Occasional reflections on Life, the World, and Mathematics

Posts tagged ‘health’

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. (more…)

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.

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