Smoking Cigarettes (My Circumstances Made Me Do It)

Rates of cigarette smoking have dropped substantially in the US over the past few decades. But lots of Americans still smoke, and the burden of tobacco-related illness does not fall evenly across our population. That is tragic under normal circumstances, with tobacco use leading to heart attacks, strokes, cancers, and emphysema, to name but a few relevant illnesses. In the face of the Covid-19 pandemic, it’s even more tragic, because tobacco smoking significantly increases the lethality of the virus.

So why isn’t tobacco use evenly spread across the population? In part, it’s because the more challenges a person faces in life, the more likely they are to smoke.

To read the rest of this piece, please visits my column on Forbes.

Where You Live in America Determines When You Die


Debates over income inequality divide liberals and conservatives. In the last few decades, income inequality has soared in the U.S. In the 1950s, the top 1% of Americans brought home about a tenth of the country’s income. By 2012, those 1%’ers accounted for almost a quarter.
Only a minority of Republicans are troubled by these statistics, versus three-quarters of Democrats. We are a nation divided—in wealth and in politics. But perhaps another kind of American inequality can bridge this partisan divide—a life expectancy gap.
Consider the facts. The average life expectancy in the U.S. is almost 80 years. But that average obscures enormous differences based on where people live. In some U.S. counties, life expectancy is close to 90. But in others, people are lucky to live to 65.
(To read the rest of this article, please visit Forbes.)

Got a Big Belly? (Why Big Sugar Is to Blame)

Growing up Republican, I have long believed in personal responsibility. In junior high school, when I observed close relatives who struggled with obesity, I vowed to never let myself get out of shape. (“Junior high” is what we called middle school back in the day.) When hip surgery gone wrong dramatically reduced my level of physical activity two and a half years ago, I cut back on what I ate to keep from gaining weight. In fact, I believe that much of our nation’s obesity epidemic comes down to personal responsibility—if people ate less and exercised more, we’d be a healthier nation.

But there is another culprit who deserves blame for American obesity—the sugar industry, which, for decades, bamboozled the American public about the dangers of its product .

My ire at big sugar was stoked by a study published in JAMA Internal Medicine analyzing correspondence from the Sugar Research Foundation (SRF) in the 1960s and 70s. In the late 50s, the sugar industry recognized that people’s concerns about the connections between cholesterol and heart disease provided them with an opportunity to tout the “no fat” benefits of sugar. By 1962, however, the industry recognized that high sugar intake could increase cholesterol levels, too.
(To read the rest of this article, please visit Forbes.)

HIV – The Epidemic Isn’t Over

We have great medications to treat HIV infections today, but the best medicine is to not need medicine – to not get infected in the first place. But according to an article in JAMA, HIV transmission is rising among gay and bisexual men, compared to the rest of the population:

And clinicians aren’t doing a good job of reminding high risk patients to get tested for HIV:

We can’t afford to relax and let this epidemic get out of control!

Hookup or Hookah?

I have two teenage boys. So of course I’m worried about them skipping the dating scene and engaging in “hookups.” That seems to be what kids do these days. But now, do I also have to worry about them engaging in hookah?
Dave Chokshi (@davechokshi) recently tweeted an image of trends in tobacco use among students. It shows a significant increase in the use of the e-cigarettes and hookahs. Here’s that picture:
Hookup or Hookah
I showed it to my sons, and they laughed. “No one uses E cigarettes or hookahs,” they told me. “They just smoke pot.”

The Harms of Believing in Exercise

Harms of Believing in Exercise Pic2Can beliefs make you fat?
The answer to this question might seem pretty obvious. If I believe that the best way to lose weight is to super-size five meals a day at McDonald’s, while consuming bags of Doritos to tide me over between meals, that belief is probably going to make me fat. If I believe that the best way to get in shape is to watch other people exercise, I’m probably never going to have a six pack abdomen.

But what if I believe that exercise is the key to losing weight? Research suggests that this belief might be bad for my health.

Let’s be clear – I like to exercise. Maybe even too much for my own good, if the amount of money I’ve spent on orthopedic surgery is any indication. But I like to exercise because it is fun to exercise and makes me feel better, not because it keeps me thin. Let’s also be clear that exercise helps people avoid becoming obese. One of the reasons I’m still under 160 pounds in my early 50s is because I exercise six or seven days a week. But regular exercise, alone, doesn’t guarantee a trim figure. I have plenty of friends who exercise quite a bit, and still have hefty frames. They are hefty because they still manage to consume more calories than they burn.
And that’s where belief about exercise can become dangerous. (To read the rest of this article, please visit Forbes.)

Cigarette Smoking Is So 1970!

I have two reasons for showing you this picture, illustrating the decline in cigarette sales in Germany, France, Japan, Switzerland and the US over the past few decades. First, to show you the decline in cigarette sales in Germany, France, Japan, Switzerland and the US over the past few decades.
Cigarette Smoking Is So 1970
Second, to encourage those of you who like pictures like this to follow Max Roser on Twitter – @MaxCRoser . His twitter feed is chock-full of wonderful pictures like this. You will probably see some of them in my twitter stream, too, because these pictures deserve to be widely shared. But if you don’t want to miss any, I suggest you go right to the source.

Calling Obesity A Disease Dooms Dieters

Obesity US News
Photo Credit: US News

In June of 2013, the American Medical Association officially recognized obesity as a disease. The organization had its reasons. For starters, obesity leads to heart attacks, strokes, diabetes, early-onset degenerative arthritis…and just about every other illness on the planet. In addition, people with obesity face a very difficult time overcoming their condition: Short of highly invasive stomach procedures, very few treatments succeed in helping people lose weight and maintain that weight loss. Finally, the organization may have been motivated by the desire to reduce stigma surrounding obesity; by labeling obesity as a disease, it hoped to signal that people with obesity cannot be wholly blamed for their affliction.

But will deflecting blame from obese people backfire? Now stricken with a “disease,” will obese people be less motivated to lose weight?

This is the question Crystal Hoyt and colleagues set out to answer in a study published in the prestigious journal, Psychological Science. Their concern? As they put it: “The term disease suggests that bodies, physiology, and genes are malfunctioning. By invoking physiological explanations for obesity, the disease label encourages the perception that weight is unchangeable.”
To see whether this concern was justified, they decided to run some studies. In one, they asked people how concerned they were about their weight. They also asked these people to select a sandwich for a hypothetical lunch. And they varied whether people in the study were exposed to a message that obesity was a disease. (To read the rest of this article, please visit Forbes.)

Do You Know How Many Calories Are in Your Burrito?

PHNHere’s a new study I conducted with Peggy Liu, Jim Bettman, and Arianna Uhalde on calorie range information. Check it out below.
Liu, Peggy J., James R. Bettman, Arianna R. Uhalde, and Peter A. Ubel (forthcoming), “How Many Calories Are in My Burrito? Improving Consumers’ Understanding of Calorie Range Information,” Public Health Nutrition. DOI link. Download here.
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When Physicians Pay Attentions to Costs, They Promote Public Health!

This week, my good friend Reshma Jagsi and I published an article in the New England Journal of Medicine, in which we explain why physicians are doing their job, as physicians, when they pay attention to healthcare costs. Here is a snippet from that article, and a link to find the full version.

Health care costs are straining budgets throughout the developed world, threatening the fiscal solvency of governments, employers, and individuals. Many countries are trying to restrain health care spending through top-down approaches, such as price regulation and even refusal to reimburse for interventions that are not cost-effective. Still controversial is the role that physicians should play in controlling health care costs. For instance, the Choosing Wisely campaign of the American Board of Internal Medicine Foundation encourages physicians to avoid interventions that “may be unnecessary, and in some instances can cause harm,” but it does not ask physicians to contemplate trading off small clinical benefits for individual patients in order to promote more general societal welfare.

Yet concern for societal interests has long been recognized as part of physicians’ duties. Physicians’ specialized knowledge and skills result from publicly funded graduate medical education and the hands-on learning afforded to them by patients who allow trainees to participate in their care. In turn, physicians gain an obligation, as members of a uniquely privileged profession, to serve not only their individual patients but also society.
Consider the campaign launched by the Centers for Disease Control and Prevention to promote “antibiotic stewardship.” The campaign recognizes that aggressive use of antibiotics in patients who are unlikely to benefit from their use promotes the development of antibiotic resistance, a serious public health problem. Thus, a physician who believes that an individual patient has only a small chance of benefiting from an antibiotic might choose not to prescribe one, out of a desire to forestall resistance in the population at large. Such societal stewardship involves forgoing a small, or even uncertain, benefit for an individual patient in order to promote the health and well-being of the general population.

 Click here to read the full article 

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