I stand by my support for the flu vaccine. Reasonable people might disagree -- and when they do, I will listen to them and encourage others to do likewise. Not so those who renounce reason altogether, and in its place offer only vitriol.

Familiarity breeds contempt, or at least complacency, and perhaps the annual return of influenza has induced that response. Perhaps that's why we seem to be dismissive of this germ, and overlook what a serious illness it can be. But that tendency is at our peril.

My career is devoted to the use of lifestyle practices -- and above all, diet and physical activity -- to the promotion of health and the prevention of disease. Feet and forks, along with fingers that do or don't hold cigarettes, are well established as the master levers of medical destiny.

Mammography specifically, and cancer screening in general, is often something of a muddle. We should acknowledge the trade-offs, work toward better screening methods, and in the interim -- muddle through.

Eating fish confers net benefit. Maybe it's the omega-3, and maybe not. Maybe it's because of adding fish, and maybe it's because of displacing meat. Maybe it's all of these, and it's in spite of the contaminants that come along for the ride.

Most days, I let one thing or another distract me from the bountiful reasons I have to be thankful. But I do, on occasion, reflect deeply on the tensions between striving and cherishing. And when those reflections take me over, they often engender a poem.

There is a particular "Thanksgiving moment" that occurs as the meal is winding down. I set down my fork -- groan -- and say something like: "My goodness, I couldn't eat another bite..." This, of course, is promptly followed by: "What's for dessert?"

The predominant efforts of health promotion might reasonably be catalogued in terms of carrots, sticks, and leading people to water -- whether or not we can make them drink it. Which leads, naturally, to horses.

If I lived in California, I would vote for Proposition 37; it makes sense to be informed. But wholesale opposition to genetic modification makes far less sense.

As told most famously by Shelley, the kingdom of Ozymandias fell to ruin in the desert sand. We are misguided to think we are too mighty to do the same. Signs of our vulnerability abound.

Our cultural attitudes about the use of our feet and our forks are ill-advised, but not crazy; they always made sense before. For most of human history, calories were relatively scarce and physical activity was unavoidable. Our prevailing inclinations are well-suited to that scenario.

Many foods can be eaten raw, and many foods are the better for it. An emphasis on eating mostly plants is irrefutably good, be they raw or cooked. But the case for raw food diets is oversold, the rhetoric is overheated, and the claims of universal benefits -- substantially overcooked.

As has likely come to your attention by now, a new study shows that daily multivitamin use is associated with a reduction in the overall rate of cancer. These findings are intriguing and promising, but far from the proverbial slam-dunk.

So "okay at any size" seems to be gathering pop culture momentum. And I regret to say, I can't be entirely okay with that. It's not the size I'm not okay with -- it's the consequences.

We want our kids to eat well because we want them to be healthy, and we want them to be healthy because we love them. They need to know that -- and that job resides with families, not government. They need to know that they can wind up loving foods that love them back.

"Smaller government" makes a swell sound bite, because it sounds like standing up against waste, inefficiency, and the quagmire of bureaucracy. But in the course of political harangues where sound bites prevail, it's often hard to tell exactly who is apt to get bitten.

Health readily takes on moral overtones. Those who have it can seem bossy, or boastful, or self-righteous. All of this goes away, I think, when we recognize that health is just a currency. Like any other, it takes some work to acquire it -- but when you do, you can spend it as you see fit.

I find myself tempted to propose a pledge we all take: the 20 minute pledge. There are 1,440 minutes in every day. Of that total, 20 minutes represents less than 1.4 percent.

Feet, forks, and fingers could reshape our personal medical destinies, and modern public health, dramatically, for the better. We have known this for decades. So why doesn't it happen?

A new study indicates that obese children and adolescents, as compared to their lean counterparts, have less sensitive taste buds. The researchers suggest that this difference in taste sensitivity may be an explanation for the development of obesity.

Now that the New York City Board of Health has ratified Mayor Bloomberg's plan to ban sugar-sweetened beverages (well, some such beverages, really) larger than 16 oz., we should be able to answer the question: Is this a big deal?

We need dietary guidance that is explicit about foods people should and shouldn't eat. Guidance that says once and for all, "If it glows in the dark -- whether it's low in fructose or not, low in fat or not, low in sodium or not -- step away from the box, and nobody will get hurt!"