Stanton's Blog

August 25, 2010

My Dream America -- Appearing Now in Queens

I visit with my son and grandson at Rockaway Beach in Queens where, in my two-and-a-half- year-old grandson's words, "we swim like dolphins," with him hanging around my son's neck as we ride the cresting waves. Cassius laughs each time we rise and fall.

While there, I observed a tall, blond, freckled boy riding boogie boards along the beach with a slender, dark girl in a long bathing suit that covered her body to her ankles. The girl wore a scarf covering her head (though not her face). They slid along the wet sand all morning, and then returned to a blanket set up by a fair-skinned woman, next to which two small girls were building "castles" in the sand. You know -- a day at the beach.

I imagined the older children (who might have been 12-13) were at the same school, maybe helped each other with homework, when the boy said, "Do you want to come to the beach with me and my mom and sister?"

"Sure," the girl said. "But I have to ask my mother first."

"Yeah," the boy replied, "my mom will want to talk with your mom."

Later, the boy's mother called to speak with the girl's. "Oh, hi. I'm Tom's mother and we want to see if Janna can join us at the beach. Tom tells me they're great friends at school. My younger daughter is coming with a friend too."

"Why, that would be lovely, Janna loves to swim."

"Ummm, I was going to bring some snacks -- fruit, cheese, crackers, maybe some cookies -- is there anything Janna's not allowed to eat?"

"No, that will be fine."

I imagined that neither the boy nor his mother was politically oriented, that they went to church on Sundays, that they backed the troops in Iraq and Afghanistan. But, who knows?

There are a large number of Muslims in Queens, both from Asia and Eastern Europe. Walking with my grandson to one park, we pass a mosque. It never fails to surprise me -- I'm not aware of any in upscale, Republican Morris County in New Jersey, where I live, although I heard about one being planned that neighbors were opposing. But Queens is a polyglot nation of its own.

Is there a better advertisement for the United States, for peace among all people, for why Muslims should reject the idea of Americans as bigoted anti-Muslims than those two kids mindlessly sailing along the beach?

"I don't know much about Islam," Tom might say. "But Janna's a good girl. We always have fun together."

Tom's mother: "Janna's a very smart girl, Tom tells me. Very polite and well-behaved. Her and Tom could run around in the water all day. Actually, I think she's a really good influence on the younger children too. She's welcome to come any time we go to the beach."

Amen.

August 19, 2010

We Don't Believe Alcohol's Good For You!

My recent post on the "hidden" benefits of alcohol -- hidden, because ... well, I'll get back to that -- elicited many comments, and many negative ones (along with the stupid ones -- you know, where someone says, "Sure alcohol is good for you," and writes like he's intoxicated). Rather than answer all these comments separately and piss people off individually, I thought I could piss everybody off more efficiently with this follow-up post.

"It's Rubbish! No such thing as moderate drinking habits."

This is an American temperance comment par excellence. Temperance advocates (and they were legion) argued that moderate drinking inevitably led to alcoholism (which they called chronic drunkenness or inebriation) in the same way that Alcoholics Anonymous today says alcohol effects the minority of drinkers who are alcoholics. As for what comprises moderation, the Dietary Guidelines for Americans says one to two drinks daily (for both women and men). The New England Journal of Medicine article I discussed offers the same figure, since the death rate was the lowest at 1-2 drinks daily for older Americans. However, even those who drank four or more drinks daily in that study had the same, or lower, mortality rates as long-term abstainers.

"These reports having been driving me crazy because after working as a nurse for over twenty years I know better. I have to wonder who is on these committees who issue these statements and who they are affiliated with. We know most of the government agencies and committees are staffed with flexians from industry. I tell women to limit their drinking to three drinks a week and men five drinks. When people start doing something that is addictive everyday, they are addicted to it."

This is a very important comment. It discounts the results on the unexamined (actually, counterfactual) assumption that this body of research (which is massive) was funded by the industry. My post states that the NEJM study was conducted by the American Cancer Society. The Dietary Guidelines are a government publication produced by the Departments of Agriculture and Health and Human Services. The chair of the Guidelines alcohol subcommittee is Eric Rimm, co-director of Harvard's Health Professionals Study, which has tracked health behavior and outcomes among doctors and nurses for decades.

But what is most significant about this post is its assumption that daily drinking must be addictive -- a very American outlook. In the United States today, 50 percent of 21 year old binge drink. This is truly astounding since only 70 percent of them drink; in other words, of 21-year-olds who drink, 70 percent regularly binge drink! If we dial back to the Monitoring the Future study of high school students, many 18-year-olds disapprove of adults drinking one to two drinks daily (the style that prolongs life) but not of having five or more drinks at one sitting on weekends -- the kind of drinking that leads to accidents and high death rates. So, in her labeling daily drinking addictive, this health professional commenter contributes to a binge mentality associated with higher drinking mortality.

"There are a lot of studies showing health benefits from moderate drinking. But recall there were many "studies" showing smoking to be beneficial back in the 50's and 60's. Tobacco companies had a lot to do with such studies and their results."

It is worth getting into the thinking behind this comment. The writer puts alcohol and cigarettes in the same category, which is warranted inasmuch as they are both commercially sold drug products capable of producing addiction. Moreover, growing up in America, many are tempted to think of them as equivalent items on some kind of morals scale -- i.e., a person who doesn't drink or smoke is better in some sense than one who does only one, or certainly both.

But the comment is wildly out of touch with the actual universe. The reason we know this? Because, at its base, epidemiological research is counting up outcomes for people who behave one way or another. As soon as researchers began tracking smokers and comparing them with nonsmokers, they found smokers got cancer AND heart disease more frequently and died earlier.*

What about drinkers? As soon as epidemiologists started following drinkers and abstainers, they found that drinkers had less heart disease and as a result lived longer. How do I know this? Because the Framingham Heart Study -- the first such community study of heart disease -- found this result in the early 1970s. But here's what is crucial to know. In 1974, Harvard investigator Carl Selzer noted this result -- but the National Institutes of Health, which funded the study, refused to allow Selzer to publish it (as he revealed belatedly, in 1997).

Why did this occur? Because the United States has a strong anti-alcohol bias -- like these commenters and much of the public health establishment. Drinking is bad, and they will never believe otherwise.

In regards to Framingham, let's dial forward some 30 years. In 2007, PBS produced a two-hour special, "The Hidden Epidemic: Heart Disease in America," devoted to the risk factors for heart disease discovered in the Framingham study. That abstinence from alcohol is among the major risk factors for heart disease seemingly could not be discussed. An excellent panel of five experts led by Larry King dealt with diet, sex, exercise, smoking -- just about everything that people do that impacts the health of their hearts. But alcohol was never mentioned.

Why not, do you think? Why wouldn't Larry ask the panelists about drinking and the heart, or why did none of them have the cojones to interrupt: "Larry, I really think we should discuss alcohol. Not smoking is the only behavior we have measured that reduces heart disease more -- including diet and exercise -- than does moderate drinking."

The ironic thing is that the major argument against the claim that regular drinking actually reduces heart disease and overall mortality is that drinkers may be healthier due to other factors, like higher incomes or other healthy behaviors. In the first place, research like the American Cancer Society study statistically control for extraneous lifestyle, economic, and other factors, so that social status can be eliminated as accounting for the drinking results. In addition, one Harvard Health Professionals study was limited to doctors who were all of normal weight, didn't smoke, exercised, and had good diets. In this otherwise healthy group, the same reduction in heart attacks was found among those who had one to two drinks daily.

But let's simply accept the "extraneous factors" critique at face value. What does it mean to say that moderate drinking is part of an overall healthy lifestyle that leads people to have less heart disease, live longer, and reduce their rates of dementia? It is certainly a different tune from the temperance chip so many Americans insist on replaying.

The three comments I included are all from frequent, popular commenters to a liberal Web publication whose readers one might think are more open than average Americans towards substance use. Obviously, this is not true of many HuffPost readers when it comes to alcohol. In the United States, the progressive movement was a primary impetus for Prohibition (think William Jennings Bryan), alongside the religious fundamentalism that is still so strong in our country. Together these remain powerful forces in the American outlook, which will always be uneasy with beverage alcohol, no matter what the data say.

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* Of course, these assertions refer to group averages, which is why large samples must be studied. The most typical comment, both in favor of -- and opposition to -- my post, begins something like, "My grandfather..." This information is obviously important and relevant to the writer, but it is not epidemiology.

August 17, 2010

Demagoguery Always Works!

That's why it's called demagoguery - playing to the prejudices of the masses is always popular.

And the idea that Americans appreciate brave people? - balderdash. That's why people who speak up to protect minorities are brave - because they will always be attacked - punished - for it. Remember the Freedom Riders who were spat upon - and worse - for sitting in at lunch counters in the South? They were lucky if they came out of there alive.

What we can't get our minds around is that the people who spat on school children going to integrated schools, politicians who barred little children from entering school buildings, people who beat - yes, and even murdered - freedom riders felt good because they were doing the right thing - and everyone they knew agreed with them (which is why they couldn't be convicted in open court).

When we look back on those times, we want to think: "bigoted people were so dumb then; thank God we've learned better."

We've learned nothing! We are as bigoted as ever; we've just moved our bigotry down the road. While the white Protestant male elite endorsed slavery in the Constitution, and didn't give women the right to vote (which had to be fought hard for almost 150 years later), as late as World War II, almost 175 years later, the overwhelming majority of soldiers surveyed refused to serve with "Negroes" or Jews.

Through memorizing enough civics texts in middle schools, we've drummed it into the heads of the majority of people that such prejudice is "wrong." But the idea that prejudice, bigotry, teaming up against people unlike us is alive and well.

And anyone with the temerity to go up against prejudice and who supports the rights of different kinds of people will pay a price -- just ask Barack Obama -- who backpedaled so quickly from his "bravery" that he almost fell on his ass. That kind of caution gets you elected president.

Unless you lose to someone even more venal, bigoted, and demagogued up -- like. . . .

August 16, 2010

The Hidden Health Benefits of Alcohol?

As someone who will turn 65 in less than six months, I noted with interest the New York Times article that summarized a new government report on drinking and the elderly.

Before doing that, I should note that the 2010 edition of Dietary Guidelines for Americans is saying some radical things about alcohol. That is, the expert report by the committee for the alcohol section of the guidelines declared that:

Strong evidence consistently demonstrates that compared to nondrinkers, individuals who drink moderately have lower risk of coronary heart disease...

Moderate evidence suggests that compared to nondrinkers, individuals who drink moderately have a slower cognitive decline with age...

An average daily intake of one to two alcoholic beverages is associated with the lowest all-cause mortality and a low risk of diabetes and CHD (coronary heart disease) among middle-aged and older adults.

What the hay -- drinking results in a longer life and less dementia, according to the government! There has been kickback on these conclusions. The comparable Australian guidelines, for example, issued a somewhat different set of recommendations. For the Aussie experts, "Any benefits are mainly related to middle aged or older people." After all, you don't usually die of fatty build-up in your veins and develop Alzheimer's until you are in your twilight years.

But the American elderly report, as represented in the Times, mentions no such coronary, cognitive or mortality benefits -- only negatives due to drinking by older Americans. At points, it seems the elderly drinking report is in direct contradiction to the government experts who created the dietary guidelines, to wit, "Alcohol also can make certain age-related health problems worse, like high blood pressure, diabetes..."

Taken together, the contrasting (or are they complimentary) emphases "drinking is only beneficial to older Americans," "drinking is most harmful to older Americans," sound like the punch line for a Groucho Marx joke -- "You should never drink before you are old, and then you should quit." To be fair, the Times article is headlined, "Why getting old means drinking less," and the government report doesn't recommend abstinence for older Americans, but "that people over 65 shouldn't consume more than seven drinks in a week." But neither makes drinking by older Americans sound very advisable.

As for how burning this problem is, the report at the government website reveals that 40 percent of over-65 Americans currently drink alcohol.

While we're discussing the matter, perhaps we can turn to some actual data, as out of place as that may be in a family publication. In 1997, the New England Journal of Medicine published a prospective study of a half a million middle-aged and older Americans and their drinking -- the largest such study of drinkers' health outcomes ever conducted. Subjects were identified and their drinking assessed, then they were followed for the next nine years. The study was funded by the American Cancer Society.

Looking at men and women who began the study ages 60-79 who were at low risk for cardiovascular disease and death, those who had two drinks a day had .8 the death rate abstainers manifested in the follow-up period; those who had three drinks daily had a slightly lower (.9) risk of death than abstainers; and only those who drank four or more drinks daily were at the same risk for death during the course of the study as abstainers. (Abstainers were lifelong, since more recent abstainers might have quit drinking due to a health condition.)

Looking at subjects ages 60-79 who were at high cardiovascular risk, the results were largely the same, EXCEPT, the relative risk of their dying compared with lifetime abstainers was .8 no matter how much they drank -- up to and including four or more drinks daily!

I don't know, shouldn't a report on health and elderly drinking take note of such findings?

August 7, 2010

Louis Armstrong: Genius and Drugs

Louis Armstrong's life is too amazing to take it all in in one gulp - as many of his contemporary political, jazz, and entertainment figures were unable to do. But he does make us think hard about marijuana addiction.

Armstrong was born in August, 1901 and grew up in New Orleans' red-light district - prostitution was essentially legal, and his mother probably prostituted (his father abandoned the family, and Armstrong was raised by his grandmother during his early childhood).

Armstrong developed an unusual relationship with his mother - treating her more like an older sister. But they were devoted to one another. In his remarkable biography of Armstrong, Laurence Bergreen describes Armstrong's mother taking him - when Armstrong was 16 or 17 - to teach him to drink "like a man." They got stinking drunk in New Orleans speakeasies.

But Armstrong never developed a drinking problem. Bergreen attributes Armstrong's sobriety (that means moderation, AAers) to another unlikely source - Armstrong's massive marijuana consumption throughout his life, which Armstrong regarded as a healthy alternative to drinking. And it might have been (compared with lethal moonshine liquor during Prohibition), were it not for the way he consumed the drug - "three cigar-sized joints a day , at least, throughout his life."

Armstrong developed lung problems later in life, and died before reaching his 70th birthday. It seems hard to believe he lived what today we would consider such a short life, given his turn-of-the-century life in New Orleans, his pioneering work in jazz there and in Chicago, and - as many people are surprised to learn - his living the last nearly 30 years of his life, from WWII on, in a residential neighborhood in Corona Queens (his home there is a national museum).

So, what did Armstrong accomplish - aside from being a beloved national figure and goodwill ambassador for the United States abroad? At one time, many jazz figures ridiculed him for his crude, "Hello Dolly" musical efforts. But even jazz greats like Miles Davis eventually realized that Armstrong was a genuine pioneer who anticipated the be-bop, free form jazz movement of the 1950s and 60s with both his early trumpet playing and his scat singing.

And what about his politics and racial attitudes? Armstrong seemed to be entirely color-blind and apolitical. Bergreen attributes this in part to Armstrong's close relationship with an immigrant Rumanian Jewish family in New Orleans, on whose junk wagon he blew a horn to attract customers. The family treated Armstrong like a member, bought him his first trumpet, and encouraged his musical aspirations.

Because he presented himself as a thoroughly happy and contented American, and represented the United States overseas, Armstrong was regarded by many civil rights and black entertainment figures as -- you know what. That all changed when Governor Orval Faubus refused to allow African-American children to integrate the Little Rock school system after Brown v. Board of Education, ringing a school with Arkansas national guardsmen to prevent kids from entering.

President Dwight Eisenhower at first wavered in the face of Faubus' racist intransigence (kind of like leading Republicans today in campaigning to prevent gay couples from achieving equal rights). Although Armstrong rarely spoke out on racial matters, a student journalist caught him in a hotel in Grand Forks, North Dakota in September, 1957. Armstrong shocked everyone in the interview, saying Eisenhower was "two-faced" and lacked "guts" for not forcing Faubus' hand, and saying he would refuse to follow through with his planned goodwill tour of the Soviet Union.

Soon after Eisenhower ordered in federal troops to effectuate desegregation. But Armstrong paid a price - leading political figures wondered if he were fueling Soviet propaganda against the United States (which Armstrong noted in this case was true), and Southern stations refused to play his music.

So, class, the question is: how did a hard-core pothead serve as a seminal American musical, racial, and public relations figure for a half century? And how would an adoring American public have reacted to Armstrong if they knew this about him?