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Re: ans NEJM: shorter

Korcok makes some interesting arguments about eating disorders.  In
addition to some good analysis about some of the nonsense that has been
written on this subject, though, he also leaps to some unfortunate
conclusions.  I just want to bring up some relevant medical information
and point to some problems, so nobody ends up thinking that anorexia will
make you live longer.

> a) the "significant morbidity and mortality" from eating disorders is
> 
> absurd.  


<snipped out information about only 62 deaths from anorexia>

Okay, so the mortality isn't "significant," but what about morbidity?
More importantly, is mortality really the measure we should be applying
when talking about a mental illness?  Few people die of manic-depressive
disorder, so is it safe to ignore it?

> now, you all heard that Naomi Wolf 1991 card that says "150,000 American
> 
> women die of anorexia each year."  SHE LIED.  made it up.  Tofler et al

Actually, she just failed to check her facts.  That is quite different
from a deliberate fabrication.  Of course, it could have been deliberate,
but there is no evidence that it was.  That wasn't the point I wanted to
emphasize here, though.  The end of this fact-checking story is that
150,000 American women have eating disorders, though only 62 (or so) die
of them each year.  This indicates that there are a lot of women out there
who are starving themselves to try to fit some physical ideal.  I consider
that a problem, even if it is not killing most of them. 

> b) the "extent of eating disorders" research is ludicrous.  

Since neither of us (apparently) has in hand the survey used to determine
the percentages of female athletes suffering from eating disorders, this
seems like an offhand conclusion.  The underlying point you make is valid,
though.  Any time one talks about defining mental illnesses, there are
gray areas, and there will be variability (sometimes a lot) between
studies.  Let's be pessimistic and say that the figures above are off by
50%.  So we only have 75,000 American women suffering from eating
disorders.  That is over twice the population of Ithaca - is that
insignificant?

> c) Tofler et al HIDE the NET BENEFIT of being very underweight.  
> 

This is where I have a serious objection.  Korcok presents the intriguing
data about underweight individuals living longer lives than "average" 
weight individuals (and I understand why you like this study - at 145
pounds and 5'9", I like it, too). From that, he leaps to the idea that
"emaciated" is good.  Wait a minute.  The research quoted is talking about
people who are "underweight," not "emaciated."  This is not a study about
anorexics.

Furthermore, weight has a considerable genetic component, as I'm sure
Korcok is aware.  I do not have the papers in hand right now, but will
gladly provide references (or you can look up recent papers in _Science_
about the mouse genes "ob" and "tubby").  In addition to the mouse
studies, medical research has shown the obvious - fat parents tend to
produce fat kids, and skinny parents tend to produce skinny kids.  A
Samoan and a !Kung are different sizes for reasons that have little to do
with lifestyle.  Now suppose for a moment that genetically thin people are
living longer not because they have starved themselves to thinness, but
because they are naturally lightweight, and this cosegregates with genetic
markers for longevity.  Since the research in question did not explore
pedigrees, this claim remains as valid as Korcok's contention that
anorexia is good for you.  In fact, given that only 150,000 American women
are anorexic (at most), we could probably calculate the probability of
snagging a significant proportion of anorexics in this study.  Check my
math, but I think it comes out something like this:

P=5.36E-4*n; p=probability of having an anorexic woman in the study, and
n=number of women in the study.  If n=100, there is a probability of
0.0536  of having ONE anorexic in the group (about a 5% chance).

The bottom line: anorexia and bulemia are mental illnesses.  They should
not be regarded as the fountain of youth.  The relevant study would be to
look at mortality rates of anorexics (not just thin people).

          --Alan

__________________
Alan Dove
N3IMU
ad52@columbia.edu
http://hs1304silver1.cpmc.columbia.edu/Alan_Dove/Alan.html
References:
Archive created by Jonathan Stanton (jonathan@cs.jhu.edu)
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