Healthcare Should Not “Be About Prevention”

The last several years has seen dramatic changes implemented to the American healthcare system. In addition to the passage of the Patient Protection and Affordable Care Act, the President’s flagship piece of legislation (known colloquially as “Obamacare),” into law in 2010, we have seen a paradigm shift in how healthcare is delivered to patients in this country. Physicians and hospitals are more committed than ever before in attempting to provide the most efficient care possible; that is, minimizing a patient’s length of stay in a hospital, reducing the amount of patient readmissions, and providing only those treatments or procedures that have been deemed “medically necessary” to the patient’s care.

Quality improvement is another newer concept in American healthcare: it describes the processes by which healthcare providers measure the effectiveness of the procedures and treatments that they administer to patients. Other outcomes measured include the sufficiency of hospital safety procedures and patient satisfaction scores, which are measured using surveys. At their core, quality improvement programs seek to emphasize treatments that have been demonstrated to be efficacious. Safe, efficient, evidence-based care that meets the patient’s needs is the name of the game now and providers must work in unison to ensure these processes and outcomes are maintained if they wish to be reimbursed and to avoid financial penalties levied by government insurers and accrediting organizations.

Medicare, our federal government’s health insurance provider for citizens over age sixty-four, and private insurers have led this charge in this new era of managed care. Medicare, working through private contractors (known as MAC’s), is more stringent and discerning than ever before in determining what it will and will not reimburse based on a host of criteria such as medical necessity, the comprehensiveness of the patient’s medical documentation, the competency of the staff involved in the patient’s care, and the safety procedures utilized. Healthcare providers must meet these benchmarks to receive payment for their services. To make matters more difficult, these goals are in constant flux and practitioners must keep up with the frequent revisions.

In this swirl of efficiency modeling, data analysis, outcomes assessment, government oversight, and seemingly endless documentation, many providers worry that healthcare is forgetting the most important piece of the puzzle: the patient.

Often, patients themselves can attest to feeling overwhelmed, under-informed, and hurried through their treatment. Some will feel confused, others angered or frustrated, and still other patients will maintain that they were violated or harmed in some way by the medical juggernaut.

Many view this emphasis on streamlined managed care and evidence-based treatments as having detrimental effects on the patient and perhaps even crumbling the most sacrosanct component in all of healthcare, the doctor-patient relationship. Physicians themselves have expressed these concerns. Some pundits, many of whom are healthcare practitioners, argue for blowing the whole thing up and starting anew. Medicine as it’s currently practiced, they allege, is failing our patients. A cursory glance at our overcrowded emergency departments, our hopelessly sick patients requiring repeated lengthy hospitalizations, and our expensive treatments that can lead to debilitating complications, serves to reinforce these concerns, so says these commentators. One study even demonstrated that the majority of treatments rendered to patients are wholly ineffective.

One idea that has gathered steam in recent years is the belief that healthcare practitioners (and presumably insurance providers) should focus their efforts primarily on preventing illness rather than simply treating it when it occurs. This romantic notion has been trotted out as a solution by many to the perceived problems that arise resulting from our traditional concept of medicine. In essence, this idea stems from the logic that, by addressing and reversing disease risk factors, such as lifestyle habits, and potential medical conditions early before they can become full-fledged chronic disease, we can reduce the incidence and severity of disease itself, better treat the patients who are sick, and save untold billions of dollars in the process. We could improve our citizens’ health and provide superior care in the hopefully rare event that some of them do fall ill.

Certainly a noble suggestion. One problem, though:

It doesn’t make any sense.

Let’s first examine the disease component of this idea.

The Centers for Disease Control (CDC) track mortality rates of adult U.S citizens and compile this data into a report known as the “Leading Causes of Death.” The most recent report available online is from 2013. Here we can examine the pertinent statistics regarding the primary causes of death in our population. The following chronic conditions, taken from the aforementioned report, kill tens of thousands of Americans every year:

• Cardiovascular disease
• Cancer
• Chronic respiratory diseases
• Stroke
• Alzheimer’s
• Diabetes
• Kidney failure

All of the above conditions have multifactorial etiology; usually some combination of genetic predisposition, a multitude of lifestyle elements such as smoking history and nutrition, perhaps even DNA mutations and/or congenital defects, and plain bad luck all contribute to their development. How are we supposed to prevent, say, cancer when cancer is considered to be not necessarily a single disease but instead a term to describe literally dozens of cellular malformations that can affect every tissue and organ system in the human body? Oncologists struggle to treat cancer patients as it is, but to task them with preventing it’s occurrence throughout our population? Unfathomable hubris or naivete, one. As one of the leading killers of American adults, cancer is an undeniably complex, insidious, and resilient affliction that has proven extraordinarily difficult to treat and so far impossible to cure despite centuries of dedicated research. We cannot fall into such unrealistically idyllic thinking to posit that cancer incidence could be drastically reduced by “prevention” strategies.

What about lung disease? Surely by greatly reinforcing the benefits of tobacco cessation we can successfully prevent the large majority of these conditions, such as lung cancer and chronic obstructive pulmonary disease (COPD). But other common lung conditions, such as interstitial disease, fibrosis, pulmonary hypertension, sarcoidosis, and bronchiectasis aren’t all directly caused by cigarette smoking per say. Many patients with severe pulmonary disease have never smoked.

How would “prevention” help these patients, some of whom are ill through no fault of their own? Many of these diseases can be associated and potentially may be caused by environmental factors such as pollution and toxins. This would presume that people living in congested urban areas or people who frequently work around toxic substances would be at a higher risk for lung disease than people who do not. This disparity would negatively impact any prevention efforts, as we can’t tell people in Los Angeles, for example, to all move to somewhere less crowded in the hopes of preventing respiratory ailments caused by polluted air.

Some of these conditions are idiopathic, meaning that the patient’s physicians (and maybe even medical literature) don’t know what caused it. We can’t prevent these maladies when we have no idea what brought them on in a particular patient, let alone millions of potential patients.

What about osteoarthritis? A degenerative condition in which the joints of the skeletal system deteriorate with age and overuse, this condition affects tens of millions of Americans, crippling a great many of them. It is the leading cause of chronic disability in this country. Osteoarthritis is the reason orthopedic surgeons perform hip and knee replacements, home health companies distribute countless canes and walkers, and the pharmaceutical industry is booming with painkillers.

Prevention of a degenerative joint disease that could be caused by mechanical stress, ie. overuse, would prove tricky. Current physical activity guidelines, proffered by the Department of Health & Human Services (HHS), recommend up to five hours per week of aerobic exercise for improving health and maintaining an ideal body weight. We could hypothesize that this chronically high volume of repetitive motion could have a deleterious effect on the joints. Research in this area is inconclusive but we can’t completely disregard the idea that exercise, while the source of many health benefits, might be injurious to our joints if done as frequently and for as long as the federal government is recommending.

But how would we prevent osteoarthritis? Caution Americans to exercise, but not too much? Inform them that while climbing stairs gets the heart rate up, it could also cause wear-and-tear in the knee joints and should be done sparingly? How do we tread this line?

Coronary artery disease (CAD) is another chronic condition that presents it’s own set of questions. If the healthcare system sought to eradicate CAD by funding extensive nationwide prevention strategies, we would certainly see some benefit as a society. But not everyone would enjoy the same downtrend of heart disease risk factors. While the typical cardiac patient can probably be described as older, overweight, and having a history of smoking and poor diet, there are a great many patients who are otherwise remarkably healthy, or at least engage in all of the behaviors theoretically associated with good health. There are many instances in which marathon runners arrest out in the field, lifelong vegetarians need bypasses, and health nuts drop dead in their thirties and forties after throwing a clot. While rare, these cases present serious challenges to the preventative healthcare model.

How can we advocate prevention when a small but important fraction of people would still fall ill despite religiously following preventative health advice?

Besides, how do we even know what advice to give? Are we settled on the ideal healthy diet? Is the research conclusive? What do we still question?

There have been and still remain critical questions as to what we should eat if we want to remain healthy. While the message of the Department of Agriculture (USDA), arguably the federal government’s mouthpiece on nutrition, has long been to consume a low-fat diet rich in fruits, vegetables, and grains, randomized trials and meta-analyses have raised doubt as to whether this diet, or perhaps one higher in animal products and lower in carbohydrate, would the best option. Zealots from both sides continue to keep this debate stirred up as the research is still inconclusive. The fact remains that our best data demonstrates that a reduced-carbohydrate diet is at least as effective in the short-term (two to eight years) as a low-fat diet for improving body weight, blood lipids, glycemic control, and markers of inflammation and metabolic dysfunction, all considered vital constituents of an individual’s overall health. While we can’t yet say that the traditional diet advice is wrong, we can’t state with confidence that it’s right, either.

Maybe prescribing medications to prevent diseases such as CAD would be prudent and effective. Elevated blood lipids, also known as high cholesterol, is usually considered to be a risk factor for future heart disease. The word “usually” is apt: while the majority of cardiologists support the notion that assaying lipids and prescribing statin (cholesterol-lowering) drugs to improve them will reduce the likelihood that the patient develops CAD, a great many physicians have long been skeptical of the cholesterol-heart disease connection.

Nevertheless, we can take solace in the fact that prescribing a statin to most of the adult U.S population would presumably curb the occurrence of CAD. Many doctors would comfortably agree with that statement based on the seemingly overwhelming support of the available data. But the research might not be conclusive. It is here I will very highly recommend the book Worried Sick: A Prescription for Health in an Overtreated America by Nortin Hadler, M.D. The book’s third chapter brilliantly describes the methods by which data is twisted and tortured in these statin trials to exaggerate the cholesterol-lowering and life-saving benefit of these drugs in a way that I cannot. Hadler’s work informed much of this article.

What Hadler contends based on the cholesterol data is that if physicians were to treat one hundred well people (ie. people without diagnosed heart disease) with statins to prevent CAD, very few of these people, perhaps only one or two would be spared a heart attack. He describes the results of the seminal West of Scotland study thusly: although purporting to demonstrate the efficacy of statins for preventing CAD, the data shows that prescribing statins to adult males with elevated blood lipids for up to ten years would result in not one person being spared from early death from heart disease. Potentially hundreds of people would need to take statins in order for a handful of people at most to realize any benefit whatsoever.

The Cochrane Collaboration, a not-for-profit organization of volunteer medical researchers, publish extensive meta-analyses of data collected from randomized trials that examine the efficacy of drugs, treatments, and procedures in treating diseases. Their systematic reviews are considered to be the most accurate and reliable medical knowledge that we have available and physicians routinely utilize their database in determining best practices for patient care. Their process is very scientifically stringent and their work is unadulterated by outside financial interests.

In 2011, the Cochrane Collaboration published a review examining the data on statins prescribed as primary prevention for CAD. The results were far less than encouraging. In fact, the authors espouse that some of this data may have been manipulated in order to suggest a benefit greater than in reality.

We’re forgetting the potential harms associated with statin use, such as liver damage and deterioration of the skeletal muscle. Memory problems correlated with statin use is still a matter of debate. Are we improving our health if, by taking a drug to lower our cholesterol by a little bit (at no benefit to our longevity), we’re experiencing potentially stifling pain throughout our body and maybe even some deficits in our cognition? Doubtful.

So “prevention” might not be the best idea from a medical standpoint seeing as how the diets may be ineffective, the drugs may be ineffective and dangerous, and the diseases themselves are still not thoroughly understand enough to offer reliable advice on how to impede their development.

This bring us to the other component of the healthcare prevention model: how would this be implemented?

Remember that in order for this to work, we would have to reach the maximum amount of people, ideally the entire U.S. population, and get them to follow lifestyle recommendations to the best of their ability.

But this would be inconceivably difficult to accomplish.

Think of all of the advertising, the public service announcements, the social media campaigns, the television and radio commercials, the internet memes, and the “expert” interviews which would need to be disseminated regularly to the American people. The messages to eat healthy, exercise (correctly), and stop smoking would have to incessant yet nuanced. Whomever took on this task would constantly have to find new and interesting methods to say basically the same thing over and over. Public interest would have to be maintained. Strategies would have to be multifaceted in order to reach such a wide range of demographic groups; senior citizens would have to be reached through newspaper columns and mainstream news media broadcasts. The younger generations would respond most favorably to grassroots campaigns and viral marketing on the Internet, perhaps using celebrities and athletes as pitchmen for the cause. Children could be taught the value of preventative healthcare as part of grade school curriculum. That is, if they have time for any more subject matter.

And on top of that, people would have to believe what we’re saying is right. Consider that faith in the competence of our government and support for our political leaders are at all-time lows, we probably can’t put this job in the hands of federal health agencies such as HHS or the USDA. So many citizens believe the government is fallible on issues foreign and domestic; they’re certainly not going to view government health recommendations as inerrant.

Finally, the public needs to act on this advice. Getting Americans en masse to put down the junk food and permanently alter their lifestyle habits is a pipe dream. It’s just not going to happen.

But maybe we have an ally in this fight, a willing battalion ready to help in the war against disease:

Physicians.

We can surmise that anything will suppress or even prevent chronic disease would have the support of our doctors. But here again we run into the challenge of trying to reach everyone. If we want to make a quantifiable dent in the prevalence of chronically diseased patients, then we would have to intervene in people well before they reach retirement age in order to increase our chances of addressing risk factors and improving lifestyle habits long enough to show significant benefit. This means getting those 20- and 30-year-olds to visit the doctor, something that this demographic just doesn’t regularly do.

Former Democratic Presidential candidate John Edwards mentioned in 2007 while promoting his universal healthcare plan that all Americans should be mandated to visit a doctor once every year. His idea, which he portrayed as a “continuum of care,” would force people, many presumably against their free will, into an examination room with a physician for a physical and a health history taking. What Edwards did not say, but can be logically implied, is that any condition or disease uncovered during these forced check-ups would have to be treated with or without the patient’s consent. What good is a doctor visit that results in a diabetes diagnosis or the discovery of a breast lump if the patient walks out the door without any treatment or guidance? Edwards assuredly would want these people treated regardless of their consent. All in the name of preserving their health. Does this sound like a reality you want to experience?

One Cochrane Collaboration review published in 2012 demonstrated that regular doctor visits did nothing to reduce morbidity or mortality in patients. The only thing these visits did do was increase the number of diagnoses a patient had. This only holds true if we can remember and effectively process the information the doctor is telling us, something with which many patients struggle.

So, according to our best research, going to the doctor does not improve health (or delay death or disease) but does saddle a person with the stigma of disease. Does this sound like preventative medicine to you?

Step back a second and look at the big picture.

Do we want to be assaulted daily from every angle with preventative health messages and advice? Is it beneficial to always be keenly aware that we may be festering with disease, riddled with plaques, and likely to keel over at any minute?

Should we trade our current system (go to the doctor when you’re sick, live your life when you’re well) for the opposite (go to the doctor when you’re well, live the rest of the time like you’re sick)?

Healthcare should not be about prevention because there’s too much to prevent. It shouldn’t be about prevention because we don’t know how to reliably prevent many of the conditions that afflict us. Healthcare shouldn’t be about prevention because we might turn healthy people into anxious hypochondriacs always shuffling to their next specialist visit or blood lab appointment.

Healthcare should be about treating patients safely, effectively, and as kindly as possible. Let them present to the doctors and hospitals when they fall ill; don’t waste the effort trying to reach them when they don’t need healthcare. You risk jading some to the benefit of medicine while inciting others into a worried frenzy about their next possible diagnosis.

The onus is on us as adults to take care of ourselves. We need to assume the responsibility for making healthy choices in our lives. In order for this to work, in order for us to avoid believing the questionable advice dispensed by government health agencies, celebrity doctors, news media, and our social circle, we must be very selective in whom we trust. A skeptical eye towards any health recommendation is prudent; there’s just too many talking heads with too many conflicts of interest. It’s easy to get overwhelmed by it all.

But we must try. At our fingertips is a wealth of information provided by National Institute of Health’s Library of Medicine. It’s a searchable database known as Pubmed. This invaluable resource allows users to search the medical literature for specific studies, papers, and data analyses of nearly every known human disease. While many of the journal articles require a paid subscription in order to access the full text, there are plenty of free papers wherein one can get a grasp on the research about a particular condition, medication, or syndrome. Pubmed, along with the aforementioned Cochrane Collaboration database, are the two preeminent sources of reliable healthcare information.

Use them when you have questions about the effectiveness of a particular drug or diet or exercise regimen. Education is the most powerful tool we have in our quest for health and we can’t expect a bloated healthcare system or an incompetent (and perhaps misleading) government health agency to do these things for us.

If we want to prevent disease, then that is our responsibility as individuals, not the job of a third party.

Your Neighbor Might Be Using Drugs: How Is It Affecting You?

Drugs are bad. Drugs are dangerous. Drugs will destroy individuals, families, communities, and society. Only worthless degenerate criminals use drugs.

All drugs should be illegal on the basis of these facts.

The above statements frame the arguments of the countless citizens who oppose marijuana legalization. Their anger over the potential decriminalization of cannabis is at times palpable. Impassioned pleas against legalization emanate from all corners of our society. Religious leaders, academic researchers, physicians, and nonprofit organizations have all gone on the record condemning the growing movement to legalize pot. Many believe that if we allow recreational marijuana use, we’ll slip as a society down the slope into rampant addiction, unemployment, sloth, violence, disease, and moral decay.

Previously employed professionals will start smoking pot and be laid off en masse. Promising college students will be handed a joint at a party, become addicted, and piss away their future. Teenagers in their naivete will follow the lead of these miscreants and soon a new generation will descend into hopeless addiction. Reformed users will be pulled back in by the easy availability of marijuana and will again flood our hospital emergency rooms, unemployment offices, and prisons. The “gateway drug” will lead us down the path to unbridled abuse of opiates, inhalants, and psychedelics.

But what if these assumptions are just wildly speculative fantasy? What if we’re stronger as a society than we all think? Its discrediting to our ambition, resilience, and virtue, not to mention our basic biology, to blindly assume that marijuana legalization would ruin us all. Plenty worse things than legalized marijuana have been thrust on us as a people and it can be argued that we’ve overcome, or at least adapted to, a great many of them.

Other situations have caused considerable harm or have proven elusive to reconcile. Prohibition repeal, the AIDS pandemic, virus outbreaks, foreign wars, natural disasters, terrorism foreign and domestic, racial integration and strained race relations, financial collapse and the devaluation of the dollar, a pitiful job market, and overwhelming destruction of our health and our healthcare, among many other things, have all tested our resolve as a citizenry. But nothing thus far has ruined us. Life has proceeded on and we have managed accordingly. The sun still rises.

We are nothing if not malleable.

Besides, this might be an example of the slippery slope fallacy. An aberration of critical thinking, a slippery slope occurs in an argument when we presume that, by taking one action, another action, this one markedly more harmful or insidious than the first, will automatically result. This process can theoretically be repeated until the results are cataclysmic. It can be considered a desperate attempt to win an argument when this tactic is deployed. The frailty of our viewpoints and the cloudiness of our perspectives are often illuminated when we recruit the slippery slope into our arguments.

Legalizing marijuana won’t ruin us as a society. Addicts won’t be convulsing in the streets. We won’t be violently mugged by stoners lurking around every corner. Our friends and our children won’t descend into an abyss of chemical abuse and wanton criminality. Our emergency rooms won’t be filled with psychotic potheads restrained on gurneys. And there won’t be scores of users riddled with pneumonia, hepatitis, and failing organs in our critical care units. The typical adult who uses marijuana recreationally won’t allow a few puffs on the weekends to lead to a debilitating heroin addiction or unhinged solvent abuse.

Perhaps I’m guilty of a logical fallacy myself: arguing against a straw man. Assuredly no one who’s reasonable can be this over-the-top and hyperbolic about weed. But we might be mistaken about that. Remember that the majority of voters in elections are older adults and seniors. Theirs is the demographic most likely to reliably turn out at the polls. A large proportion of these seniors identify as Christians and conservative Republicans. Drug use offends their sensibilities and runs counter to their religious beliefs; people shouldn’t smoke pot because its dangerous, gross, indecent, and just plain wrong. And some are adamantly, vehemently opposed to not only drugs but alcohol, too. Have you ever met an octogenarian who despises drinking and the people who partake in it? This mindset is pervasive among seniors; its what many belonging to their generation continue to believe.

And these are the people who are deciding elections.

And maybe you agree with them. Or maybe your family does, along with your friends and coworkers.

Think about your next door neighbor for a minute. He’s probably a nice guy. Polite, social, waves hello to you. Say he’s got a family. His wife is also neighborly. Kids seem bright and well-behaved from what you’ve seen of them. He has a job; an accountant, maybe, or insurance salesman or mechanical engineer or college administrator. It doesn’t matter: he’s gainfully employed and providing for his family.

He and his family are good neighbors. They’re quiet and unobtrusive. He keeps his yard and property maintained. They don’t have droves of guests over at all hours. From what you can assume, he pays his taxes and his bills. He has a good reputation as a responsible and caring family man in the community.

Now let’s say he smokes marijuana.

Does this instantly change your opinion of the guy? Is he now a detestable pothead? Do you pity him? Does he disgust you?

If your answers are yes, answer this: how does his smoking weed affect you? As described above, there’s nothing he’s doing that is impacting your life as a direct result of his recreational marijuana use. For all you know, he’s a responsible upstanding citizen aside from this perceived affliction, this character flaw. He is not harming you or infringing upon you by quietly smoking marijuana in the privacy of the home he owns. He’s just trying to relax.

Who cares if your neighbor smokes pot?

Now let’s say that you have the same good reputation as your neighbor. But on the weekends you like to smoke a cigar and have a few cocktails. You do this to relax. What’s the difference? Should he view you as a crass, disheveled, reckless drunk? Of course not. The evidence, the public opinion of you, suggests the opposite: you’re an intelligent, responsible, and kind person.

The substance you choose to help you unwind should be irrelevant to any discussion of your merit as a person. The means by which you contribute to society, the ways that you demonstrate kindness to others, the actions you take to improve your life and the lives of those around you should be the criteria by which you’re judged.

The coworker who helped you get a promotion might be a cocaine user. The lady down the street who found your missing dog might down a fifth of vodka every night. Your favorite childhood teacher might have been a two-pack-a-day smoker. The best friend who stood by you during the most difficult time in your life could be hiding an addiction to painkillers.

Plenty of lifelong sober people can be unproductive, unstable assholes.

The point is that, so long as someone’s marijuana use doesn’t affect others, we have little ground to shun that person and venomously protest their right to do it. We all have our vices, our bad habits, and our comforts, many of which we would prefer to keep hidden from others.

If you have a valid argument against marijuana decriminalization, perhaps potential financial repercussions of legalizing it, that’s one thing, but it’s exceedingly arrogant, contemptuous, and illogical to support keeping a defensibly innocuous substance out of the hands of consenting adults just because of your personal beliefs. Especially when the adults using that substance are doing so without harming or disturbing anyone else.

This description may include people who you know, people you respect, maybe even loved ones.

So get off of your high horse.

-D.H.

Why do we have to prove that marijuana is safe?

News broke this week that Safe Streets, a Washington, D.C.-based anti-crime group, has filed two lawsuits in federal court regarding marijuana law. In one suit, the group plans to target government officials in the state of Colorado over their alleged violation of the Supremacy Clause of the U.S Constitution. The group contends that by “promoting the commercialization of marijuana,” Colorado has acted in direct violation of federal narcotic laws. The other suit names several prominent Colorado-based business owners who work in the cannabis industry.

Regardless of the group’s knowledge of how to spell marijuana, this incident is another in a long line of attempts by politicians, government officials, law enforcement, special interest groups, religious leaders, and newspaper columnists to halt the decriminalization of marijuana possession and dissuade the public from voting to legalize marijuana for medicinal and recreational use.

Arguments and rebuttals against this diverse onslaught of pundits have originated from a variety of mediums. From rallies and demonstrations on Capitol Hill to Congressional lobbying to lengthy op-eds and dedicated blogs, the fervor for legalized marijuana is as strong as ever. One of the most popular strategies employed in this battle has been to evoke the supposed health benefits of marijuana use.

While the science is burgeoning, it is also deeply flawed, filled with holes and questions, and is too poor to extract any conclusions from one way or another. Relying on this research to frame and support an argument favoring marijuana legalization is dicey at best; one can’t get far with shoddy incomplete data and assumptions. Regardless of this reality, the pro-marijuana crowd has soldiered on undeterred, boasting study after study purporting to demonstrate the efficacy of cannabis and it’s ingredients in treating any number of health conditions.

This appears to be the best method for bringing about legislative change to decriminalize marijuana. But, in addition to the uncertainty surrounding the whole of the marijuana scientific literature, there are other untoward possibilities that could result from this tactic.

To the fearless recreational users crying for reform, the ambitious grassroots organizations lobbying their representatives, the bloggers unearthing obscure studies, and the cancer patients asserting it’s palliative effects, I have one word for you:

Stop.

Stop trying to educate the public about the potentially health-promoting effects of marijuana. Stop trying to convince our policy makers that cannabis is not a danger. Stop invoking tales of chronic pain alleviated, of headaches relieved, of vision loss arrested, of anxiety calmed. Stop playing this game.

This situation is reminiscent of a child begging her mother to buy a particular snack food at the grocery store. “But mom,” she whines, “it’s healthy!”

Its the mother’s choice as to whether or not she’ll buy the junk food. The little girl believes that her pleading and bargaining is helping her cause, giving her some influence over the decision. But ultimately it may be for naught. It may just be serving to further define their two roles. Mom is in charge and she knows best. The little girl is at the whim of the mother’s judgement and there’s realistically not much she can do about it.

Now replace the mother in this situation with the federal government. The fussing child is the public, the tax-paying citizenry, clamoring for cannabis to made lawfully available to them.

Is this the precedent we want to set? Is this how we want our government to treat us going forward? Do we want to succumb to the nanny state by acting like little children who do indeed need a nanny?

We as citizens should not bear the burden of demonstrating the safety of everything we want to consume. We aren’t particularly adept at it, especially considering the questionable quality of data and flimsy biology with which we’re equipping ourselves in this battle. The results of a few studies and copious anecdotal evidence might have aided in getting the ball rolling in Colorado and Washington State, among other states, but in order to finish this fight against an overbearing, overreaching mommy-knows-best government and thus be free to smoke marijuana in the comfort of our homes, we don’t need to assume the position of a submissive, compromising, and desperate populace.

We shouldn’t be throwing statistics and purported benefits at the wall in the hope that something sticks. Hold strong to your convictions and forget the burden of proof; it shouldn’t be on us. And if it is, no data, no matter how compelling and noteworthy, is going to reverse our role as the angry child in the grocery store begging for cookies from an overprotective mother.

The nanny state won’t be swayed by numbers. Unless, of course, those numbers are dollar figures.

-D.H.

You’re Not Smarter Than the Coach

The Monday after Super Bowl XLIX was an interesting day. The second day of February was an opportunity for people from all walks of life, from rabid New England Patriots and Seattle Seahawks supporters to casual football fans to people who only watch the Super Bowl for the commercials, to proclaim that they’re smarter than an NFL head coach.

What prompted this undoubtedly nationwide phenomenon was the second-down pass attempt by the Seahawks at the New England one-yard line that was intercepted by Patriots reserve cornerback Malcolm Butler. This play occurred with twenty-six seconds remaining in the game and the score 28-24 in favor of New England. The Seahawks had to score a touchdown.

This post will not be an attempt to explain the thought process behind this play. Other writers and experts have already explained the multitude of factors that influenced Seahawks head coach Pete Carroll and offensive coordinator Darrell Bevell to call for a pass attempt in that situation.

Instead it will be an attempt to quell the overconfidence that Super Bowl viewers felt in the wake of that momentous game-shifting play. At your office, in the break room, around the dinner table, at the bar, or on social media, you assuredly were exposed at some point to the opinions of casual football fans regarding this play.

Here’s the thing: They don’t know what they’re talking about.

Even if they’re right, even if the play call was a bad decision, these people can’t thoroughly and accurately elucidate why it was a bad decision. The pass was intercepted, the Patriots took over on downs, and won the biggest sporting event of the year at the last second. “What a stupid call!” cried millions as the final seconds ticked off the clock. The magnitude of this scenario and the import of the event itself elicits opinion from all but the most uninformed of viewers.

But can these people explain why the thought process behind it was flawed? Probably not. Pete Carroll tried to enlighten us as to he and his staff’s thinking at that critical moment. He mentions having one timeout remaining. He mentions a potential replay on a previous catch by wide receiver Jermaine Kearse. He mentions the game clock. He says that his team would probably have time to run three more plays. He talks about personnel (offense having one back, one tight end, and three receivers while the Patriots sent out their goalline defenders to stop a potential rushing play) and the perceived advantage by the Seahawks based on this matchup. (Patriots coach Bill Belichick denied being at a disadvantage).

He goes on to explain that he wanted to preserve play-calling multiplicity for third and fourth down if they had needed those downs to score. They sought to do this by calling for a pass on second down in order to save a little time on the game clock (rushing plays take more time than passes). Had they rushed on second down and not scored (as was the case on first down), according to Carroll, then they would have had to throw the ball on third and fourth down. New England would have known this and sent personnel on the field to stop a pass attempt.

In essence, Carroll was trying to catch New England off-guard and also trying to use the game clock to his team’s advantage. We all know what happened. It didn’t work.

But to the casual football fan, it was a terrible decision.

Okay, casual football fan: Detail a better method for trying to win this game. Be sure to include in your counsel clock strategy, timeout usage, your knowledge of personnel groupings and matchups for these two teams, your insights following your film study of the Patriots defense, and your game plan which included analyzing the Patriots defensive tendencies on down-and-distance at the goalline from the 2014 season. Maybe even include some analytics as many teams are now using advanced statistics to evaluate in-game decisions. Oh, are any of your players hurt during this game? How about previous injuries? What have the trainers told you about any potential injuries to players you might need?

Now give us your play call, which obviously includes personnel, protection, motion and shifts, audibles, quarterback reads and route combination (if you’re wanting to call a different pass).

Since the vast majority of Super Bowl viewers thought the Seahawks should have run the ball on this play, tell us what kind of rushing play you would choose. Would you pull a guard and play power? Maybe pull a tackle or the center? Or just have the line drive block? Would you have a fullback? If so, would he carry the ball? Or would Marshawn Lynch, the Seahawks starting tailback? Would you run an inside zone? Outside zone? Would you give the QB a read-option? If so, would you add in a packaged pass option? How about a naked bootleg and hope your QB can run it in himself?

We can keep going if you want. Let’s say you do score. Take us through how you would manage the kickoff following the point-after attempt. What defensive personnel would you put on the field knowing that New England needed to throw the ball down the field to score a game-winning touchdown (a field goal would do no good as its a four-point game)? What coverages would you run? Would you blitz the Patriots QB Tom Brady? If so, how?

All of these were running through Pete Carroll’s mind in the span of probably one minute. Obviously the interception made much of this moot. But the fact remains that its his job to consider these myriad factors and make quick decisions with the Super Bowl on the line. Careers will be defined by your decision. Sports history will be written with your decision. Hundreds of millions of viewers worldwide hang in the balance as you have seconds to make arguably the biggest decision of your career.

Could you do better than Pete Carroll at this very moment?

What if the tables were turned?

Say you’re an auditor for a large company and you royally muck up the company’s tax filing with one small but significant oversight.  Would you want a bunch of guys in visors exclaiming the stupidity of your mistake all over social media when they themselves probably couldn’t do long division?

Imagine you’re a registered nurse who works in a hospital’s intensive care unit. During a particularly stressful shift you accidentally administer too much insulin to a diabetic patient. The patient has a seizure and lapses into a coma. A momentary misjudgement resulted in severe harm to a patient and you’re devastated and afraid that your job is in jeopardy. Would you appreciate guys like this going on and on about your medication error on TV, in print, and on the web? What if these same people have never heard of a gallbladder and can’t name three bones in the human body?

The point is that lambasting a coaching decision in a game is human nature when that decision ends up costing the team victory. But to proclaim the coach incompetent, a fool, a person too stupid to have his job, based on one wrong decision is asinine. Especially when that coach, Pete Carroll, was at the absolute pinnacle of his profession, Super Bowl champion, one year prior and has a track record of success.

And to castigate the decision itself when you can’t explain the thought processes behind it is even more ridiculous. Football fans thought Carroll should have called for a running play to Lynch on second down. But most don’t even consider the game clock as a factor when in actuality it was probably by far the largest factor in Carroll’s decision making.

In the end, the call had a disastrous outcome for the Seahawks. Carroll’s explanation makes at least some sense and if you disagree with it, as most fans do, then you should be able to reasonably articulate why if you’re hell-bent on letting loose the profanity and personal attacks against Carroll, his coaching staff, and his players. Most Super Bowl viewers who rebuked Carroll probably didn’t even know how many cornerbacks the Patriots had on the field for this play.

Casual fans only show their ignorance of the game and it’s strategy in moments like this. In sports, when tide-altering decisions affect games on such a scale that they enter the public consciousness and become popular topics of discussion, the more appropriate, and certainly more rewarding, way to respond would be to educate oneself on the situation and the thought processes behind it.

That way, when you’re ready to interject your opinion on the big game, you can come off as having a grasp of the sport’s inner workings, it’s schemes, rules, and structures, instead of sounding like another in a long line of mindless spectators.

-D.H.

The Nanny State Lifestyle: How Useful are Government Health Recommendations? (Part One – Nutrition Guidelines)

Let’s say the time has come for you to improve your health. You’ve noticed that your clothes are getting tighter and that your annual winter cold has lingered longer than usual. It seems more difficult to do yard work without feeling short of breath. You lack energy and your back always hurts. Say that you want to stop smoking, too.

How do you fix these problems? What’s the best way to get in shape? To lose weight? To lower your risk of disease? How can you reduce joint pain? An Amazon.com search of key phrases like “weight loss” or “diet” leads to an overwhelmingly dense and diverse selection of books. How do you know which has the right information, the advice you need to begin following a healthier lifestyle?

You could turn to a lot of resources for answers. The Cochrane Collaboration is a not-for-profit organization of volunteer researchers who provide thorough analyses of data comprised from the results of dozens of randomized controlled trials, the gold standard of research design, in order to determine the most effective treatments for a host of medical conditions. Using a discerning and highly-selective standardized methodology and unadulterated by the financial influence of outside sources, the group provides physicians and healthcare practitioners with “best practices” backed by data that can be trusted to be accurate. See the Cochrane Library for the results of these meta-analyses concerning a number of health conditions.

But medical literature can be intimidating to and difficult to understand for a layman. You risk encountering any and all degrees of quackery sifting through blogs, social media, TV shows, magazine articles, news columns, and internet videos for health advice. Family members and coworkers might not be of much help. Personal trainers, supplement store employees, and nutritionists can provide conflicting and incorrect information. Your doctor may just pull out the prescription pad and hurry you out the door when all you wanted was some guidance. It’s easy to feel misled and overwhelmed.

So let’s turn to our government health agencies for help.

And since we want to improve our overall health, let’s try to follow all of the health recommendations made by these federal agencies.

Is it even possible to live the nanny state lifestyle? How useful is the information that these agencies provide the public?

The U.S. Department of Health and Human Services (HHS) is one of fifteen executive departments of the federal government and an umbrella agency for a number of federal agencies and centers aimed at “protecting” the well-being of all Americans. Below is a partial list of the divisions that operate under the administration of HHS and that provide health recommendations and/or guidelines for the general public:

• Centers for Disease Control and Prevention (CDC)
• Food and Drug Administration (FDA)
• National Institutes of Health (NIH)

In addition to these agencies and their own multitude of offices, there are other executive departments which publish health recommendations. The Department of Agriculture (USDA) and Department of Labor (DOL) both offer detailed directives against developing chronic disease and sustaining injury, respectively.

For the purposes of our discussion, we will analyze the main public health recommendations proffered by the aforementioned agencies. Certainly with some more research of the other federal departments we could uncover additional suggestions for maintaining or improving our health. This post is not meant to be an exhaustive review of every piece of health information dispensed by our government’s myriad voices of authority.

What we’ll instead attempt to do is answer these questions: Can an Average Joe expect any benefit by following these guidelines? Can he do so without having to do time-consuming research? Can we the public, a nation of Average Joes, follow government advice without doing a disservice to our health, our sense of well-being, our family, our free time, our privacy, and our liberty?

The Average Joe might indeed have a bad back, a smoking habit, some extra weight, and maybe even a little depression. Let’s say Joe can use an internet search engine to find popular medical websites that espouse basic health information. Joe cannot, however, interpret papers from medical journals. Distilling scientific research into usable information is just not in Average Joe’s wheelhouse.

So Joe will turn to government health agency websites for help.

Let’s start with those extra lbs. What’s Joe supposed to eat if he wants to maintain a healthy weight and minimize his risk of disease? The USDA’s Dietary Guidelines Advisory Committee, who work in the Center for Nutrition Policy and Promotion (CNPP), an agency of the USDA’s Food, Nutrition, and Consumer Services mission area, release every five years the Dietary Guidelines for Americans in collaboration with HHS.  This hundred-plus page document is meant to summarize the best available scientific literature concerning nutrition, overweight and obesity, and chronic disease and provide to all Americans over age two sound research-based guidelines for making healthy food choices. The next version of this document is expected to be released in Fall 2015.

For our purposes of deciding what to eat to facilitate weight loss, we’ll first use the four-page executive summary, as no busy American can be expected to read the entire voluminous Dietary Guidelines report.

If Joe wants to lose weight, he’s going to have practice “calorie balance” according to this report. Also known as energy balance, this entails counting the calories in everything you ingest and also estimating how many calories you burn through resting metabolism and physical activity. Although poorly understand and nearly impossible to do accurately long-term, practicing energy balance is the go-to method for losing weight as prescribed by the U.S government. This is in spite of a growing body of evidence from research that seems to demonstrate that it is, at best, a theory in need of further study.

So Joe is going to have to calculate the calories of everything he eats and the energy requirements of everything he does. Is that any way to live? Can Joe enjoy food and enjoy life constantly worried about portion sizes and calorie expenditure? Luckily for Joe and the rest of us, the CNPP has an online tool for tabulating this data, the SuperTracker, which provides calculators for physical activity, food choices, and a personalized weight management system.

For practicing energy balance to be efficacious, Joe will (theoretically) have to count calories all day, everyday, presumably lifelong. It wouldn’t be too far fetched to assume that this process could lead to one of two outcomes: Joe gives up on the whole idea, or he becomes obsessively focused on it at the detriment of a healthy relationship with food and his own self-image.

What foods should comprise Joe’s new healthy diet? The 2010 Dietary Guidelines executive summary counsels all Americans to choose low-fat protein sources, get plenty of fruits and vegetables, emphasize whole grains, and avoid sodium and dietary cholesterol (they’ve changed their tune on this one, however). The full document is worth a cursory glance but perhaps other government resources could be more illuminating. For example, the Dietary Guidelines Advisory Committee releases to the public “Nutrition Insights” which are brief literature reviews aimed at providing Americans with tangible research-backed dietary information.

If Joe wants to know what to eat for breakfast to help him lose weight, he’s in luck: this very topic was covered by the Committee in 2011. For reasons unspecified, however, they failed to “review the literature on the use of breakfast consumption as a tool for adults actively losing weight.” Curious decision seeing as how adults, not children, seek the help of these guidelines as they try to lose weight. Previous incarnations of the Guidelines have netted similar complaints. Good thing the USDA has instead focused their research efforts (and funding) on more pertinent topics such as whether Americans like to eat sandwiches and how to measure a piece of cake. Or maybe they’re too busy playing with their food.

Looks like Joe has exhausted the help of the USDA. Sure, they have issued other recommendations for healthy eating, but Joe is a little confused by the ambiguity of the Dietary Guidelines. He’s certainly not the only one.

But the USDA does have the Nutrition Evidence Library (NEL), a sort-of government-sponsored version of the Cochrane Collaboration, except dealing in only dietary matters. With eight topics ranging from energy balance to food safety, the NEL’s reviews cover plenty of issues applicative to Joe’s quest for health. There’s only one problem: the NEL, despite its collaboration with “leading scientists” to create “systematic reviews,” makes a blunder most high school statistics students wouldn’t make. They confuse correlation with causation. In matters of public health, a slip-up of this magnitude, apparent throughout the NEL’s reviews, could have disastrous consequences.

Vague advice is one thing but recommendations riddled with potential mistakes are another. This is Joe’s health we’re talking about. We have to get this right.

Joe can try the USDA’s MyPlate website. Released from the CNPP in 2011, MyPlate served to update the agency’s “food icon” from the Food Guide Pyramid, which endured plenty of criticism throughout it’s reign as the previous icon for the USDA’s healthy eating crusade. The website is full of helpful tips, including these simple guidelines for constructing a healthy meal, and these instructions for making smart food choices in a cafeteria.

After perusing the content of the MyPlate website, several things become apparent to Joe. The most perplexing is the concept of tricking yourself into eating less. Take a look at this guide on portion control. The USDA is assuming that smaller plates are a key strategy in conquering the obesity epidemic. The problem with this logic is that it just might not work.

Eating less than necessary to satisfy hunger is the key tenet behind what used to be called the semi-starvation diet. As expected, the effects of these diets on the dieters were not conducive to long-term adherence. Research in rodent models on semi-starvation diets serves to further dampen the enthusiasm behind the government’s portion control advice. Perhaps the authors of these MyPlate tips are putting too much faith in microorganism research. Besides, maybe Joe doesn’t even need to restrict calories everyday to obtain the benefit.

As evidenced by the MyPlate icon, the USDA heavily emphasizes grains, vegetables, fruits, and starches as majority components of a healthy diet. Never mind that carbohydrates as a macronutrient are inessential to human life, numerous studies have demonstrated the benefit of diets that are devoid of these foods can result in improved health markers.

Can we fault the USDA for being a little behind the research? We could especially considering how busy they are saving us from bad shrimp and imported pork rinds and crafting over a hundred documents on nectarines and peaches grown in California. At least they can define for the discerning public what a catfish is.

But it looks they can’t help Average Joe lose weight.

Research is surprisingly inconclusive on what exactly constitutes a healthy diet. Although they attempt to designate which foods can and cannot be labeled as healthy, the reality is that the literature is ambiguous. The USDA’s nutrition recommendations are at best an educated guess and might very well be a good starting point for Average Joe looking to drop some weight and improve eating habits. But doubts over their accuracy and usefulness have persisted throughout the federal government’s tenure as health educators. An internet search of critiques of the USDA’s Food Pyramid is illuminating.

Would it hurt Average Joe to just eat more fruit, pass on the salt, and maybe cut down on the red meat? Probably not. (The salt thing is debatable; actually, it’s all debatable, but we’re running out of room). These guidelines can give us some semblance of informed counsel on dietary matters but their research certainly is not airtight. To us as citizens, as naive consumers, as a people rapidly getting sicker, the USDA, despite their best efforts, are lacking as a resource.

Other federal agencies which cover nutrition, such as the FDA, might be better in this regard. But they’re more caught up in food labeling which does have undeniable value. One could make the case, however, that they get a little carried away with this responsibility. Consider this forty-four thousand word document on how to quantify the serving size of fruit cake and breath mints.

Could the CDC be our source of usable, accurate, and detailed information? Their Division of Nutrition, Physical Activity, and Obesity offers some guidelines on healthy foods, and although these are aimed at food service, we can still potentially glean some individual advice. But something strange appears on their page detailing “healthier choices:” 100% fruit juice. With the help of the FDA, we as consumers can read the labels on many fruit juices and find alarming amounts of sugar and high fructose corn syrup. See this video for an initiation into the research of these substances on human health. The literature on this deleterious effects of sugar is growing exponentially. To pick a couple papers would do a disservice to the research as a whole. This considered, it’s certainly odd that the CDC, in its quest to prevent disease, is hocking a nutritionally-worthless and insidiously disease-causing food.

Average Joe still has a gut, however, and would like to lose it. It’s no surprising that upping consumption of fruits and vegetables is a tenet of the CDC’s weight loss dogma. Consider their Weight Management Research to Practice series which discusses for health professionals, in the hopes they will provide clients and patients with this information, the “science on… weight management.”

One look at the recommendations for fruit and vegetable consumption, housed in a “research review” for practitioners, reveals an almost laughable admission: “no studies have directly linked consumption of fruits and vegetables to weight loss.” That doesn’t mean they don’t know that eating these foods causes weight loss. They don’t even know whether or not there is a relationship between eating these foods and body weight. How can they have built an empire of recommendations on healthy eating when one of their key pillars is not supported in any way by any research? And how can you review the literature when you admit that no literature exists for your particular topic?

The average person simply doesn’t have the time or the education required to peruse medical journals and read human physiology textbooks and glean from them practical information on how to live healthily. It could be argued that the federal government’s public health agencies are doing us a favor by condensing down this huge morass of data and complicated biology and extrapolating from it simplified guidelines on what to buy at the grocery store and how to prepare it at home. The sheer amount of funding required for this undertaking, provided by our tax dollars, suggests this argument is invalid. A more productive argument would be whether or not our government should be spending our money to provide nutrition guidelines in the first place.

In Part Two, we will examine the government health agencies’ advice on physical activity, smoking cessation, and mental health.

-D.H.

Cheat to Win: Should We Dismiss the Success of Athletes and Teams Who Break the Rules?

On the heels of Super Bowl XLIX, which saw the New England Patriots defeat the Seattle Seahawks to capture their fourth championship in fourteen years, many have accused the Patriots organization of perpetuating a “culture of cheating” that has allegedly helped fuel their success.

In the two weeks leading up to the Super Bowl, even the most casual football fans were inundated by mainstream, alternative, and social media alike with accusations and stories of the Patriots playing the AFC Championship game against the Indianapolis Colts with underinflated footballs, a scandal that quickly snowballed into “DeflateGate.”

The NFL has launched an investigation into the matter and time will tell (or it might not) if the Patriots are culpable in attempting to create an unfair advantage against the Colts. Underinflated footballs are easier for quarterbacks to grip and throw and are also easier to catch, especially in cold weather. The league mandates that all game balls be inflated to within a narrow pressure range.

Never mind the fact that the Patriots beat the Colts by more than six touchdowns; never mind that New England looked like far and away the best team in the conference throughout the latter portion of the season, continuing a decade-plus run of dominance almost unparalleled in modern professional sports, every football fan outside the greater Boston area seemed to assume the Patriots made it to the Super Bowl by cheating.

New England has been accused of breaking the rules before. In 2007, the team was accused and later found guilty of video recording an opponent’s defensive coaches signaling in plays, a practice the NFL explicitly forbids. This morphed into “Spygate” and resulted in the team losing its first round pick in the 2008 NFL Draft and being levied a quarter million dollar fine. (Head coach Bill Belichick was fined a half million dollars). This scandal coincided with the Patriots appearance in Super Bowl XLII on the heels of a record-setting undefeated regular season (they would lose to the New York Giants). Even though New England lost, many, including head coaches current and former, now declare their success tainted due to Spygate.

In fact, some NFL insiders believe that the Patriots indeed do operate using a “culture” of cheating. Players have accused them of being serial rule breakers; some even as far back as the 2001 season, which marked the first of their six Super Bowl appearances under Belichick. Coaches from rival teams have stated that many of the Patriot’s indiscretions haven’t been made public but yet are common knowledge among league personnel. Former Patriots employees who have left the organization have corroborated some of these claims, including Eric Mangini, the former Patriots defensive coordinator and ex-Jets and Browns head coach who initially accused Belichick and co. of taping his team’s defensive signals.

Add it all up and it seems difficult to defend New England’s innocence. Logic would tell most sports fans that this team’s run of success is tainted, that its victories should be recorded with an asterisk. Let’s stop right here for a minute. The New England Patriots since Belichick took over are one of the most successful organizations in all of professional sports; few individuals or teams (Jordan’s Bulls, Torre’s Yankees, mid-2000’s Jimmie Johnson) can match the Patriots’ run of success. As time goes on, Belichick’s Patriots will be remembered as a dynasty, a team operating at a level above its competition. Many would argue that they have greatly benefited from bending, tip-toeing over, and even blatantly disregarding the rules.

Maybe all of this is true. Maybe the Patriots have been a rogue organization engaging in illegal tactics to win football games. Maybe they do seek to gain any unfair competitive advantage they can over their opponents. If this happens to be the case, should we as football fans dismiss the team’s accomplishments over the past fifteen years on the basis of competitive disadvantage?

No way.

Regardless of if Tom Brady, the Patriot’s quarterback during this stretch of time in question, and the Patriots coaches knew some of their opponent’s defensive signals, and thus some of the defensive coverages, he still had to adjust the protection from his offensive line, audible to a play likely to work against the expected coverage, manage the play clock, take the snap, and complete the pass. In other words, the “cheating” was only a piece of the puzzle. Brady and the other ten players on offense still had to do their jobs. And they had to do consistently them at a high level, play after play, game after game, year after year to attain this kind of sustained success.

Take a second-string quarterback and give him the same information gleaned from the Spygate video tapes and put him on the field. Will he lead his team to playoff berths? Unlikely. Brady is a rare talent and is firmly entrenched in the discussion of one of the best professional football players ever. All of these instances of cheating, alleged and proven, distract from this fact.

The same holds true for underinflated footballs. Sure, they might be easier to catch, but the quarterback still has to read the defense, identify the open receiver amidst a sea of linemen and pass rushers and he has to make that throw on time and in a location where the receiver can make the catch. Put an offense from a 5-11 team on the field against the Colts in that AFC title game, deflate their footballs to whatever illegal specification they wish, and they will probably still struggle to win the game.

The point is that blanket statements about how cheating nullifies success detract greatly from everything else an athlete or team does to win the game. Regardless of the competitive advantage that’s obtained, if there even is one, there are still a multitude of things to be done in concert for that athlete or team to be successful.

Take, for another example, the success of NASCAR driver Jimmie Johnson, the winner of five consecutive Sprint Cup championships and a sixth in 2013. Johnson’s cars have failed inspections performed by NASCAR officials at least five times due to unapproved modifications. His crew chief, Chad Knaus, who has been at his helm for the entirety of Johnson’s historic run, has been penalized at least nine times for violating rules on car specifications. Some fans have speculated that NASCAR deliberately turns a blind eye to Johnson’s and Knaus’ bending of the rules. Others wonder if only divine intervention can explain Johnson’s dominance.

Just as with the case with the Patriots, there is much more to Johnson’s string of success than what are mostly minor technical infractions. He still had to drive the damn racecars. And drive them well, race after race, year after year, with Chad Knaus directing the pit stops, coordinating the fuel and tire strategies and car adjustments, and seeing that each week Johnson’s cars had high-performing engines and were tuned to provide maximize performance for a given racetrack.

Many fans have understandably grown frustrated with Johnson’s dominance as it has happened concurrently with a multitude of cheating allegations over the years. But these fans would be remiss to write off the career of one of the sport’s greatest drivers due to some seemingly minor rules infractions. It takes a tremendous amount of driving talent and technical expertise, not to mention some teamwork amongst a large and diverse racing team, to consistently win racing championships. The violations Johnson and Knaus have been accused of probably aided their success only a miniscule amount. It’s not like Johnson would have been at the back of the pack had it not been for an illegal fender or unapproved seatbelt.

There are endless examples that could aid our discussion but the following quote from former Phillies and Red Sox pitcher Curt Schilling is illustrative. With regards to the seemingly rampant cheating in baseball, particularly the alleged egregious use of anabolic steroids, Schilling remarked, “There isn’t a team in the last twenty years that has won clean.”

Perhaps he’s talking about his own Boston Red Sox, whom he said nudged him towards using performance-enhancing substances to recover from a pitching injury in 2008. A few years later, new allegations of Red Sox pitchers skirting the rules would surface. These allegations can be added to the growing mountain of other cheating accusations that have been made against baseball players over the years.

If we dig deeper across all sports we can find alleged examples numbering in the hundreds of teams and players infringing on competition rules. Recruiting violations in college football. Trained lip-readers spying on NFL coaches. Salary cap violations. Paying off referees. Performance enhancing substances. Racecars sitting too low. Blood doping. Cash payments for players who injure opponents on the field.

The list can go on. The point is that if we dismissed the accomplishments of every athlete or team on the basis of an alleged instance of cheating, we probably wouldn’t have many sports accomplishments to celebrate. The feats of incredible athletes would be erased from the record books. Cinderella stories could become irrelevant. Dominant teams would be forgotten. Entire dynasties might as well have never taken the field.

If we want to see an even competition between two equally matched opponents with no possible hint of an unfair advantage for one side, we can tune into the next televised spelling bee or chess match. But if we want to watch and celebrate true competitive drive, we’re going to have to tolerate a little rule bending from time to time. That’s the nature of sports. Filled with paranoid, hyper-competitive individuals who often obsess to the point of sickness over every loss, it’s understandable that we will see some occasional underhandedness in the pursuit of victory.

Don’t like it? Don’t watch the games. Don’t read the stories or play the fantasy sports. Don’t purchase the merchandise. And don’t incessantly ostracize the accused rule breakers and deny their accomplishments. It takes much, much more than a little deception to win championships at the professional level in any sport. By dismissing the success of every alleged cheater, you’re only showing your ignorance and spite as a fan.

So the next time a story breaks about, say, a Tour de France winner caught doping, just remember that although he may have cheated, the riders behind him were probably cheating as well. And despite all of this, he still had suffer to through two thousand miles over three weeks, fending off waves of competitors and his own pain and fatigue. He still had to ride the damn bike.

-D.H.

Open for business

Welcome to The Skeptic’s Tap Room.

This blog will serve as a place where we can discuss a wide range of topics, including libertarianism, current events, philosophy, healthcare, law, and sports. It will quickly become obvious to the reader that we as authors are not experts on any of these subjects. Nor are we skilled writers. Please feel free to comment on our posts with your thoughts. We look forward to writing about and discussing a variety of issues.