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David Katz, M.D.

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Public Health and the Illusion of Your Autonomy: Kill the Umpire?

Posted: 01/06/12 04:35 PM ET

I watched this year's Sugar Bowl with particular interest, given my daughter's graduation from the University of Michigan last year. So, I was happy with the outcome. Regarding the wild and wooly play, I can say only: Thank goodness there were referees! And that is the real point of this tale.

You may be one of those stopping by here because you tend to agree with me, or at least find what I have to say interesting. If so, thank you. I like being liked as much as the next guy!

But, I fully appreciate that you may just as well be one of those stopping by here because you almost never agree with me, and are looking for the next opportunity to put me back in my place or pick a fight. If so, I'm game. This one's (mostly) for you.

What you probably like least about me and my left-leaning inclinations is my penchant for so-called nannyisms (a conclusion I derive from innumerable less-than-complimentary comments in response to my columns). I realize I am by no means the quintessential nanny -- you probably like many of my friends and colleagues -- Mike Jacobson, Marion Nestle, Kelly Brownell, Michael Pollan -- even less. But let's talk about me.

Yes, I think food marketing to children should be regulated; I don't think a Madison Avenue marketing executive vs. the average 6-year-old is a fair matchup. I think nutrition guidance systems should be devised independently of the companies selling the food, should convey overall nutritional quality, and should correspond to health effects. I think a soda tax is perfectly reasonable, although I favor a nutrition-based system of financial incentives. I think tobacco should be banned. And what the hell, let's really go for it: I believe in gun control. Nannyisms, all.

But not so fast. Let's look at this from a different quarter altogether -- such as the fourth quarter of the Sugar Bowl.

For that matter, pick a sport, any sport -- preferably one you like to watch and/or play. With very rare exception (bowling comes to mind), that sport -- up to its highest levels -- is supervised by some kind of... well... nannies.

Baseball has umpires. Football, basketball, soccer and hockey have referees. So does boxing. Tennis and the Olympics have judges.

Should we kill the umpire, and all the rest?

That inclination does take over when the calls go against our guys. But chances are, we don't really mean it.

We don't mean it, because in the absence of an umpire or referee, any game becomes a no-holds-barred affair.

Of course, it might all run sweetly in accord with the honor system. But if you believe that, it's time to talk about my moonlighting as a bridge salesman. I've got a doozy for you...

No, what tends to happen in the real world when we've killed off all the umpires and referees is that the less scrupulous team prevails. Cheaters prosper in a world of no accountability.

What's that you say? You can look after yourself? You are, after all, a fully autonomous adult?

Well, alrighty then -- you and your team can indeed fight fire with fire. The other guys throw low blows, or lob pitches at the batters' heads, and your team can do the same. But that rapidly evolves into an arms race, and devolves into a debacle. Such a contest ends either when someone wins, or when a whole lot of people get very seriously hurt -- and everyone loses.

Viewed through an uncompromising "We're all adults who can look out for ourselves" lens, umpires and referees are unneeded, unwelcome nannies who wantonly trample the autonomy of the players.

But viewed through a lens I suspect most of us might be more inclined to use, they simply make sure the rules of engagement are reasonable, equitable and enforced. They prevent cheaters from prospering. They prevent an arms race. They prevent the outcome where whoever actually plays by the rules gets clobbered.

I won't speak for my friends and colleagues in public health, although I suspect they feel the same; I'll just speak for myself. I am nobody's nanny. But as you play with the military-industrial establishment with your health on the line, I don't mind being a referee.

You may feel you don't need one. But just like the basketball player who believes he doesn't need no stinkin' refs just before taking an elbow in the kidney... You are wrong. With all due respect, and meaning no offense -- you are dead wrong.

I find that often my job in public health is not about telling people things they never knew -- it's about telling them things they never knew they never knew. Nutritious food does NOT need to cost more. "Organic" and "natural" do not reliably mean organic and natural -- let alone better for you. "Zero grams trans fat" doesn't really mean zero.

If you have diabetes and are advised to control your sugar intake, beware pasta sauce -- which at times contains more added sugar than ice cream topping. If you have hypertension and are advised to watch your sodium intake, beware breakfast cereals -- which are, as a matter of routine, more concentrated sources of added salt than potato chips.

"Multigrain" doesn't mean whole grain. "Fat-reduced" does not mean more nutritious. Sugar may appear divided up into ten different aliases in an ingredient list so it doesn't have to be listed as the first ingredient. Physical activity during the school day does not interfere with academics, but often tends to enhance them. A slice of pizza is NOT a vegetable. And so on.

You may think you are defending your autonomy by opposing a ban on toys in Happy Meals. But while you are resisting the tyranny of public health, you are playing right into the hands of a large and rich corporation that is far more concerned with its profits than the health of your child. Did they consult you about putting the toy in -- or did they hold a closed-door session where highly-paid marketing executives told them how to manipulate you by manipulating your children?

You may not need your hand held in the supermarket, because you can make sense out of things all on your own. But which is better for you -- the unfortified breakfast cereal made from whole grain, or the highly fortified cereal made from stripped down grains with added fiber? Which is better for you, the whole grain bread which may or may not contain partially hydrogenated oil, or the bread made with less whole grain and canola oil? Do vitamins and minerals truly "enhance" water?

If you think you know the answers, I think you're wrong. I've devoted 20 years of my career and nine years of post-graduate education to these issues, and I find them challenging. I've written two editions of a textbook on nutrition, and still think this stuff is hard to sort out. What isn't hard to sort out is how the front-of-pack messaging is designed to take advantage of your confusion, and influence what you buy.

That you can even attempt to make informed decisions about nutrition (even if often failing in the attempt) is because products carry a nutrition facts panel and ingredient list -- mandated by that pack of nannies in the federal government. Absent that nannyism, none of us would have a clue what's in our food. I think we can, and should, do a whole lot better than a long list of factoids the average shopper and most experts can't readily assemble into a summative measure of overall nutritional quality -- but that's a discussion for another day.

Perhaps you have such faith in your autonomy that you believe you can outwit Ph.D.s in marketing paid large sums to outwit you. Perhaps your autonomy is the equal to the collaboration of food scientists, nutritional biochemists, and neuro-physiologists who have used functional MRI scans to determine what combinations of flavors and ingredients make it a virtual certainty that you can't eat just one!

If so, you probably don't want rules for airline safety checks either. No matter what the financial pressures, we can surely just count on the airline industry to avoid any corner-cutting, can't we? Airplane safety inspections and maintenance are endeavors overseen by aviation nannies.

Or maybe they are just referees. Objective third parties with a priority other than which team wins. Umpires who are committed to making sure the game is fair.

I don't think we're surrendering our autonomy by acknowledging a role for referees. In their absence, the team with more resources and fewer scruples will, indeed, win.

We needn't wade into the weeds about scruples, but let's acknowledge the resource inequity in public health. The companies and industries my fellow referees and I work to constrain have hundreds of millions of dollars to spend; you don't. They have access to every doctoral-level expert money can buy; you don't. They have proprietary data about the details of what makes customers like you tick. They've got the ear of Congress. All you've got is caveat emptor. You're going down!

Which is where I come in. Not as a nanny, but as a referee.

I realize I may still make calls you don't like. There may be times you want to kill the umpire. But perhaps we can agree that unlike a nanny, an umpire is not here to curtail anyone's autonomy. The job is to do the best one can to make sure the contest is fair.

After that, it's up to you. Play ball!

-fin

For more by David Katz, M.D., click here.

For more on personal health, click here.

Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org

 

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01:18 PM on 01/08/2012
"You may think you are defending your autonomy by opposing a ban on toys in Happy Meals. But while you are resisting the tyranny of public health, you are playing right into the hands of a large and rich corporation that is far more concerned with its profits than the health of your child." EXACTLY. Why are people so much more willing to be dictated by for profit corporations than the recommendations of public health professionals?

www.pursuitofpublichealth.com
Genders
Love, Tolerance, Enlightenment
05:12 PM on 01/09/2012
FF.
09:15 PM on 01/07/2012
Oh, they are very clever at marketing and getting to you subliminally and even into your subconcious. Try snoozing lightly to cable tv and see what the advertisements do to your imagery and dreams. If you can do lucid dreaming you can have quite an adventure. Then the next day or two go shopping and you will find yourself automatically directed to the adverised products as if they are naturally what you want.
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egal
Reality disagrees with Conservative assessments
08:01 PM on 01/07/2012
The one thing the least-informed and most-ignorant can do to keep from feeling as uninformed, ignorant, and powerless as they are is to REFUSE TO ADMIT HOW UNINFORMED, IGNORANT, AND POWERLESS THEY ARE.

They resent the people who tell them what actually IS best for them because if they find out that truth, then they might have to acknowledge they're not as superior as they would like to think they are.

And they continue to refuse to accept that there's a need for this sort of information because that admission reveals their own weaknesses in not knowing the answer without having to learn it.

The proponents of self-reliance to such an extreme that no referees are needed to ensure fairness are willfully ignorant of the way the world works, and that's why they're so easily manipulated. They convince themselves they're wise enough not to need the help that all those poor sods interested in facts and reality and logic and information need.

Remaining ignorant of their own ignorance lets them think themselves better than average, and thus likely to rise to the top in a free-for-all.

THAT's the real reason they fight so hard not to have anyone else tell them what to do--because if they admit that somebody else is better than they are, or more knowledgable, or that some people aren't playing fair, then they might have to admit that they're just as fallible and in need of help as everybody else.
04:43 PM on 01/07/2012
Dr. Katz is right: "I think nutrition guidance systems should be devised independently of the companies selling the food..." The federal government's primary guidance is the Dietary Guidelines (1980-2010), arrived at by a 13 member Dietary Guidelines Advisory Committee. It's no secret that the selection of these 13 members is heavily influenced and controlled by food processing interests, coordinated in part by their Washington-based International Food Information Council Foundation whose trustees include major food companies like General Mills.
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12:33 PM on 01/08/2012
The entire deregulation movement was promoted for financial gain by the selfish and greedy who are the beneficiaries of the scheme. It is equivalent to telling your children that there are no longer any rules that they must abide by. How many of us think that that would be a good idea.

Thanks for the fan.
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01:08 PM on 01/07/2012
Until the US sheds the current RULE BY ECONOMIC POWER and returns to DEMOCRATIC MAJORITY RULE, it is wise to choose foods that have been the least handled by commercial interests. How to return to democratic majority rule? Here is an idea:

http://signon.org/sign/citizen-imposed-congressiona?source=c.fwd&r_by=462982
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HUFFPOST SUPER USER
Horatio Nelson
01:07 PM on 01/07/2012
If you want to help, advocate universal healthcare for all and strict public control of medical cost before we're all driven to bankruptcy. This way you can contribute without messing with other people's choices.
12:59 PM on 01/07/2012
I like this umpire analogy, though I am not really sure what is wrong with a nanny government. A nanny does not have the authority of the parent, after all. A nanny works to ensure the parents' wishes are carried out. Perhaps as a country our difficulty is in agreeing to what or who those "parents" are. Is it the Christian Jesus, the Constitution and Founding Fathers, or the post-Civil War pragmatism that took over when that conflict shattered the notion that civilized men could always talk their way through conflict? (Great book about that btw - The Metaphysical Club) Until we can identify who we are together, our "nannies" will be at odds, "interfering" with our health car or our sexual habits.
12:16 PM on 01/07/2012
In this world there continues to be a flood of 'food science' information, occasionally this Information acts like a reality distortion field. The phrases 'nanny' or 'referee' here don't really match what you do Dr. Katz. What you are attempting to do is morph this 'reality distortion field' into something people can use absent the 20-30 years training and experience. Nutrition science for dummies some might say but this would be an inaccurate assessment. It is more like nutrition science for people who really want to know the truth. To understand the plays in the other team's playbook. So I would call your role one of coach. And you know as well as anyone you could double or triple your income by playing for the other side. I for one am glad you are on this side. Did you ever consider some of your biggest haters may spend their days creating addictive tastes?

BTW: Nutrition is not a left or right leaning proposition; it is party neutral.
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flyovermark
...Obamacare is tyranny...
10:15 AM on 01/07/2012
When two teams enter the field to play football, both teams expect the referees to enforce the rules of the game fairly and, to the extent of what is humanly possible, impartially. How would you feel, Dr. Katz, if the referees in the Sugar Bowl had been WRITING the rules of the game according to their own personal idea of "fairness" as the game is played?
Unless you are capable of understanding this simple concept,

...all you will ever be is a nanny...
09:56 AM on 01/07/2012
With better regulation comes more accurate and reliable information on food products....
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LadyXoc
08:13 AM on 01/07/2012
We don't need regulation as much as we need information. Facts are facts, and knowing them, the consumer makes his/her own decision. The record of anointed wisdom being wrong - on butter/margarine, cancer-preventive foods, Vitamin D etc., etc., is too long to have this "wisdom" codified into laws or even a tax structure.

Agreed, soda is not a nutritious alternative to fruit juice (which, btw, has recently come under attack as a cause of obesity - what is a parent to do?). However, in many parts of the world, cola drinks are consumed in the belief that they combat gastrointestinal illnesses. This may be true, especially if consumed instead of local water. Unfortunately, this may be now applicable to parts of the US where fracking or rotting oil storage from the last oil boom are polluting the aquifer. Ginger ale is a respected treatment for upset stomach. Tax these? I think not.
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David Katz, M.D.
Director, Yale Prevention Research Center; Editor-
10:37 AM on 01/07/2012
Agreed- provided the information is good. But that depends on who is providing it, doesn't it? Should it be those trying to sell you the soda, or the ginger ale- or the fracking? Actually- ginger ale is not a respected treatment for stomach upset (if so, by whom?). Ginger is. Commercial ginger ale contains far more sugar than ginger, and does not satisfy the dosing requirements for use of ginger as an anti-emetic. That use, by the way, is quite valid- and of particular utility for pregnancy-related nausea when most pharmaceuticals are contra-indicated. For some useful 'information' on this and related topics, I recommend Murray and Pizzorno's Encyclopedia of Natural Medicine.
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LadyXoc
03:45 PM on 01/07/2012
Hey, I didn't say MDs respected ginger ale for tummy aches - I was talking bout us MOTHERS. Have you ever tried to get a 4 year old to chomp down ginger?
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Waveskiboy
06:19 AM on 01/07/2012
Many thanks, Dr Katz.
12:33 AM on 01/07/2012
We need more accountable governmental regulations...no question about it...let's stop deluding ourselves by playing "19th century cowboy individualism and freedom from governments" ...we need referees and umpires in order to live together peacefully...the alternative is increasing conflict and wars...let's make our democratic governments work better and not let them self destruct or destroy them...this applies to all aspects of our community and not just public health...I am afraid we are becoming more afraid and beginning to get rid of our umpires and referees...
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BigBearcatBill
This is the real Bearcat - a Binturong
11:53 PM on 01/06/2012
You have many great points and your pointing out that the average consumer can be manipulated in a sense to buy worse food when the same amount of money can buy better nutrition is correct. Marketing and availabiility are the main factors. I believe large corporations hire psychologists as well as nutritionists and food scientists to develop strategies for their products that get customers almost "addicted" to their products, even ones that they know are not real healthy in large quantities. Basically our national obesity problem is due to having too much high calorie/fat/salt/low vitamin-mineral-fiber food available everywhere. We don't take the time to make our own food at home as much where we know what goes into it, and even spending the effort to get yourself, your family and even friends to chomp on good food like fruits and vegetbles and high-fiber breads and cereals is not as typical as our parents pushed on us years ago. Sad to say with all our nutritional sciences knowledge and research over last 50 years, our real efforts to get the best food into people are not nearly as good as they were 50 years ago - parents knew what type of well rounded meals made their families strong and able to work hard all day doing real physical work at farms, factories and construction. They gained applied knowledge over thousands of generations on what combo of foods produces the best health and strongest workers.
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hornedcog
Tax Tea Now!
10:44 PM on 01/06/2012
As long as I can smoke weed.