Bad news for dieters

The New Neo Posted on by

Not that we needed more evidence, but new research is explaining just why it’s so hard for most people to lose weight and maintain the loss.

I already knew about this from personal experience and observation. And don’t get me wrong—I’ve never been fat, but I’m one of those people who is always trying to lose ten to twenty pounds to look and feel what I’d consider my best. Trouble is, this comes at the price of a sort of mild but steady starvation, an experience I’m not willing to voluntarily endure for more than a few weeks or months at the most. Plus, my weight loss is agonizingly slow (and this despite the fact that my nutrition is good, and I already exercise virtually every day) and my rebound weight gain is astoundingly fast.

In other words, I can diet for months and lose about five pounds total, and I can regain that five in just a couple of days of eating what most people would call normally. Although the tendency has gotten worse as I’ve gotten older, twas ever thus. Even when I was young I had to severely limit my calories in order to maintain my dance weight (very slender), despite the fact that I was highly active on a daily basis.

Your mileage—and poundage, and diet experience—may differ, especially if you happen to be a man. Men are generally bigger, less affected by weight-clingy hormones such as estrogen, and with bodies that have a higher proportion of metabolically active muscle.

In Lancet, Dr. Kevin D. Hall and his colleagues at the the National Institute of Diabetes and Digestive and Kidney Diseases have described “a more realistic model of how the body responds to changes in caloric intake and expenditure, basing their calculations on how people of different weights responded to caloric changes in a controlled setting like a metabolic unit.” So this study is not relying on such inherently suspect measures as people’s reports of what they’re eating and how much they’re exercising; it rests on more exact measurements than that.

The news isn’t pretty, but it reinforces what I’ve long suspected and also observed among my heavier friends, most of whom don’t seem to eat all that much:

According to the researchers, it is easy to gain weight unwittingly from a very small imbalance in the number of calories consumed over calories used. Just 10 extra calories a day is all it takes to raise the body weight of the average person by 20 pounds in 30 years, the authors wrote.

Furthermore, the same increase in calories will result in more pounds gained by a heavier person than by a lean one ”” and a greater proportion of the weight gained by the heavier person will be body fat. This happens because lean tissue (muscles, bones and organs) uses more calories than the same weight of fat.

In an interview, Dr. Hall said the longstanding assumption that cutting 3,500 calories will produce a one-pound weight loss indefinitely is inaccurate and can produce discouraging results both for dieters and for policy changes like the proposed tax on sugar-sweetened beverages.

If the 3,500-calorie rule applied consistently in real life, it would result in twice the weight loss that the new model predicts, the authors wrote. This helps to explain why even the most diligent dieters often fail to reach weight loss goals that were based on the old rule.

A more realistic result, he said, is that cutting out 250 calories a day ”” the amount in a small bar or chocolate or half a cup of premium ice cream ”” would lead to a weight loss of about 25 pounds over three years, with half that loss occurring the first year.

Why is this bad news? Well, for starters, people like me are not eating small chocolate bars or half a cup of premium ice cream on a daily basis. Some of us have already pared our daily calorie consumption done to the bone.

Do the math: if a person is losing 25 pounds over three years, that’s approximately 8 pounds a year or about 2/3 a pound a month. Hardly enough to provide the motivation to keep the struggling dieter going. Plus, how many people have such an exact idea of their daily caloric consumption that they can consistently cut back that much, not to mention doing it for that long? If the weight loss rate is so slow, just a couple of days a month of special treats (on special occasions, for example) can undo all the good of the far more numerous days of deprivation, just as I’ve observed. The requisite consistency of denial is more than most mortals can manage, especially with the constant temptation of wonderful food at the grocery store, in advertisements, and at social events.

It’s not surprising that most people have trouble keeping the weight off. The wonder is that anyone ever succeeds, considering what’s required.

On the EU folly

The New Neo Posted on by

Shorter Daley on the EU: good fences make good neighbors.

“Consensus” has become coercion. The imperatives of federalism and ever closer union have come bang up against the basic principle of democracy: that elected governments should be answerable to their own electorates, particularly on matters that affect the lives of ordinary citizens, such as taxation and public spending. Federalism cannot allow democracy to disrupt its objectives, and democracy will not permit federalism to ignore its anger and frustration. Angela Merkel cannot do what her critics are insisting that she must do ”“ as George Osborne put it, show that she recognises “the gravity of the situation” and is “dealing with it” ”“ because her electorate will not wear it. She cannot commit herself to endless bail-outs and the under-writing of infinite Mediterranean debt, just as the Greek government cannot deliver the EU’s austerity measures ”“ because the people of both these countries do not wish it. The irresistible force has met the immovable object.

What’s going on in Europe is extremely worrisome. One thing I have never understood is how people ever believed that yoking the economically weaker nations of Europe to the stronger ones would benefit the whole. Isn’t a chain only as strong as its weakest link?

But then I remember that federalism is not always a bad thing. Witness the US: e pluribus unum.

[NOTE: Here’s the text of the Frost poem:

Something there is that doesn’t love a wall,
That sends the frozen-ground-swell under it,
And spills the upper boulders in the sun,
And makes gaps even two can pass abreast.
The work of hunters is another thing:
I have come after them and made repair
Where they have left not one stone on a stone,
But they would have the rabbit out of hiding,
To please the yelping dogs. The gaps I mean,
No one has seen them made or heard them made,
But at spring mending-time we find them there.
I let my neighbor know beyond the hill;
And on a day we meet to walk the line
And set the wall between us once again.
We keep the wall between us as we go.
To each the boulders that have fallen to each.
And some are loaves and some so nearly balls
We have to use a spell to make them balance:
‘Stay where you are until our backs are turned!’
We wear our fingers rough with handling them.
Oh, just another kind of out-door game,
One on a side. It comes to little more:
There where it is we do not need the wall:
He is all pine and I am apple orchard.
My apple trees will never get across
And eat the cones under his pines, I tell him.
He only says, ‘Good fences make good neighbors’.
Spring is the mischief in me, and I wonder
If I could put a notion in his head:
‘Why do they make good neighbors? Isn’t it
Where there are cows?
But here there are no cows.
Before I built a wall I’d ask to know
What I was walling in or walling out,
And to whom I was like to give offence.
Something there is that doesn’t love a wall,
That wants it down.’ I could say ‘Elves’ to him,
But it’s not elves exactly, and I’d rather
He said it for himself. I see him there
Bringing a stone grasped firmly by the top
In each hand, like an old-stone savage armed.
He moves in darkness as it seems to me~
Not of woods only and the shade of trees.
He will not go behind his father’s saying,
And he likes having thought of it so well
He says again, “Good fences make good neighbors.”]

Fact-checking Obama

The New Neo Posted on by

This AP article fact-checks Obama on the topic of millionaires paying at a lower tax rate than their secretaries:

On average, the wealthiest people in America pay a lot more taxes than the middle class or the poor, according to private and government data. They pay at a higher rate, and as a group, they contribute a much larger share of the overall taxes collected by the federal government…

There may be individual millionaires who pay taxes at rates lower than middle-income workers. In 2009, 1,470 households filed tax returns with incomes above $1 million yet paid no federal income tax, according to the Internal Revenue Service. But that’s less than 1 percent of the nearly 237,000 returns with incomes above $1 million.

This year, households making more than $1 million will pay an average of 29.1 percent of their income in federal taxes, including income taxes, payroll taxes and other taxes, according to the Tax Policy Center, a Washington think tank.

Households making between $50,000 and $75,000 will pay an average of 15 percent of their income in federal taxes.

But that’s not really news, is it? It’s probably not even news to Obama, although it’s hard to say just how ignorant he might be about economic matters. Plus, of course, that’s only federal taxes; states can add a lot to that.

So what is news? Well, I’ve noticed in the last few months that the AP and other MSM outlets have become somewhat more interested in fact-checking Obama than they used to be. They may not be fact-checking his ass, but they’re fact-checking at least some small portion of his anatomy.

And then there are pundits such as David Brooks, who today has declared himself a sap (actually, he calls himself an “Obama sap”) for believing Obama was serious about deficit reduction:

In his remarks Monday the president didn’t try to win Republicans to even some parts of his measures. He repeated the populist cries that fire up liberals but are designed to enrage moderates and conservatives…

This wasn’t a speech to get something done. This was the sort of speech that sounded better when Ted Kennedy was delivering it. The result is that we will get neither short-term stimulus nor long-term debt reduction anytime soon, and I’m a sap for thinking it was possible.

Brooks is a bit late to the party, and his mea culpas ring hollow. Anyone who almost immediately becomes entranced with a candidate’s perfectly creased pants leg, or even his ability to quote the intellectual’s intellectual Niebuhr, has got a problem. Here’s Brooks on that pants crease, to refresh your memory:

I remember distinctly an image of””we were sitting on his couches, and I was looking at his pant leg and his perfectly creased pant,” Brooks says, “and I’m thinking, a) he’s going to be president and b) he’ll be a very good president.”

And here’s what I wrote a while back about that [emphasis mine]:

The whole thing reminds me of Daisy’s veneration for Jay Gatsby’s beautiful shirts””although even Daisy wasn’t silly enough to think that his lovely shirts qualified Gatsby to be president, much less a “very good” one. But this is the sort of thing that passes for thought in the MSM these days.

So now—or should I say, at least for now—the scales have dropped from Brooks’s eyes, the antidote to the love potion has been applied, and Brooks, like many others, is wondering what he ever saw in Obama.

I wonder what took so long.

[NOTE: On the substantive issue of raising taxes on the very rich, the Wall Street Journal has much more to say:

If Mr. Obama really wants all of these people to pay even more in taxes, there are only two ways to do so. One is to raise tax rates on capital gains, dividends and other investment income that is taxed at 15% and represents a great deal of income for the wealthy. This is probably Mr. Buffett’s tax secret, though to our knowledge he hasn’t released his returns to the public.

The problem is that this is a tax increase on capital investment, which the U.S. already taxes at prohibitive rates thanks to our high corporate tax rate of 35%. Capital gains and dividends are taxed twice, first as corporate profits and then as payouts to individuals. Their real capital gains tax rate is closer to 45% than 15%, which is why politicians of both parties have long supported a capital-gains rate differential.

The other way to raise taxes on the rare Buffett is with a new Minimum Tax, a la Joe Barr. But as we’ve seen with the AMT, while the politicians may start by chasing “millionaires and billionaires,” over time they always end up taxing the middle class because that’s where the real money is. Mr. Obama could tax every billionaire in America at a 100% rate and still wouldn’t make a dent in the federal deficit. He would, however, succeed in making those taxpayers invest less and search for tax shelters, assuming they didn’t move offshore.

We rehearse all of this because it shows that the real point of Mr. Obama’s Buffett Rule and his latest deficit proposal isn’t tax justice or good tax policy. It is all about re-election politics.

This is not only correct, it’s also not unusual. As no less an observer than former mentor Rev. Wright once said about Obama, “He’s a politician…And he says what he has to say as a politician.”

Well, yes. And Obama’s not the only one; most politicians do the same. And no one should be surprised—least of all David Brooks.]

[ADDENDUM: I’ve decided to republish my previous post on falling out of love with Obama. It continues to seem timely to me. You’ll find it below.]

[ADDENDUM II: Marty Peretz is so far out of love with Obama that it looks like hate. But check out the comments to his piece; TNR readers are still very much in love with Obama, or at least they’re in so much hate with Israel that the enemy of their enemy is their friend.]

Falling out of love with Obama

The New Neo Posted on by

[The following is a reprint of a post I first wrote about a year ago. It still seems timely, so I thought I’d post it again.]

Even the left appears to have fallen out of love with Obama, and wonders how and why it all went wrong. Read as Tom Junod tries to puzzle it out in Esquire:

Though many Americans didn’t know very much about him, there was one thing that was never in doubt when we saw and heard Obama on the stump: his ownership of his gift. By the way he carried himself, we could tell that he had always had it, and because he always had it, we could be sure that he always would have it. How could we resist a man who simply by opening his mouth could move mountains ”” and who had ascended all the way to the presidency by staking his political life on his own eloquence? How could we resist a man who seemed so sure that we could not resist him?

Now his gift has all but deserted him, and all that prevents the story from becoming tragic is his own apparent refusal to be affected by it…In less than two years he had gone from sounding like a man who could always count on his ability to strum the mystic chords of memory to a man who, no matter what he said, sounded like a politician, and one in over his head at that. Now he sounded like a man who had already realized that he had lost more than he imagined he could but was just starting to understand that he was never going to get it back.

Junod is right, and he’s also wrong. He’s describing what he perceives to have changed about Obama, and it’s true. Rather like Dumbo when he lost his magic feather, Obama has lost some of the belief in his own invincibility that carried him along, and it shows.

But Junod thinks he is describing something that mainly has its locus in Obama himself, and that it is Obama who has changed. Not really, except for a slightly lower confidence level. Junod is actually describing the process of falling in and then out of love on the part of the viewer.

Obama never was a great communicator. It’s been said before, but it bears repeating now: he rode on a stump speech and a vague promise, and the fervent hope in people’s minds that he would be whatever they happened to want him to be. He was never articulate off the cuff. He was always condescending and cold once he left the confines of that set speech. He had a terrible and/or nonexistent political record. He had never run anything except the Annenberg Challenge (and that was done poorly) or the Harvard Law Review. He had no sense of humor.

They fell in love nevertheless. Love is great. It feels good, but it tends to be blind. And when you fall out of it, you wonder what happened. You can explain it by saying that it’s the love object who has changed. Or you can wonder whatever you were thinking of in the first place.

Junod and many Obamaphiles (is it premature to call them ex-Obamaphiles?) are doing the former. In one of my favorite Shakespearean plays, “A Midsummer Night’s Dream,” Titania does the latter:

tatianabottom.jpg

Shakespeare’s play is an exploration of love and its mysterious qualities. When Shakespeare has the character Puck observe to the Fairy King Oberon, “Lord, what fools these mortals be!” he’s talking at least in part of their propensity to be fooled—in the case of the play, by his own magic machinations, among other things. The play has the lovers manipulated in a curious way: Puck puts some drops in their eyes that alter their perceptions and make them fall in love with the first being who comes their way.

Thus, the locus of the change is placed in the beholder, where it often belongs. The object of love remains the same person, whether adored or despised. When Puck places the drops in her eyes, Fairy Queen Titania falls in love with an ass (that is, a rude laborer, Bottom, who has been transformed by magic into a man with a donkey’s head, but let’s not get too technical). When Puck later applies the antidote and she falls out of love, she can’t believe she ever liked Bottom in the first place.

Junod, on the other hand, doesn’t doubt that Obama originally possessed the sterling characteristics his admirers perceived in him. Junod sees the main locus of change as being in Obama, not in himself as Obama-watcher. When Junod writes, “How could we resist a man who simply by opening his mouth could move mountains?” he’s being hyperbolic (at least I hope he is). But Obamalove came close to being just that irrational and just that emotional.

In the play, everything comes out all right in the end (although, as the character Lysander says, “The course of true love never did run smooth”). In politics, not so much. Of course, 2012 is a long way away…and there’s a lot of room for reconciliation. But can one ever recapture that initial glow?

Model faces

The New Neo Posted on by

I’ve noticed, on looking at photos of models and some starlets (is that still an acceptable word?), that you need to have a rather broad and almost triangular face to continue to be pretty while at the same time sporting a body that is close to being emaciated. That’s where someone like Sarah Jessica Parker breaks down—her face is as thin as her body, which is painfully scrawny. Her face doesn’t hide her state of starvation behind a facade of prettiness.

For many models, though, their faces do. It’s an interesting combo. See, for example, this photo taken during fashion week:

It’s not a combination that exists all that often in nature. But then, most of the attributes of models don’t exist all that often in nature. That’s what makes them models.

Raising taxes on the rich

The New Neo Posted on by

Let’s not get too taken with the minutiae of the Obama deficit-reduction proposal, which are a bit difficult to discern at this point anyway. This is merely Obama’s latest move in a chess game that will have many more moves and countermoves before it is finished.

It certainly was inevitable that Obama’s deficit-reduction proposal would include raising taxes on “the rich,” however that is defined at the moment. Is this a good idea? This video of Obama from two years ago has gotten a bit of traction; he says that raising taxes in the middle of a recession is not a good idea:

But before we criticize Obama for hypocrisy or changing his mind, reflect on the question of whether we are still technically in the middle of a recession. And reflect on the fact that the tools for fighting a recession are not necessarily the same tools that tackle deficit reduction.

That’s the dilemma as I see it. Democrats and Republicans differ greatly on how to fight both. Democrats lean heavily on the side of more taxes, especially for those shape-shifters “the rich,” and on the notion of income redistribution to make things more “fair.” Republicans believe that “the rich” includes small businesses that cannot be bled too much or they will cease to drive the engine of our economy, and that it only “fair” that people should be allowed to keep their earnings as much as possible.

We can argue till the cows come home on whether higher taxes on the rich will depress the economy. I happen to think it will have a chilling effect on an economy that is already cold enough. But I really have no idea (I’m being honest here) whether we’ve reached that point already, or whether some slight increases would be okay (I also don’t think that couples making $250,000—especially if they run a small business—are particularly rich, although I’ve never seen anywhere near that income in my lifetime.)

What’s more, in my opinion Obama’s proposed cuts in Medicare don’t go quite far enough, despite the fact that any cuts in entitlements feel noxious. But we’re going to have to get used to more of that feeling.

But I’m waiting to see what the gang of 12 is going to come up with. And then, to see who will win the battle. None of this continuing uncertainty can possibly be good for the economy, however.

Palestine’s UN gambit

The New Neo Posted on by

Abbas’s announcement that he will seek UN approval for a Palestinian state and a seat at that august institution is hardly surprising. Israel’s position during the Obama years has been understood by the world to have been significantly weakened, because so many of Obama’s actions (insulting Netanyahu, for example) have telegraphed that his commitment to Israel is exceedingly squishy compared to that of his predecessors. In addition, so much of his Middle East policy has transmitted a sense of a drifting and powerless administration that no one respects or fears, no matter what its intentions—which are nearly impossible to divine.

And without the US as stalwart friend, Israel is more isolated than ever. The Palestinian PR campaign has been remarkably effective. Support for its agenda has only increased in the nearly forty years since the Munich massacre of 1972 gained Yasser Arafat the prestige and privilege of addressing the UN a scant two years later, empty gun holster and all:

Apart from Pope Paul VI, Arafat is the only person who does not represent a government ever to address the plenary Assembly. The Pontiff had a claim to legitimacy as head of a state; he is ruler of Vatican City. Arafat heads a heterogeneous organization whose popular strength is untested, but the Arab nations nonetheless greeted him as a conquering hero.

Except for a brief moment at the beginning of Israel’s existence, when the UN voted to partition the former British colony into two states, one Palestinian and one Israeli (a partition the Israelis accepted and the Palestinians rejected, leading to war), the UN has been the stalwart champion of the Palestinians. This latest move is only the most recent in a long long line of actions in which the UN is nearly obsessed with condemning Israel; you’d almost think it was the UN’s main function.

Abbas seems a bit surprised that the Obama administration appears determined to hold to America’s usual support for Israel through a Security Council veto. But such a move is hardly surprising; even Obama is not prepared to abandon Israel so publicly and break precedent so openly.

Equally unsurprising are the responses of pundits such as Friedman of the Times to the Abbas move and the US reaction. It’s the Israel lobby holding the US hostage, yada yada yada. If you read the comments section after Friedman’s piece, you’ll see that’s the acceptable party line now, not a fringe opinion (as Glenn Greenwald approvingly points out here).

Nothing much may come of the UN gambit except more PR. The US will veto the action in the Security Council. If Abbas chooses to go to the General Assembly, he will win the vote, but the win doesn’t seem particularly meaningful in practical terms. It will probably only serve to further convince Israel of how alone it is, as though it needed any convincing at this point.

[NOTE: See also this and this.

Oh, and a prediction: just watch the trolls come. They nearly always do when Israel is the topic.]

Looking back at George W. Bush

The New Neo Posted on by

A number of people have recommended this article by Walt Harrington about George W. Bush, whom the journalist first met back in the 80s and became friendly with. Those people are correct; it’s a fascinating read.

Their friendship endured throughout Bush’s presidency. Despite the fact that Harrington seems to be a Democrat, he clearly likes Bush and has long been outraged by the hatred directed against him.

Harrington describes watching the advent of BDS (he doesn’t call it that, though) from his perch as journalism professor at the University of Illinois during the early years of the Bush presidency. He was shocked and mystified, knowing Bush as he does and knowing the man that he is. He sees some graffitti reading “Kill Bush” scrawled on a wall at the university and wonders “Is this America?”

Although Harrington did not vote for Bush, he did write a column during his presidency attacking the attackers and saying, “[Bush is] smart, thoughtful in a brawny kind of way and, most of all, a good and decent man…It baffles me that grown people must convince themselves that those with whom they disagree are stupid or malevolent.”

Those who feel that Bush is actually stupid and malevolent (and their numbers are legion) probably either are not reading Harrington’s piece, or are discounting it if they happen to read it. They know what they know, and one thing they know for sure is that Bush never reads and that even if he did he wouldn’t understand what he read, although Harrington describes a Bush whose love of reading (especially history) goes back at least to their meeting in the 80s, when Bush was still called “Junior” and his father was still president.

Harrington quotes Bush as once having told me that “reading books means you’re not lonely.” But one thing the Harrington article makes clear is that loneliness has not ordinarily been a big problem for Bush; he’s always been good at making friends and keeping them. This ability was probably Bush’s most salient characteristic, going back at least as far as his school days at Andover (see this about Bush’s prep school career, which describes a well-liked, friendly, and humorous guy whose people skills were already highly developed; also see this profile in Time that appeared before BDS had taken such a firm hold of the press).

Harrington writes about how disturbed Bush II was during the Bush I presidency at the bad press his father was getting, and when I read that I wondered how the son had subsequently managed to handle his own far more vicious press so well. He had learned something in the interim:

“When I got elected governor and president, history gave me a chance to study the decisions of my predecessors,” Bush says. As governor, he read The Raven, by Marquis James, a biography of Sam Houston, the father of Texas statehood. “I was fascinated by the story of Houston voting against secession, and reading a description of him basically being driven out of town by angry citizens. ”¦ My only point is that one lesson I learned, if they’re throwing garbage on Houston, arguably Texas’s most famous politician””Sam Houston Elementary School, where I went to school in Midland, was named for him!””if they’re throwing garbage on him, they can throw garbage on me.”…

When Bush read, in Presidential Courage, by Michael Beschloss, that historians were still debating whether George Washington had been a good president, he told Laura that if they were still debating Washington’s presidency more than 200 years later, he would not worry what public opinion was saying about him now. “And the other thing for me was that I saw a great man be criticized, as you might recall,” he says, referring again to the vitriol aimed at GHWB during the losing reelection campaign of 1992. “On the harshness meter, it seemed unusually harsh to me, as the son. So, therefore, when I became president, the criticism to me was nothing compared to the criticism to him. And so I was able to keep life in perspective two ways: one, through reading of history and how other leaders were treated, but also having witnessed history with my dad.”

Also there’s this (and as I read it, I can’t help but wonder if Obama, who seems to revere Lincoln as well, has read 14 biographies of him, as Bush has. Certainly if he has, he’s not learned the lesson about signaling weakness, or passing the responsibility buck):

Bush believes that one of the most important stage requirements of the presidency is indeed never to signal weakness or self-doubt or confusion: “One of the things you learn about great leaders is that they never project the burdens of responsibility on others.” He remembers Richard Carwardine’s Lincoln: A Life of Purpose and Power (one of 14 Lincoln biographies Bush read while he was president), which recounts the 16th president’s perseverance through not only military defeat after defeat, stupefying troop casualties, and public ridicule, but also the death of his son Willie and the debilitating emotional turmoil of his wife.

“You’re not the only person that’s ever gone through hard things,” Bush says of the lessons he has learned from history. “In other words, can you imagine the signal I would have sent had I said, ”˜Ah, why me? Why am I thrust in the middle of all this stuff?’ And they had kids on the front line of combat who were actually having to do all the work.”

But perhaps the most interesting part of the article is when Harrington visits his old friend GW at the White House in 2003, and asks him what it’s like to be president. Bush answers only after ascertaining that his response will be off the record:

And he began to talk””and talk and talk for what must have been nearly three hours. I’ve never told anyone the specifics of what he said that night, not even my wife or closest friends. I did not make notes later and have only my memory. In the journalism world, off the record is off the record. But I have repeatedly described the hours as “amazing,” “remarkable,” “stunning.”…

As he talked, I even thought about an old Saturday Night Live skit in which an amiable, bumbling President Ronald Reagan, played by Phil Hartman, goes behind closed doors to suddenly become a masterful operator in total charge at the White House. The transformation in Bush was that stunning to me.

Here’s Bush in a later post-presidency interview with Harrington, on how history will judge him:

“Some people walk up and say, ”˜Oh, man, history is going to judge you well.’ And my quip is, ”˜I’m not going to be around to see it.’ And to me, that’s one of the most important lessons you learn through history””you’re just not gonna be around to see it. ”¦ I’m confident of this: that those conclusions will be more objective with time than they could conceivably be now.”

I wonder whether those judgments are already starting to change.

Feeling your pain

The New Neo Posted on by

The news is out that a way to objectively document a patient’s pain is being developed:

A team at Stanford University in California used computer learning software to sort through data generated by brain scans and detect when people were in pain.

“The question we were trying to answer was can we use neuroimaging to objectively detect whether a person is in a state of pain or not. The answer was yes,” Dr. Sean Mackey of the Stanford University School of Medicine in California, whose study appears in the journal PLoS One.

The method is in the earliest stages. But it may someday make it possible to tell whether an infant, a coma patient, or a person who’s elderly and demented is in pain.

I can also think of some potentially troublesome uses for it: to deny pain medication to patients whose brains don’t test out as undergoing enough pain to justify the treatment, despite the fact that a machine like this could never be flawless.

A personal note: back when I was in fairly severe chronic pain for a number of years (I’ve written about that experience here), I fantasized the invention of a pain replicator, to show doctors exactly what the experience felt like, if only for a moment. I imagined the sort of machine you see in 50s science-fiction movies, a metal contraption that a patient could step into and have his or her pain recorded in detail. Then the doctor would enter it, and for a minute or so would undergo exactly the same pain as the patient. This would not only help with diagnosis, it would bring on a bit more empathy from the medical profession.

I realized, of course, that even my imaginary machine couldn’t tell them about the suffering chronic pain patients feel at the seemingly intractable quality of their pain: the perception that it may never end, that there is no relief to be had. I had read the work of Dr. Eric Cassell, who had observed in his book The Nature of Suffering and the Goals of Medicine (excerpt here) that pain and suffering are not always the same.

There are three other times when suffering in close relation to pain is commonly reported…First, when the pain is so severe that it is virtually overwhelming. The second is when the patient does not believe that the pain can be controlled. The suffering of patients with terminal cancer can often be relieved when it is demonstrated that their pain truly can be controlled. They will then often tolerate the same pain without any medication, preferring the pain to the side effects of their analgesics. Another type of pain that can be a source of suffering is pain that is not overwhelming but continues for a very long time so that it seems the pain is endless. Physicians commonly tell patients that they will “get used to the pain” but that rarely happens.

It is difficult to describe the effect this book had on me at the time I read it, which was in the early 90s, when the treatment of chronic pain was still in its relative infancy. It sounds depressing, but to me it wasn’t. It held out a ray of hope: if this doctor understood, then chronic pain patients weren’t so alone.

For most chronic pain patients, the pain is not imaginary or “all in their head.” For example, my pain had very clear antecedents, and the neural path of my pain was consistent with my injuries, so fortunately I was not usually tormented by physicians accusing me of malingering or being a whackjob. Nevertheless, I knew that pain does have a psychological component and a psychological effect, and Cassell understood both without needing a pain-replicating machine to show him.