Wednesday, February 29, 2012

Santorum, Snobbery & Schoolin'

I was recently lamenting to my friends that sometimes I wish this were a blog about politics so that I could rant and rave about the lunacy being spewed by the current presidential candidates. Then I decided that I could find a health-related theme for the subject about which I would like to rant as an excuse to do it anyway. So here goes my rant about Santorum's infamous recent comments about higher education.

Let me start by saying that I am registered as a political independent. I have voted for members of both parties, and it is rare that I agree with either party 100% on an issue. But on this particular issue, I don't see much room to argue with Obama. I know full well that education makes a difference, not only in lifetime earning potential, but also in human health!

For those who haven't heard yet, Rick Santorum called Obama a "snob" for reportedly "saying that everyone should go to college." This was hard for me to believe, but here is an actual video of the speech in Michigan.

Of course, after hearing such a strange insult to our president, I decided to find out what Obama actually said. According to a Politico article, the quote was, "I ask every American to commit to one year or more of higher education or career training. This can be community college or a four-year school, vocational training or an apprenticeship. But whatever that training will be, every American will need more than a high school diploma."

It's hard for me to see how this quote translates into liberal snobbery mandating that everyone must attain a degree. That is clearly a limited and disingenuous reading of what was said. Obama was discussing the fact that increasingly, we are competing globally with countries who are focusing on education. Years down the road, it may become more and more difficult to find a job with only a high school diploma. This is not to say that people who do not go to college are somehow less important, not hard working, or otherwise bad. It is simply to state the fact that job prospects are better for those who attend some form of higher education, and this is becoming more true with each generation.

Consider the current economic issues in our country. According to the Bureau of Labor Statistics, the average unemployment rate in 2010 was 8.2%. However, among those with a bachelor's degree (and no master's) it was 5.4% compared to 10.3% for those with only a high school diploma.

One article I read in the San Francisco Chronicle said that the median annual pay of those 25 years and older with a bachelor's degree is $56,472. That is 70% higher than those without a diploma. That means a person with a college degree may individually earn about the same as the average household income (presumably a measure of the total earnings of multiple persons living together) in our country. According to the same article, 30% percent of adults now hold college degrees, and 94% of parents with children under age 18 expect their children to go to college.

Now to be fair, I do think there are people who are prejudiced against those of a different social class or education level. It's great to speak out against that sort of intolerance. And I agree with Santorum that there are plenty of hard-working people at important jobs without one minute of higher education. I think many Americans, especially in small towns across the nation or in manufacturing centers like Detroit, would echo sentiments of pride in their communities, regardless of the average education levels in the areas. It is even true that some people have gone on to make millions without a degree (Bill Gates, for example - and for him, it was billions). As the Montgomery Gentry song, "Where I Come From," says, "That old man right there in the rocking chair at the courthouse square - I'll tell you now he could buy your fancy car with hundred dollar bills. Don't let those faded overalls fool ya'. He made his millions without one day of schoolin." Pride in your job and loyalty to your friends and family of all social classes are beautiful things. I agree wholeheartedly that education does not make one person better than another. The idea that our worth as a person is not determined by our social status, income, or level of education resonates strongly with my understanding of humanity. Amen to equality before God!

But the fact remains that statistics show average quality of life increases with higher education. No, that does not mean for every person every time. It means for most people most of the time. And I do not in my heart believe that Obama is among the ranks of the socioeconomically prejudiced for acknowledging this. I find it especially improbable that there is much truth behind the accusations of elitism given that Obama's life before running for Congress involved working with residents in the south side of Chicago.

Santorum also berated higher education for "indoctrinating" young people into liberalism. I would agree that there is a left bent in higher education as a whole, but there are a few things to point out here. (1) Not every professor holds the same views. (2) If conservatives do not obtain higher ed degrees, then they cannot become professors. So it stands to reason that if Santorum sees a problem of disproportionate representation among college faculty, he should be encouraging more conservatives to get degrees, not fewer. Hey, if there were enough of them banded together, they could even start new colleges. (3) As my husband intelligently pointed out to me the other day, colleges not only produce liberal thinkers, they also produce deeper conservative thinkers who are able to counter balance the arguments of liberalism. Without a strong understanding of politics, philosophy, economics, and the like, it is pretty difficult to make a believable case against an expert in one of those fields. Please do not mistake me for saying that education is the sole predictor of good ideas. That is certainly not true. But how does Santorum intend to fight "elite leftist" ideas if he has not also read the same texts, analyzed the same arguments, etc.? How can a person condemn a book he or she has never seen? How can an individual make a point against a philosophy he or she has never heard? We need more thoughtful thinkers of all political persuasions, not fewer.

So you may be wondering what this has to do with "mind and body musings?" Well, I found something that clearly justifies this entire rant! Education is also a predictor of....drum! According to the National Poverty Center, better educated people have lower morbidity for many chronic illnesses and higher overall life expectancy. The NPC also states, "Health behaviors alone cannot account for health status differences between those who are less educated and those who have more years of education."  The policy brief I read suggested that some likely contributing factors to the health gap are complicated relationships between education and family background, effects of poor health in childhood, greater resources associated with more education, a learned appreciation for positive health behaviors, and social networks, among other mechanisms.

As I discussed in a previous blog post, education is also related to health literacy. To reiterate some of the statistics from that piece, the National Assessment of Adult Literacy targeted a portion of its latest assessment using health care related questions. The study found that among adults who never completed high school, approximately 49% had below basic health literacy, compared to 15% of adults who completed a high school diploma with no post-secondary education and just 3% of adults with a bachelor's degree. Low health literacy can inhibit someone's ability to read health pamphlets, follow medication instructions, make medical decisions when caring for a loved one,  understand post-operative instructions, or complete other similar tasks.

In another related post, I described some of the connections between food insecurity and obesity. Since food insecurity is a socioeconomic issue, and lack of education is a predictor of lower earnings, these problems are a likely link between education and health. Some of the issues I discussed in more detail in that post include fewer full service grocery stores in lower income neighborhoods, lower quality produce, a greater prevalence of fast food, fewer parks or recreation centers, and less access to health care, among other concerns.

I believe that Santorum was misguided in his Obama name-calling on the higher education topic. He was speaking to a crowd in Detroit, and it seems likely to me that he was catering to his audience. I'm not even going to get into Santorum's campaign goals from past years related to higher education (but please do Google the topic - he used to think college was a good idea). Suffice it to say that a quick glance at Santorum's own life and credentials makes it clear that his education got him where he is today and that he intends to provide the same for his children (just like 94% of parents hope for their own kids, as mentioned above).

As LZ Granderson of CNN put it, "Granted, some of us are gullible enough to give each other high-fives because Rick Santorum called Obama a snob for promoting a college education. But the rest of us look at 'Slick Rick's' college degree, law degree and MBA, and the fact that he's sending his kids to college and owns at least six properties, and has earned millions, and wonder - What is he talking about?"

I have been wondering that myself.

Monday, February 27, 2012

The Obesity Epidemic and Physical Appearance: The Heart of the Matter

"The LORD does not look at the things man looks at. Man looks at the outward appearance, but the LORD looks at the heart." ~1 Samuel 16:7b

You may have heard about the Georgia campaign against childhood obesity that has started a major conversation around the country. Many bloggers seem to have opinions about the controversial ads. Since I have written several posts related to childhood obesity, I thought I should chime in, as well.

To put it bluntly, I don't like the ads. I find them offensive and unhelpful.

The ads feature pictures of overweight children with captions like, "It's hard to be a little girl if you're not." They were intended to grab the attention of passers-by and to get a conversation started. As I mentioned in my post on Childhood Obesity and Food Insecurity, the organization that ran this campaign, Strong4Life, conducted a study which showed that 75% of parents of obese children in Georgia do not think their child has a problem. So start the conversation they did, by thrusting all the negative stereotypes of obesity even more directly in the faces of the public.

My main gripe with this ad campaign is that it fuels the negativity about physical appearance with which overweight children are almost certainly already bombarded on a regular basis.

Now don't get me wrong. I do think childhood obesity is a serious problem. I think doctors need to be straight with parents. I think parents need to come to grips with reality. And I even think it's ok to discuss your child's weight problem with him or her under most circumstances. But I do NOT think it is ok to make this an issue of physical appearance.

While the ads may have aimed to show many effects of obesity through their captions, the message they sent loudest of all was, "See the image of this body? It is not acceptable. And you need to fix it."

I believe the appropriate way to address the issue of childhood obesity is from the perspective of the health and lifestyle effects of carrying excess weight. This focus shows concern for a person's well-being, not critical or self-righteous judgment.

The Health Consequences

According to the Centers for Disease Control and Prevention (CDC), in a study of five to seventeen year olds, 70% of obese youth had at least one risk factor for cardiovascular disease. Obese adolescents are more likely to develop prediabetes, a condition of elevated blood glucose that can lead to type II diabetes. According to the Mayo Clinic, type II diabetes itself, which used to be called "adult onset diabetes," is growing in prevalence among children, largely due to the obesity epidemic.

The CDC also states, "One study showed that children who became obese as early as age 2 were more likely to be obese as adults....and are therefore more at risk for adult health problems, such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis."

The Lifestyle Consequences

Not only does a high Body Mass Index put children at risk for chronic disease, but it may inhibit them from participating in activities they do (or would) enjoy, such as sports, dance, music, and theater, which often require stamina and endurance that may be limited by excess weight. For a young adult, obesity may even affect his or her stamina or self-confidence in sex. (Now that's a good reason to get fit, right?)

Where The Ads Went Wrong

Unfortunately, the negative effects of obesity don't end there. Obese children are more likely to be bullied or to experience depression. Obese adults are more likely to experience discrimination on the job (as often as racial discrimination, according to one study, and possibly more often than age or gender discrimination).

And this is where I think the Georgia ads get the issue wrong. While I think we should be campaigning to "change" obese people for the benefit of their physical health, longevity, and a better lifestyle, I think we should be campaigning to change ourselves for the problems that result from discrimination based on physical appearance. Judging anyone by physical appearance is not a problem with the person being judged; it is a problem in our own hearts and minds. Sure, some people's appearances may be a clue as to what is going on inside their heads or hearts, but this is not a universal truth. No person's worth is based on his or her appearance, and we should not perpetuate that myth ever.

To tell our children that we agree with the world's judgement that worth can be based on appearance is a tremendous mistake. To love someone despite their imperfections is not the same as tacit approval of their every choice. It is the nature of love itself.

Some will say that obesity is lethal, so we should go to extremes to curb or prevent it, even if it means hurting someone's feelings. I would agree that a little hurt feeling in the context of an intentional and caring conversation about health is well worth it. But in my view, to bring appearance into the conversation is not simply about a little hurt feeling; it may impose long-lasting damage. It is beyond a mere temporary pain when we tell a person, with a mind and heart, that our love is contingent on a particular physique. Appealing to a child's vanity may provide short term success, but it ultimately sets the child up for long term problems. To shame a child into losing weight is putting a skewed view of personal worth on a pedestal and sacrificing the ultimate mental health of the child in order to serve the false god of physical perfection.

The Media Has The "Judgment" Thing Covered

Children are already besieged by an unending stream of messages about their physical appearance.

I recently read a book called, "Cinderella Ate My Daughter," by Peggy Orenstein. While I lamented the disorganized and desultory nature of the book to my book club friends and thought the author made some grand leaps of logic, the overarching theme of the work stuck with me. Children are exposed, almost from birth, to a plethora of marketing images that tell them they need to fit into a specific mold. For girls, this mold largely leads to the conclusion that to be cool and accepted is to be "hot." A woman's worth comes from her physical appearance.

Anyone who watched the Superbowl ads will likely recall the GoDaddy segments featuring scantily clad women enticing the watcher to go to to "see more." I would not have known that this is a domain name registration site had my husband not told me. Photographers secretly take pictures of every inch of cellulite on an actress at the beach and enlarge the images for the covers of the magazines we see in the grocery store. We even grow up watching soap and deodorant commercials that tell us if we buy the product, we can look like the model.

I am pretty sure I get the point already. My cellulite is not acceptable, my breasts aren't perky enough, and I would never be called beautiful by a major news outlet.

For a kid being exposed to this constant marketing, the idea that certain body types are more valuable may become deeply ingrained. This can lead to bullying (by the kid who thinks others are unacceptable) or a sense of shame (for the kid who thinks he or she is the unacceptable one). In some cases, both lines of thinking may be at work in the same child.

One Piece of Evidence: Eating Disorders

It's all well and good for me to say that this is having a negative impact on obese children (and on all children, really), but what is the evidence?

I submit that one important signal of the impact is the growing prevalence of eating disorders among youth. According to a study published in the American Journal of Preventative Medicine, as cited by the National Eating Disorder Information Center (NEDIC), girls who reported body-based teasing by family members were 1.5 times more likely to engage in binge eating and extreme dieting behaviors five years later. A Canadian study also cited on the NEDIC site showed that 37% of girls in grade nine and 40% of girls in grade ten wished they were thinner. Even among those considered a healthy weight based on BMI, 19% believed they were too fat and 12% reported attempting to lose weight.

According to the National Eating Disorders Association, the number of young women aged 15 - 19 diagnosed with eating disorders has risen every decade since 1930. But it is not only teenagers who are affected. Psychotherapist Abigail Natenshon was cited in a recent Parenting magazine article as saying that "the average age for the onset of anorexia used to be 13 to 17. Now it's 9 to 12, and children as young as 7 have been diagnosed." In this same article, I learned that 10% of adults with eating disorders showed clear symptoms before the age of ten, and more than 60% of elementary and middle school teachers report that eating disorders are a problem in their classroom. Did you read that? Elementary school! In a 2010 article from Health Day, I learned that the Agency for Healthcare Research and Quality found that hospitalizations for eating disorders jumped 119% for kids under age 12 between 1999 and 2006. 

 Not only that, but anorexia has the highest mortality rate of any mental illness. The South Carolina Department of Mental Health website cites a study conducted by the National Association of Anorexia Nervosa and Associated Disorders, which reported that 5 - 10% of anorexics die within ten years of contracting the disease, 18 - 20% within twenty years, and only 30-40% ever fully recover. Other sources show lower numbers - the ANAD website itself now says that the American Journal of Psychiatry (2009) concluded that the ultimate mortality due to eating disorders is 4% for anorexia nervosa, 3.9% for bulimia nervosa, and 5.2% for eating disorders not otherwise specified. One of the reasons the statistics may vary between sources is that deaths related to eating disorders may be recorded under other causes, such as heart failure. Regardless, anorexia still stands at the top of mental illness mortality.

My Take

While it is important for us to recognize and address the growing obesity epidemic in our country, it is also worthwhile to pay attention to the unintended consequences of the strong rhetoric around the issue. At the same time obesity rates are growing, so are those of eating disorders and unnecessary dieting among youth. And this is only one of the potential problems that arise with such a strong focus on physical appearance. There are undoubtedly countless other emotional, relational, and even physical effects.

By not telling obese kids that they look "different," we are not hiding the truth from them. Many children who are overweight, and even many who are not, are already keenly aware of how their bodies are being scrutinized. The magazines they read, the television ads they see, the kids who bully them, the employers who don't promote them, are all sending them that message already. It's true that some parents and kids need a wake up call from a medical professional telling them they are on an unhealthy path. But the message we need to send is to take care of your body, for your own health's benefit, for the enjoyment of life, and for the sake of the work that God has for you in your time here.

Who you are and your personal worth as a human being are not based on how you look. 


Friday, February 17, 2012

Magical Health Map

I found the coolest interactive map online, which ranks the health of the states in the U.S. The map can be digitally tilted to various angles of viewing to show the healthiest state raised high and the worst state sunken in. The information is based on a study conducted by the United Health Foundation. According to the full 2011 report, "first published in 1990, America's Health Rankings provides the longest running state-by-state analysis of our country's health and the factors that affect it."

Based on this magical map, I learned that the top five healthiest states, starting with most healthy, are Vermont, New Hampshire, Connecticut, Hawaii, and Massachusetts. The five lowest ranking states, with the worst listed first, are Mississippi, Louisiana, Oklahoma, Arkansas, and Alabama.

The overall rankings are based on a variety of factors, from cholesterol, diet, and blood pressure, to infant mortality, occupational fatalities, and infectious disease, to air pollution and percentage of children in poverty.

The map shows not only the overall rankings, but also the rankings for each individual category used for the study. For example, with one click on the category list, one can learn that Wyoming currently enjoys the least air pollution, whereas California has the most. And Maine experiences the least violent crime, while Nevada has the most.

Another cool feature of this map is the ability to view various years by scrolling across the timeline on the bottom of the screen. For example, while Vermont is ranked 1st in overall health this year, a quick slide of the timeline shows it was ranked 4th in 2008.

The full report on the findings from the study that led to the creation of this map can be found here. There are also several interesting commentaries found here. I think this is a great resource for nonprofit organizations, governments, companies, and individuals in various states to figure out what are the specific factors affecting their populations and to cater actions towards these issues. Check out your state!

Saturday, February 11, 2012

Food Insecurity and Obesity in Children

After my posts on Jamie Oliver and McDonald's, a doctor I know asked me why so many of her young patients from lower income families are obese. "Many of these families struggle to provide three square meals a day," she said, "so where are the calories coming from?"

According to a 2010 Los Angeles Times article, which summarized a study from the journal Health Affairs, nearly one in three children currently has a body mass index above what is considered healthy. The study also found significant discrepancies between children of different racial groups, socioeconomic groups, and regions of the country. According to the article, these factors are not necessarily independent. For example, the article says, "In Alaska, poor children were only 1.2 times more likely to be overweight or obese than better-off children. But in Arizona, the difference in rates was 3.8. Why would it be different to be poor in Alaska than Arizona? That's basically what it amounts to - it's not the same being poor in one state as it is in another."

According to the Food and Research Action Center's (FRAC) page on poverty and obesity, "obesity rates increased ten percent for all U.S. Children ten to seventeen years old between 2003 and 2007, but by twenty-three percent during the same time period for low-income children."

One thing that is important to note is that the stereotype that virtually all low-income people are obese is not true. The Food and Research Action Center (FRAC) also shows that the link between income and obesity has actually been weakening over the past few decades. But the question still remains, why do the statistics show a link at all?

For answers, I turned to the FRAC page on food insecurity and obesity. Most of the information I am going to mention below is from this website, and the authors of the studies are specifically mentioned there. For me to put a citation after every sentence would make this post very long, so please refer to the FRAC food insecurity and obesity link for the authors of the studies and facts mentioned.

One of my friends, Sara, commented on my McDonald's post that many families live in "food deserts," which is actually one of the main points FRAC makes, as well. According to multiple studies, low-income neighborhoods often lack a full service grocery store where families can purchase fresh produce, whole grains, and low-fat dairy. Instead, many residents rely on small convenience stores, which do not carry the variety of healthy and low-fat options available in larger establishments. Low income communities, especially areas near schools, are also more likely to have fast food restaurants. Frequently eating fast food has been linked to high-calorie, low-nutrition diets, which may lead to weight gain.

According to other studies cited by FRAC, fruits and vegetables in low income neighborhoods are often of poorer quality, thus making it less likely that residents will be prone to purchase them. Furthermore, healthy food, such as fresh produce, whole grains, and low-fat options are often more expensive compared to more processed fats and sugars. Many families trying to stave off hunger look to purchase the maximum calories per dollar by buying energy-dense foods, which provide the calories a family needs, but not necessarily the other nutritional components of a healthy diet. "Feeling full" may be the priority for a family who is unsure when the next meal will be available, especially when it comes to preventing feelings of hunger in children. Carbonated beverages, such as soda, for example, will make a child "feel full," even if they do not provide any other nutritional value.

In addition, chronic ups and downs in the availability of food may encourage people to eat more when it is available. This can lead to general over-consumption or even metabolic changes that affect fat retention.

According to FRAC, the problem is not just about food consumption. Low income communities also have fewer resources for physical activity, such as parks and recreation centers. Even in communities that do have open space areas, they may be less attractive due to trash, noise, traffic, and criminal activity. It makes sense that parents would not want their children to play at the park in a particularly dirty or high-crime neighborhood. This puts children at a higher risk for staying indoors and living a sedentary lifestyle. According to other studies, lower income children are less likely to participate in organized sports or to have access to/participate in physical education classes and recess.

Additionally, the financial and emotional pressures of poverty may have a serious impact on both adults and children. Stress can contribute to unhealthful eating behaviors, hormonal/metabolic changes, and even chronic anxiety or depression, which have all been associated with adult and childhood obesity.

Many low income families also lack access to quality, affordable health care. Chronic illnesses that are related to obesity may not be diagnosed. Furthermore, families may not realize their child is overweight. For example, according to Strong4Life, an organization fighting childhood obesity in Georgia, 75% of parents of overweight or obese children in the state did not believe their child had a problem. I recently read an article saying that even among families who do have access to health care, less than 25% of parents of overweight or obese children recall a doctor telling them their child is overweight. If even medical professionals are unwilling to confront or acknowledge the issue, how can we expect households who have less access to health education and basic health care to recognize obesity and take action steps to prevent or correct it?

To me, the fact that obesity is inversely related to income is further support that the socioeconomic disparity in our society is not just a matter of money, but is linked to a complex set of dynamics that affect all aspects of life.

So what can be done to stave off the obesity epidemic in lower income communities in particular? I would suggest communities can start with the specific issues mentioned above, by bringing farmers markets to lower income neighborhoods, investing in community recreational centers and low/no-cost sports leagues, requiring schools to provide more hours of physical education, providing free health education for parents and kids, offering free classes on how to manage a tight food budget, focusing efforts on preventive health services (including attention given to decreasing stress), among other actions.

I have tried to lay out some of the reasons for the weight disparity, but I think it will take a lot of people with a lot of brain power to improve the health future of all our nation's children. If you have other ideas, please share!

Photo credits:

Thursday, February 9, 2012

To Me, That's Beautiful

A friend sent me this brief YouTube clip from the show "Parks and Recreation." I'm a sucker for a good laugh. Freeedommmm!

Tuesday, February 7, 2012

What Your Mother (and Your College) Didn't Tell You About Chlamydia

I recently read a book called, "Unprotected: A Campus Psychiatrist Reveals How Political Correctness in Her Profession Endangers Every Student." The basic premise of her book is that campus health and counseling has a bias toward presenting material in an inclusive/non-judgmental way to the point that they actually neglect to provide complete medical information. Their jobs are controlled by fear of offending or by the desire to uphold a particular ideological view. The author takes the stance that medical professionals should be delivering medical facts rather than information filtered through political opinion. The book is written anonymously, because the author believes she might experience career repercussions for stating an opinion outside the prescribed norm.

There were many points of the "Unprotected" book which did not sit well with me. For one, I think the author somewhat undervalues general sensitivity within the doctor/patient relationship and assumes that all discourse framed by an attitude of "inclusiveness" automatically leads to sugarcoating, bending, or omitting facts. I personally think it is possible to be both truthful and tactful, and I am not sure the author would agree. Even so, the book presents a compelling argument for a few issues in particular, one of which I would like to share.

I thought the most well-written chapter was the one on chlamydia, from which I actually learned something new. As it turns out, this common sexually transmitted disease can present a serious risk to fertility, not only when a person is infected, but even potentially years after treatment. I was always taught that it is a very common, pesky sort of infection, which is easily treatable with antibiotics. That's what all the pamphlets seem to say. Only women who don't go for their yearly exam need to worry about the long-term effects.

But apparently, that is only part of the story. The author claims that we do not hear about the rest of the information, because that would imply more long-lasting or permanent consequences to sexual choices. It would suggest that engaging in more "risky" behavior increases the chances of infertility, regardless of following student health mantras about getting yearly exams and treatments. To present such information to students could border on judging a person's sexual choices and is therefore out of bounds.

Based on the very plausible examples and meticulously sited statistics in the book, as well as my own experiences, I would mostly agree with her that there is a bias in the health system on many university campuses.

But even as she argues that there is an agenda at play, I recognize that her book also has an agenda of its own.

With this in mind, I consulted outside sources, such as the CDC website and medical journal articles, in addition to the statistics cited in the book itself, to find out if what she is saying about chlamydia is just the fear tactic of an extremist or the truth about the disease. And here is what I found:

According to the Center for Disease Control and Prevention (CDC), there are 19 million new STD infections every year. In 2010, 1.3 million of these were cases of chlamydia, and chlamydia is the most reported bacterial STD in the United States. The CDC also says that less than half of sexually active young women are screened annually, as recommended by the organization.

Young women are more likely than older women to contract STD's for many reasons, one of which is that the "transformation zone" on a young woman's cervix is immature. This an area where cells are more vulnerable to bacteria and viruses, and it continues to develop/shrink with age, into adulthood. This is mentioned in the "Unprotected" book and is also confirmed on the CDC website.

Further complicating the picture for young women, the author of "Unprotected" mentions a study from The Journal of Sex Research 37, no 1 (February 2000), which reported that forty percent of college women experience a sexual encounter without commitment, and ten percent report doing so more than six times. She also sites the Journal of American College Health, writing, "the most recent study of heterosexual college students showed that less than half used a condom during their last vaginal intercourse, and that was an all-time high. The reasons? There wasn't one available, there was no concern about pregnancy, the participants were high or drunk, they considered themselves uninfected, it felt better." Even those who do use condoms are still at risk, because chlamydia can live on skin that is not covered by this protection. Many women also re-contract the disease even after being treated because their untreated partner(s) still have it.

Given the shockingly high number of new cases of chlamydia each year, the specific risks to younger women, and the lack of testing being done, I wanted to get to the bottom of this idea that it can continue to affect women even if treated and eradicated.

Chlamydia is asymptomatic, or "silent," for most infected individuals. Men usually have no symptoms, but some may experience discharge from the penis or a burning sensation. If symptoms do occur for women, they usually appear within a few weeks of infection and can include abnormal vaginal discharge or a burning sensation when urinating. For women, chlamydia starts by infecting the cervix or urethra. According to the CDC fact sheet, in about ten to fifteen percent of women, untreated Chlamydia spreads to the uterus or fallopian tubes, causing pelvic inflammatory disease (PID). This can occur as soon as a few weeks after the initial infection. (So much for those yearly exams as protection against the progression of the disease.) PID also displays little to no visible symptoms, yet it can cause permanent damage, such as scarring of the upper genital area, which can lead to infertility or an ectopic pregnancy (a potentially fatal pregnancy outside the womb).

Research has indicated that once chlamydia progresses to PID, traditional antibiotic treatments may or may not actually get rid of the entire infection. More research is needed to determine the likelihood that some cases may simply remain in a dormant state once treated. This is one way chlamydia can potentially damage a woman's reproductive organs in the future.

The more striking information suggested in "Unprotected," however, is that even if the infection is completely eradicated, the chlamydial antibodies that remain in a woman's system may be linked to future miscarriages.

The reason I call this information striking is that it is rarely presented to women as a potential long-term effect of this infection. Instead, we teach that if detected early enough, we can treat Chlamydia with antibiotics before it becomes full blown PID and thus prevent potential infertility. No pathogen, no problem. Right?

Well, it's actually not always so simple.

When our body encounters a disease, we develop antibodies in our blood which help to fight the disease. These antibodies may remain in our system for months or even years, depending on the type of infection. If we contract the same disease in future, our antibodies recognize the pathogen and mount a defense against it based on their "memory" from the previous battle. They are already well versed in taking out the disease quickly. This is why, for example, most individuals can only contract chicken pox once in their lives. Their chicken pox antibodies make them immune to future attacks. Another common example is the flu vaccine, which is basically an injection of inactive flu virus, allowing a person's blood to build up a supply of antibodies. If the right strain is used for the vaccine, when the person is exposed to the real pathogen, they are ready to fight it off before it becomes a full blown case of the flu.

Similarly, a woman exposed to chlamydia will typically build up antibodies to fight the disease. Chlamydia bacteria make a type of protein called HSP, which is released when the cells in which the bacteria are hiding die. White blood cells realize HSP is an invader that does not belong in the body, and once exposed to it, they make antibodies that will specifically recognize HSP as a signal of chlamydial infection for years to come.

Interestingly enough, an important part of a human embryo's development also involves producing a type of HSP. The book "Unprotected" posits that the body of a woman previously infected with chlamydia thinks the HSP-producing embryo is another chlamydial infection and attacks, leading to a miscarriage. I was skeptical on the factual nature of this assertion, however, so I did a little side research.

A paper published by the European Society of Human Reproduction and Embryology in 2000, called "The Role of Heat Shock Proteins [HSP] in Reproduction" describes several studies from the 1990's which showed that "since bacterial and human HSP share ~50% amino acid sequence homology (Shinnick, 1991), it has been proposed that prolonged exposure by the immune system to chlamydial HSP60 and a concomitant exposure to both the chlamydial and human HSP60 may lead to autoantibody formation (Witkin, et al., 1997)." (Just so you don't get confused, I need to clarify that Witkin is one of the authors of the year 2000 "HSP in Reproduction" paper and also cites his own previous studies a number of times within the paper. Hence the pre-2000 Witkin citations within the quotes.) The paper goes on to say that other scientists have proposed specific models for how this autoantibody formation may interfere with early stages of pregnancy, ultimately causing the embryo to degenerate or undergo apoptosis.

In order to evaluate these suppositions, the authors of the "HSP in Reproduction" paper tested women undergoing in-vitro fertilization (IVF) for the presence of the anti-HSP60 chlamydia antibody. The antibody "was present in 26.3% of women who did not become pregnant after transfer, 33.3% of women with only transient biochemical pregnancies, 30% of women with spontaneous abortions, and 7.3% of women with live births (Witkin, et al., 1994)." The paper describes three other similar experiments in women undergoing IVF, in addition to studies on mouse embryonic development. Then the authors state, "In conclusion, the summarized results of these studies revealed that a previous infection with C. trachomatis (chlamydia) and a resulting immune sensitization to chlamydial heat shock protein (HSP) epitopes was associated with a poor prognosis for reproductive outcome and, in addition, impaired IVF results."

To my amazement, this is just as the author of "Unprotected" presents the information, with a few caveats.

The scientific paper does not specify how long of an exposure to chlamydia a woman must have before developing the strong immune response, so I did not see definite proof to rule out the possibility that near-immediate treatment can prevent the HSP antibody issue. That said, the half of women who do get tested are typically only tested once a year, so there is plenty of time between exams for a "prolonged" exposure. Furthermore, some women may receive false negatives in a given year, making their actual infection before treatment even longer than assumed. Just because a woman does not develope PID does not mean her infection is brief; as mentioned above, PID only develops in ten to fifteen percent of cases. And then there are the more than half of women who avoid the exam altogether for an assortment of reasons and would almost undoubtedly experience a prolonged exposure if they contracted chlamydia.

The research ultimately shows that a woman who has built immunity to chlamydia is much less likely to have a live birth in IVF. As far as scientists can tell at this point, this is the direct result of the interaction between chlamydia HSP antibodies and the embryo. These findings can be extrapolated to suggest that the chlamydia antibody is harmful to embryonic development in all pregnancies.

As I stated at the beginning of this post, I did not agree with every point in "Unprotected," but on this particular topic, I am genuinely compelled to be of the same mind as the author. The facts have long been hidden and are actually worth considering. Being a woman myself and having never heard of these potential consequences of chlamydia, I felt it was my duty to share with others. The risks you take can have an impact not just on your immediate health, but on your long-term reproductive health. There is not a magic pill for every infection, as popular culture would like us to believe. And some of the consequences are actually permanent and quite serious. They should not be glossed over in pamphlets and health centers because they make some people feel "judged" or "uncomfortable."

Just as we warn people of the risk of heart disease from being overweight and getting insufficient exercise, we should warn women of the risk of lifelong infertility from casual sex. Some people will determine the risks of overeating and sedentary lifestyle are worth it to them, just as some will prefer sexual freedom over safety. But let's not hide medical truths in order to promote a particular agenda or ideology about sexual consequences or a lack thereof. Each woman must be informed enough to weigh the risks, decide if they are worth it, and take care of the only body she will ever have.

Saturday, February 4, 2012

Heart-Pounding Super Bowl

I am not much of a football fan, but even those of us who care nothing about the sport the rest of the year muster up the enthusiasm to care a little on Super Bowl Sunday (or to at least pretend). If nothing else, a Super Bowl party guarantees time with friends and a schmorgishborg of delicious snacks.

For those who have been following the sport all year, undoubtedly the game will be full of heart-pounding action on the field and, as it turns out, in their own homes. Today, while I was thinking about the big game, I recalled reading an article in 2011 saying that heart attacks are more likely around the time of the hoopla. Heart-pounding action indeed!

Per the usual, I did a little Google search, and last year's article was right at my fingertips! (I was glad to confirm I didn't make up something that crazy in my head.)

Apparently, one study suggests that heart attacks may be more prevalent in the weeks following the Super Bowl, namely in the areas where people supported the losing team. The research, which was published in the journal Clinical Cardiology, examined heart-related death rates in Los Angeles following two Super Bowls, one where L.A. won and one where they lost, in comparison to the same weeks other years.

In 1980, when the Los Angeles Rams were defeated by the Pittsburgh Steelers, heart attacks in L.A. were 15% higher for men and 27% higher for women in the two weeks following the game compared to the same weeks in 1981 - 1983. In 1984, on the other hand, when the L.A. Rams beat the Washington Redskins to win the Super Bowl, the L.A. cardiac death rate did not increase in the weeks following.

Due to a variety of design factors in the study, as well as the fact that it only covered one city for two Super Bowls, it does not conclusively prove that the Super Bowl loss caused the upshoot in heart related deaths. Regardless, the findings were pretty drastic in the difference from one year to the next

So why would this happen?

Well, assuming that the connection is true, researchers have a few theories. To begin with, it is important to note that those affected were already at high risk for a heart attack before the game, so the changes experienced as a result of the game would have been one contributing factor among many health issues. My first thought was that people died of boredom, but no one else seems to be espousing that view. One more popular theory suggests that individuals' emotional attachments to the team triggered a major stress response when the team lost in 1980. Others have suggested that it was not the sadness over the loss, but rather the tense game itself, that was the difference between the two Super Bowls. The 1980 game was a much closer nail-biter, with many ups and downs, compared to the 1984 game. The range of emotions associated with the 1980 game could have caused people's hearts to experience greater strain. Another additional factor might have been the copious amounts of beer and fatty snacks typically consumed around the game, although one would assume those were more or less the same from 1980 to 1984.

I have no idea if this cardiac connection will be supported by further research. As a math major, I am inclined to be a skeptic of such simplistic statistical studies until further proof is provided. But hey, this is the one interesting link that immediately came to mind between health and the Super Bowl, so I felt compelled to share. Ultimately, all I can say is, be careful while watching football!

Have fun! Go Giants!

Check out some more detailed articles on the subject here:

Friday, February 3, 2012

Texaco's Public Health Threat to the Amazon

My lovely Aunt Cathie, who lives in New York City, recently sent me a copy of the January 9, 2012 issue of The New Yorker, because it contained an article about the ongoing nineteen-year lawsuit over Texaco’s oil drilling in Ecuador. Since I studied abroad in Quito, Ecuador’s capital city, for a semester my junior year of college, she knows I care about the issues the country is facing.

Recently, an Ecuadorian appellate court upheld an $8.6 billion ruling in the matter, but the legal battle will undoubtedly wage on, as the ruling is sure to be appealed once again. Interestingly enough, during my stay in Ecuador, I traveled extensively throughout the country, and I even made a visit to the Amazon, where I saw the damage from the oil drilling for my own eyes. The New Yorker article brought back memories of the black, tar-like substance scattered throughout the fields of the Amazon, of the sick people who just wanted to be left alone, and of the terrible injustice caused by this international oil company in collusion with the dysfunctional Ecuadorian government of the day.

Starting in 1967, a consortium of companies led by Texaco spent twenty-three years drilling for oil in the Amazon. Today, what remains is a vast array of environmental damage that has altered the face of the treasured rain forest and harmed the health of the populations who once enjoyed life there.

As The New Yorker article explains, one challenge with drilling oil is deciding how to handle the additional residue that comes from the ground in the process. This heavy-metal fortified liquid is called “produced water,” and it is separated as much as possible from the crude oil at the site of drilling. In the United States, it is common practice to re-inject this liquid deep underground into wells designated for this purpose. In Ecuador, however, Texaco used the far less costly method of dumping the liquid into large pits dug into the earth, each about the size of a typical swimming pool. Various organizations have attempted to quantify the scale of this dumping, and the consensus seems to be that there are at least eight hundred of these pits dotting the rain forest, with total estimates in the billions of gallons for the amount of toxic waste involved.

In 1993, a group of Ecuadorians began a legal battle against Texaco for the environmental and community destruction caused by the oil drilling. When Texaco was purchased by Chevron in 2001, Chevron inherited the lawsuit. The plaintiffs have produced study after study showing the higher rates of cancer, miscarriage, birth defects, dead livestock, and sick fish in the area. Of course, for each study produced along the way, Texaco hired ecological consultants, who provided their own counter studies showing the opposite effects.

To Chevron’s credit, a lawsuit does not hold much water if the company did not actually break any laws. Consequently, Ecuador had virtually no environmental protection laws in place during the time of the drilling. At the time, oil earnings constituted about a third of the Ecuadorian government’s revenue, so one can imagine that corruption and self-interest may have played a role in the government's lack of regulation surrounding Texaco’s activities. Texaco has long claimed that their operations were in line with the standards of the time. In addition, Texaco was part of an oil consortium, which included the government-owned oil company, Petroecuador. Provided that Texaco truly did remain within the boundaries of Ecuadorian law at the time, and provided they did not intentionally mislead the government about their practices, I am not sure there is a strong legal case to be made. (I am not a lawyer, however, so perhaps I am missing something here.)

Further complicating the situation is the problem that lawyers on both sides of the lawsuit have engaged in ethically questionable behaviors, which are reported in great depth in The New Yorker article. I will not go into those details in this post, but the important point is that this has brought the entire basis of the lawsuit into question on a number of occasions.

In 1995, Chevron finally admitted that Texaco had made a mess in the Amazon and spent forty million dollars on cleanup. However, because Texaco had only held a 37% share in the oil consortium, they determined to clean up only 37% of the reported pits. This is despite the fact that Texaco had been the sole operator overseeing work in the Amazon, drilling 100% of the oil wells and physically creating 100% of the produced water pits. After this cleanup effort, Chevron left the rest of the cleanup to the nationally owned Petroecuador – with the Ecuadorian government officially releasing Chevron from any further responsibility in 1998. Of course, given the other pressing issues of the country, it is unlikely the government will be able to produce the funds to undertake the rest of the cleanup effort in the near future.

From Chevron’s perspective, as expressed by a Chevron lawyer, “This is not about dirt in Ecuador. It is about a contract and how to interpret it.” In other words, they have met what they believe to be their minimum legal obligation, and that means they are done.

But that’s just it! While the lawsuit may not ultimately hold up in a court of law and is arguably “not about the dirt in Ecuador,” the ethical issue of who should claim responsibility is precisely about that dirt!

What about doing the right thing for the right reason, period?

While Chevron may not be held to a precise legal obligation to do any further cleanup, I cannot help but be disconcerted that they are clinging to legal technicalities to neglect what I would consider their greater moral obligation. I do believe that the government of Ecuador should be held responsible for its egregious failure to pass laws to protect its own citizens or to monitor the activities of large corporations. At the same time, I know that the government of Ecuador does not have the experience or the funds to undergo such a large-scale cleanup effort in the wake of the devastation left by Texaco.

I understand that companies like Chevron are primarily concerned with making money, and I know they have little fiscal incentive to take responsibility above the bare minimum required by the law, but it is still outrageous that they are willing to ignore a major public health issue for the sake of money. These are real people suffering real life-threatening consequences from Texaco's real mistakes!

I found a few quotes from The New Yorker article especially enlightening. At one point, the article cites a Chevron lobbyist in Washington as stating to Newsweek in 2008, “We can’t let little countries screw around with big companies like this.”

If that is not corporate arrogance at its finest, I don’t know what is.

Another section of the article reads, “In Quito, I met a woman named Margarita Yepez, who spent eighteen years as a social worker for Texaco. In the early days, she said, gringo oilmen told the Lago Agrio locals, in jest, that oil was good for one’s health; a coffee can full of crude could cure arthritis or male-pattern baldness – just rub some on the affected area. ‘They were the authority, so we trusted them,’ she said. ‘We were dumb.’” (Read a few paragraphs down to find out the real effects of human exposure to crude oil.)

I believe that Texaco not only took advantage of inadequate environmental regulations, as many companies have done throughout the world, but also exploited a vulnerable population that they regarded as inferior, treating them with a lack of empathy and outright disrespect.

When I visited the Amazon, I heard and observed some additional information that was not published in The New Yorker article. Most of this came from local sources in the region, so of course it is likely to reflect the biases of the storytellers. But it is still worth sharing.

The first piece of information was that even though the pit-dumping method was not the preferred one for getting rid of produced water, there were still industry standards for constructing these pits. The standards were designed to keep the produced water confined to the pits, so that it did not leak into ground water. Unfortunately, the produced water (as well as patches of the crude oil that remained in the produced water) can be found strewn throughout the Amazon, not just constrained to these pits. In other words, it has found its way out of the designated areas over the years. I was told by local sources that Texaco cut corners constructing the pits, neglecting safety and environmental norms, which caused these problems. Regardless of whether or not they actually intentionally mis-constructed the pits, the evidence on the bottom of my shoes spoke for itself that something went terribly wrong with the quarantine plan.

The second piece of information I was given was that Texaco had been under legal obligation to report all of the constructed pits to the Ecuadorian government. However, it is believed that they only reported a fraction of the total number of pits. This is another reason why it is hard to determine the precise environmental impact – new pits continued to be discovered years after Texaco discontinued operations in the region.

The third piece of additional information was that Chevron’s forty million dollar cleanup job of 37% of the pits also consisted of shoddy work, primarily involving the removal of the top layers of sludge from the soil and planting grasses and shrubs on the affected areas. Unfortunately, I visited these “cleaned-up” areas and saw with my own eyes that in just a few short years of normal erosion, the soil had turned up more sludge, which is clearly visible among the shrubs and grasses.

Chevron has claimed that locals intentionally plant contamination in rivers, fields, etc. to support their case of environmental damage. I can see this happening in a few isolated instances, but I find this hard to believe on a consistent basis, given the large scale of the problems I personally witnessed.

In a rather humorous story in The New Yorker article, which illustrates Chevron's state of denial, the author tells of his visit to an oil pit with a Chevron spokesman. He writes, "A few miles outside Lago Agrio, we stood on the lip of a waste pit, and Craig [the Chevron spokesman] told me that the vile-looking residue on its surface was only a few inches thick. To illustrate this point, he picked up a rock and lobbed it into the pit. It landed, with a sickly thud, on the surface. 'If we had a bigger rock...' he said, and threw a much larger one. It, too, failed to sink." Just prior to recounting this experience, the author shares that a local showed him how he was actually able to stand completely on top of the crust, and when he shifted his weight from foot to foot, the surface undulated beneath him. That sounds like a bigger problem than a few inches of filth.

Chevron also continues to claim that “there is no corroborating evidence” of adverse health effects related to oil development in the region and complains that those who live there blame Texaco for every problem they experience. As Sylvia Garro, Chevron’s global issues executive said, “If their cow dies, it’s Texaco. If their wife has diabetes, it’s Texaco.”

Yet consider the dramatic concerns over the approximately two hundred million gallons of oil spilled into the Gulf of Mexico in 2010. Would BP have dared to call the fearful people of the Gulf Coast towns paranoid or ignorant locals? No! We would have considered that disingenuous, at best. (Not to mention, that would be criticizing American citizens, rather than indigenous peoples of a third world country. So of course, this would invoke more anger, because it is us and not someone else.)

But let's consider the plight of these "someone else's." Multiply the Gulf Oil Spill by one hundred, and you will have an estimate of how much toxic oil waste is believed to pollute the Amazon after Texaco’s tenure.

According to the Utah Department of Health, the prolonged effects of crude oil exposure include “lung, liver, and kidney damage, infertility, immune system suppression, disruption of hormone levels, blood disorders, gene mutations, and cancer.” Produced water, the black sludge found in the Amazon, has been shown in countless scientific studies to contain significant traces of the crude oil from which it is separated. How, then, can Texaco/Chevron in good conscience claim that “produced water” has no health effects?

It is easy to sit in an executive office and claim that the public health threat is not real, but entire tribes of people have been nearly wiped out from the area, locals can no longer drink the water, and many of their traditional healing herbs can no longer be found or used. Babies are being born with a wide range of birth defects, and entire families are dying of cancer. I can tell you from my own travels that I would be hesitant to eat even one salad grown from the soil I saw in these Amazon villages, never mind subsisting entirely on what is grown there. I would love to see a Chevron executive back up the company’s claims by eating the produce from the affected areas for a year or more. I think you would be hard pressed to find one who would consider doing it for even one week.

As mentioned at the beginning of my post, on January 4 of this year, an Ecuadorian appeals court upheld an $8.6 billion ruling against Chevron. The ruling also indicates that Chevron must apologize to Ecuador, or the fine will be doubled. Chevron has said they will appeal this latest ruling to the next level, Ecuador’s National Court of Justice, as they maintain that they have done nothing illegal, that the ruling is politicized, that the judgment cannot be enforced, and that corruption has tainted the case as the justice system has been inappropriately conspiring with the plaintiffs’ counsel.

Perhaps Chevron is right that they should no longer have a legal obligation to clean up the Amazon.

However, the more important question, in my mind, is whether they should take that as the green light to leave the rain forest in a state of environmental disaster, and more importantly, to ignore the heart-wrenching plight of real, live people? In the absence of a legal obligation, does that mean it is right for Chevron to walk away?

I think not.

Note: The above photos were actually taken by my friends when we traveled to the Amazon together.

Wednesday, February 1, 2012

Chili Cheese Corn Dog Casserole Supreme!

This isn't exactly the "healthiest" posting, but I am so overjoyed that one of my best friends, Sara, actually tried a recipe I sent her, then forwarded it to one of my other best friends, Pam, who also made it! And I think they even liked it.

I happened upon this highly-rated recipe on the internet when I was trying to find a way to get rid of the turkey and chicken hot dogs that had been in our freezer for months. I originally bought them on sale as a potential alternative to regular hot dogs, but they didn't actually taste so great on their own. This casserole experiment worked well, however - neither my husband nor I could really tell the difference from your run-of-the-mill quality beef franks when the hot dogs were mixed in with the other ingredients.

I am delighted to report that after I shared the somewhat unhealthy (but oh so delicious) recipe with Sara, she found a way to make it healthier for her diet! I had made some substitutions of my own when I tried it by using low-fat chili, excluding the sugar in the original recipe, and substituting the above-mentioned turkey/chicken hot dogs.

And as it turns out, both Sara and I discovered that all the added fat and sugar were not really necessary to make this a flavorful and delectable dish.

For anyone who likes corn dogs and chili dogs, you will LOVE this casserole. This recipe also has some serious child-pleasing potential. And with a few substitutions, it's really not that bad for you!

Check out Sara's blog for the recipe and other tasty details!

For more information on how to make your favorite recipes a bit healthier, check out some of these great resources:

Original Recipe and Photo Credit: Taste of Home