Why in the hell do people wait so long to get married?

May 25, 2008 at 12:58 pm (Uncategorized)
Tags: ,

I was 21 when I proposed to my wife. I was spending the semester studying abroad in Italy, and I was surrounded by Italians and other Europeans who looked at me aghast when they learned that I was engaged to be married. I didn’t think much of it at the time. After all, I’d heard plenty about how Europeans, and Italians, in particular, were notorious for prolonging childhood well into their adult years (i.e. 30 year-olds living with their parents, declining birth-rates, etc.). If anything, I probably thought they were right, I was a little bit weird. Even by American standards, Lily and I were preparing to tie the knot well before most of our peers. Here’s a graph I put together from data available at Wikipedia (don’t know what’s wrong with the thumbnail, but the link seems to be working):

As you can see, the United States is somewhere in the middle of the pack across the nations surveyed, but it’s an outlier with respect to its developed cohort. Even still, the average age at first marriage for American men is 27, for American women, 25. From what I gather through personal experience and anecdote, though I don’t have any data at hand to back this up at the moment, those averages increase as people climb the economic ladder. As I’ve gotten older, and gained a little more perspective, I’ve become more and more perplexed by this trend, and I have to ask, what’s going on?

Here’s what I see. Most people I meet (right now heavily weighted towards yuppies and aspiring yuppies)that are my age (currently 26) are unmarried. Most of those approve of marriage as a general concept. Most of those (though a decidedly smaller percentage and with much less confidence) want to have kids. Yet very few of these are currently involved in long term relationships, and those that are seem to have no definite plans on actually getting hitched. Why not?

There was an interesting article in the Atlantic a few months ago describing the situation from the perspective of older-single women. The author even went so far as to propose a solution for younger single women: stop waiting for Mr. Right and start settling for Mr. Good Enough. Do you think she’s right? Are people really just too picky? Seems possible, but I think that may be giving most people too much credit. It seems like that might be a relatively painless way of averting an acknowledgment of fear of commitment. If that’s the case, I have to say that most people seem to have an idea of commitment which runs counter to my experience with marriage. Commitments are hard. Marriage is easy. Getting up every day to go to work is exhausting and requires a conscious effort to balance the rewards (paychecks) with the costs (cubicles and crowded subways). Coming home at night to spend time with my wife is easy. Chasing tail in bars is hard. Going to the movies, taking walks, and eating dinner with your best friend is easy. Having kids by yourself is hard. Having kids with a spouse is a little less hard.

So I ask you: Are you married? Do you want to be? When do you think you’ll get married? What are you waiting for? Just curious.

~Fox

10 Comments

Praying to ace an exam

October 25, 2007 at 1:59 pm (Uncategorized)
Tags: , , ,

I’m a medical student, and my classmates and I have an exam coming up. It’s not uncommon for students to send out study guides, flashcards, mistakes in lecture notes, etc to the entire class via our listserv – we’re generally a cooperative bunch and like to help out fellow classmates and save each other time. There are also occasions in which different school organizations send emails to the class advertising meetings, events, etc. Some of these organizations are strictly medical (interest groups related to every medical specialty imaginable), and others are religious or political in nature – “Catholic Medical Students Association”, “Med Students for Choice”, “Jewish Medical Students Association” – you name it, we’ve probably got a group for it. I’m an atheist, but generally am not bothered when these religious groups advertise to the entire class. They’re an organization, and it’s the easiest way to reach everyone until you have your first few meetings and narrow down your list of interested individuals.

But the most recent email I received was different. It was from a few of my Christian classmates who were advertising an hour long “prayer session.” I’m not sure how to explain it, but the email felt weird. They weren’t trying to be exclusive – indeed they specifically mentioned it didn’t matter whether you were “Christian or not” – but it still came across that way. It still made me feel like an outsider – a reminder that the majority of this country (some of my family members included) think I’m destined for hell, or that I’m the equivalent of a murderer or rapist. Maybe it wasn’t the tone of the email, but the fact that these classmates in particular like to conspicuously “advertise” themselves as Christian – one frequently has the word “Jesus” displayed quite prominently when he comes to class. When I see that, I can’t help but think he doesn’t want to pray with anyone “Christian or not”, but rather for them – to save their soul. Is this true? Maybe I’m wrong. They’re very nice people, but I still feel like they are judging me for my (lack of) beliefs.

Moving on from my initial impression, what also bothered me was what they wanted to gather and pray about. We’re in the middle of an infectious disease course, learning about all of these viruses and bacteria that cause death and destruction around the world. We learned about rotavirus, which kills around 650,000 children every year. Were they praying that children in developing countries could have access to sanitary water or a vaccine to prevent this infection? No! Part of our local patient population includes many poor and homeless people. Were they praying that these families would not have to worry about paying their next bill? No! Were they praying that the homeless man on the corner could get access to mental health-care and a safe place to sleep? No! They were praying so they could do well on our upcoming exam. That may reflect more on their personalities or the fact that they’re medical students rather than their religious background, but it came across as incredibly selfish.

I don’t even believe in the power of prayer to change outcomes (most recent evidence here), but I do think it can be beneficial for the person praying (as a form of meditation) or a person who knows that loved ones are praying for them (as a form of emotional support). However, regardless of whether it works or not, I must ask my classmates – seriously? Out of all the things you pray for, and you choose an exam?! Are you an idiot?! Do you not care about other people in the world?! Are you really that selfish?! And now, until they prove otherwise, my answer is…yes. They are that selfish. They would rather pray for a good grade then for a decrease in human suffering around the world. They would rather spend an hour praying to do well on an exam, than an hour studying (which is guaranteed to help them on the test). They would rather pray for an hour than spend an hour volunteering at a local homeless shelter and making a tangible difference in the life of a person. Maybe I’m crazy…but it seems like they’ve got their priorities wrong.

/rant

~ Lily

2 Comments

Archbishop hasn’t read recent abortion study

October 21, 2007 at 1:43 pm (Uncategorized)
Tags: , , , , ,

Or at least that’s the impression the Archbishop of Canterbury gives in his recent writings. He thinks that people see abortion as an “easy” option, rather than using it only in extreme cases:

“But the rapidly spiralling statistics – nearly 200,000 abortions a year in England and Wales – tell their own story. We are not now dealing with a relatively small number of extreme cases (and clinical advances have in fact reduced the number of strictly medical dilemmas envisaged in 1967 act’s supporters). When we hear, as in a recent survey reported in the Lancet, that one-third of pregnancies in Europe end in abortion, we may well ask what has happened.”

Ok, so he has read the Lancet article in question (or at least is aware of the journal issue). Why then, does he think abortion rates are “spiralling” simply because they are legal? I was under the impression that the study showed it didn’t matter whether abortion was legal or not – people still sought them at the same rate. I also like when people quote statistics such as “one-third of pregnancies in Europe end in abortion.” He means induced abortion, which is fine – but he should state that explicitly. He fails to say that 20-25% of recognized pregnancies result in spontaneous abortion. The percentage is probably even higher, given that many women spontaneously abort without being aware they were ever pregnant (I’ve heard it quoted as high as 40-50% taking that into account). People of God never like to quote that one (surprise, God kills babies too!). My favorite quote of the Archbishop – and by favorite, I mean the one I am most appalled by – is this (emphasis mine):

Recent discussion on making it simpler for women to administer abortion-inducing drugs at home underlines the growing belief that abortion is essentially a matter of individual decision and not the kind of major moral choice that should involve a sharing of perspective and judgment. And that necessarily means that certain presumptions have changed.

Seriously? Is that really what he believes? That there is a “growing belief” – implying a change in previous belief – that abortion is a decision made by an individual? Abortion has always been an individual decision – sure, a woman may consult friends and family members, but she is the one that has to go through with it. You can argue that she should consult the father of the baby (which is debatable), but she should never have to get permission from a complete stranger (archbishop, political figure, etc) in order to proceed. If you don’t want an abortion, don’t get one. If you think abortion is wrong, then try and intelligently communicate to people why you think it is wrong. But you should never get to tell someone what to do with their life, when their actions have no consequence to you. If you think a woman is damned to hell for eternity if she gets an abortion, then fine – that’s your belief. But her decision makes no difference to you and your spiritual quest. I may believe that it’s appalling when people eat meat, but that doesn’t mean I should get to ban you from ordering that hamburger the next time you go to a restaurant. It makes no difference to my life whether you do or do not consume meat. (this said after I just consumed eggs and sausage for breakfast)

I find it hard to believe that this Archbishop has ever met a woman who had an abortion – I doubt it’s an easy decision for most of them. They understand that it’s a baby – their baby, but they get the abortion because in their situation it is the best decision for them. Maybe they don’t have the means to care for the child. Maybe they’re not in a stable relationship, and want to raise the child in an environment with two capable parents. Or maybe they have a medical condition and don’t want to put their body through the stress of pregnancy. It shouldn’t matter. Plus, who wants to have any sort of medical procedure done “just because”? It carries certain risks, which most are aware of – but the benefit to their personal situation outweighs the risk.

I will give the Archbishop credit for acknowledging that there aren’t necessarily “absolutes” when it comes to deciding what is right or wrong:

“There is no escaping the tough decisions where no answer will feel completely right and no option is without cost. But when do we get to the point where accepting the inevitability of tough decisions that may hurt the conscience has become so routine that we stop noticing that there ever was a strain on the conscience, let alone why that strain should be there at all?”

I just disagree that women who get abortions don’t notice a strain on the conscience – they’re human beings after all, not unemotional robots. Perhaps if women had better access to contraceptives then there would be fewer abortions in the first place. I don’t know the Archbishop’s stance on that issue, but a lot of vocal anti-abortion people seem to be against those measures as well.

I also find his discussion on the issue of “fetal rights” interesting – that is, the “paradox” between legislation that would punish women who harm their unborn child (he gives the example of smoking or drinking) versus the legislation that protects a woman’s right to terminate the pregnancy. I don’t know much about those laws, but it makes for interesting debate. One thing I know for sure is that we do not give a fetus the same rights as a woman (at least in the past…perhaps the fetal-rights laws are changing that). This is because our society does not view someone as a “complete” person (with all rights) until they reach a certain age. You can’t drive until you’re 16, you can’t vote or enlist in the military until you’re 18, you can’t drink until you’re 21, and you can’t run for President until you’re 35. By the definitions we’ve put forth in our legislation, a fetus does not have the same rights as an adult. I think it’s harmful to say otherwise – to try and put the rights of an unborn child on the same level (or above, if you are restricting abortion) as the woman is a dangerous path.

As much as I disagree with most of the Archbishop’s opinion, I’m glad he wrote it. It’s helpful to think about these things from time to time, and to see how different each of our views can be. This is why I am a libertarian. We can continue to disagree, but under my political philosophy those disagreements remain personal, rather than public. My views on any issue will never trump yours, just as yours will never trump mine. Live and let live, so long as we don’t infringe upon the rights of each other.

To read the Archbishop’s entire letter, click here.

~ Lily

Leave a Comment

NY Restaurants win in battle with city over calorie content

September 16, 2007 at 11:39 am (Uncategorized)
Tags: , , , , , ,

I posted about this awhile ago (“Raise your hand if you think eating at McDonalds is good for you“), but now there is an update in the situation. First for some background: NYC sees rise in fat people, thinks citizens can’t think for themselves and wants to require restaurants to post nutrition info on menus directly next to food item of interest. Restaurant association gets upset – says it’s not fair, and that it punishes many of those who already voluntarily post the info on their website or chart in the restaurant.

Says Big Brother NYC officials:

The regulation will counteract “an obesity epidemic” in New York…The city argued that posting calorie information in a prominent place would have had “a substantial potential for public health impact” and that consumers were likely to decrease their intake if they knew how many calories they were eating.

The state restaurant association:

[They] challenged the regulation by arguing that it was technically superseded by the federal Nutrition Labeling and Education Act of 1990, which requires nutritional labeling on all packaged foods and outlines some criteria for restaurants that voluntarily post their own caloric information.

Manhattan District Court Judge Holwell took the side of the restaurants (though it appears there is still plenty of room left for the city to tweak the legislation so it’s legal).

I’ve got a couple points to make – first, NYC officials lose points for misusing the term “epidemic”. Obesity cannot be an epidemic, flu and other infectious diseases can (let me know if you ever get fat just from standing next to an obese person who breathes on or touches you, and I can add it into the epidemic category). Second – they thought that by merely making the information more obvious and in-your-face, that people will magically make healthy choices. Seriously? If you’ve already followed the fried-potato smell from the street into the McDonalds, you’re not going to turn around and walk out after seeing exactly how much fat is in that Big Mac. The people who eat at those places on a regular basis tend to order the same thing each time anyway, so they probably don’t even glance at the menu. (side note – I once knew someone who referred to a quarter pounder with cheese as a “snack” – all the labeling in the world won’t change that mindset) Third – NYC officials wrote the legislation because of the “potential” to make a public health impact. Aren’t you happy that the city experiments with your tax dollars, instead of spending time and money on things that are proven to benefit public health? Just gives me a warm fuzzy feeling…

But I’m not letting the restaurant association off too easy. A spokesperson for the group said that:

federal regulations that require nutritional information on packaged food have done little to combat obesity. “We feel the way to address obesity is through education, not legislation,” he said.

I’m willing to agree that nutritional info on packaged goods probably hasn’t had a huge impact. Although I tend to look at the labels when shopping in order to avoid foods really high in salt or saturated fat, my guess is someone who is not as health-conscious (and thus more likely to be obese) could care less that the labels are there. As for education over legislation, I don’t know how I feel about that. Certainly I won’t side immediately with legislation for its effectiveness – in my opinion legislation tends to consist more often than not of nanny-state regulations – an attempt to control how you live your life. But I’m not convinced education has a huge impact. Yes you need some education if you want to know what you should eat, but how many people who went to public schools and had the food pyramid beaten into them actually eat according to those guidelines? (I mean, let’s be honest – I know I don’t get the recommended amount of fruits and vegetables everyday.) Incentives are what people need – carrot and stick. Reward people for healthy choices, punish people for unhealthy choices. But this isn’t the job of the government (or it shouldn’t be, but of course I also don’t think they should be involved in health care to the extent they are) – health insurance companies and businesses that pay health insurance premiums for their employees are the ones who should be in the incentive-business. You don’t really have the option of switching countries if you disagree with the government, but you can always change jobs if you don’t like your employer.

To read about how financial incentives can help people lose weight, check out this article from the Journal of Occupational and Environmental Medicine (via SciGuy)

Source

Leave a Comment

Sept. 12 – A day of intercourse in Russia

September 11, 2007 at 7:54 pm (Uncategorized)
Tags: , ,

You can get off work for half a day if you pledge to have sex with your partner…and if you happen to give birth on June 12 (Russia’s national day) you could win a car or other prizes. It’s only for a region of Russia and not the entire country, but the idea is amusing, as it’s primary goal is to help boost the country’s dwindling population (and it seems to be working, at least for the particular region). A bit of a perverse way to win money, but I suppose there are worse things you could be doing than getting pregnant while in a relationship.

More on this strange story here.

1 Comment

Companies charging unhealthy employees

September 11, 2007 at 5:25 pm (Uncategorized)
Tags: , , ,

Private companies are beginning to charge extra for employees who are unhealthy – either through a higher insurance premium or through deductions from their pay (around $5 or $10 per paycheck depending on condition). It’s a bit different than the other side of the issue I’ve talked about before, which is offering discounts for healthy employees, but the outcome is the same – those who are unhealthy end up paying more. Some employees are happy about it, and see it as an incentive to get healthy:

“I knew if I wanted to be healthier and pay less, it was up to me to do something about it,” said Morrison, who has lost 54 pounds and lowered his body mass index enough to earn refunds the past two years.

Though of course not everyone will like the idea:

Some workers and employee advocates say companies are intruding in workers’ private lives.

The National Workrights Institute says employers adopting the charges are trying to control private behavior and amassing huge amounts of personal health information.

“It’s a backdoor approach to weeding out expensive employees,” legal director Jeremy Gruber said.

First off, I wouldn’t exactly call it an intrusion on their private lives. Yes the employers need certain health information, but if you want to keep it private technically you have the choice to pay the penalties or get insurance through a different source – obviously that is not ideal to most people, but it’s a choice nonetheless. As for weeding out expensive employees, I don’t think it will do that. I think the companies are simply getting real about the fact that health care inflation is out of control, and something needs to be done about it. It makes sense for smokers or the obese to pay more in premiums, because they will likely consume more care, and their conditions are preventable. If companies don’t start to make these changes, they won’t be able to offer insurance at all because it will be too expensive.

I really don’t understand the mentality where it’s considered wrong for an unhealthy person to have to pay more. If you fail to quit smoking, you should have to pay for your COPD treatment. If you need to lose 75 pounds because you never exercise and your diet is terrible, you should have to pay for the multitude of health problems that will inevitably result from your obesity (e.g. diabetes, hypertension, etc). It just doesn’t make sense for someone who doesn’t smoke, who exercises fairly regularly, and who eats healthy, to subsidize someone else’s poor choices. I could understand the uproar if the companies were trying to charge more for someone who got cancer – I mean, the whole point of insurance is to protect yourself against certain risks, and obviously the odds of a working age person getting cancer is small (whereas the odds of a smoker getting lung cancer or COPD is really high and thus not much of an “insurable” risk).

There’s an entire article from the AP discussing the issue: “Some Companies Penalize for Health Risks“

Leave a Comment

Obesity is not a ‘public health’ issue

August 28, 2007 at 12:09 pm (Uncategorized)
Tags: , , ,

Flu epidemics, SARS outbreaks, multi-drug resistant infections, etc – these are public health issues. Obesity is not. Flu is contagious and can easily pass from person to person, leading to serious injury or death in susceptible patients (i.e. elderly). It mutates, and can thus transform into a more dangerous strain and have the potential to kill quickly on a large scale if not controlled. Obesity is not contagious – you can argue that environment plays a role (hence the recent NEJM article about how obesity is “spread” through social circles), but ultimately most obesity can be prevented through actions of the individual. Eating in moderation along with physical activity does the trick for most, although of course there are hormonal imbalances and other health issues that may make it more difficult for a certain percentage. The term ‘public health’ has been led along a twisted path for so many years that it has lost its meaning, and is used to scare people and make hasty (and poorly constructed) policy decisions.

Why am I drawing attention to this distinction? Because a panel recently compiled a report called “F as in Fat: How Obesity Policies are Failing in America,” and has called for the government to formulate a national strategy for controlling obesity, essentially comparing it to a flu epidemic (side rant – “epidemic” implies the rapid spread of something infectious, thus obesity fails to qualify as an epidemic). Short of physically holding people’s hands to drag them to grocery store and pick out healthy food, or poking them with a cattle-prod to get them to exercise, I’m not sure what will a national strategy will accomplish. People know the food pyramid – this stuff is drilled into our heads in elementary school. They know they should exercise, and they don’t. The author mentions environmental problems that inhibit our ability to take action, such as suburban neighborhoods without sidewalks. I call BS on that. Almost every suburban neighborhood I’ve ever lived in had no sidewalks, and I still exercised. They are paved, after all, providing a suitable surface for walking, running, or even riding a bike. Most homes aren’t built on a busy highway, so traffic is not much of an issue. You don’t need a fancy gym membership to exercise (although those are nice if you can afford them).

The author also mentioned dangerous urban environments. I don’t think most urban areas are dangerous. I don’t have a statistic to back up this claim, but I live in the heart of a city right now and feel safe walking and running by myself in most areas during the day. Still, I acknowledge that there are neighborhoods in urban areas that are indeed very dangerous, and may make it difficult for people to feel safe walking around. I have a different solution for that, namely a change in our policy towards illicit drugs. The drug war has not worked to end, let alone diminish, drug usage in this country. Most urban violent crime seems to be associated with gang activity (and thus related to drug activity), so a change in strategy here would probably eliminate that problem, and create a safe neighborhood where citizens may freely roam. A committee debating obesity from a government office will have little impact in this regard.

The report also states that the “strategy of focusing on personal responsibility is failing.” Personal responsibility would not fail if people have sufficient incentives to take action. For me, as a medical student, learning about every possible disease (even though I know many are rare) is enough to make me paranoid about staying healthy. For someone else it might be looking good in a swimsuit, or feeling confident, or being able to walk a mile with their child without getting out of breath. But my guess is that those incentives don’t work for most people. Money, however, usually does. I knew of an insurance company at my last university that offered significant premium discounts (10-15%) for customers who agreed to live a healthier lifestyle. This included moderate exercise, no smoking, and weekly or biweekly phone calls from a nurse to check in and keep them on track. It is my opinion that we should be focusing on those kinds of incentives (or coming up with new ones), rather than continuing to publish government-approved guidelines or develop yet another “task-force” to evaluate the scope of the problem. New ideas are good and should be implemented first on a small scale to test their success – a bloated government program is a fail-proof way to ensure the status quo for a long period of time, and usually inhibits any real change.

Via CNN – “Report: National strategy needed to fight fat”

To read the entire report, click here (fair warning, it’s 120 pages long, and misuses “epidemic” 37 times)

2 Comments

What do video games and public health have in common?

August 20, 2007 at 8:15 pm (Uncategorized)
Tags: , ,

One (the video game) has been used to predict possible scenarios of real life disease outbreaks. Sound a bit strange? It started back a few years ago when the popular game, World of Warcraft, had a digital virus spreading amongst its players. From a 2005 article describing the situation:

The plagues started on September 13 after Blizzard updated the game to include, among other new content, a dungeon known as Zul’Gurub. In the heart of that dungeon sat Hakkar, an in-game demon, that cursed any characters who attacked it with Corrupted Blood, a damaging curse that spreads from player to player.

The disease would have not spread from the original dungeon but for the efforts of griefers. The online roleplaying game equivalent to terrorists, griefers would teleport their characters to inhabited areas or used their pets as plague carriers to spread the disease to the general population of a server, according to postings on various community sites.

So it probably would not have been an epidemic if it weren’t for some malicious individuals using their pets to spread the disease. Still, Nina Fefferman, a medical epidemiologist at Princeton University, found inspiration in the scenario (or just a lot of useful data?). Instead of placing the blame on the ‘griefers’ (aka terrorists), Efferman attributes the spread of the virus to “the stupid factor,” something she apparently hadn’t considered before.

“Someone thinks, ‘I’ll just get close and get a quick look and it won’t affect me,'” she said.

“Now that it has been pointed out to us, it is clear that it is going to be happening. There have been a lot of studies that looked at compliance with public health measures. But they have always been along the lines of what would happen if we put people into a quarantine zone — will they stay?” Fefferman added.

“No one have ever looked at what would happen when people who are not in a quarantine zone get in and then leave.”

Ah…human stupidity…now a (new) factor in epidemiological studies. While I certainly can’t argue that it’s something that should be included in her analysis, I’m not sure if a video game world is completely applicable to real life (though I know some people who get way too involved in their games and start talking about it as if it’s real life). In World of Warcraft it seems, based on the little I’ve read, it was a group of individuals responsible for most of the outbreaks. I understand that there is always the possibility of some crazy nut trying to intentionally infect people, but I question to what degree that would happen in real life where there is also then the possibility of infecting friends and loved ones in the process (not to mention the death is…well…real). Plus in the game the characters could teleport themselves…last time I checked we didn’t have that ability, which I imagine would slow the spread of the virus. Regardless, it’s always difficult to model what would happen in real life…I’m not an epidemiologist -I just think it’s cool that video games are influencing real research. Perhaps we have yet to discover the deep wisdom of Super Mario Bros. and other games…

Reuters article on Fefferman and the ‘stupid factor’

Article discussing 2005 World of Warcraft virus outbreak

3 Comments

“237 Reasons to have sex” part II

August 1, 2007 at 12:10 pm (Uncategorized)
Tags: ,

The University of Texas article has been posted in its entirety here.  More interesting than simply giving the overall rankings of reasons is Table 3, which lists those answers differing the most between men/women.  The authors write that:

Women exceeded men on only three of the 237 reasons (at p < .005): “I wanted to feel feminine”; “I wanted to express my love for the person”; “I realized that I was in love.”

I can’t really say that surprises me, but its difficult to know whether women are more likely to have sex to express their love, or if they are just more likely to give that reason when asked.

Via newsday.

Leave a Comment

237 reasons to have sex

July 31, 2007 at 5:24 pm (Uncategorized)
Tags: ,

Or at least 237 reasons given by a survey of University of Texas students, as part of a research study conducted by Cindy M. Meston and David M. Buss (published in August’s issue of “Archives of Sexual Behavior”).  I don’t have access to the full article via my university yet, but you can read a summary of the findings via the NY Times here.

The responses range from burning calories to making babies, but what surprises me is that those 237 reasons are only from about 400 students.  Who would have thought there would be such diverse responses among such a small sample size?  Quite amusing to say the least.

Leave a Comment