There’s a great scene in the classic West Side Story in which members of the Jets gang go through all the different things people say is wrong with them.
“The problem is he’s crazy, the problem is he drinks, the problem is his mother, the problem is he stinks.”
“I’m depraved on account ‘a I’m deprived!”
It’s satire, and it’s funny, and it’s a catchy song, but it illustrates the complexity of social and behavioral problems and their origins and solutions. The theme still rings true, the most recent example being the recent labeling obesity as a disease by the American Medical Association. Oh! The problem is I gotta disease!
This move effectively creates sick people where none existed. Which takes said sick people off the hook. Cancer is a disease. Type 1 diabetes is a disease. Plague is a disease. Those are things that happen to you despite your best efforts and through bad luck, bad genes, bad karma, whatever your belief system might be.
Obesity is, with few exceptions, created by the person who is obese, or by his or her surrounding environment. Moreover, obesity in and of itself is not even bad. It can create disease, but is not a sickness itself. So a person with a BMI in the obese category who is otherwise completely healthy and happy is now sick. And the person who has sleep apnea, diabetes, high blood pressure, and poor circulation from a lifetime of doughnuts and pizza is also sick, but it’s not his fault, because he has a disease. Wow. That ought to be a load off a lot of peoples minds. Once you allow people to assume the sick role, personal responsibility tends to fade away.
Of all organizations, the members of the AMA should know the difference between a symptom and a disease. It is basic first year medical school stuff. Obesity, in people who are obese and also sick with the things associated with obesity, is a symptom. All doctors know any isolated symptom can be caused by a host of different processes, some lethal, some benign. A healthy person might be obese by classification. Many football players would fall in this category. A lot of sick NFL stars out there.
Obesity could be a symptom of low self-esteem, a symptom of poverty, a symptom of environment, a symptom of hormonal imbalances (in which case there is a disease, but it’s not obesity), a symptom of medication. As Dr. Paul Farmer would say, “Sure, he’s got TB, but problem is he’s starving.”
Or, I guess semantically, obesity could be a cause of disease. Pneumococcus is a cause of pneumonia. Is pneumococcus a disease? No, it’s a bacteria. The thing about causes is, if you can treat the cause, the disease goes away.
Finally, the AMA has added another way for the health care industry to make money. Label something a disease and suddenly drug companies, procedures, and specialists spring up from the earth ready to reap the benefits of the fact that now Medicare is going to pay for all this new stuff. Because there are so many more sick people now.
That need drugs. And surgery. To treat their disease.
Shirie Leng is an anesthesiologist who blogs at medicine for real.
