This might be interesting - Totally Anonymous Medicine

I was thinking about the state of medical care lately and thought this would be an interesting experiment (but not likely doable).

Imagine, if you will, a one month Metabolic Cruise.  To replicate real life as much as possible, no food or drink would be free.  It would be available as it is in every day life at normal market values in a variety of stores, restaurants and bars on the ship.  There is 24/7 video surveillance and each person has a GPS tracking advice.  Each person uses a card to purchase what they consume and places unconsumed foods in a receptacle to be analyzed.  In other words, a sort of free-living metabolic ward.  Of course rooms would need a kitchenette too.  But this cruise to nowhere would not allow for foods from outside sources.  Legally solid assurances were made from the outset that all video and such would be destroyed following analysis for compliance.    

At the end of the cruise, full metabolic workups would be done and the patients would fill out a typical medical history (which could be verified?) survey including self reported lifestyle.  They would also get weight, body composition, gender, age.  Then all of this would be sent off anonymously for several doctors to evaluate independently.  Perhaps there would be so many patients that each doc would "see" the same patient twice -- once provided the self-report, and once provided the cruiseship records -- or two groups of docs would evaluate patients in some sort of randomized fashion so that there was no rhyme or reason as to which doc group evaluated verified/self-report data.  Again, a legally superbinding agreement would be in place.  The docs would never know the identities of the patients, and the patients would be the only ones to receive any identifiable info.  Not even their family doc would get the results unless they directed it.

My reasoning for this post:

I think a lot of us have one or more "unhealthy" habits -- whether or not the establishment thinks they are -- that we are likely to .... erm ... stretch the truth about with our doctors.  It is well known in the statistics field that anonymity can drastically change the outcome of surveys -- the more controversial the topic, the more divergent the results.  

Those in my age group probably related "big time" to the classic Seinfeld episode about the "permanent record".  As kids, if we got in trouble, we were scared sheetless that it would go on our permanent record and follow us throughout our lives.  (Ha!  Was that a big lie.  Nobody ever gave a damn what my extracurricular activities were in college, save, perhaps my first employer, let alone that I led a little mutiny at recess in the 2nd grade convincing half the class to stay out with me in protest over who-knows-what!)  With changing healthplans, pre-existing conditions, life-insurance premiums on the line, etc., I think we are becoming more and more loathe to be honest with our physicians about even innocuous behaviors.  A diabetes diagnoses is, apparently, permanent as it stands, even if someone reverses it with lifestyle changes.   Stuff like this ...

So ...

Based on this sort of scenario, I'm curious what you think might happen.  Do you think the different docs would come to the same conclusions/recs re: health and corrective measures?  Do you think the evaluations would change based just on whether real or reported lifestyle parameters were provided?  How about the "bluntness" of the advice.  Do you think dishing the cold hard truth out to a nameless/faceless person in an impersonal manner would be easier or more likely to be what needs to be said vs. what a patient wants to hear?  How about the patient.  Do you think a more objective appraisal of one's lifestyle might impact behavior?   

What say you?


TWJS said…
Three small points before the serious discussion gets under way:

"I think a lot of us have one or more "unhealthy" habits" That would be everybody BUT me, right? (-:

The classic Seinfeld episode, in my case, would not be the 'record' one, but rather the one with Elaine and the wedding cake. "Just a taste..."

As to the restrictive, documented cruise, I imagine it going something like this:

(Enough wasted space, let the thinkers get started)
bentleyj74 said…
Evelyn: "With changing healthplans, pre-existing conditions, life-insurance premiums on the line, etc., I think we are becoming more and more loathe to be honest with our physicians about even innocuous behaviors. A diabetes diagnoses is, apparently, permanent as it stands, even if someone reverses it with lifestyle changes."

Bentley: Right on, I would even add to that and say that people avoid or delay seeking treatment when they only suspect something might be wrong in part because of the impact a diagnosis has on so many areas of life.

Then on the flip side, most docs that I have known either personally or professionally are aware of those problems and are sympathetic to that as well as the rather non PC elephant in the room that physical problems [especially behavior related and especially at extreme ends of the spectrum] and psych problems often overlap.

Does any casual observer believe that the whole of JMs problems arise from his ignorance that chasing entire boxes of snack cakes with several liters of soda might be bad for him? His dysfunction is entirely within the parameters of his diet? What would you do if you were his primary care doc? Suggest a psych eval? Then stand there poker faced while it's vehemently rejected and you receive a lecture about all the things he's read on the internet before being dismissed as ignorant, sold out, and one of "them"?
bentleyj74 said…
Little kicks, sponge worthy, soup nazi, the much salty goodness to choose from.
CarbSane said…
Oh ... I by no means think that episode is *the* classic, just the most apropos for this discussion.

I think JM is in EDD (care to guess? LOL). I think it's great that there are docs out there open to low carbing, but when I listened to Mary Vernon/Andreas interview (check my twitter scroll) and I hear her say everyone should eat LC, I wonder ... is THAT progress?
bentleyj74 said…
Then on the flip side of the flip side, totally anonymous physicians could easily become totally callous as well. Having to interact with people and look them in the face puts some probably protective dynamics in place and helps to keep orwellian nightmares at bay.

The boundary between objectivity and objectification is one that probably needs to be a little bit in conflict for the sake of posterity.
bentleyj74 said…
Eating disorder denial?
MM said…
I sort of doubt that having an anonymous doctor telling a person they have some less than healthy habits is really going to help. It seems to me that most people are either aware of their habits, or firmly in denial. JM is a perfect example. He slams Jessica Biel for binging when he's done the same himself and even admitted it on his blog. There's no way an anonymous doctor pointing this out will help. I don't know what will help someone like that. Eventually some kind of crisis may force him to take a long hard look at himself.
bentleyj74 said…
On an unrelated note [my thoughts run downhill when I'm bored changing out seasonal clothes] your metabolic ward cruise scenario has all the makings of a mind bending horror movie.
Tsimblist said…
I personally found this anonymous risk assessment to be life changing:

And much more convenient and cost effective than a cruise.
Swede said…
Oh my Lord I just followed your Twitter link to the LLVLC blog post about Jessica Biel. Those comments are pure gold - They have diagnosed Jessica Biel with an eating disorder! Never mind the fact that she appears to be one of the fittest young female movie stars out there.

Her approach actually seems healthy to me. She wanted some type of food, so she ate what she crave and then continued on with her lifestyle choices that appear to keep her quite fit and trim.

The comments decry how she is a bad influence for her younger admirers, but I doubt that even they are dumb enough to think that Jessica Biel got her body from eating donuts and pizza.

The irony is beautiful. A bunch of carbophobes claiming that someone who craved some junk food has an eating disorder.
I love that experiment. I'd volunteer!!!

I do think that if anonymity and clear REAL info would go a long way. Folks can't fudge, lie, or make themselves look good. Well, unless they eat differently on the cruise on purpose to LOOK like they are more food virtuous, like some folks do eating out: eat a salad on a date, pig out on pizza when they get home.

My unhealthy habits are sitting too much and doing too much web surfing. Foodwise, I'm 95% virtuous, cause I still eat stuff with nitrites (deli meats for convenience). Heck, even my brother got impatient with me cause I refused his Cuban coffee cause he'd added sugar. Hey, my sisters make it sans sugar for me, he should, too. hah! I said, 'I choose when I'll waste calories on sugar, and for coffee, not worth it. Now, for some good dark chocolate, oh, yeah. I'll eat the sugar."

I'm ridiculously honest with my docs. I take my notes, I print out my nutrition tracker for my dietitian. I figure, they can't help me unless I tell them the truth. Since I'm pretty much a goody two shoes re food, exercise, and everything else (have maybe 6 drinks a year, never smoked, never slept around, never contracted some weird social disease, live low stress, sleep plenty, have a happy sex life, great marriage, good siblings), they probably think I'm makign it all up. hahahahhaha

But I really do sit too damn much. I'm a computer and tv junkie. My vices. And ham and bacon.
bentleyj74 said…
Ironic JM quote from that link in
1 ...

"How can anyone deny it isn't true after watching her admit that she binges on carbs when she is trying to eat healthy".

Those tricksy double negatives will get you every time.
P2ZR said…
Wow, that's actually many important questions lumped into one post. But to answer the big ones--

1)(a) Yes, true anonymity (not just confidentiality) would have really helped. I recognized the problems, but was so afraid of the stigma of disease that I mustered all my brains and managed to talk my way out of institutionalization and most treatment.
(b) Doubt this is always the case, though. Even if the LC cruise ship is headed straight for its proverbial iceberg, some people are too intent on dancing away the truth. And given that for some gurus, it's too late to jump ship, you get, e.g., Peter/Hyperlipid whipping believers into a dogmatic frenzy and getting drunk off the adulation.

2) Mostly agree with bentley re: doing away with the need for good bedside manner. A doc who is bending over backwards trying to sugarcoat things is most likely dealing with a case of 1b, where the only hope lies in overcoming the epic denial. Otherwise, having seemingly-random numbers, a diagnosis, and a prognosis thrown at you can be really disheartening (e.g., if you've had to deal with elderly loved ones). My sense is that adding the human touch is usually helpful--so long as it remains sincere.
P2ZR said…
@Princess - Don't you fret about them nitrites, 'cause Mr. Sisson said they're okay! At least compared to carbs. So just remember--when in doubt, another few slices of ham, but NEVER the spoonful of mashed potato containing the 151st gram of CHO!
Anonymous said…
The cruise 'metabolic ward' idea is fantastic! Make the cruise last at least a month first time around. Later, it could last as long as six months. You could sell the data. Remember, you read it here first!
Margaret said…
Had to laugh - "soup nazi" was one of the answers in a recent crossword puzzle that I didn't know because I never watched Seinfeld - and here it pops up again in your comments!

This discussion reminds me of something I saw not too long ago about the FDA considering changing their "serving size" definitions on food labeling. People regularly underestimate what they actually consume, and if they use the serving size calorie amount in their estimates but actually consume several servings, clearly they are going to be way underestimating their actual calorie consumption per day. That's pretty easy to do when you look at some of those serving amounts and see if they make sense.
Tonus said…
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Tonus said…
I'm shocked that they're being so harsh with Jessica Biel. She's not a doctor or a researcher, so she must know what she's doing!
CarbSane said…
@Swede: I do believe most of the commenters are spot on -- re: eating disorder -- but she is no more a carb addict than she is a fat addict. If she's eating skinless chix breast and veggies, with periodic donut & pizza binges, that's a form of bulimia whether or not she's purging in the classic way. Having a couple of slices of pizza and even two donuts to go with, OK ... a "cheat". But her description is binge-land.

As to her fitness? When I got myself into my mess, I was the epitome of fitness and could bench my 110 lbs at that! When you're young you can get away with quite a bit looking normal -- even hot -- to the outside world. My preferred coping mechanism was fasting.

I would note she doesn't binge on plain pasta, bread, or even soda. I can enjoy any food in moderation now that I used to binge on. For me (and I suspect the vast majority) it's a mindset, not a physiological drive. Which, before I offend anyone, is totally foreign/unachievable to someone in the throes, but also does not necessarily require hours of couch time to fix either. When I think about it it is incredibly scary how easily one can go from totally "normal" with food to totally out of control.

Sigh ... Eating disorders throw most obesity research out the proverbial window. Really! It's a whole different ball game when your brain -- not the hypothalamus, but your higher functioning brain -- takes over the reins.
CarbSane said…
Hi guys, I guess using a cruise made it seem that I was targeting LC , but I was actually getting more at taking both patient reporting and subjective evaluations out of the picture and where that would get us. I was thinking floating city type scenario. Perhaps metabolic aircraft carrier ;)

Personally, I've been remarkably healthy despite my weight and between college, moving, changing insurance companies and such, such I have not had a doc I would call mine since I was ... well ... a child.

@Bentley, yeah, doing away with the bedside manner is chilling in a way, but perhaps if the docs were told -- this is what you know about a person, if they were your mom,dad,sis,bro,etc. what would you advise ... sigh ... then you get wishful thinking in there again I suppose.
Swede said…
@ Evelyn: I see. I have no experience with eating disorders so I thought it might have been rather rash to call a single binge an eating disorder. I suppose that those who made such comments have struggled with eating disorders and may have recognized a common behavior.

I am hesitant to jump to calling her behavior a disorder because I was under the assumption that the word "disorder" implies that the behavior is seriously interfering with normal life activities. Almost everyone I know, including myself, has an occasional episode where we eat (or drink) a lot of a particular food, but it no case would I consider it to be disordered eating.

It is interesting how some fitness gurus use binges as a means of achieving a better physique. Martin Berkhan eats whole cheesecakes on occasion, and Scott Abel's cycle diet involves days where calorie intake exceeds 10,000 calories in one day!

To me it just sounded like her body was craving carbs and fat so bad that she just lost control at that moment.
Sanjeev said…
I bet she was lying. At the least, grossly exaggerating.

Makes her look more human and marketable. The current entertainment industry and "people handling" is all about "image management" and branding and so on.

Looking like "joe 6pack blough" is imporant, even if it is "J 24 donuts blaugh"

> She's not a doctor or a researcher, so she must know what she's doing!

But I bet she has a lab coat or 2, maybe even a stethoscope, kept from modeling or acting work, or for >>ahem<< "private role playing".
Rob said…

I wouldn't call Berkhan's cheescake eating as binges, yeah he'll eat thousands of calories in one sitting but they're planned events generally around holidays, birthday, etc. He doesn't lose control and devour everything past the point of fullness.

He maintains 6% bf because he found a lifestyle (practicing IF, using regular refeeds, etc.) that works for him. It is impressive for a guy who isn't genetically lean or on gear.
Sue said…
Rob, I agree. Johnny from Lean Saloon has also found a way to maintain leaness with fasting and then eating what he desires.
CarbSane said…
@Swede: No worries. As others have noted, Martin's "ways" are quite different from what she described. @Sanjeev, what with eating disorders seemingly en vogue in Hollywood these days, it's not clear whether she did stretch the truth or was telling it. I think folks who've never had a binge disorder, however, cannot fathom eating that much so tend to disbelieve it. I don't know that I ever made it through two pizzas and two dozen donuts though.

If she does this regularly it is certainly a disorder ... whether she's out and out bulimic? Unfortunately more likely than not if she's really eating all that on a binge.

As an aside, I saw Tracey Gold on TV the other day looking a wee bit pudge. Just a wee bit. It looked so good on her IMO. She's got a show on anorexia out now or coming out soon.
Tonus said…
Sanjeev does bring up a good point. Promotional interviews can be pretty over-the-top by design. There are a number of examples at the Snopes site (which investigates popular myths and urban legends) of how the famous will weave some pretty tall tales when doing promotional interviews. Jessica's story (wherein she becomes a slave to overwhelming carb cravings on a diet of skinless chicken and vegetables and winds up eating a massive amount of junk) does tend to come across as a fish tale.

I agree that anyone who responds to a healthy diet with a dangerously unhealthy binge has some manner of disorder, physiological or psychological. And while it's tempting to point at her physique and wave off the concern, it's also true that someone who is young and (presumably) very active can mask such problems for a while. Time will tell, but I get this nagging feeling that we've been, ah... fed a line by an actress playing the timeworn game of promoting your latest work indirectly as well as directly.
bentleyj74 said…
It looked and sounded like hyperbole to me. She's 29 or 30? Something like that? Young but not magic recovery young. If her "bad" habits were significantly impacting her life we'd see some of it by now probably. It shows on plenty of her former peers who made the mistake of turning 22. This will all be recanted and denied when she writes her tell all biography [cough].

I'm more and more persuaded though that any diet that defines itself as "healthy" by means of prescription or proscription does a pretty good job of setting the stage for an ED.
Swede said…
bentlyj74 said:

"I'm more and more persuaded though that any diet that defines itself as "healthy" by means of prescription or proscription does a pretty good job of setting the stage for an ED."

Great point. Orthorexia is noticeable in many blog posts and comments. Forgive me if this has been posted before: Anthony Colpo had an interesting point on the not so spectacular health and longetivity of many health gurus.
bentleyj74 said…
Interesting article swede!
CarbSane said…
I agree with you guys, ultra restrictive diets -- convincing yourselves that whatever it is you are to avoid will kill you -- can very easily turn into an ED of one form or another. I tend to think most paleo diets (there are variations) are quite healthy, and yet there are many reports of folks developing ED's a few months into committing to it. Just as calorie counters, carb counters, fat counters, sugar avoiders, whatever.

And yup, bentley, you guessed EDD.
I just read that Jessica Biel post. Nice excuse to use a celeb name to try & drive traffic plus breaking down her comments to dispense LC "wisdom" and health insights. He's got some balls critiquing her way of eating when she looks the way she does & he looks the way he does. (I know, I know, there I go with the "looks" thing again.) I remember when he was criticizing Jillian Michaels for having the audacity to tell a listener on her podcast that calories count. These LC types are increasingly ridiculous.
CarbSane said…
@FTD, reading Jimmy's additional contributions in the comments section is even worse! It wouldn't be so bad if the man didn't binge -- by his own admission -- back on up 170 lbs in a matter of months. He's awfully hard on her being a "role model", though she doesn't seem to be embracing that mantle. Meanwhile he is actively being a role model and doling out diet advice to his readers ... all the while denying his own eating disorder. When he says things like (paraphrase) "nobody needs that much pizza", it wouldn't sound so ridiculous were it not for his BLOGGING about chowing down on SIXTEEN slices in one sitting. Oh ... but they were small. Sheesh!
CarbSane said…
Hi Princess, Yeah, I've been thinking about getting one of those Buggs just to remind me to stay active ... I blog too much, even with the standing desk I use part of the time.
Galina L. said…
This comment has been removed by the author.
CarbSane said…
Ummmm Lustig? I don't think he'd even like to be described as "old" just yet! Are you sure you weren't thinking of someone else?
Galina L. said…
@ Sweede,
I enjoid the link to the Colpo's post on prematurerly dead health experts. It is so funny! Life is full of irony. I am not a religious person, but sometimes I think if there is a High Force above us, it treats us based on the sense of irony.
It there a list of long-lived health experts, I wonder? Only two names came into my mind - Jack Lalanne and Dr. Wolfgang Lutz. Probably, it could be mostly genetic at work.
Galina L. said…
@ Evelin, Yes it was a mistake, I removed the post with the wrong name, but not fast enough.
CarbSane said…
I love your last post Galina: " if there is a High Force above us, it treats us based on the sense of irony". Sure does make you wonder sometimes!
OnePointFive said…
"It there a list of long-lived health experts, I wonder? Only two names came into my mind "
Well how about:
Ancel Benjamin Keys (January 26, 1904 – November 20, 2004?

At the moment I'm furious at JM for another matter concerning EDS.
He started a thread on his forum, linking to the blog of a young woman recovering from diabulimia (very much an EED). She blogged on her annoyance that some people tried to suggest low carb as an answer to it. He and some of his acolites hadn't the foggiest idea what it was yet still felt justified in commenting.(why on earth is he reading blogs on Tu diabetes anyway?)

I think that you'd have a lot of applicants for the cruise, I'd predict weight losses since I think that the participants eating behaviour would also alter significantly from normal.
Sanjeev said…
Evelyn, as a simple system to motivate moving more, the fitbit looks better - cheaper, and the online service is not needed to get all the data off the device -

last time I looked bodybugg was doing something proprietary that made their subscription service mandatory.
CarbSane said…
Thanks Sanjeev, definitely not up for something that requires subscription or even online. I have a Garmin GPS unit I use for walking/biking outside, but I'm looking to motivate a bit indoors as it's getting cold.

@OPF: I hear ya! That DFH jerk has been allowed to trash people on JM's forum for too long now too. Oh ... but it's not Jimmy -- aw shucks good guy baybeeeee -- Moore saying it. He (a) has no clue for posting that link, and (b) is even more clueless for not retracting it when it was pointed out that he was off base. Sigh.
Galina L. said…
Probably, a lot of people would love to be exposed to 24 hour observation in order to find out what they are doing wrong. Our self-exposure on blogs in a way serves the same purpose, even when somebody is telling how he/she is right all the time. Mostly, we have no doctor to guide us, because GP mostly function as a gate-keepers and prescriptions dispensers for people who want to ignore symptoms of their diseases. Self-observation is the most available option, and it is easy to get stack on the personal search of better health, shape, weight, while getting older, and plateaus are way too common.
Galina L. said…
Thank you for the encouraging of my idea about the life making fan out people all the time. After forming that hypothesis, I keep noticing it explains a lot, or at list more than the concept that the life suppose to be fair.