Self-deconstructing clichés: Weight-loss edition

Continuing my series on figures of speech being modified to eliminate their actual meaning, we have this comment on the discovery of the “holy grail” of obesity research. The holy grail, as a reminder, was a unique item in Christian mythology, the dish that caught Jesus’ blood, the single holy focus of the quest of King Arthur’s knights. According to legend it had magical healing properties. As for this holy grail,

Tam Fry, of Britain’s National Obesity Forum, said the drug is potentially the “holy grail” of weight-loss medicine… “I think there will be several holy grails, but this is a holy grail and one which has been certainly at the back of the mind of a lot of specialists for a long time.

As for the magical healing,

All of the other things apply – lifestyle change has got to be root and branch part of this.

And then we have to wonder — a self-deconstructing cliché twofer — what does he mean by “root and branch part”?

The real question about “e-cigarettes”

I’ll preface this by saying, whoever thought to call inhalable nicotine delivery devices “e-cigarettes” probably deserves a marketing prize. More generally, the whole framing of these devices seems bizarre.

There’s an article by Sally Satel in The New Republic, under the title “Everyone Is Asking the Wrong Questions About E-Cigarettes”, which presents current opposition to the e-cigarrette phenomenon as a kind of neuropharmacological Luddism. The argument — which is depressingly common — is that electrically generated nicotine vapour is so clearly a health gain relative to tobacco smoke that no regulatory hurdles should inhibit an addict from replacing the latter by the former.

This sounds compelling, but it’s not, because it ignores fundamental principles of government regulation, and in particular the awkward respect that it shows to stasis: Very often we impose new regulations on changes, allowing the old to remain in place because the expense or disruption imposed by requiring the old to be replaced is seen as excessive. An example that first caught my attention many years ago was the way Boston (and presumably Boston is not at all unusual in this) imposed a requirement that, for example, new outdoor light fixtures or windows need to meet requirements of historic preservation — even (and this was the part that amazed me at first) if it’s just a matter of replacing one fixture by a new but identical fixture. But of course, the idea is that over time replacements will be made, and that will the appropriate time to upgrade to the desired (historically sensitive) appearance. Continue reading “The real question about “e-cigarettes””

What is a disease?

Gilbert’s Syndrome is a genetic condition, marked by raised blood levels of unconjugated bilirubin, caused by less active forms of the gene for conjugating bilirubin.

There are disagreements about whether this should be called a disease. Most experts say it is not a disease, because it has no significant adverse consequences. The elevated bilirubin can lead to mild jaundice, and some people with GS may have difficulty breaking down acetaminophen and some other drugs, and so be at greater risk of drug toxicity. They also have elevated risk for gallstones. GS may be linked to fatigue, difficulty in concentration, and abdominal pain. On the other hand, a large longitudinal study found that the 11% of the population possessing one of these Gilbert’s variants had its risk of cardiovascular disease reduced by 2/3.

WHAT? 2/3 lower risk of the greatest cause of mortality in western societies? That’s the “syndrome”?

Maybe we should rewrite that: anti-Gilbert Syndrome is a genetic ailment, marked by lowered blood levels of unconjugated bilirubin, caused by overly active forms of the gene for conjugating bilirubin. This leads to a tripled risk of cardiovascular disease. On the other hand, the 89% of the population suffering from AGS has lower risk of gallstones, and tends to have lowered risk of acetaminophen poisoning. They may have lowered incidence of fatigue and abdominal pain.