Zero Tolerance To Racism

It was hideous.  It had enormous, malevolent eyes which protruded from its head and stared in almost every direction.  Its mouth was a snarling black pit, framed by two pairs of segmented horns covered in spines.  Its huge legs reached forward, each of them covered in barb-like hairs that spiked the atmosphere.  It was as if Jabba the Hut was wearing porcupine skin, although not even Jabba could ever evoke the same visceral fear that staring into the eyes of this monstrosity could produce.

But then again, none of us ever look closely enough at a house fly to ever stare into its eyes.

It’s all  a matter of perspective.  The difference between a hideous monstrosity and a pesky little irritation is about 2000 times magnification with a scanning electron microscope.  Sometimes the bigger we make something, the more evil and abhorrent it looks.

Similarly, I contend that our community’s collective approach to various social injustices, especially sexism and racism, has made real but relatively minor problems into enormous monstrosities because we have magnified them to extreme proportions.

Don’t misunderstand me.  I’m not suggesting that racism and sexism aren’t real forms of injustice.  Nor am I denying western society’s historical plague of prejudice that has been radically transformed over the last few decades.  Neither am I suggesting that racism or sexism no longer exist in our modern culture.

I believe there is a lingering social discrepancy in Australia that still affects many aboriginal people, which is reflected by objective health indicators such as poorer life expectancy, objective educational indicators such as illiteracy and chronic truancy, but also in the personal stories of aboriginal people I have talked to over a my professional career.

Dismay and displeasure over this persistent injustice would be reasonable, but our nation tends to ignore this ongoing inequality and instead, erupts with anger when a footballer is piqued because someone called him a name.

In the few days following Adam Goodes tanty, social commentators made some pretty dumb statements to take umbrage while showing how saintly they were.  Eddie McGuire referencing Adam Goodes and King Kong in the same sentence hasn’t helped to ease the inflammation.

But frankly, the confected public outrage hasn’t achieved anything of substance in helping to remedy the real and ongoing disparity of the Australian aboriginal community.

The “zero-tolerance” approach to racism has taken a minor part of a real problem and magnified it so much that it it looks horrific, when it actual fact, it is just a nuisance.

Adam Goodes may have been truly hurt by the comments made to him or about him.  But I doubt it will be anywhere near as painful as the 40 year old aboriginal man on Cape York with his chronic festering foot ulcers from his poorly controlled diabetes.

The journalists, the holier-than-thou social commentators, and the vitriolic trolls hovering around social media should catch their breath and gain some perspective.

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Aspergers: A diagnostic conspiracy

Andrew Bolt published a letter from “Reader B” today, who claims that the diagnosis of Aspergers Syndrome is nothing more than well meaning, easily manipulated doctors ticking whatever box is put in front of them, for no other reason than unfairly claiming government funding for those undeserving children.  Reader B claims to be a “very senior medical practitioner in this field”.

If he was a very senior medical practitioner then he would know that Autism, Aspergers and Pervasive Developmental Disorder can only be formally diagnosed by paediatricians or psychiatrists. Other doctors, allied health and other professionals can have suspicions, but no funding will be released until the diagnosis has been confirmed by the relevant specialist. If anything, this has lead to underfunding, as children are forced to wait for assessment by the bottleneck of public health services.

He would also know that to be diagnosed as having an autistic spectrum disorder, the child’s condition has to meet specific criteria in the DSM – the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders. “Not a charming little extrovert” is not one of the criteria.

He would also know that the diagnostic criteria are about to be revised. A change which autism groups believe will make “the diagnosis of autism spectrum disorders will be more specific, reliable, and valid.” However, “legitimate concerns have been raised regarding how these changes might impact people on the spectrum. One of the biggest concerns is that some who are higher functioning will no longer meet the more strict diagnostic criteria and will therefore have difficulties accessing relevant services.” (1) So tighter diagnostic rules will apply to a condition which is already under diagnosed.

Meanwhile, the CDC in America states that “On average, medical expenditures for individuals with an ASD were 4.1–6.2 times greater than for those without an ASD.” (2)

I am just a humble GP working in Brisbane’s northern corridor. My son is “not a charming little extrovert”. He was diagnosed as having Aspergers by one of those “bright, sincere” but obviously misguided developmental paediatricians, who incidentally has three other Bachelors Degrees and a Masters.  If Reader B would like to take my son for a couple of weeks.  He is welcome to make pithy, judgemental statements after that.

Even at the “mild” end of the spectrum, the Carers Payment of $115.40 per fortnight from Centrelink would only pay for half of what therapy costs for my son. For many of my patients, this modest amount is the difference between some therapy and none at all.

As for the potential cost blow outs, it depends on how you look at the issue. Say the funding for “mild” ASD dries up. Ok, so should we stop funding healthcare for mild diabetics or mild asthmatics as well? Besides, I would argue that spending money on healthcare for even “mild” ASD is an investment. An ASD child will grow up into an ASD adult. Maximising their development now will cause them to be more productive in the future, more likely to be taxpayers than welfare recipients.

As Reader B explained in his opening paragraph, “there is no conspiracy, just well meaning misguided bias.” And it’s true. But it doesn’t come from the ASD community. It comes from an outspoken few who stand on the sidelines and smugly wag their fingers at those who struggle, while never truly understanding how sometimes even the simplest tasks like brushing teeth can become a 2 hour ordeal.

Please, stop wagging your fingers. Instead, lend us a hand.

(1) http://www.autism.com/index.php/news_dsmV
(2) http://www.cdc.gov/ncbddd/autism/data.html

Comment threads: Where everyone rants and no one listens

Whenever I should be doing better things with my time, I inevitably procrastinate and read whatever it is that’s not what I am supposed to be doing.

I usually wind up absorbed into a Facebook rant or semi-intellectual blog post somewhere on the internet.  The blogs are sometimes worthwhile, sometimes not.  But often the best part of the blog piece are the comments made at the end of it.

I like to think I am open minded, although there are some subjects which have become pet peeves where I have found myself increasingly unable to budge from a certain viewpoint.  And at times I have unleashed a stream of pseudo-intellectual ranting into cyberspace.

But I am finding more and more that the comments on every post I read are nothing but  fetid, vexatious bickering.  Freed from the normal constraints of social cohesion and manners, respondents engage in some of the worst forms of intellectual snobbery or laziness.  And the arrogance of some of these people is astounding.

An example from a blog I read tonight called, ironically, “The Conversation”.  The article itself, critical of those who would dare to disagree with the climate change “consensus”, was terminally jaundiced.  But what followed typified for me the languid pretentiousness displayed in so many comments.

David, there is a good case for removing denialist posts that repeatedly bring up the same repeatedly debunked points on every climate change thread you ever read. The case is this – it is a waste of everybody’s time. You have most certainly read the answer to your “last sixteen years” argument many times by now. If you haven’t taken it in by now, you never will. Why should people who actually care about this subject waste their time saying it to you again?

Further, the discussion about the best way to deal with climate change has been blighted for many years now by the delaying and diversionary tactics of denialists. Not you, real pros (http://www.guardian.co.uk/environment/2013/feb/14/funding-climate-change-denial-thinktanks-network?intcmp=122). It almost feels as if there is an ethical obligation now just to block their opinion. They’ve done enough damage as it is.

The sheer arrogance is amazing.  “I’m right, you’re wrong. You should know I’m right. That you don’t know I’m right means I’m smart and you’re dumb.  You’re obviously so dumb that you don’t deserve to be even heard.”  The last sentence, “It almost feels as if there is an ethical obligation now just to block their opinion”, is blatantly illiberal, borderline totalitarian.

When I was in high-school I was given a book which detailed the history of surgery.  The practice of modern surgery – stern people covered head to toe in gowns and masks in the cold sterility of present day operating theatres – is many times removed from the torturous barbary of the olden days.  The book contained a chapter on the unfortunate story of Ignaz Semmelweis.

Semmelweis was an obstetrician who noted than women who gave birth in the clinic run by doctors were several times more likely to die of post-partum sepsis (“child-birth fever”) than the women who delivered in the midwife clinic or even outside the hospital (“street-births”).  He eventually realised that the doctors, in an attempt to find an answer to why the women died, would autopsy the women but then go straight back to the labour ward to deliver more babies.  The midwives did not perform autopsies.  Semmelweis thought there must have been a contagion that was spread from the dead women to the living by the doctors.  He instituted hand-washing, which almost eradicated child-birth fever from his clinic.

Hand-washing.  Sounds simple to us.  But in the 1800’s, the germ theory of disease was not known.  Disease was thought to arise from distortions in “the four humors”, or that all diseases arose from “bad air”.  To the medical community in the mid 19th century, the idea that cleanliness had anything to do with disease was preposterous.  It was also offensive, since doctors thought that they were gentlemen of the highest order, such that no disease could ever be carried on their hands!

From Wikipedia: “In 1856, Semmelweis’s assistant Josef Fleischer reported the successful results of handwashings at St. Rochus and Pest maternity institutions in the Viennese Medical Weekly (Wiener Medizinische Wochenschrift).  The editor remarked sarcastically that it was time people stopped being misled about the theory of chlorine washings.”

Sound familiar?  There was an established consensus.  The most pre-eminent doctors and scientists all published papers in peer-reviewed journals and publications all contradicting Semmelweis.  He was not allowed an opinion.

Women died unnecessarily.

Today, the blogosphere is full of people all-to-willing to repeat the same mistakes.  That everyone else believes the same means that the theory is popular.  Doesn’t mean it’s true. There is no ethical obligation to block opinion.  On the contrary, there is an ethical obligations to reasonably and rationally discuss all opinions.

Reasonable rationality is what is missing from most posts and comments.  There is no discussion – only ranting.  Slanderous dismissal harms intellectual expression, which in the end, helps no one.

I realise that in making this call I am probably opening myself to get trapped by my own words.  So if you ever see me publish a purposeless ranting blog then draw my attention back here.

But for the love of all things sacred, please from now on, lets have a discussion.   Engage in critical argument.  Consider both sides.

Because ignorance and arrogance is inevitably fatal.

Tacky Tim misleads men and offends everybody

Tim Mathieson sure put his foot in it at a state reception at the Lodge this week.  But the real victims weren’t asian women.

Tim Mathieson is Australia’s “First Bloke”.  As such, he gets to host official functions and receptions, and gets to make speeches of importance.  People listen to Tim … well, as much as anyone listens to politicians or their partners.

Tim is also the patron of the Australian Mens Shed Association, whose aims are to provide “a safe and friendly environment where men are able to work on meaningful projects at their own pace in their own time in the company of other men. A major objective is to advance the well-being and health of their male members.” [1]

So, as a prominent Aussie man who is looking to promote good health to other Aussie men, he tried to encourage what he thought was a good health habit in a jocular manner which men would understand.

He said, “We can get a blood test for it, but the digital examination is the only true way to get a correct reading on your prostate, and perhaps look for a small Asian, female doctor is probably the best way.” [2]

In making this statement, the Prime Minister’s partner was both ignorant and insensitive.

The Adelaide Now labelled him “tacky”.  Hmmm … perhaps.  He certainly wasn’t tactful.  I understand what he was trying to say.  I’ve often joked to colleagues that gynaecologists should have long skinny fingers.  Mr Mathieson’s comedic compass was pointed in a similar direction, but while asian females may have fingers of a smaller diameter, actually referring to them in his joke drew the attention away from the pun and pricked the most sensitive of subjects.

In the pub over a beer with your mates, joking about doctors with skinny fingers may have been a winner.  But for Tim, it simply highlighted the ridiculous standard for sexist remarks which the Prime Minister set when she redefined misogyny as simply disagreeing with women.  If the same benchmarks were used for Mr Mathieson’s remarks, the media should be all over him for being sexist (and probably racist too).

It also highlighted the absurdity and excessively authoritarian nature of Gillard’s proposed anti-discrimination laws which seeks to criminalise any speech which is considered by anyone to be offensive or insulting.   George Brandis may have been a little hysterical when he said Mr Mathieson would be taken to “a re-education camp by the thought police” if Gillard’s laws were in place.  But Mr Mathieson would certainly be sued or arrested if the precedent set by England’s equivalent law was followed here (where a man was arrested by UK police because he called a police horse “gay” – http://www.youtube.com/watch?v=gciegyiLYtY from about 1:10).

As the editorial in the Australian said today, “WHILE his partner Julia Gillard might not thank him for it, the man affectionately known as the first bloke has done the nation a great favour. Tim Mathieson’s tasteless joke – complete with mildly racial and sexist undertones – has exposed the cant of the Prime Minister’s misogynist campaign against Tony Abbott, and even underlined the absurdity of the government’s proposal to further impinge on free speech through new anti-discrimination laws.” [3]

I’m thankful Mr Mathieson’s statement did something, because it certainly wasn’t of any educational or health-promotional value.

Unfortunately, prostate cancer is an enigma.  There is a myth that is still perpetuated by the media and male role models trying to make a token promotion of mens health – that prostate exams save lots of lives.  The lay public believe that prostate exams are the equivalent of pap smears for women.  In actual fact, they are poles apart.

Pap smears are the best screening test in the history of medicine.  Women hate them and I can understand why.  But as far as the accuracy, cost and effectiveness of the test goes, the pap smear is the gold standard for disease prevention through early detection.

Compared to pap smears, prostate testing in its current form is like an inbred third cousin.  Even combining both the PSA (the “prostate blood test”) and the infamous digital rectal examination does not improve the early detection rate or survivability of prostate cancer.

From the “Red Book”, which is the official guidelines for preventative activity in General Practice in Australia, published by the Royal Australian College of General Practitioners:

“Routine screening for prostate cancer with DRE, PSA or transabdominal ultrasound is not recommended.  DRE has poor ability to detect prostate disease.”
and
“Even if we were to conclude there was a survival benefit (from current or future trial data), this survival would need to be balanced against the harms of cancer overdetection and treatment.” [4]

In other words, not only is screening for prostate cancer pointless, but it is also potential harmful.

Men whose lives “were saved” by prostate screening, and whose stories are published by the media to further perpetuate the heroic prostate screening myth, were either really lucky, or whose prostate cancer was never destined to be fatal.  Prostate cancer seems to be either slow and indolent, and eminently non-lethal, or so aggressive that it becomes untreatable before symptoms become apparent and screening can detect it.

Rather than our political leaders and mens health advocates pushing men into unnecessary and potentially harmful screening tests, they should be lobbying the government to fund research into better methods of detection, or better treatments to better manage even the most aggressive prostate cancers.  That is the only way the survival rate from prostate cancer will improve.

Tim Mathieson sure put his foot in it at a state reception at the Lodge this week.  To asian females, sure.  But when he failed to check his facts, and then missed the opportunity to lobby for better health for future Australian men, that was the real tragedy.

[1] http://www.mensshed.org/what-is-a-men’s-shed/.aspx

[2] http://www.adelaidenow.com.au/tim-was-tacky-but-was-he-offensive/story-e6frea6u-1226564538077

[3] http://www.theaustralian.com.au/opinion/editorials/ask-not-who-points-the-finger-as-it-points-at-you/story-e6frg71x-1226564558412

[4] http://www.racgp.org.au/download/Documents/Guidelines/Redbook8/redbook8.pdf p72

POST SCRIPT: I understand that my discussion on prostate screening may be confusing for some people, and may seem to be contrary to advice that you have have previously received or have heard of.  Ultimately, the question of whether a man is screened or not screened for prostate cancer is between him and his doctor.  If you wish to proceed with prostate screening, or if you have any questions, the best place to start is your GP.  Find out about the risks of prostate screening as well as the potential benefits.  If you decide you want to go ahead, I would recommend both a blood test AND a rectal examination.  Tacking a PSA to some other blood tests is not adequate screening.

It should also be noted that screening of healthy men without symptoms is different to testing for cancer in men who believe that they have symptoms.  Symptoms of prostate cancer include:

• Difficulties starting and stopping urination
• Pain or a burning sensation when passing urine
• Urinating more often than usual, particularly at night
• The feeling that the bladder can’t be fully emptied
• Dribbling urine
• Blood in the urine or semen
• Pain during ejaculation.

Unfortunately, all of these symptoms can be caused by conditions other than prostate cancer.  Or prostate cancer may have no symptoms at all.  But if you believe that you have symptoms of prostate cancer, or you are not sure, then you should see your GP as soon as you can.

For more information on prostate cancer: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Prostate_cancer

Grace and Acceptance: Antidote to New Years Delusions

New Years – a time of hope, and promise.

Most hope that New Year will be like a reset button for life.  Some will even go so far as to make themselves promises.  We mislabel them “resolutions”.  They’d often be better labelled “New Years Delusions”.

One thing that always strikes me is that we either make these etherial statements which are high on hope but short on substance like, “Let’s move onward and upward to the next level, and live your purpose!” Or we make unattainable resolutions that are more like political promises – they are always broken.

There are so many areas of my life that are flawed.  I have resolved to rectify and repair them, but they have been impossible to fix, and trying to fix them gets so frustrating.  I’ve also tried the etherial “Onward and Upward” statements, which gave me a warm glow for a few seconds before they evaporate.  So I have been stuck in my rut, asking myself why it is so hard to move forward in life.

Then while I was having a shower at 2:30 yesterday morning I came to a realisation.  I am frustrated because I fight against what I can not control.

Ok, so then, when can I do about this?  My options are limited.  I can keep fighting what I obviously can’t beat.  Or I accept that I am a complete screw up in many areas of my life and just move forward anyway.

I came away thinking, “Gee, that made sense.  Why haven’t I been doing this before.”

And it struck me that I’ve encountered this theory a bazillion times before.  Acceptance of  weaknesses as integral to life change is everywhere – from the first step of Alcoholics Anonymous, all the way through Acceptance and Commitment Therapy, and even a little bit of Cognitive Behavioural Therapy.

The Bible too.  2 Corinthians 12: “Three times I pleaded with the Lord to take it away from me. But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly about my weaknesses, so that Christ’s power may rest on me.  That is why, for Christ’s sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong.” (v8-10)

I did a word study on this once before.  The image used is of a broken brick wall, crumbling, decayed, with missing bricks and cracking mortar.   And when God says, “My power is made perfect in weakness”, the image is of God filling in all the missing parts with his power, leaving a wall that isn’t new, but is renewed.  The best analogy is that of urban renewal.  Take an old building, fix the walls and fittings, and you have an old building restored to its former glory.  God’s power renews us, and restores that which was broken.  We don’t become a different person, we remain the same person that God made us to be but with God filling in the gaps.

In my life thus far, instead of letting God in to fill the gaps in my wall, my life, I’m stressing and striving trying to fix it all myself.  And the result of all this stress is simply burnout.  So rather than just accepting that I am broken, I have tried to fix everything myself and in doing so, made myself even more broken.

I need to accept that I am ill-tempered, impetuous and insecure.  I need to lean on God’s grace.  God himself said that it’s sufficient, so even though my problems seem insurmountable to me, I’m sure God can handle it.

So the purpose of this little essay is certainly not to tell you what to do or how to do it.  I’m not going to feed you some ethereal, saccharine garbage about how you can dream a dream, live your destiny, or go to a higher level.

I do want to say that there are parts of all of us that are broken, and are very difficult to fix.  You don’t have to do it all yourself.  Sometimes you have to accept that there are some things beyond your control.  Rely on God’s grace to restore and renew.

“My grace is sufficient for you, for my power is made perfect in weakness.”

Misogyny, Misandry, Or Just Mistaken

or “My Bum’s Got Nothing To Do With This Story Either”
A reply to Tracey Spicer

Dear Tracey,

Thank you!

What you wrote in your letter to Mr Misogynist was so heart-felt.  I totally agree that your gluteal aesthetics are completely irrelevant to your journalistic ability.

And unlike the men you rage against, I am proud to say that I have modern beliefs, a high intellect, and an average sized penis.  I believe in the value of women and I have a healthy respect for them.

A comment on this story I saw on Facebook said, “Seems like we’re having a national debate on sexism via social media. It’s long overdue!”  Too bloody right!  Sexism is rife.  And it is time that something is done about it.

Those misogynist bastards need to be eradicated once and for all.  The fact that women are constantly maligned because they don’t look a certain way is pure evil.  It is a fetid, bitter after-taste that still lingers despite the sweetness of all that feminism has brought us.

Although, I was told when I was a child, “When you point the finger at someone, there are three other fingers pointing right back.”

Men are sexist, true.  But women are just as judgmental and misandrist on the whole.

You know Tracey, I once had a lactation consultant tell me that I couldn’t advise women about breastfeeding because I didn’t have breasts.  She assumed that my medical degree didn’t compensate for my mammary insufficiency.

In the same way, many women assume that I don’t know anything about gynaecology, or would be bad at pap smears for the same reason, because I don’t have the “equipment”.  And yet I have had hundreds of women over the years who, after the procedure is finished, say with a surprised tone, “You are so much more gentle than all of the lady doctors I’ve been to!”

Note that I am not trolling for more pap smears.  The point is that women assume that a man would be less proficient at women’s health because he is a man, even though gender has nothing to do with it.  Women are sexist in their own way.

Mirroring the male half of the population, some women’s misandry is malignant and narcissistic, but most woman hold on to benign misjudgments, resulting from simple ignorance that defines us all as human beings.

You know, it’s funny.  Your title was certainly provocative, and summed up your views so eloquently, “And here’s the news: My bum’s got nothing to do with the story.”  And yet in your closing few paragraphs, you link the misogynists IQ and the size of their phallus.  Is it equally wrong for a woman to enunciate irrational stereotypes about men’s bodies?

If so, then we find ourselves in a conundrum.  Fighting against misogyny is noble, except that to do so exposes the equally distasteful problem of hypocrisy.  Let she who is without sin cast the first stone, as it were.

Perhaps instead of “F— you, you misogynist bully with your archaic beliefs, intellect of a pygmy, and tiny dick”, you could have said something to yourself more like, “Build a bridge” or “Swallow a spoonful of cement.”  Harden up.  Get over it.

Because what we don’t need is more of the same impetuous blend of ignorance and self-righteousness.  We need to focus on what is positive.  Fostering the strengths that our collective humanity possess is a much better way than focusing on and trying to fight the negative.  We need to accept that we are all guilty of sexism on some level, and move forward in spite of it.

It’s a message that even the most inane would find compelling.  No matter what your buttocks looked like.

Ode to Joy: My Musings On Happiness

Happiness.  A great irony in western civilisation.   We have never been more prosperous, and yet we seek that elusive dream of happiness with greater and greater fervour.

It struck me that we all seek happiness, but do we truly know what it is?  Is happiness just an illusion that we chase after like the legendary pot-of-gold at the end of the rainbow?  Is it that we are so overfed with images of suffering by our media that our happiness is overwhelmed by the constant stream of pessimism and hopelessness.  Perhaps happiness is a construct of a human existence that is desperately looking for something to distract it from it’s journey of pain on it’s way to inevitable demise.

I wrote this essay for the same reason that I write most things,  for my own catharsis and self-catechization.  But I am publishing it because I would be grateful for intelligent, constructive feedback as I continue to review and reanalyze my beliefs and ideas on this subject.

I will attempt to define happiness at it’s most fundamental level, and attempt to link the psychology to its neurobiological basis.  I will examine the pursuit of happiness, whether it is possible to ever find true happiness, and how that might be achieved.  I then want to review the biblical concept of joy and try and understand it scripturally, and correlate it with our understanding of happiness to see if biblical joy is something deeper than normal human happiness.

DEFINITION OF HAPPINESS, AND IT’S NEUROBIOLOGY

Firstly, what is happiness?

Happiness is a neural construct related to the mood circuit of the brain interacting  with the rewards circuits of the brain in the context of environmental stimuli and innate perception.  It is one half of a continuum of mood, which ranges from depression and dysphoria at one end of the spectrum to happiness, joy and then euphoria at the other end of the spectrum.

I know that sounds so cold and impersonal. It may even engender a vague sense of repulsion in some, like I’ve insulted Mother Theresa.  It’s hard to take something so rich and complex an emotion as happiness and strip it of all it’s personality and warmth.  Happiness, like all other human emotions, is difficult to quantify.

But happiness as part of the mood continuum explains why happiness is often evasive, and why it is normal to pursue greater happiness, but never truly attain it.  It also helps us to come to terms with our current state of happiness, since it allows us to understand that happiness is both internal and external and not mutually exclusive as is so often quoted by many a pop-psychologist.  It aids the understanding of depression, and other psychiatric disorders of mood.

Imagine that mood can be measured on a scale.  For example, plot a graph where the centre of the vertical y-axis is zero, negative ten at the bottom and positive ten at the top.  The units and increments are somewhat arbitrary.  Importantly, the different units represent a level of mood at any given time.  At mood zero, a person would be neither happy nor sad, they would feel neutral.  A score of positive ten would represent euphoria.  Likewise, dysphoria would be represented by a score of negative ten.

Mood fluctuates between these states of euphoria and dysphoria.  This is a normal part of our biology, and follows a similar pattern to any other biological process, where a particular biological variable rises and falls depending on the inputs and outputs of the system and the homeostatic mechanisms that the body has to maintain the variable within a particular range.  This is a quintessential trait of human on all levels: a complex layering of multiple variables which all interact but are all still controlled to a point to maintain them within parameters compatible with life.  Mood is no different on both a biological level and philosophical viewpoint.

In normal human experience, without disease or drugs, mood would not reach either of the extremes, but would usually fluctuate within a smaller range, arbitrarily fifty to sixty percent of the extremes.  The extremes of mood are only reached in either drug states (drug induced euphoria, “a trip”) or psychiatric illness (severe depression).  The point of neutral on the scale, and the causes of fluctuations within the system, vary between individuals, and are set by both biological and cognitive factors.

Mood is ultimately determined by levels of serotonin, noradrenaline and dopamine within different parts of the cerebral cortex and midbrain.  In turn, levels of neurotransmitters are influenced by genetics, environmental influences and cognitive beliefs.  For example, if a person is taught to be pessimistic, their cognitive beliefs will usually pull their mood levels lower than someone who is generally taught to be optimistic.  Further, a person who is relatively affluent will, by their nurtured outlook on life, have a higher innate zero point than someone who is brought up in relative poverty or suffering.  A person who is chronically unwell may not think it distressing to have a simple cold, but a person who does suffer sickness often may find a simple cold quite distressing.  Environmental influences create variability in the fluctuations of moods.  A fine, sunny day will enhance a mood, and conversely a cold, rainy or dark day will often decrease mood.

However, while environmental and cognitive factors play a part, biological factors tend to predominate.  Twin studies suggest that if an identical twin has a mood disorder (depression, anxiety, bipolar disorder) the other twin has a 70 to 90% chance that they will also develop the disorder.  If a fraternal (non-identical) twin has a mood disorder, their other twin will have a 16-35% chance of developing the disorder.  Thus, scientists believe that genetics account for about 50 to 70% of the development of a mood disorder (depression or anxiety disorders).  It would be reasonable to assume that the opposite is also true – that happiness is possibly 50-70% genetic.

A number of sub-factors influence the biology of our moods.  The set point of our moods is related to both the number and function of the neurotransmitter receptors that are available on our neurons, and by the average amount of neurotransmitters that saturate them.  Some depressive illnesses are caused by a high proportion of defective dopamine receptors, so that no matter how much dopamine is produced, the upper limit of mood is set lower than a normal subject.  Further, individuals have a idiosyncratic set point for the production capacity of their neurotransmitters and an idiosyncratic average output.

These variables can be demonstrated by the following diagrams.

Normal mood

In this example, the average mood level of the average population is set at the arbitrary level of zero.  Over time, levels of mood will fluctuate between a degree of melancholy to a degree of joy within a normal healthy person.  Experience of the extremes of mood would only be felt in extra-physiological or pathological states (as states before, like with drug use or with diseases such as depression).  Some people have a lower or higher set point and/or a naturally greater or smaller fluctuations in their levels of mood.  For those people, levels of mood may be smaller or they may experience happiness as much as others or they may experience greater natural variability.  But since happiness is subjective, their level of happiness is their level of happiness.

Depressed mood

Enhanced mood (“Happiness”)

Euphoria

THE PURSUIT OF HAPPINESS

So why is there a global pursuit of happiness?  Granted, there are some people that, for whatever reason, have a reduced level of happiness relative to other people, and for them a pursuit of increased happiness might be reasonable.  But what about the rest of society that, for the most part, have a relatively average or increased level of happiness?  Why would people who are relatively happy be unsatisfied with their level of mood and live in an endless pursuit of further happiness?  The answer may lie in the neurobiology of dopamine.

Dopamine is a neurotransmitter.  Neurotransmitters act in the brain as a chemical bridge from one nerve cell to another.  Nerve cells are separated from each other by a small gap called a synapse.  When the upstream nerve cell is electrically stimulated, it secretes the neurotransmitter.  As the neurotransmitter fills the space within the synapse, it makes contact with receptor proteins on the downstream nerve.  Once enough receptors have been stimulated on the downstream nerve, an electrical current is generated and the message continues on the downstream nerve and the nerve message continues on. (More information on synapses, with diagrams: http://bit.ly/gsYTrn)

In the 1960’s, Canadian researchers experimenting on rats discovered that placing electrodes in certain brain regions would cause what they thought were intense feelings of pleasure.  The rats skulls were skewered and the electrodes attached to a lever that the rats could press voluntarily, which when pressed, delivered a small dose of current which stimulated the selected brain region.  The scientists noticed the rats with electrodes in a region labelled the “rewards centre” feverishly pressing the levers, sometimes up to two thousand times an hour.  Early theories proposed that the stimulation of the rewards centres of the mammalian brain were causing a euphoric sensation each time, and by extension, eternal happiness was possible if we could stimulate our brains in the right way to remain in a state of indefinite bliss.

As time has progressed, it has become evident that the dopamine-mediated rewards system is mainly a system of ‘liking’ rather than ‘wanting’.  Dopamine responds most to new stimuli, but in doing so, it imprints the brain to stimuli that are important enough to seek in the future.  The memory of the stimulus that lead to the initial dopamine release becomes a template over which the brain builds behaviour patterns.  Despite the brain building up a tolerance to the stimulus, called ‘repetition suppression’, the template has been formed and our behaviour shaped to follow the pattern with a degree of automation, seeking the same stimuli which the brain has been taught is salient.

Thus, the response of our dopaminergic systems to salient or pleasurable stimuli is one of the ways that human beings learn behaviours that offer a survival advantage, since most of the behaviours that provide pleasure are also good for our behaviour (such as eating, or copulation).  As an aside, behaviours which are disadvantageous are usually unpleasant, or downright painful, providing negative reinforcement.  This is another form of learning used to adapt and survive.

Drug use is an example of how the rewards system of the brain can be hijacked.  When certain medications are used (opiates like heroin, or stimulants like cocaine, for example) the dopaminergic neurons in the brain are massively stimulated.   Either a surge of dopamine is forced from the upstream nerve cells, or the drug tightly binds and saturates the receptors on the downstream nerve cell.  The overwhelming stimulation of the dopaminergic system in certain parts of the brain gives the user an intense form of pleasure known as euphoria, the highest feeling of pleasure that one could ever feel.   Addiction occurs because the novel stimulus of the drug, combined with the strong positive correlation from the dopamine surge, forms a hard-wired circuit in the brain of the addict.  The more often they receive the stimulus, the less euphoria they experience, but their brains salience pathways still provide strong impulses to seek the stimulus obsessively.  The addict knows that the stimulus doesn’t give them the same response, but the behavioural template remains such a powerful subconscious force that it compels them to seek the same stimulus anyway.  Most addicts are unable to control that intense craving.

Scientists studying the neurobiology of rewards behaviours have tended to divide happiness into physical pleasures associated with biological needs, and feelings of higher pleasure.  Physical pleasures, such as eating and sex, are known as ‘hedonia’ while the higher feelings of pleasure, associated with the appreciation of art, music, et cetera, as ‘eudaimonia’ (‘a life well lived’) after the distinction that Aristotle made in his writings on the subject.  Recent research using animal and human subjects has confirmed that the same rewards circuits in the brain are used for both hedonistic and eudaimonic stimuli.  In other words, while the source of the appetite may differ, the foundation of the response is the same.

Each time we do something positive that stimulates our rewards networks, we feel happy, joyous or even euphoric depending on the activation of the rewards centre.  And our brain seeks to perform the same action.  However, each level of happiness that we achieve is accompanied by tolerance to the repeated exposures of the rewarding stimulus.  To continue to feel happy we seek more novel stimuli.  When the sources of new stimuli reduce, either by natural selection or attrition, it is harder and harder to find ways of stimulating the rewards centres.

Hence, our never-ending pursuit of happiness.  Our brains have been hard-wired to continue to seek behaviours that give us positive stimuli to the benefit of our survival.  But the imperative comes at a cost, as it becomes harder to find such stimulation.  Most will eventually find a new rewarding behaviour, but some people will not.

Some believe that the pursuit of happiness is nothing more than an expression of the selfish individualism that pervades our society, selfishness disguised as consumerism.  But as shown, the rewards systems need for stimulation by novel or salient stimuli suggests that the ongoing pursuit of happiness in spite of material wealth and abundance is fundamentally biological.

Just as there are other biological, cognitive and environmental factors which affect our mood state, there are other biological, cognitive and environmental variables that affect the pursuit of happiness.  Some people have a dysfunctional rewards circuit either through reduced dopamine production or through dysfunctional dopamine receptors and reduced dopamine sensitivity.  In this situation, these people would have a biologically-based dissatisfaction with life, and would either live in a state of reduced mood and unhappiness or pursue ever-increasing amount of stimuli which would help to boost their dopamine to higher levels.  They would have an abnormally high drive to achieve happiness, despite what other people would consider a happy or abundant life.

There are those who would be the opposite, who no matter what possessions or experiences they find themselves in, would feel enriched and contented, and whose pursuit of material or experiential stimuli would be minimal.  An example of this is the Greek philosopher Epicurus, who was wrongly labelled as the father of hedonism (the pursuit of absolute pleasure at all costs).  In actual fact, Epicurus sought a tranquil life – “a state of satiation and tranquility that was free of the fear of death and the retribution of the gods. When we do not suffer pain, we are no longer in need of pleasure, and we enter a state of ‘perfect mental peace’.” (Wikipedia, “Epicurus”)  He spent his time in a garden and taught his school of philosophy there.  He was content to eat simple meals, and aspired to a neutral mood.    To me that sounds like a man that had a highly functional dopaminergic system.

Just as moods can be affected by cognitive and environmental factors, so can the rewards system and the pursuit of happiness, whereby positive outlook is more likely to lead to a release of dopamine related to the higher centres of the brain influencing outlook in a positive way.  Experiencing external pleasures from the environment would also enhance the dopamine release, and may augment the rewards system.  Certainly, exercise has been shown to increase the number of dopamine receptors within the brain, while in animal studies, loss of social status correlated with a decrease in dopamine receptors.  This supports observational studies which show that loneliness increases the risk of depression.

So happiness, then, is a neural construct related to the mood circuit of the brain interacting  with the rewards circuits of the brain in the context of environmental stimuli and innate perception.  The level of happiness of a given person at a given time depends on the pre-determined functional capacity of the neurotransmitter system and its function at that time, combined with environmental variables processed through the filter of a persons cognitive frameworks.  The pursuit of happiness is the inevitable consequence of repetition suppression of neural networks causing a search for further stimulation of both pleasure centres and the dopaminergic neurons of the rewards system by novel or salient stimuli.

THE ATTAINMENT OF TRUE HAPPINESS

But the fundamental question still remains: Can true happiness be obtained, and if so, how?

True happiness is impossible to define on a global level, since happiness is affected by an infinite number of genetic, neurophysiological and environmental factors which aid or limit the level of what may ultimately be achieved by an individual, or indeed, what level of happiness truly satisfies each individual.  It is certainly possible for an individual to achieve what they define as true happiness depending on what set point they accept satisfaction.  But if the “Addicted to happiness” model holds true, then long-term satisfaction with a set level of happiness would be rare since most people would naturally crave greater and greater levels of happiness.  The more happiness one obtains, the more likely one is to seek further happiness.

Perhaps the best way to look at this question is not what leads to true happiness, but what leads to greater happiness.  Ultimately the level of happiness that one can achieve is related to three factors that affect mood, namely the neurotransmitter system of the brain, cognitive frameworks and environmental influences.  Of these three, only one is subject to our control as individuals.

Levels of neurotransmitters can not be controlled easily and reliably.  It is conceivable that regulation of neurotransmitter levels using can be attempted by certain medications such as SSRI’s, SNRI’s, or dopamine agonists.  However, the precision of their usage and the usual side effects preclude their use in normal subjects.  The course of environmental stimuli can be controlled with certainty either.  Hence, the only variable that is subject to any self-control or improvement is an individuals cognitive frameworks.

The field of positive psychology has exploded in the last decade or two, as psychologists came to realize the limitations of negatively focussed psychological approaches, combined with increasing research data to show the correlations of positive behaviour with health outcomes and psychological wellness.

Aspects of cognitive frameworks which relate to the attainment of greater happiness are psychological expectations, and cognitive response to choices and scenarios.  If your baseline expectations are high, then higher net stimulation of the rewards circuits would be needed in order to promote greater feelings of happiness.  So, should we lower our expectations and be pessimistic all the time, so that when positive things occur, our response would be towards greater happiness?  Perhaps.  Referring back to dopamine, the pleasure centres in our brains respond the strongest with the initial pleasurable or novel stimulus, while repeated exposures result in reduced responses.  The biggest response is when we are exposed to an unexpected reward.  In other words, we get more of a euphoric response when our brains did not see the reward coming.  If it is expecting it, the response is dulled.  So if we never expect anything good, when something good comes, we will feel much happier.  But the flip side is that pessimism is associated with a predisposition to depression and other forms of psychological distress.  Lowered expectations offer a solution of sorts, but at a high cost.

Cognitive response to choices and scenarios relates to the basic psychology of optimism.  Optimism is wrongly thought of as the rose-coloured glasses view of life, where if you just believe that life is just, that good always wins, and see only the positive in the situation, then everything will turn out fine.  In actuality, optimism is more related to behaviour rather than outlook.  It is the act of engagement with the world, of taking concrete steps towards goals.  “Characterizing optimists as smiley-faced romantics is unfair. Optimists are actually realists who take steps to solve problems” (Larry Dossey).  Suzanne Segerstrom, a psychologist from the University of Kentucky, says that optimism “leads to increased well-being because it leads you to engage actively in life, not because of a miracle happy juice that optimists have and pessimists don’t.”  This ‘grounded optimism’ also contains an ability to reframe life and find new meaning.  It is the ability to be fluid and flexible while continuing to re-invent the end goal.  Some psychologists refer to this form of optimism as hope.

In terms of happiness, the optimist will be more likely to accept the situation before them, either positive or negative, and look for ways to engage with it in order to move through it.  While temporary sadness or stress may be encountered, they will usually be able to find a way of dealing with the situation and either solve it, or compromise with it.  This forward movement will increase the chances of them encountering novel or salient stimuli again, which will allow happiness to be rediscovered.  The pessimist, with no hope of finding a solution to the same problem, is more likely to retreat, involute, or remain stuck in the problem.  This guarantees that rewards centres can not be stimulated adequately because there is no chance of encountering novel or salient stimuli, and further happiness will not be attained.

BIBLICAL JOY, AND IT’S RELATIONSHIP TO HAPPINESS

The Bible speaks of the concept of joy many times.  The joy of the Lord is our strength, that joy is one of the fruits of the Spirit, and that our joy may be full, to name a few.  What is biblical joy, is it different to happiness, and how can it be achieved?

The greek word translated most often as ‘joy’ in the New Testament is ‘chara’ which is the joy or gladness received from a person, or the cause or occasion of joy.  It is derived from the root word ‘chairo’ which means to rejoice (or rejoice exceedingly), or to be well, to thrive.  ‘chairo’ was often used at the beginning of letters as a salutation.  So Biblically speaking, it is fair to say that joy connotes a sense of wellbeing as much as it denotes happiness or ebullience.

Joy is listed as one of the fruits of the Spirit.  The greek word used is ‘chara’, so on the surface it would seem that the joy that one receives from the Holy Spirit is of the same nature as joy received from the presence of other people.  It is not really clear from a literal translation of the text that the joy from the Spirit carries a transcendence over genetic or environmental influences (that is, the joy of the Spirit is necessarily impervious to hardships, etc.)  So having the Holy Spirit dwelling within us does not necessarily immunise us against all adversity, so that we will always smile in the face of tribulation and trial.

However, Hebrews 12:2 says, “Looking unto Jesus the author and finisher of our faith; who for the joy that was set before him endured the cross, despising the shame, and is set down at the right hand of the throne of God.”  This verse uses the same word for joy to describe future happiness so perfect that Jesus was able to endure the worst physical, emotional and spiritual suffering in order to obtain it.

John 15:9-11 quotes Jesus to his disciples, “As the Father has loved me, so have I loved you. Now remain in my love.  If you keep my commands, you will remain in my love, just as I have kept my Father’s commands and remain in his love.  I have told you this so that my joy may be in you and that your joy may be complete.”  Again, the same greek word is used is this verse, ‘chara’.  Jesus promised his joy to his disciples, the same joy that enabled him to endure the suffering and shame of the cross.  And they would receive his joy in full.  By logical extension, we as his disciples can also receive the same joy, by following his commands and remaining in his love.  This would suggest that the joy the New Testament describes is more than just happiness, a superficial emotion, but is fundamentally deeper and more profound.

Certainly, the eternal hope that the promise of heaven provides is a deep psychological and spiritual anchor point.  If hope is a key ingredient to grounded optimism, and if grounded optimism provides a cognitive approach that increases the likelihood of continuing to find happiness, then the eternal constant of the hope of heaven and God’s love, and the promises that he provides (like “I will never leave you or forsake you,” and “Nothing can separate us from God’s love” and that “all things work together for good for those that love God according to his will and purpose” for example) are focal points that can reframe any situation in life and enable actions towards these goals.  This alone is enough to increase the propensity for Christians to find ongoing happiness.

How does one obtain the joy that Jesus describes.  The key seems to be in the same passage in John 15.  Jesus said, “I have told you this so that my joy may be in you, and that your joy may be complete.”  What did he tell us?  “If you keep my commands, you will remain in my love, just as I have kept my Father’s commands and remain in his love.”  So, keep Jesus commands and his joy will be in us, and our joy would be full.  What was his command to us then?  That is found in verse 12 and 13, “My command is this: Love each other as I have loved you.  Greater love has no one than this: to lay down one’s life for one’s friends.”  Selfless love, then, is the key to biblical joy.

Giving selflessly to others as a way to finding happiness is counter-intuitive, especially given the prevailing trend in western secular society, which promotes self-analysis and self-help, or gaining more material possessions, or engaging in whatever activities to seek self-pleasure.

As discussed before, eudaimoniac activity does provide stimulation of the rewards centres of our brains, just as hedonistic activity does.  Working to help others in need would help our psyche regain perspective about how fortunate we find ourselves, which would help restore happiness by refocusing the cognitive set point and expectations.  However, altruism has positive effects in and of itself.  An experiment showed that performing acts of kindness for 10 days resulted in a higher life satisfaction score compared to normal daily activities (Buchanan KE, Bardi A. “Acts of kindness and acts of novelty affect life satisfaction” J Soc Psychol. 2010 May-Jun;150(3):235-7).

Is it possible to be simply content?  Can one be content and happy simultaneously, or are the two mutually exclusive?  Certainly, the Apostle Paul wrote, “But godliness with contentment is great gain. For we brought nothing into [this] world, [and it is] certain we can carry nothing out. And having food and raiment let us be therewith content.”  (1 Timothy 6:6-8)  This comment to Timothy seems obvious enough, and seems to contradict the teaching of Jesus.  Can the two be reconciled?

An answer may lie in the original greek word for ‘contentment’ and in other contexts in which the word has been used.  The original greek word for contentment in the King James is autarkeia.  It is only used twice in the New Testament and both times by Paul.  The other use of the word is in 2 Corinthians 9:8, “And God is able to make all grace abound toward you; that ye, always having all sufficiency in all things, may abound to every good work.”

In context, 2 Corinthians 9:8 refers to giving – a person should decide what they are willing to give to God, generously and cheerfully, because God is able to make all grace abound towards them, so they will always have all they need in everything.  Why?  To abound in every good work.

This converges with Jesus teaching rather than contradicts it.  Jesus instructed that joy would be full when leading a life of selfless love.  Paul’s guidance simply augments this.  When you give selflessly (cheerfully and generously), God provides you with everything that you need for everything you do, so that you have ample for every good work.  God does this by his grace.

A similar theme runs through Paul’s teaching later to the Corinthians in the same epistle.  A famous verse with the same motif is 2 Corinthians 12:7-9, “Therefore, in order to keep me from becoming conceited, I was given a thorn in my flesh, a messenger of Satan, to torment me.  Three times I pleaded with the Lord to take it away from me.  But he said to me, ‘My grace is sufficient for you, for my power is made perfect in weakness.’ Therefore I will boast all the more gladly about my weaknesses, so that Christ’s power may rest on me.”

Central to this verse is the powerful phrase, “My grace is sufficient for you.”  The word ‘sufficient’ is a derivative of autarkeia, and means “to be possessed of unfailing strength – to be strong, to suffice, to be enough”.  Again, the message is that it is God’s grace that provides that which we need but do not have.

So then, joy and contentment are not mutually exclusive, but rather, are different aspects of the same whole.  Contentment may best be though of for Christians as a higher that neutral set point on the mood scale.

Performance of a selfless act of kindness triggers a surge of neurotransmitters that raises mood.  God’s grace provides all that is needed for every good work, thus restoring supply, allowing further giving which further enhances mood.  God’s grace then supplies further, and so on.  This system of ongoing replenishment enables regular stimulation of rewards centres by altruistic acts (joy), but without the diminishing of resources with which to give (contentment).  This enhances mood while at the same time maintains a state in which all needs are met.  In this way, a Christian living a life of selfless love is like a dam with a constant inflow to match it’s outflow, so that while it waters the valley below, it also remains full.  The constant enhancement of mood should therefore reset the average mood point higher.

SUMMARY

George Bernard Shaw summarised it well, “This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being thoroughly worn out before you are thrown on the scrap heap; the being a force of Nature instead of a feverish selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy.”

So, happiness is a mood state that is dependent on innate biological and cognitive factors, and is relative to our life experience.  It is the flow of the natural tidal rhythm of mood, opposite to the ebb of sadness.  It is a neural construct related to the moods circuit of the brain interacting with the rewards circuits of the brain in the context of environmental stimuli and innate perception.  The level of happiness of a given person at a given time depends on the pre-determined functional capacity of the neurotransmitter system and its function at that time, combined with environmental variables and the persons cognitive frameworks.

Happiness can only come under conscious control through the cognitive approach, involving our expectations, our choices, and our thought patterns.  By retraining ourselves to have realistic expectations for ourselves and others, retraining our conscious awareness to look for the good in our environment and relationships instead of the negative, and retraining ourselves to make choices which improve our relationships and our environment, we can do all that is possible to achieve happiness.

Biblical happiness, usually translated ‘joy’ in the New Testament, in it’s purest form is a profound joy that Jesus himself enjoyed, and promised to his disciples.  This is partly related to the deep psychological and spiritual anchor of hope in God and his promises, which in turn helps believers cognitively restructure any life experience and take positive action with eternal hope as their constant.  It is also related to selfless love, which Jesus commanded that his disciples show to others, and it’s action on our rewards systems.  This is supported by recent psychological research which showed that altruism is associated with higher life satisfaction scores.  Contentment as outlined in the Bible is a state of constant replenishment by the grace of God, enabling both ongoing selfless love and a higher average set point for mood.

(March 2011)

Water is bad, coffee is good … wait, what?

Sometimes I don’t know whether to laugh or cry when I read stuff on the internet.  Take, for example, the article on news.com.au today about the long-held notion that drinking eight glasses of water a day is good for you.

The article centered around comments made by a lecturer at La Trobe University, Spero Tsindos, that you didn’t need to drink eight glasses of water a day to maintain your fluid balance, and that continuing to make such a statement to the public was just perpetuating a myth.

Stripped of its context, such comments make Tsindos sound like a douche bag, though what offended me more was the layer upon layer of arrogance and ignorance that followed in the comments section.  Some of the comments were from people that were genuinely confused by the disparity between what the article appeared to say and what their personal trainer keeps telling them.  Others were just plain stupid, or perpetuated hysterical mistruths from people that probably should have known better, which just made it all the worse for the people suffering from genuine confusion.

So while it may not be ever be appreciated by the readers of news.com.au, if I don’t try to rectify the myriad of mistruths ensuing from this article, I’ll spontaneously combust.

First of all, lets add some context to the comments made by Mr Tsindos.  The poor guy was just engaging in a robust intellectual debate with other public health academics, in a peer-reviewed forum, considered the most appropriate vehicle for such debate.  He was not making a statement to the press, or writing something for the lay public.  His letter was probably part of a whole series of debate for and against the idea that eight glasses of water a day is mandatory for good health.  Intellectual debate in journals takes a lot longer than posting to facebook, but unfortunately the general public has an attention span shorter than the average goldfish and can only process one paragraph at a time, so the notion of intellectual debate is lost on them.

And for the record, Mr Tsindos is correct in that whatever we put in our mouths contributes to our fluid balance since most of the food we eat contains a lot of water.  So do all fluids, be they water, milk, juices or soft drinks.  Even coffee adds to your fluid balance, despite the caffeine, but we will get to that later.  He was talking about our fluid balance not our overall health.  Unfortunately, again due to our collective attention deficit disorder and our affinity for jumping to conclusions, that was lost on most people.

The comments ranged from the reasonable, “Isn’t coffee a diuretic, so wouldn’t drinking lots of coffee dehydrate you” to the ignorant pseudo-experts, “Everyone should be taught to interpret the colour of their urine properly to see if they are adequately hydrated.”  And from the plain hysterical, “Coffee is pure acid.  Coffee taxes the liver”, to the ridiculously hysterical, “It’s all a conspiracy from juice/coffee companies to deceive you.  Just like evil doctors that push vaccinations full of mercury, that all cause autism.”

First of all, caffeine is a weak diuretic.  Diuretics are drugs that make your kidneys produce more urine.  People who are not used to caffeine will get a diuresis from coffee.  But unless you drink nothing but espressos, there is usually more fluid in the coffee than the small increase in urine output from the caffeine.  And like all drugs, your body develops a tolerance for the diuretic effect of caffeine after a while, so habitual coffee drinkers will get a reduced effect, increasing the fluid contribution from coffee.  You will not dehydrate if you drink nothing but coffee.

And the suggestion that coffee is taxing to your liver and leads to health problems is a myth still held dear by alternative practitioners and overzealous nutritionists.  Broad population studies that follow hundreds of thousands of coffee drinkers for decades have shown that coffee drinkers live longer than non-coffee drinkers, especially chronic habitual coffee drinkers who drink over four cups a day.

Back to the notion that you need to drink 8 glasses of water to be healthy.  Broad generalisations are like one-size-fits-all clothing … they usually don’t fit anyone properly.  The same goes for the idea about the number of glasses of water that you should drink.  You drink the water that you need to drink.  How do you know how much?  The human body has been pre-equipped with the ability to determine exactly how much water we need in a day, and it has nothing to do with eight glasses or the colour of our urine.  It is thirst.  If you are thirsty, drink some water.  If you are not thirsty, don’t drink water.  It’s not that complicated, is it?

The point with the eight-glasses-of-water dictum is that water is beneficial and we don’t drink enough of it.  On this point, I agree with Tsindos, the eight glasses rule should be discarded.  Rather, all we need to say is, “drink more water”.  When you are thirsty, choose to drink water instead of soft drinks or fruit juice.  It’s that simple.

When I have more time I will write a blog about all the virtues of water, because if a drug-company could, they would patent it, such is the overall health benefits of water.  But for now, just remember to drink more water in line with your thirst.

Oh, and lets cut Mr Tsindos some slack.

Placebo therapy is fraud

I’ve often had discussions with friends and patients that go something like:

Friend/relative/patient: “I went to [blah blah] alternative therapy the other day.  I feel great.  You should recommend [blah blah] alternative therapy to all your patients.”
Me: “But [blah blah] natural therapy is a sham.  There’s no good quality evidence to prove that it’s better than a placebo.”
Friend/relative/patient: “But I feel better, and so does Jo Bloggs who lives two doors down.  She said it cured her bad back that she’s had for twenty years.”
Me: “Well, that’s great for Jo Bloggs.  It still doesn’t mean that it’s any better than a placebo.”
Friend/relative/patient: “I don’t care whether there is any evidence for [blah blah] alternative therapy.  I feel better.  That’s all the evidence that I need.”

As they walk away from this conversation, most people think I’m an arrogant unsympathetic retard because I didn’t gush with enthusiasm for their miracle cure.  I’m not unhappy for them.  But placebo therapy is a pet hate of mine that tends to overshadow any deeper joy.

A placebo is any medical treatment that is inert or inactive.  Around one third of people who take placebos will experience an end to their symptoms. This is called the placebo effect.

Placebo therapy is my own description for any treatment which is marketed as having amazing healing properties, but in reality, the only healing it provides is through the placebo effect.  To me, profiting from such therapies is tantamount to fraud.

Some would disagree.  After all, the pillars of medical ethics are, “First, do no harm” and, “Do good.”  If the therapy they offer does no harm, and does some good, then what’s the problem?  The end goal was to make the patient feel better, and if they do, what does it matter that it was the treatment or the placebo effect?

Here’s a hypothetical.  Imagine if I go into a hardware store and ask for a hammer so that I can make some minor repairs to my house.  The store only had baseball-sized rocks, and sold one to me.  I could use the rock to knock out some walls, nail some bits of wood together.  It just so happened to help me.  But it isn’t a hammer.  It’s barely even a tool.  To sell it as a tool or specifically a hammer would still be fraud, despite the eventual outcome.

What if a drug company were to market a sugar pill, claiming a medicinal benefit.  The placebo effect would guarantee that one third of the people who used it would feel better for it, but it would still be fraud.  Our community would be outraged.  Imagine the scathing media reports and the indignation from political and community leaders.  There would be calls for jail time for the executives who profited by misleading the public, and rightly so.

The market for herbal supplements in Australia alone is worth billions of dollars.  Yet there is a paucity of rigorous scientific trials of these herbs.  I could count on one hand the number of herbs that have evidence that they’re better than a placebo.  The other thousand or so unproven herbal supplements are no better than mass-marketed sugar pills.

Any herb, supplement or other treatment needs to show that it has a better outcome than a placebo before it can claim to be therapeutic.  To claim otherwise is fraudulent, and even though I may seem like an arrogant unsympathetic retard, I think people deserve better than being mislead by claims that can not be fully substantiated.

More information on the placebo effect can be found here – http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Placebo_effect?open

Dieting. Is it worth it?

In an opinion column on the Brisbane Times news site, Kasey Edwards wrote about the recent struggles that weight loss company Jenny Craig have had finding celebrities to endorse their product.

Edwards cited Australian actor Magda Szubanski, and Kirstie Alley before her, as typifying the difficulties that dieters have. She also stated that over the last 50 years of research, dieting has a typical success rate of only 5%.

Her source was unstated, but if it’s correct, then it’s somewhat disheartening. She said, “With such damning rates it is extraordinary that we still blame individuals for ”failing” at weight loss programs rather than accusing the diet companies of selling snake oil. Can you imagine buying any other product with a 95 per cent failure rate and then blaming yourself when it didn’t deliver on its promise?”

The question is then, “Do all diets suffer from the same failure rate, or are there one or two really successful diets who’s success is diluted by the failure of others?” The answer, not really. It depends on how long you measure for.

From the eMedicine article on obesity, “The results of most weight-loss programs are dismal. On average, participants in the best programs lose approximately 10% of their body weight, but people generally regain two thirds of the weight lost within a year. When defined as sustained weight loss over a 5-year follow-up period, the success of even the best medical weight-loss programs is next to nil. Most available data indicate that, irrespective of the method of medical intervention, 90-95% of the weight lost is regained in 5 years.” (Reference)

So, you can invest thousands of hours, and hundreds of dollars into a program, and the end result is most likely the same, nothing.

That sounds depressing. So what’s the point? Perhaps we should just quit while we’re ahead.

You could, but I think there is a solution. Dieting is not the answer, but I think making healthy lifestyle choices is.

That’s for another post.