[Epi]

Nobody is suggesting that we have olympic qualifying standards... just enough to get the kids off the couch. It's hardly devious to insist that kids have a level of athleticism that would enhance their quality of level, make them less prone to injury and reduce health care costs in the long run. I think that's a noble goal.

I think one of the biggest problems with what you are proposing is that your solution (more gym classes, more testing) will probably not do much for the answer (a more generally fit population) in the long run. In fact what you propose will likely cause even more problems (money for gym teachers, taking away time from classroom instruction, parents suing when their smart kid who can't pass PE for whatever reason is denied entry to Harvard cause they can't graduate high school) then solve.

The issue of having a 'physically fit' population is also a bit hard to define. If our goal is to increase people's abilities to be better at gym class, then I guess more gym is a good idea. If our goal is to increase life expectancy or decrease the burden of preventable chronic/killer disease, then many other types of public health interventions are necessary.

Here's a short list of things that could be done at the high school level:
1) Even more powerful anti-smoking and anti drugs campaigns focusing on health
2) Classes specifically designed to teach about nutrition, healthy eating, healthy COOKING, and lifelong activity. Whatever it was that I had in high school about this was arbitrary dictated by the teacher, and was an optional class.

One part of these classes, is also to teach about chronic disease and cancer. Teach about sunscreen and sun avoidance. Teach about getting kids to urge their parents to get screened for colon cancer (Ontario for some reason has per capita more colon cancer than anywhere else in the world). Get kids to learn about type 2 diabetes, so that they can annoy their parents to be healthier too.

One final part of this, is safety, safety, safety. Encouraging safety begins with education, and accidents are the #1 killer of people under 40, people in the prime of their productive lives, and incredibly expensive to treat (trauma centers and ICU!). I'm not saying that kids will magically stop being kids and stop doing stupid things, but we can try and reduce stupid acts. Remember, all it takes is a critical mass of people against drunk driving to make it so that it's really not cool to do so when you're at a party.

3) Stop selling soft drinks, sugared juice, chocolate and chips in vending machines. Stop selling any type of unhealthy food in cafeterias. Sadly the only types of food available is unhealthy food.

4) Stop having stuff like pizza days, and juice carts at the grade school level. Replace with something healthy.

5) Provide free soccer balls, footballs, basketballs, tennis balls/racquets and so on for kids to play with at recess.

6) Allow kids access to the gym during recess and after school for activity, especially during winter.

7) Encourage active participation in sports, not via testing, but via school wide 'ladders' (aka competition ladders), regular fun competitions, sports days (we stopped those after grade school). Most of these would be voluntary, but open to all. Perhaps have special awards for active participation, and offer incentives to being active such as getting free fruit to eat or something.

8) Stop letting kids drive to school unless they are super far from the school and are at the school for special reasons. The easiest is to close the student parking lot and keep a few spots open.

9) Construct all new schools to be like 4-5 stories and small, instead of spread out and 2 stories. Allow elevator access only with special permission as is done now.

10) In poorer areas, give kids access to free lunch programs. The effects of well nourished growing children, especially in a learning environment is huge as has been seen in the USA where these programs exist.

 

[kEiThZ]

Epi,

You've made some excellent suggestions. And there are many of them I would incorporate. For starters, I would love to see school breakfast and lunch programs which would have the dual goal of teaching kids healthy eating habits while also providing nutrition to fuel their little bodies and minds. I also particularly like your idea about ladder competitions. In India for example, schools were often divided into 'houses' and the houses engaged in athletic and academic competitions all-year round. It gives kids something to aim towards: earning points for your house. The Harry Potter system has great appeal among kids and is easy to implement. Some of the other stuff (more gym classes, sports equipment, taller schools, etc) as you pointed out entail higher costs.

When it comes to testing, I believe that testing for fitness should be part of a balanced education. So what if the kid can't go to Harvard just cause he can't do a few sit-ups? That kind of mentality is what's led to a decline in standards these days. Every parent wants an exception for their little darling. I would argue that if your kid can't pass basic PE (and even the nerdiest of kids should be able to do a few push-ups and run a few kms), then that kid will be a drain on society (higher health care costs, more prone to injury, etc.) and therefore does not deserve their diploma. As for parents suing, I wouldn't be worried. They wouldn't have a leg to stand on...the government has the legal authority to determine what gets taught and who graduates with what. But to me if you are defending a kid who is out of shape, that in large part reflects your failure as a parent to help provide your child a well balanced up-bringing. Lastly on this issue, I would argue that if you look at kids who go to Harvard, or any other top school, you'll find that most of them are quite well-rounded. It's pretty rare to get the brilliant physicist who's extremely obese. It's often that work hard, play hard attitude.

People forget that the primary goal of elementary and secondary education is to make kids productive members of society. To me fitness is just part of the equation. I would also argue that we do a poor job teaching the arts, sciences, etc. But fitness is one that can be easily remedied. The other ones will require more complex (and expensive) solutions. I agree that a test is a cheap solution. But it's also damn effective. If you know that you have to prepare for a test, you'll do so. Just like studying for a math test, you'll start jogging to prepare for a PT test. In that sense, its cheaper but it has the added benefit of shifting some of the onus onto the student (requiring them to take responsibility for their fitness). Not everything has to be about resources. I find some of these arguments just bizarre. We don't start saying that we shouldn't give math tests and that we should spend more money on puzzles just because a few kids would find math hard. We expect kids to take responsbility, do the hw, learn the subject and pass the test. Why should it be any different for a PT test?

Last point, this debate on 'measuring' fitness. I really don't think its that hard. The military, the police, firefighters, paramedics, etc. all do it. They hire kinesiologists and physiologists to sit down and come up with appropriate tests based on the organization's desired criteria. Why would it be hard to do that? Could we not sit a bunch of medical professionals in a room and ask them what the criteria for 'fitness' should be and then have health professionals design an appropriate test and curriculum?

 

[Epi]

Last point, this debate on 'measuring' fitness. I really don't think its that hard. The military, the police, firefighters, paramedics, etc. all do it. They hire kinesiologists and physiologists to sit down and come up with appropriate tests based on the organization's desired criteria. Why would it be hard to do that? Could we not sit a bunch of medical professionals in a room and ask them what the criteria for 'fitness' should be and then have health professionals design an appropriate test and curriculum?

The problem is that there is no such thing as a 'fitness requirement' for being a kid. There are a lot of reasons why someone would be exempt from such a program that I can think of at the top of my head (and which I have already listed) as well.

Furthermore, I wasn't talking about the super obese kid that couldn't go to Harvard, but the fact is, even big nerds who are thin and might not have any of the 'weight-related' health problems that plague our society might just not be that 'fit'.

If the standards are general enough so that most of the population could reasonably pass it (i.e. run 200m, do 10 sit ups), then you will quickly find that the standards are useless. If the standards are severe enough that they might have a large effect, then lots of people will actually fail and then that is when it becomes a problem. How do we phase in the program? What type of support are we giving in addition to putting in a test? Will voters be focused on the test and thus derail the entire fitness program altogether?

Currently we have a huge problem with dropouts (last I read 25% of kids drop out of high school in Ontario) and that is just with the academic side of things. Imagine of a physical fitness component were added as well?

Furthermore, the academic side of things does have a huge gradient of achievement. At the very top we have the gifted/enriched classes, and at the other extreme we have the general or remedial classes. Were we to be truly fair, we'd have to duplicate such a thing for the fitness aspect as well. Considering a lot of high schools (including mine) stopped PE after grade 9, that's a LOT of new teachers you have to be hiring.

Considering money for anything government-related is contentious, would voters even accept hiring so many more teachers for such a program (whose overall health benefit to society is dubious) when class sizes are so large, and when the dropout rate is already so high? The last thing any government needs is to have kids who may not be so fit, but are smart fail out of school. I can imagine it now, both fat and poor kids and parents protesting outside the provincial legislature, it would be a huge debacle, no pun intended.

Finally, a point I didn't touch on in my previous posts. I say this entire program of testing kids for passing fitness tests is useless, because it is just a test, nothing more. I took 9 years of mandatory French and I speak very little French. Many more people take more years of math or science or whatever and retain even less than I do of French. They may have done well in school (certainly I got 90% in grade 9 french), but in the long-term the gains are very small compared to the potential costs.

Even hypothetically speaking, a fitness test that most voters will agree to will end up failing the 5% of kids who are really super out of shape, but pass everyone else who admittedly are at the prime of their lives (teenagers are vastly more healthier than the rest of the population), while doing little to ensure that they will try to live a healthy lifestyle for the REST of their lives (really chronic disease from being sedentary and obese doesn't become a population-level issue until you hit your 50s). I know so many people who used to be extremely fit in high school who are no longer so.

So for that reason, I believe that a very comprehensive and systematic method of changing attitudes about health more than just a required test is what's needed. I'm advocating completely changing how it is viewed to be fit starting from kindergarten. Surely if it worked for recycling we can do it for fitness. A test is fine, but I think it would add very little with high costs (both monetary and political) and thus not be worth it in the end and would be a detractor to the vastly bigger benefits from a less politically charged but more powerful change in the system.

As for getting professionals to design some system, sure that's possible. Unfortunately I'm sure every single individual professional would disagree on what would be a good MANDATORY standard. It would not be a good idea to make these guidelines mandatory and conditional on passing high school because either it puts an unfair burden on too large a number of people using generally arbitrary standards, or the standard is so general and 'acceptable' that it is useless to begin with.

Should society be healthier in general? Sure. But this is not the way to do it.

 

[golodhendil]

Pardon me rearranging your post so I can answer in a coherent fashion.

I said that smoking increased the risk for lung cancer. What's factually wrong about that? The majority of smokers never get lung cancer. Check the statistics. Lung cancer is a relatively rare disease, that's also can be checked. There are people who don't smoke who get lung cancer. Is that factually incorrect? No.

You didn't say "there are" nonsmokers who get lung cancer, you said a large number of people who get lung cancer have never smoked, but in fact only at most 10-15% of lung cancer patients are never-smokers. As for smokers not getting cancer, while the current estimates peg it at 15-25% of all smokers getting lung cancer, this is complicated by the fact that many smokers will get/die from other cancers or heart diseases (all of which are at significantly increased risk as well) before being diagnosed with lung cancer, so that value is most definitely an underestimate. The bottom line is that smoking increases your chance of getting lung cancer by more than 20 times.
Lung cancer is also not a "relatively rare" disease; it's the 10th leading cause of death in the world and is responsible for more than 2% of all deaths (looks small, but pretty significant when no single cause of death except heartattacks accounts for more than 10%). In a developed country like the US, lung cancer is the second leading cause of death after heart diseases and accounts for almost a quarter of all deaths. It is the second most common cancer, with more than 200000 new cases a year. This is hardly a "rare" disease in the absolute, let alone relative, sense.

Before you go off assuming, I don't smoke, never have, never will, don't see the point, hate butts littering the city, and believe that it is an addiction for some people.

Don't worry, that thought never came across my mind. But perhaps now you should add "hate it 'cause it kills another person every minute" to your list of reasons.

Not at all. To put it simply, epidemiology cannot eliminate all the variability among humans. Applying probability to a group leaves a lot of room for the role of noise from other variables.

Which is also part of my point. I don't see you suggesting that, on the basis of your own admission, that requires that "we can basically throw out all of medicine" as you implied I was suggesting.

Actually no. What you said was that to claim something is "related to the appearance of disease in a person, then you should know all the possible root causes of these diseases first" -- ie, you can't say something is a possible cause (even on an epistemiological level) until you know all the possible causes, of which there are none because all possible causes are dependent on all other possible causes to be possible! On the other hand I am affirming that we can consider something a possible cause before we know all possible causes and we should take all of them into account for diagnosis and healthcare policy, but that is not necessarily true for a fiscal policy.
That epidemiology can only give population-level probabilities doesn't mean we should not use the probabilities to determine public health policies. Ultimately everything is probabilistic; even ingesting 10g of cyanide does not have a 100% chance of killing you. Even when genomic epidemiology matures, it's still not possible to eliminate baseline biological probabilities, so if one demands there be absolute certainty for health policy, then science and medicine will never be able to give that to you.

This does not change the fact that this type of measurement is still arbitrary - and a rather small element of what is popularly invoked or identified with the vague notion of "fitness." Rather baldly stated, all the CRF tells you is what portion of a population can pass a certain type of test. It does not tell you with any certainty that those individuals who pass will automatically avoid disease, or those who fail will all die an early death (but for afransen, they're a big potential source of tax revenue).

The problem with the word "fitness" is that anyone can come up with their own test for it, can choose whatever parameters, and adjust them as they may see fit (pardon the pun). Insurance companies have had a love affair with the BMI. More recent adjustments to that measure have increased the number of people defined as obese. This often includes people deemed to be physically "fit."

In other words, change the measure, get a new result. Change your measure of what fitness is supposed to be, get a new result. Otherwise the term is not particularly useful.

So what is a fitness? What is a "fit" person?

In other words, when push comes to shove, "fitness" is still an arbitrary term. There is really no such thing as fitness; there presently are assumptions, constructs, beliefs and prejudices about what fitness people think fitness is.

This brings us back to the point you had been harping on all along, that "fitness" is "arbitrary". Arbitrary means something is without base and defined/changed at the muse of whomever. But "physical fitness", measured by CRF, is a precisely defined scientific/medical concept with an evidence-based correlation with cardiovascular events and mortality (with the latest data showing an increase of 1 MET in CRF decreasing CV event and mortality risk by 15%, and a low CRF [<7.9 MET] giving 6-70% higher risk than a high CRF [>10.9 MET]). Of course the standards and definitions will, and should, change as more evidence is evaluated, but that does not make the measures "arbitrary" nor render them non-applicable for health policy. The public's fascination with BMI (to some extent fanned by certain irresponsible factions in the medical community) was unfortunate, and a proper evaluation of CV/obesity related risk should take into account BMI, fitness, and various serum chemical markers (and eventually, genetic markers), something that societies and institutes like the NHLBI has been recommending. Of course, no combination of measures would ever give you certainty about whether you will get a disease; if you want certainty, the real world is not the place for you. And ultimately it does not matter what the general public likes to define "fitness" as in their everyday language. For a sound policy that is science- and evidence-based, only the scientific definition should matter.

Your talk of "assumptions, constructs, beliefs and prejudices" almost reeks of postmodernist cultural studies gibberish.

 

[kEiThZ]

Epi,

Several points I will respond to.

First off, the issue of 'arbitrary' testing. As golodhendil pointed out that can be overcome. I trust our health professionals to be able to design reasonable tests. I wonder why you wouldn't have faith in their abilities?

Next the issue of academic failure and athletic failure. We can agree to disagree. I have no sympathy for anybody who could not reasonably succeed at both. That we are doing a poor job at academically training students is in no way an excuse for not improving other portions of the curriculum. And in my opinion, a lot of this has to do with parenting. In many other parts of the world that I have lived in, parents are very involved. As a result, failure rates are lower. This is not the case in North America where quite a few parents treat schools like 9 to 5 day cares.

Next the suggestion that just because you took french and didn't pick it up the same would apply to phys ed. I disagree. Even if you were more fit at that age, that would be immediately beneficial to you. But more than that, fitness has long term benefits even if you don't necessarily stay in the best of shape. French not so much.

On the issue of resources. Like I have suggested, that's why a fitness test is good because it leaves the responsibility up to the student. I disagree that we need expensive programs to get fit. Running outside, doing push-ups, sit-ups, chin-ups on a park bar, are all free. In my books its a false notion and a delay tactic, the demand that we always need more resources to get people fit. If entire Armies can get thousands of personnel in great shape by jogging on streets and doing push-ups and sit-ups, I don't see why teens (in probably the best shape of their lives) should need much more than that. So no, I don't see huge protests outside Queen's Park from parents over the lack of gym teachers. And if there were, I would have the Minister tell these parents that it's time they took responsibility for their kids' health.

... the lifelong issue. Yes, we need to do more to make it easier for adults to stay fit. But that's not a separate issue from growing childhood obesity rates (which does contribute to lifelong health issues). If we can nip this in the bud then we can reverse many trends. Numerous studies have documented the linkages between unfit kids and their unfit adult selves.

Finally, what you are suggesting is that we should do nothing because it's too difficult (parents would be up in arms about testing) and too expensive (we could use the money for other things like hiring more math teachers). I guess we can agree to disagree. I think by avoiding the problem we are simply storing up challenges for ourselves down the road (with higher health care costs). And I disagree that such programs have to be expensive or elaborate. I have faith that were such a program to be implemented that most parents would respond by encouraging their kids to be fit in anticipation of the test. Presumably, over the course of working to stay in shape, the kids would develop good personal habits on their own. Yes, you didn't retain much french but you do know how to learn languages really well and that should stay with you. The other issue being that you learned french till grade 9. If you took it till grade 12/OAC, you would have retained a significant amount (I certainly did). Overall, we'll have to agree to disagree. Where you see insurmountable problems, I see them as obstacles that can be overcome in a final goal to make the lives of kids better.

 

[AlvinofDiaspar]

Keithz:

So what if the kid can't go to Harvard just cause he can't do a few sit-ups? That kind of mentality is what's led to a decline in standards these days.

Sorry, but this is probably one of the MOST foolish thing I've ever heard on the forum. So you think not utilizing someone's intellectual capacity to the fullest just because the individual doesn't satisfy your personal idea of healthiness should be is a desirable policy outcome? That does, above all else, society a disservice.

Society isn't the army, keep that in mind the next time you suggest policy options.

AoD

 

[kEiThZ]

Keithz:



Sorry, but this is probably one of the MOST foolish thing I've ever heard on the forum. So you think not utilizing someone's intellectual capacity to the fullest just because the individual doesn't satisfy your personal idea of healthiness should be is a desirable policy outcome? That does, above all else, society a disservice.

Society isn't the army, keep that in mind the next time you suggest policy options.

AoD

You are taking a line out of a context of a whole discussion.

 

[AlvinofDiaspar]

Keithz:

No offense, but the scenario you've painted (with disdain) is an outcome of your policy suggestion, i.e. standards of physical fitness that must be met in order for one to graduate.

AoD

 

[kEiThZ]

^ ...in the context of a wider discussion on what I believe should be standards for education given that I believe the purpose of education is to make young people productive members of society.

In that context, what is wrong with saying they must pass a fitness test? I have asked that before and nobody has answered the question. We say they must have 30 credits to graduate. We say they must pass certain tests and assignments to get those credits. What's so absurd about suggesting another test?

 

[Epi]

Epi,

Several points I will respond to.

First off, the issue of 'arbitrary' testing. As golodhendil pointed out that can be overcome. I trust our health professionals to be able to design reasonable tests. I wonder why you wouldn't have faith in their abilities?

As a physician myself, I know how hard it is to define health. I also know how much controversy each proclamation of new standards is for doctors worldwide by any study, and that standards will often change as new information will often contradict old information. I know that doctors in general are extremely leery of proclaiming that any particular level of health is what you need, because we know that:
1) You can always do better
2) General population-level recommendations mean absolutely NOTHING at the individual level, which is why doctors will frequently overlook patient's problems with meeting even very well known targets such as blood sugar or blood pressure because we understand that individual factors are huge in exceptions to cases. (i.e. too low BP (which may actually be higher than the commonly accepted 'high' levels) in the elderly leads to more falls, too low blood sugar leads to dangerous hypoglycemia).

Any attempt to define any sort of standardized 'fitness' is bound to fail in the general population. I have absolutely no problem in having targets that we try our best to meet, but to have targets be the absolutely minimum I have a lot of problem with. There are just way too many exceptions which will rightly be given to people. There will also be a lot of inbetween cases

You are allowed not to take math, or not take french or whatever past a certain grade. You are allowed many different avenues to pass school and to get your credits. There are very few absolutely firm standards that must be met, and the only exception I can think of is English class. There's an obvious reason why we would want people in our society to know English. There's a much less obvious reason why we would want our society to be proficient in whatever 'fitness standard test' is assembled in school.

If you want to look at this more philosophically, I can say that testing only works if it has a specific target and a specific purpose. Testing in calculus works because it tests your abilities you have gained after a course in calculus. It does NOT say whether or not you are 'good at math' but only good at what the course attempted to teach. As a general idea, it is understood that ability in math for instance can easily be applied to many other areas in academic studies and as such is absolutely critical to academic success. As well, there are many professions which require a good grasp of math to be successful in. Thus society needs people to gain specific math skills in order to succeed.

If applied in a health setting, you can have specific tests for say, doing a specific drill that you learn. For instance, you have a class that teaches situps and does drills. At the end you have tests to make sure people know how to do it. Or you have classes that teach certain sports. At the end you have a test that shows that people have learned how to play these sports. You can have specific tests for learning specific health facts such as preventative facts or healthy eating, but you must teach it first.

You cannot have testing for some general idea of fitness where you don't even have any sort of instruction or set aside time for with the vague understanding that 'health professionals' said this was the minimum level. No only is that irresponsible for the professionals, it will degrade trust in the health professions by the general public considering the huge number of people who will likely have not 'passed' these tests and still ended up healthy (i.e. not having major medical issues) vs those that will pass this 'test' and still have lots of issues in the future.

Your idea that you don't need new PE classes or teachers, but that kids can just learn on their own to be healthy is wishful thinking. It's like saying there should be testing on English, except we won't have English class, people should be able to just pick it up on their own. Some people will need real direction in order to pass any sort of test which is onerous enough to not be a complete joke. There are more than enough overweight kids with overweight parents who have no idea how to change things around, and who have picked up bad habits from their parents that can't easily just 'get into shape in their spare time' as you suggest.

As well, kids do have specific and demanding things that they need to do. A lot of teens have after school jobs, some support their families, others struggle enough just to maintain academic standards. To suggest that they will also find extra time to self-teach themselves how to pass some test is simply not realistic. It may be that you say 'well people should be able to figure these things out for themselves', but the fact is, you're FORCING people to do this, and you're also not offering any extra help for this. That is not fair, and should not happen for ANY requirement in high school, fitness or not.

Next the issue of academic failure and athletic failure. We can agree to disagree. I have no sympathy for anybody who could not reasonably succeed at both. That we are doing a poor job at academically training students is in no way an excuse for not improving other portions of the curriculum. And in my opinion, a lot of this has to do with parenting. In many other parts of the world that I have lived in, parents are very involved. As a result, failure rates are lower. This is not the case in North America where quite a few parents treat schools like 9 to 5 day cares.

If parenting sucks already as you claim, and you're not devoting extra resources to help kids pass this test of yours, I don't see how this wouldn't become a huge boondoggle from day 1.

Next the suggestion that just because you took french and didn't pick it up the same would apply to phys ed. I disagree. Even if you were more fit at that age, that would be immediately beneficial to you. But more than that, fitness has long term benefits even if you don't necessarily stay in the best of shape. French not so much.

I don't see why me passing a fitness test at that age would have any direct on my overall health. In fact, I don't see how being able to pass this test would actually make MOST people 'more fit' in the first place. I assume that the majority of people would be able to pass this test without any problems or any extra effort doing whatever it is they already do every day. It is the large minority of really out of shape kids that will have trouble. If you made the test any harder so that it's even hard for normal people (i.e. go run 5km or do 100 push ups like the military), then you'll guarantee that a huge proportion of kids will NEVER pass high school. My point is that most kids will be able to pass this test with flying colours because of the very nature of the test, and as such it won't do anything. A huge number of subsequently 'sick' adults were likely able to pass any generalized population-level test at some point in their adolescence I'm willing to bet.

... the lifelong issue. Yes, we need to do more to make it easier for adults to stay fit. But that's not a separate issue from growing childhood obesity rates (which does contribute to lifelong health issues). If we can nip this in the bud then we can reverse many trends. Numerous studies have documented the linkages between unfit kids and their unfit adult selves.

No studies have shown that any specific test that kids have to pass at a certain age will make them more healthy in the long term or help society overall. I understand this is all a proposition and as such it's hypothetical, but I would like to see more scientific evidence before such a large and wildly controversial program is implemented. I say this, because countries that have the highest life expectancy rates in the world such as Hong Kong and Japan, probably have tons of people who wouldn't be able to pass any sort of physical fitness test because so many people are not athletic. That is unless the test was 'walk up a flight of stairs' or something pointless.

Finally, what you are suggesting is that we should do nothing because it's too difficult (parents would be up in arms about testing) and too expensive (we could use the money for other things like hiring more math teachers).

Where have I suggested that we do nothing?

I stated that your idea of universal population-level generalized testing will not solve your goal of making society more fit. I have given a lot of reasons why this is so, and you have not provided a real good argument as to why it IS a good idea (by addressing any of my points in a convincing manner) except to say that in general testing is a good idea, and that this can be had for free (which I have rebuked above). Sure some kids may be more fit to pass this test for a short period of time, but it's not like kids die from any chronic non-congenital health issues anyway.

I have given numerous other ways to solve your stated problem of society not being fit enough in fact. I really don't think testing is worth the trouble, the resources and the controversy because I really don't think it would make a difference because of the very nature of generalized population-level testing and the inevitable lawsuits that will follow.

 

[afransen]

Given that we graduate people who can't read, I think perhaps some leniency is warranted on fitness standards.

 

[Hydrogen]

You didn't say "there are" nonsmokers who get lung cancer, you said a large number of people who get lung cancer have never smoked, but in fact only at most 10-15% of lung cancer patients are never-smokers.

Some studies suggest 20% - which I think is a large number (dare I think such a thing). Are you trying to diminish the relevance of those cases? I would hope not.

Lung cancer is also not a "relatively rare" disease; it's the 10th leading cause of death in the world and is responsible for more than 2% of all deaths

Fine, but then why question my original statement that there are a large number of people who get lung cancer who never smoked?

The fact is that most people who smoke won't get lung cancer. Also, there is no way to predict which smokers will get lung cancer. There is no way to ascertain with any certainty such a direct cause and effect outcome at the level of individual persons. Those are facts. However, let me make it abundantly clear to you (as you feel scientific authority being questioned) that this predictive paucity is certainly not reason enough to end a campaign to turn people away from smoking. Smoking increases the risk of lung cancer (and other diseases) - regardless of the fact that a majority of smokers will not get that particular disease (lung cancer).

This brings us back to the point you had been harping on all along, that "fitness" is "arbitrary". Arbitrary means something is without base and defined/changed at the muse of whomever. But "physical fitness", measured by CRF, is a precisely defined scientific/medical concept...

Well, actually the word "fitness" was simply used in the naming of a measurement. The word existed before the development of things like CRF measurements - as did the content concerning what was meant by the word at that time (yeah, more harping). More simply put, fitness meant something else. The test for CRF is a test, it's not all of fitness. It measures something particular, but it alone has not become the last word on the definition of fitness. One can certainly employ it as a definition, but others can opt to use the word and supply their own criteria defining what they mean by fitness (and typically they will). Just because the word was selected for the name of a specific measurement does not impart absolute exclusion of the word from all other uses (or abuses).

 

[afransen]

As one of hundreds of examples one could select, speeding is prohibited. Speeding increases the probability and severity of accidents. However, someone may speed their entire lives and not cause an accident. Therefore, we should not prohibit speeding? Any behaviour that needlessly exposes an individual to a significant risk of death, illness or injury ought to be discouraged.

 

[golodhendil]

Some studies suggest 20% - which I think is a large number (dare I think such a thing). Are you trying to diminish the relevance of those cases? I would hope not.

Fine, but then why question my original statement that there are a large number of people who get lung cancer who never smoked?

The fact is that most people who smoke won't get lung cancer. Also, there is no way to predict which smokers will get lung cancer. There is no way to ascertain with any certainty such a direct cause and effect outcome at the level of individual persons. Those are facts. However, let me make it abundantly clear to you (as you feel scientific authority being questioned) that this predictive paucity is certainly not reason enough to end a campaign to turn people away from smoking. Smoking increases the risk of lung cancer (and other diseases) - regardless of the fact that a majority of smokers will not get that particular disease (lung cancer).

I think 15% is the aggregate result from meta-analyses. But regardless, it means 80-85% of lung cancer cases are in smokers. It is not a matter of diminishing their relevance, it's a matter of what's the most productive way of looking at the disease. Of course every single life and patient is relevant and precious, and of course it is important to find out the aetiology of lung cancer in those cases, but in the context of determining the best public health policy, 85% is significantly "larger" than 15% and that is what should guide policy (at the same time without disregarding that 15%, of course). And of course there is no(t yet?) a way of determining which individual will get lung cancer; as I repeatedly said even with personal genomes of everyone it is not possible to control for baseline biological probability and the random nature of the world - even standing outside in the sun for one minute "too much", or inhaling that extra mole of radon gas coming out from the ground underneath your house, could give you lung cancer. But what's the point of talking that way? Stating the obvious that there is no certainty in science and medicine, or no certainty in the world, period, is not going to help anyone prevent or fight diseases or in designing useful public health policy. It's not a matter of scientific authority being challenged; it's about the best action for the public and patients.
I'm glad you at least agree that campaigning against smoking is a good policy. I guess my reaction was mostly because I have heard too many of the similar excuses coming from tobacco companies and pro-tobacco lobbies.

Well, actually the word "fitness" was simply used in the naming of a measurement. The word existed before the development of things like CRF measurements - as did the content concerning what was meant by the word at that time (yeah, more harping). More simply put, fitness meant something else. The test for CRF is a test, it's not all of fitness. It measures something particular, but it alone has not become the last word on the definition of fitness. One can certainly employ it as a definition, but others can opt to use the word and supply their own criteria defining what they mean by fitness (and typically they will). Just because the word was selected for the name of a specific measurement does not impart absolute exclusion of the word from all other uses (or abuses).

Of course the word - like most words in science, came before its scientific use, and of course in everyday language we can use the words whatever way we want. But when a rigorous definition is needed in a context of science and public health policy, we must adhere strictly to the one (or qualified few) definitions that have well-confined meanings. To conflate lay/non-rigorous definitions with a scientific/medical context is to lay the same trap (perhaps with less malice) as creationists applying non-scientific meanings of words like "theory" and "evolution" and "fitness" (yes, the evolutionary biology term with its own specific definition) when they discuss the science and policy.

 

[Brandon716]

Senate Democrats are essentially admitting defeat: they can't overcome corporate interests, install the money-saving techniques that only single-payer can bring, and they are not delivering real health care reform.

Have no fear Canada, your better health and competitive edge isn't going anywhere, anytime soon. Who knew Obama would be such a non-change agent?

http://www.cbsnews.com/stories/2009/06/17/politics/main5092969.shtml?tag=cbsnewsSectionContent.7

Senators Tackle $1T Health Care Challenge

(CBS/AP) Eye-popping new cost estimates for President Obama's plan to overhaul the U.S. health care system are forcing majority Democrats to scale back their plans to subsidize coverage for the uninsured.

The $1 trillion-plus estimates come as the Senate Health Committee prepares to meet Wednesday to begin crafting a bill around Mr. Obama's top legislative priority.

Big holes remain to be filled on the most controversial issues in the health care bill authored by the committee's chairman, Sen. Edward Kennedy, D-Mass.: a new public insurance plan to compete with the private market, and whether employers must provide health care for their workers.

Kennedy is suffering from brain cancer and was not expected to be present. But his deputy on health care, Sen. Christopher Dodd, D-Conn., said the committee would move forward anyway with a session to finalize and vote on a bill he said would provide "successful, affordable, quality health care."

The committee was scheduled to meet daily through next week.

Disagreements over costs and other issues hung up another key committee, the Senate Finance Committee, which has a more moderate makeup than Kennedy's panel and is considered Congress' best hope for producing a bipartisan bill.

The Finance Committee was supposed to produce a draft bill Wednesday. But Chairman Max Baucus, D-Mont., said that wouldn't happen and the bill would come out "when it's ready" - later this week or next. The Finance Committee was supposed to start voting next week.

Majority Democrats in the House could unveil their bill later this week, with committee votes after Congress returns from its July 4 recess.

Negotiations were roiled Monday by an analysis from the Congressional Budget Office that said Kennedy's bill would cost about $1 trillion over 10 years but leave 37 million people uninsured, compared with 50 million who are uninsured now.

Democrats called the numbers inconclusive, reported CBS News correspondent Wyatt Andrews, and even the CBO called its own report incomplete. But the sheer magnitude of what Congress is considering is undeniable.

"The news yesterday from the CBO is a turning point in the health-care debate," said Rep. Eric Cantor.

Also on Tuesday, a cost estimate for the Finance Committee bill became public: $1.6 trillion. Senators quickly huddled on ways to bring down costs, with Baucus insisting the final price tag on the Finance Committee bill would be around $1 trillion.

At the Senate Health panel, officials said that after penciling in subsidies for families with incomes as high as $110,000, or 500 percent of the federal poverty level, they would limit the help to families up to $88,000 in income, or 400 percent of the poverty level.

The emerging Finance Committee bill also cuts off subsidies to help people buy insurance at 400 percent of the poverty level, but Baucus told reporters a reduction was "a live option." There were indications the final cutoff would be closer to 300 percent of poverty - $66,000 for a four-person family.

Major cuts in Medicare and Medicaid will pay for some of the new costs but senators disagreed among themselves over whether to tax employer-provided health benefits - something Mr. Obama campaigned against.

Andrews reported that Mr. Obama believes he can raise $267 billion to partly fund the program by limiting tax deductions for high income wage earners, but the reality is that most of Congress opposes the idea.

"And if they're unwilling to do that, they're going to have to pick an option that has other political difficulties," Jonathan Oberlander, an associate professor of Social Medicine at University of North Carolina, told CBS News. "So the question is which kind of poison do they want to drink."

Also elusive was a compromise with Republicans on a new public insurance plan, which the GOP opposes.

The emerging bills envision a new insurance market "exchange" where people could go to shop for insurance coverage, helped by federal subsidies. Individuals will almost certainly be required to obtain coverage.

Business groups were working overtime to soften any requirement for employers to provide coverage for their employees or face fines. Most large employers already offer health care, but senators are looking at requiring certain levels of care, so businesses fear a scenario in which the government would force them to offer more or different coverage than they already do.

"We're concerned that the plan requirements will be so robust that our members' plans won't meet those requirements," said Jeri Kubicki, the National Association of Manufacturers' vice president for human resources policy.

Also Wednesday, four former Senate leaders - Democrats Tom Daschle and George Mitchell and Republicans Bob Dole and Howard Baker - were releasing a $1.2 trillion proposal that would cover everyone and be fully paid for with a combination of spending cuts and tax increases.

...the reason why the 'reform' is 'too expensive' is because no one has seriously considered single-payer, but rather patching up the existing system and making our existing programs bigger.

Canada should be proud it doesn't deal with this non-sense.