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Freiburg, Germany, 12 pm

Who Wants To Tell A Kid He’s Fat? Ctd

A reader writes:

I am an emergency room pediatrician, and your post about reluctance to tell a patient he or she is fat struck home. Overweight and obese children, aside from the well-publicized risks of diabetes, hypertension, and heart disease later in life, are at increased risk for things like injury (because when they fall their weight makes them more likely to be seriously hurt) and delayed diagnosis of appendicitis (because it is much harder to rely on an exam of an obese child, and radiology exams like ultrasound are much less reliable in overweight children.) The same mind-set that says “every kid deserves a trophy” is at work here. Doctors, and perhaps more so parents, are so afraid of harming a child’s self confidence that we refrain from telling the truth.

In addition, remember, most of us work in practices where we are judged on “patient satisfaction,” meaning we have to avoid saying or doing things that might upset parents. I have been cursed at by parents for even suggesting that weight loss might improve there child’s health.

Along the same lines, I’ve had parents walk out of the emergency room when I told them that the biggest risk to their asthmatic child’s health was the parent’s smoking. In some states, mentioning gun safety and risk (gunshot wound being the most likely cause of death after a car accident for most of the pediatric population) can land you in jail. Under Obamacare, hospitals and physicians can be docked pay if their patients aren’t satisfied enough.

Society has come to a place where hard truths are the last thing many want to hear. Most physicians, most of the time, would rather not buck that trend.

Another reader:

Your post struck such a chord for me. I’m the father of two young-adult daughters who are morbidly obese. They were above-average on the height/weight charts pretty much from birth, and compulsive overeating runs through both sides of our family. Our pediatrician was a wonderful person, yet it was clear that she had no training in or comfort level with addictive eating disorders as they relate to children. This is somewhat understandable since research on the psycho/bio-chemical triggers for overeating is still pretty new. But even when we quizzed our pediatrician about the issue and urged her to look into it more, she found that there just isn’t much info out there that will give doctors the comfort level they want before broaching such a volatile subject.

I feel like my wife and I failed our daughters. We couldn’t figure out how to balance being too restrictive with being supportive. We talked with both our daughters about it a lot and made them aware of the issues. But both daughters are morbidly overweight.

Yes; personal choices by the parents and the child matter in childhood obesity, but there are built-in societal causes (high-fructose corn syrup anyone?) and hereditary factors (addiction) that drive these negative outcomes for those with the predisposition. I only hope that pediatric practice will continue to improve its knowledge of this subject so that effective and compassionate interventions can someday become the norm.

The Best Of The Dish Today

My husband has forbidden me from writing any more posts titled New York Shitty. He’s as tired of all that whining as many of you are. But the NYT has come to my rescue. The Times recently asked readers for a reverse bucket list of all the things they’ve experienced in the Big Apple that they never want to experience again. It turns out I’m not alone:

“Disinfecting a phone that’s fallen into a sewer grate puddle,” Francesca Fiore wrote on Twitter. A reader named Ronnie K suggested in a comment on our City Room blog, “Finding a few black specks on your pillow case and a couple of bites on your arms.” Jennifer Fragale offered on Twitter: “Having to move furniture down from a 4th Fl walk up, around the block, and up a 5th Fl walk up.”

Navigating the streets of the city, by whatever mode of transportation, was a particularly rich source of discomfort.

Do you drive? Try “Being stuck in August rush hour traffic behind a garbage truck leaking hot garbage juice, a.k.a. ‘Satan’s Sangria,’ ” Jerome Goubeaux suggested in the comments. You could take a cab instead, or try to. Howard Freeman’s lament almost demands the mournful strum of an acoustic guitar: “Hailing a cab in the rain at 4:30pm, with a broken $5 umbrella.”

Satan’s Sangria. Genius.

Today, there were more questions than answers. Did Israel share what it found by bugging John Kerry’s phone with Russia? (And why on earth was Kerry talking on a non-encrypted phone anyway?) Is a Third Intifada brewing on the West Bank? How much should we spend on the health and longevity of our pets? Did Edward Snowden tip off al Qaeda about US encryption? Was Montaigne an atheist?

You want an answer? Try the Mental Health Break. That‘s the answer.

The most popular post of the day was “Why Sam Harris Won’t Criticize Israel“. On a program note, Sam and I are going to have a conversation about this subject this week. We’ll post an audio and a transcript soon thereafter. So stay tuned. The second most popular post was “We Tortured. It Was Wrong. Never Mind.”

Many of today’s posts were updated with your emails – read them all here. You can always leave your unfiltered comments at our Facebook page and @sullydish. 23 more readers became subscribers today. You can join them here – and get access to all the readons and Deep Dish – for a little as $1.99 month. One quickly jumped aboard:

I just thought you should know that it was precisely because of John Oliver’s scathing indictment of the native advertising model, and in particular the insane comments by NYT’s Meredith Levien, that by 8:35 pm last night, I cancelled my Times subscription and went looking for an NA-free source of content. Sadly, most search engine results are links to articles about how media outlets are starting NA groups or campaigns. But it took me all of 30 seconds to find your site, which I subscribed to immediately. Thank you for your principled services and your voice in the public discourse, both on TV and in the ether.

If you long-time subscribers want to help spread the word, gift subscriptions are available here. From a Dishhead last week:

I am sitting at the airport in Orlando with my daughter, who is entering 11th grade, on the way to visit my mother in Alexandria, Va. I am reading the Dish on my phone and she is reading your coverage of Gaza over my shoulder. I love her, but enough is enough. I just bought her her own subscription.

See you in the morning.

(Photo of Dish subscriber’s Gmail pic used with permission)

Finding Grace In Outer Space

Mark Strauss surveys the various ways Christian theologians have considered the possibility of life on other planets, which ranges from panic to an affirmation that God extends his love even to aliens. Here’s one way to explain how the latter might work:

Assuming other beings are self-aware and capable of free will, the very idea of denying them salvation is at odds with the concept of a God who deeply loves his creations. Thomas O’Meara, a theologian at the University of Notre Dame, writes in his book, Vast Universe:

Could there not be other incarnations? Perhaps many of them, and at the same time? While the Word and Jesus are one, the life of a Jewish prophet on Earth hardly curtails the divine Word’s life. The Word loves the intelligent natures it has created, although to us they might seem strange and somewhat repellant. Incarnation is an intense way to reveal, to communicate with an intelligent animal. It is also a dramatic mode of showing love for and identification with that race. In each incarnation, the divine being communicates something from its divine life….Incarnation in a human being speaks to our race. While the possibility of extraterrestrials in the galaxies leads to possible incarnations and alternate salvation histories, incarnations would correspond to the forms of intelligent creatures with their own religious quests.

Meanwhile, Tina Nguyen notices that creationist Ken Ham, of debating-Bill Nye-fame, doesn’t think aliens exist, but that if they did they’re definitely going to hell. He explains his, uh, logic in a recent column:

Now the Bible doesn’t say whether there is or is not animal or plant life in outer space. I certainly suspect not. The Earth was created for human life. And the sun and moon were created for signs and our seasons—and to declare the glory of God.

And I do believe there can’t be other intelligent beings in outer space because of the meaning of the gospel. You see, the Bible makes it clear that Adam’s sin affected the whole universe. This means that any aliens would also be affected by Adam’s sin, but because they are not Adam’s descendants, they can’t have salvation. One day, the whole universe will be judged by fire, and there will be a new heavens and earth. God’s Son stepped into history to be Jesus Christ, the “Godman,” to be our relative, and to be the perfect sacrifice for sin—the Savior of mankind.

Jesus did not become the “GodKlingon” or the “GodMartian”! Only descendants of Adam can be saved. God’s Son remains the “Godman” as our Savior. In fact, the Bible makes it clear that we see the Father through the Son (and we see the Son through His Word). To suggest that aliens could respond to the gospel is just totally wrong.

(Photo of night sky at Yosemite by Waqas Mustafeez)

Raging Against The Small Screen

In a review of a recent show by Neutral Milk Hotel, Grayson Haver Currin griped that frontman Jeff Mangum’s no-photo policy for concertgoers plays like a cynical ploy:

Mangum is attempting to preserve the same legacy of an enigma that turned into a bankable career during his prolonged absence; in an age of instant information and updates, where what you had for breakfast becomes part of your digital identity, can you actually prove that you saw Neutral Milk Hotel without telling and showing your friends? … [T]he unexpected and unfortunate part … is that he’s dictating how those who actively fund him can interact with their own nostalgia, the exact thing he’s been preying on and profiting from for several touring years now. Mangum’s reluctance to be photographed seems less like a savior complex or a production concern than a brilliant financial ruse: If you can’t preserve this experience, then goddammit, you will have to pay for it again and again and again.

Judy Berman doesn’t follow:

I don’t think that logic holds up. If you’re the kind of person whose concert experience is made or broken by the ability to “preserve” it via Instagram, then what do you get out of repeatedly paying to see a band that will never, ever let you do that? If Mangum’s photo ban really were rooted in some master plan to exploit his fans’ memories, you’d hope he’d do a better job monetizing it. Where is the Neutral Milk Hotel Tour 2014 Official “Bootleg” Series? Where is the one band-affiliated photographer who will sell you his shots of each show, with a hefty percentage of the proceeds going right into Jeff Mangum’s pocket? Where are the dumb fan-exploitation schemes like this one?

She sees plenty of advantages in no-photo shows:

At most shows I’ve been to recently, especially the ones where the performers have a significant following, I’ve been practically surrounded by people who’ve had their phones out for the entirety of every set, constantly Instagramming and shooting videos and texting or Snapchatting all of it to their friends. I’m fully aware that you can’t criticize this shit in 2014 without seeming like an out-of-touch Luddite, but so be it. It’s a special kind of terrible to shell out money to see a band you love, only to realize you’ll be watching them through the iPad the guy in front you is holding over his head. I mean, is that dude’s right to spoil the show for me (and everyone else unlucky enough to stand behind him) more important than my right to a clear view of the performance I paid for?

(Video: Jeff Mangum performs an encore at MASS MoCA on February 16, 2013)

A Predator As Protagonist

Praising the above Kroll Show sketch about drone pilots as “smart and disturbing,” Sam Lipsyte offers a caustic take on how we might start incorporating drones into war lit:

Should we now envision drone protagonists for the new war fiction? One could portray the drone as a gung-ho robot that begins to question authority. It can work in a short satiric burst, but if it goes for too long, the technical questions (where did these feelings come from?) might overwhelm the narrative missile’s “arc.” The robots-turning-against-us motif, from Philip K. Dick’s “Second Variety” to 2001’s HAL, seems a little old hat now. Perhaps it’s time to revisit Joseph McElroy’s innovative ’70s novel Plus, which tracks the consciousness of a cyborg brain as it confronts its limits and its mortality. Maybe it’s time for a long-form meditative drone. Or something more parable-like: Jonathan Livingston Seadrone?

Or maybe not. We like to think we’re all sealed up safe in our technology, but it’s a delusion, and good war fiction tends to shred societal delusions. Drone pilots are often suicidal PTSD cases themselves, after all, and plenty of soldiers from all sides died in combat during the last few wars, not to mention the horrific slaughter of so many civilians. Even with Pentagon-issued joysticks, it’s still about boots and dead bodies on the ground. The drone as a fictional character might have some promise, but the grunt’s-eye view will continue to resonate. We’re all underpaid, overworked, underinsured first-person shooters now.

Dating While Disabled

Elizabeth Heideman examines how wheelchair users and others with visible disabilities navigate the world of online dating:

Because of disability trolling, some people may hesitate to disclose their differences right away. Wheelchair users may only post photos that show their bodies from the waist up, or people with visual impairments may not mention their guide dogs and white canes in bios. Only when they schedule an in-person date with someone do they mention their disability.

Tiffiny Carlson calls this “dropping the D-bomb.” Carlson, a writer who uses a wheelchair due to spinal cord injury, has been online dating since 1998. “I always disclose my disability right away in my profile and photos,” she says via email. Just like a messy divorce-in-progress or the fact that there are three kids under the age of 10 waiting at home, Carlson feels that disability is an important fact that potential partners should know from the beginning.

Unlike Woodward, who feels the Internet can bring out more negative in people than positive, Carlson thinks online dating is actually a better, less scary way for guys to approach her. For people who’ve never interacted with a wheelchair user, the first time can be intimidating (especially if you don’t know proper etiquette). Exchanging a few flirtatious messages online, though, paves the way for a smooth first date.

The Pro-Life Resurgence Has Peaked

But Lane Florsheim suggests that’s a measure of its success:

Though the rate of passage for restrictive laws has slowed down this year, in certain states, this is because much of the damage has already been done. In these states, it seems, the pro-life movement is winning. Reproductive rights were one of many issues for which the 2010 midterms served as a turning point, thanks to the wave of newly elected conservative state legislators taking office around the country. “We’ve seen 226 abortion restrictions enacted over the past four years,” Elizabeth Nash, State Issues Manager at Guttmacher, told me. “That speaks to some states enacting multiple restrictions, and perhaps the urgency in some of those states to adopt further restrictions is just not there.”

Meanwhile, Amanda Marcotte notes that the abortion rate in Texas – where new regulations have forced more than half of the state’s providers to stop offering the procedure – has not fallen as much as many expected:

New regulations requiring Texas abortion providers to have hospital admitting privileges forced more than half of the clinics in that state to stop offering abortion services. This was expected, by both pro- and anti-choicers, to cause a significant drop in the abortion rate in the state. But as Amelia Thomson-DeVeaux reports at The Week, the drop was much less significant than expected. Research by the Texas Policy Evaluation Project at the University of Texas at Austin found a 13 percent drop in legal abortions over the previous year, which is significant, but not nearly as big a drop as you’d expect when half the clinics in the state shut down. “In some ways, we were expecting a bigger decline,” study author Daniel Grossman told the Texas Tribune. Abortion rates have been falling on their own nationwide for decades, likely due to improved contraception use. That suggests that while most of this drop is due to the law, some of it might just be part of the larger national trend.

The findings demonstrate a fairly serious flaw behind the push for more and more restrictions on abortion laws. “If more clinics close, one might reasonably assume, the demand for abortion will also decline, either because wait times at the existing facilities are too long or because women will decide that an abortion isn’t worth the hassle or expense,” Thomson-DeVeaux writes. However, this thinking relies on the false belief that women enter into the abortion decision lightly, and that a few obstacles will deter them. Avoiding the expense and hassle of having a child when you don’t want one remains extremely motivating, more than many health care experts realized.

On that note, let’s revisit last week’s rousing reader debate over abortion regulations:

As I’m about to send this, I see you’ve posted more dissents, and you comment, “Who is making abortion impossible?” Come on. Really? Please look up how many clinics around the country have closed in the past three years due to these obstructive “standards,” check out how far women might need to travel, and tell me that’s not putting safe, legal abortion out of reach for many, many women. You also describe these laws as “a way to provide some sort of speed bump before human life is taken.” OK, if by “speed bump” you mean requirement after requirement, with new ones continually added.

Another continues:

To say that a “speed bump” is needed before choosing to have an abortion assumes that women have abortions as a lark, without prior discussions with partners, friends, family members, health care providers or clergy. Or maybe a woman doesn’t discuss her decision but just, you know, takes the time to think about it on her own. Do you think the federal or state government should put up “speed bumps” just in case a woman didn’t think about her decision long enough, or not long enough to suit you? This attitude also ignores the other “speed bumps” that already exist: getting the money, taking time off work or finding day care (most women who have abortions already have children), traveling the possible hundreds of miles to an abortion provider, much more likely now with with these disingenuous “safety” restrictions on clinics.

In fact, you bemoan later-term abortions, but there are already so many “speed bumps” in place that by the time a woman takes the time to make a decision and deal with the practical issues I listed, and then has to possibly put up with a government-imposed waiting period, more time has elapsed in her pregnancy. Wouldn’t you prefer that a woman who knows she wants to have an abortion have it as early as possible and not be forced to delay because of these “speed bumps”?

Another adds, “For most women, the speed bump doesn’t change their minds; it just pisses them off.” Another reader:

In your latest exchange with dissenters you end by saying, “I do not apologize for my belief that that there is a genuine moral issue with abortion – the fate of human life – that a fair argument would acknowledge rather than dismiss as self-evidently untrue.”

That is only one of the moral issues with the abortion issue, and I will concede that often those who fall into the pro-choice camp want to avoid talking about that. But the anti-abortion camp is equally (if not, more so) averse to acknowledging the moral implications of their position. Specifically, what are the moral implications of forcing a woman to take an unwanted pregnancy to term? What are the moral implications of bringing more unwanted children into this world, especially considering the fact that most unplanned and unwanted pregnancies occur in low-income populations? What are the moral implications of the anti-abortion camp’s objections to contraception coverage, which has been clearly demonstrated to be the most effective way to reduce unwanted pregnancies?

One more:

With regards to the abortion questions at hand, perhaps it is best to meet in the middle.

Laws requiring counseling and wait periods might be okay, but those requiring admitting privileges are not. While I disagree with both and firmly believe that abortion should be freely available, I can understand the moral concerns. The issue with adding “medical” requirements on abortion clinics, however, is not about encouraging thoughtful decision making. It is about closing clinics by way of overbearing regulation. As a conservative, I would think you would be against such tactics. Fewer clinics farther away providing more costly procedures leads to unsafe abortions which is equally morally questionable.

If people want to make abortion illegal because of their moral or religious beliefs, fine. Say that. But over regulating a business in order to kill it under the auspices of making it safer is not conservative. It’s lying.

Steroids For Your Brain?

Marek Kohn suggests that’s the wrong way to think about “smart drugs” such as Adderall and Ritalin:

“I think people think about smart drugs the way they think about steroids in athletics,” [professor Amy] Arnsten says, “but it’s not a proper analogy, because with steroids you’re creating more muscle. With smart drugs, all you’re doing is taking the brain that you have and putting it in its optimal chemical state. You’re not taking Homer Simpson and making him into Einstein.”

Smart drugs have provoked anxiety about whether students who take drugs to enhance performance are cheating, and whether they will put pressure on their peers to do likewise to avoid being at a competitive disadvantage.

Yet some researchers point out these drugs may not be enhancing cognition directly, but simply improving the user’s state of mind – making work more pleasurable and enhancing focus. “I’m just not seeing the evidence that indicates these are clear cognition enhancers,” says Martin Sarter, a professor at the University of Michigan, who thinks they may be achieving their effects by relieving tiredness and boredom. “What most of these are actually doing is enabling the person who’s taking them to focus,” says Steven Rose, emeritus professor of life sciences at the Open University. “It’s peripheral to the learning process itself.”

Previous Dish on Adderall here, here, and here.

A Crisis In Clowning

Reporting from an industry convention in Chicago, Leigh Cowart notes that the future for red noses doesn’t look so rosy:

[One] seminar, called “Posing for Pictures and Working with the Media,” is for the most part a simmering rally for strategy and solidarity in the face of the current clown PR crisis. Of course, there’s the usual scary-clown trope to deal with, like the recent separate attempts by filmmakers to drum up some publicity by donning clown garb and standing ominously along roadsides and construction sites, last year in Northampton, U.K., and more recently in Staten Island.

But there’s an additional tension this year: Just weeks prior, the New York Daily News reported that America might be facing a clown shortage. Citing decreased membership rates in the country’s largest trade organizations– Clowns of America International (CAI) and the World Clown Association (WCA) – the article painted clowning as the loser in a war of attrition, but nonetheless steadily committed to the fight. CAI President Glen Kohlberger claimed membership numbers are dropping because “[t]he older clowns are passing away.” Compounding this, the reasoning goes, is that interest in clowning is waning: Kids just aren’t joining up like they used to.

(Photo by Flickr user downing.amanda)