behavior of Americans along cleaner, more healthful, and more rational lines. Because we drive too many miles in the wrong kind of cars, use the wrong kinds of light bulbs and tools, mismanage our finances, garden with the wrong fertilizer, eat too much of the wrong foods, and so on and so on--all with far-reaching consequences that we refuse to calculate--Congress and federal agencies are taking greater interest than ever before in the habits of their fellow citizens.

Kessler's present preoccupation, the evils of food, is nicely timed. At last count his book had spent three months on the New York Times bestseller list. During the last week of July he was the subject of two special reports on ABC, one on Good Morning America ("Food Addiction Confessions") and another on Nightline ("Hooked on Food"). And the Centers for Disease Control held its first national conference on obesity, cutely titled "Weight of the Nation," to address the subject from a perspective identical to Kessler's.

His thesis is that sugar, salt, and fat--the lures with which the food industry entices Americans into obesity--are the new tobacco, ripe for the same regulatory regime that has bankrupted companies, upended livelihoods, and put the centuries-old custom of smoking on a fast track to ultimate extinction. In this view, the food industry, health care reform, and American eating habits are all tangled together, creating another opportunity to make us live more sensibly. One leftwing blogger for the Washington Post outlined the reasoning:

"Health reform is in the works. And the administration is desperately looking for ways to cut costs without denying care. One way to do that is to make people healthier so they need less care. And one way to do that is to avert the obesity epidemic."

The Post's blogger probably doesn't know the meaning of "avert," for it is now common wisdom that the epidemic is already upon us. Under cover of health care reform, Congress and the administration are entertaining several ways to "make people healthier," as the blogger put it, by changing what we're fed: higher subsidies for the production of foods regulators approve of, higher taxes on foods we should dislike, rewards and punishments sprinkled all along the path that food travels from farm to feedbag.

One of the more modest proposals is the Menu Education and Labeling Act. MEAL would require restaurants to trash their old menus and print new ones that will announce, in big block letters, the level of trans fats, saturated fats, carbohydrates, sodium, and calories found in every dish they offer. MEAL echoes the exhaustive labeling that Kessler, as FDA chairman, helped mandate for packaged food in 1995. Those earlier labels increased costs to food producers by billions of dollars and have proved an unambiguous flop; consumers stubbornly continue to eat whatever they want and ignore the gruesome details about what they're eating. In the logic of regulators, however, the failure of one regulation can always be overcome with an additional regulation. And for a government guy, regulatory activity is its own reward.

This is where Kessler's new book will prove particularly useful, for both regulators and their adversaries, as either guidebook or sounding alarm. The End of Overeating offers a case study in progressive paternalism. He's giving us an inside look at the thinking that leads a person in power to scan his citizens and reconceive their private failings, individual preferences, or personal indulgences as pressing matters of state, and thus fit for government correction.

When it comes to the question of what to do about all these fat people waddling around, Kessler believes he's the bearer of big news. "No one has recognized what's really happening," he writes. "Let me try to explain." At bottom is this insight, which he says is supported by the very latest scientific data: "Weight gain is primarily due to overeating: "Eat more, gain more weight." The idea that fat people get fat because they eat too much may not strike you as earth-shattering, but that just means you haven't been following the back-and-forth palaver about American obesity.

For nearly a generation the popular notion has been advanced that obesity is something that happens to people; more often than not fat people are fat through no fault of their own. In a massive effort at blame-shifting, network medical correspondents, morning show hosts, and newspaper health columnists advanced theories designed to put the primary responsibility for obesity everywhere but on the person who gets fat. Obesity is a heritable trait, went one popular theory; it's genetically determined, so thank mom and dad. Or it's a consequence of overconsumption of specialized "fat grams," the inevitable result of a predisposition to seek out the wrong kind of calories. Or it's a question of a faulty metabolic system that layers globs of fat along beltlines and bottoms instead of shedding them in the normal manner.

All wrong, according to Kessler, speaking here as the man of science. No such theories are supported by the most recent research. In their absence, the more commonplace notion of personal responsibility might enter in: People are fat because of what they do themselves, not because of what is done to them, and therefore the consequences of what they do are best borne by them alone--are best thought of, that is, as nobody's business but theirs.

But Kessler the man of government recognizes that the old idea of personal responsibility undercuts the case for governmental regulation, which at least in theory is designed to prevent harm being done to one party by another. So Kessler the man of science enlists Kessler the man of pudge to testify to the helplessness a fat person feels. The blame can still be shifted. All those fat Americans may not be victims of screwy metabolisms or genetics, Kessler says, but we can still think of them as helpless victims. And where there's a victim, a victimizer must be found.

The primary victimizer is, of course, the American food industry. Kessler believes that the products it offers its customers are irresistible. This is a common view and getting commoner. As our Baby Boomers age, the famous ardor they once felt for sexual intercourse has been transferred to food, which at their time of life is more easily attainable and requires less fuss. Kessler's tortured encounters with one foodstuff after another are described in a prose that is nearly Jackie Collins-like in its sensual intensity. Embarrassed readers may wonder whether they shouldn't just leave the room....

How could this be? Are we not men, human beings endowed with a will, free citizens of a self-governing country? Well, not exactly. At this point, in The End of Over-eating, Kessler the man of science returns. For it is not only the food industry that is doing the victimizing. The dark forces of capital are in cahoots with the natural forces of evolution and biology to force the American population into obesity. Kessler has embraced the fashionable reductionism that most popular science writers succumb to these days. And no wonder. Reductionism is the metaphysics of our intellectuals. Somehow they have convinced themselves that the most accurate way of accounting for reality is to reduce everything that happens to its physical processes: Neurons dart, chemicals percolate, synapses bristle, and--presto--you've got the Sistine Chapel and the Bhagavad Gita, the Little Sisters of the Poor and the bombing of Hiroshima, Rosalyn Tureck playing the Goldberg Variations and an American consumer going limp watching an ad for a Triple Stack Baconator from Wendy's. Reductionism gives off an air of scientific rigor. With Kessler it makes his case for regulation appear more impressive and, what amounts to the same thing, more complicated than it really is.

Kessler is an old hand at this. As FDA director, in agitating publicly for regulation of tobacco, he never referred to a cigarette as a cigarette; it was instead a "nicotine delivery device." As a description, the phrase is so incomplete as to be essentially inaccurate. But it sounded clinical, and it shifted the subject to what Kessler wanted to talk about, away from the free choice of the smoker and onto the ostensibly sinister motives of the cigarette maker. And it worked. In The End of Overeating he does the same for food, especially if it's food that people enjoy. He describes each food item in terms of its components--sugar, salt, fat, or some combination of the three--as if this disaggregation were a more accurate rendering of the thing as a whole.

More here

Eye drops 'may reverse glaucoma'

A new type of medicated eye drop may be able to reverse symptoms of glaucoma, an Italian study has suggested.

Glaucoma, the world's leading cause of blindness, is caused by pressure inside the eye - intraocular pressure - which damages cells in the optic nerve. The study of rats and human patients found drops containing a nerve growth factor may stop these cells dying, and actually improve vision. It is reported in Proceedings of the National Academy of Sciences.

It is estimated that 77m people have glaucoma around the world. The build up of intraocular pressure can sometimes be controlled through other techniques. But once pressure has started to damage optic nerve cells, called retinal ganglion cells (RGCs), it has proved impossible to recover that lost function. And often people with glaucoma do not seek expert help until the condition is already relatively advanced.

The researchers, from the University of Rome, treated rats with symptoms of glaucoma with eye drops containing nerve growth factor. The animals who were given the eye drops showed decreased levels of RGC death compared with those who did not receive the treatment. The researchers went on to test the drops in three human patients whose intraocular pressure had started to be controlled, but who still showed signs of progressive deterioration in their vision. In two of the patients vision improved, while in the other it was stabilised. The improvements lasted up to 18 months after the eye drops were applied.

Nerve growth factor appears to trigger chemical changes within cells that prevent them from dying in response to damage. It might also enable cells whose function had begun to be damaged to bounce back. And it might boost the capacity of healthy RGCs to form new connections within the optic nerve, to compensate for any damage that had already taken place.

However, nerve growth factor cannot rescue RGCs that have already died - in common with brain tissue, the optic nerve cannot regenerate. Lead researcher Dr Stefano Bonini said: "Although neuroprotection in glaucoma has already been attempted with several compounds, this is the first time that an improvement in visual function is observed in patients with advanced optic nerve damage."

David Wright, chief executive of the International Glaucoma Association, warned against drawing firm conclusions from such a small study - but said the results were encouraging. He said: "There have been many false dawns in the search for neuro-protective agents for the treatment of glaucoma and it is a feature of research on other compounds that early promise does not always translate into clinical effectiveness when larger studies are undertaken. "However, this research would seem to indicate both effectiveness and acceptability as to the means of drug delivery. "If these early indications are carried through to wider trials and there are no other problems, then this has the potential to open a completely new method of treating glaucoma and of preventing unnecessary visual loss in the future."

Professor Peng Khaw is director of the National Institute of Health Research Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology. He said many other substances had achieved good results in animals, only to fail in humans. However, he said, if the researchers could perfect an easy-to-use eye drop formulation that would represent a huge step forward.


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