tag:theconversation.com,2011:/us/topics/viewpoints-7274/articlesViewpoints – The Conversation2020-11-25T15:58:23Ztag:theconversation.com,2011:article/1504292020-11-25T15:58:23Z2020-11-25T15:58:23Z‘Constructive arguing’ can help keep the peace at your Thanksgiving table<figure><img src="https://images.theconversation.com/files/371292/original/file-20201125-18-1l7j574.jpg?ixlib=rb-1.1.0&rect=310%2C567%2C4980%2C3358&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Those with different perspectives don’t have to butt heads.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/brothers-having-a-discussion-while-on-a-family-royalty-free-image/1210634816">FluxFactory/E+ via Getty Images</a></span></figcaption></figure><p>Sex, income, religion and politics – these are some of the biggies on the list of taboo topics during polite discussion. Even a conciliatory tone doesn’t always protect you if the subjects are spicy. When singer Katy Perry once tweeted post-election encouragement to reach out to family members who supported the other candidate, <a href="https://www.independent.co.uk/arts-entertainment/music/news/katy-perry-trump-family-us-election-b1718881.html">she was skewered online</a>.</p>
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<p>Traditionally the year-end holidays are a time when friends and family with diverse points of view gather. In a pre-Thanksgiving Pew Research Center survey in 2018, people who reported more family discord about politics were <a href="https://www.pewresearch.org/fact-tank/2018/11/20/most-say-their-family-is-ok-with-discussing-politics-but-it-helps-if-the-family-agrees/">less likely to be comfortable talking politics</a> with their family, with 40% of respondents saying they try to avoid the subject.</p>
<p>Even during this tumultuous year, with stress running high for so many reasons, there are ways to discuss politics without the shouting and angst. Based on courses I teach on <a href="https://utdallas.academia.edu/JamesHoneycutt">conflict resolution in relationships and organizations</a>, here’s my practical advice, whether you’re connecting via Zoom or in person.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/371294/original/file-20201125-13-wsdr0a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman and man arguing at table" src="https://images.theconversation.com/files/371294/original/file-20201125-13-wsdr0a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/371294/original/file-20201125-13-wsdr0a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/371294/original/file-20201125-13-wsdr0a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/371294/original/file-20201125-13-wsdr0a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/371294/original/file-20201125-13-wsdr0a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/371294/original/file-20201125-13-wsdr0a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/371294/original/file-20201125-13-wsdr0a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">What do you have to gain by letting the conversation get heated?</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/family-of-4-having-a-discussion-at-dinner-table-royalty-free-image/161097992">Klaus Vedfelt/DigitalVision via Getty Images</a></span>
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<h2>Keeping the conversation conflict-free</h2>
<p>During arguments, it’s easy to fall into what marriage therapist John Gottman calls the <a href="https://www.gottman.com/blog/the-four-horsemen-recognizing-criticism-contempt-defensiveness-and-stonewalling/">four horsemen of the apocalypse</a>: contempt, criticism, defensiveness and withdrawal. Once you go there, it’s hard to have any kind of constructive or positive outcome.</p>
<p>Here are the rules I’ve developed for <a href="https://doi.org/10.1177/026540759301000208">constructive arguing</a> among couples:</p>
<ul>
<li>Show positive understanding – “I get where you’re coming from.”</li>
<li>Exhibit rationality – for instance, keep cool, don’t raise your voice.</li>
<li>Be concise, be specific, don’t generalize.</li>
<li>Show consideration – for example, don’t push your view as the only one.</li>
</ul>
<p>It’s easy to get frustrated and start letting go of these ideals, especially in the heat of the moment.</p>
<p>A <a href="https://www.routledge.com/The-Process-of-Highly-Effective-Coaching-An-Evidence-Based-Framework/Hicks/p/book/9781138906013">coaching strategy</a> that encourages empathic understanding can help here. Known as support for thought, this technique encourages you to support your counterpart’s willingness and ability to think constructively. You show respect for their different point of view and ask questions that reflect active and supportive listening.</p>
<h2>Changing minds through discussion</h2>
<p>Maybe you have higher aims than just keeping the peace. Sometimes you really want to challenge someone’s beliefs. There are ways to do so constructively.</p>
<p>For example, you can try to get your family member to recognize a discrepancy between their current anxiety and their ideal future by suggesting some outcomes that are counter to their current beliefs.</p>
<p>Imagine your aunt is scared of losing health insurance. What she hopes for in the future is affordable health care. If you can recognize where she’s coming from and where she wants to wind up, you can bring up a point that might not fit with her current view but that would help her accomplish her goals – like mentioning the possibility of using less expensive telemedicine options. You’re using <a href="https://ebrary.net/8755/psychology/empathic_understanding">empathic understanding</a>, identifying with the perspective of another.</p>
<h2>Brains like to keep it simple and the same</h2>
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<a href="https://images.theconversation.com/files/371296/original/file-20201125-21-1lh8z1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman not liking what she's hearing from man" src="https://images.theconversation.com/files/371296/original/file-20201125-21-1lh8z1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/371296/original/file-20201125-21-1lh8z1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=644&fit=crop&dpr=1 600w, https://images.theconversation.com/files/371296/original/file-20201125-21-1lh8z1v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=644&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/371296/original/file-20201125-21-1lh8z1v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=644&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/371296/original/file-20201125-21-1lh8z1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=809&fit=crop&dpr=1 754w, https://images.theconversation.com/files/371296/original/file-20201125-21-1lh8z1v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=809&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/371296/original/file-20201125-21-1lh8z1v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=809&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Accept that some people aren’t open to a new perspective.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-speaking-with-senior-man-royalty-free-image/pha120000025">Patrick Sheandell O'Carroll/PhotoAlto Agency RF Collections via Getty Images</a></span>
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</figure>
<p>You might save yourself some unpleasantness if you keep in mind the old maxim that you can’t teach an old dog new tricks. People can change their minds – but it’s not easy. The human default is to <a href="http://psychology.iresearchnet.com/social-psychology/social-cognition/belief-perseverance/">stick to your beliefs</a>.</p>
<p>For one thing, people are cognitive misers and it’s more efficient to adhere to pre-existing beliefs. It takes time, research and mental effort to make a change. Back in the 1950s, <a href="http://webspace.ship.edu/cgboer/genpsypiaget.html">psychologist Jean Piaget called the process</a> of modifying your existing ideas as a result of new information or new experiences “accommodation.”</p>
<p><a href="https://www.earlyyearseducator.co.uk/features/article/assimilation-and-plasticity-help-to-shape-the-brain">Neuroscience research</a> reveals that the way the brain’s connected makes it easier to assimilate new information that reinforces existing beliefs than to “unlearn” old information and replace it.</p>
<p>Political beliefs appear to be particularly “mindless” – people don’t tend to spend a lot of time <a href="https://doi.org/10.2190/IC.34.2.b">internally rehearsing their arguments</a> when those claims fall along party lines. People rely a lot on existing stereotypes as shortcuts as they move through political discussions. </p>
<p>So, if a person is not receptive to your political arguments after you’ve given it your best shot, maybe you can take heart in knowing you’re up against brain functions that have evolved over millennia to help people make efficient decisions without needing to painstakingly analyze every new bit of data.</p>
<p>Since the alternative is utter futility and fatalism, try to keep hope alive that compromise does sometimes occur. With any luck your holiday discussions, when approached calmly and respectfully, can provide some examples.</p><img src="https://counter.theconversation.com/content/150429/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James M. Honeycutt does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Talking with people who hold different political views doesn’t have to be an exercise in futile rage. Here are some tips to help you peacefully and fruitfully discuss spicy topics.James M. Honeycutt, Lecturer in Executive Education; Distinguished Professor Emeritus of Communication Studies from Louisiana State University, University of Texas at DallasLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1098822019-01-17T03:41:42Z2019-01-17T03:41:42ZViewpoints: should teaching students who fail a literacy and numeracy test be barred from teaching?<figure><img src="https://images.theconversation.com/files/253812/original/file-20190115-180504-1riovcq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Starting this year, teaching students won't be able to register as teachers unless they pass a literacy and numeracy test.</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>Starting this month, teaching students who fail or haven’t yet taken the <a href="https://teacheredtest.acer.edu.au/">Literacy and Numeracy Test for Initial Teacher Education</a> (LANTITE) will not be able to teach in Victorian schools. Previously, around <a href="https://www.theage.com.au/national/victoria/teachers-must-now-pass-mandatory-literacy-numeracy-tests-20190114-p50rbh.html">one in 20</a> teachers who had failed the test or hadn’t taken it yet received provisional registration. Prospective students who took the test late in 2018 received their results <a href="https://teacheredtest.acer.edu.au/results">on January 11</a>.</p>
<p>Victoria is the first state to implement these new standards. The test is a <a href="https://www.education.gov.au/literacy-and-numeracy-test-initial-teacher-education-students">federal initiative</a>. By 2020, all states and territories will be required to ensure all new teachers pass the test before registration. </p>
<p>The test is meant to ensure all new teachers can read, write and perform simple maths equations. In this Viewpoints, Lynn Sheridan argues this test can’t predict a teacher’s effectiveness, while Nan Bahr argues we should prevent teaching students who haven’t yet passed, or who fail the test, from registering.</p>
<hr>
<p><strong>Lynn Sheridan:</strong> The <a href="https://teacheredtest.acer.edu.au/">Literacy and Numeracy Test for Initial Teacher Education</a> (LANTITE) is limited in assessing the future quality of teachers. This test only assesses the students’ baseline literacy and numeracy skills for teaching in the classroom. It is modelled on year nine NAPLAN tests, complex to administer and <a href="https://www.smh.com.au/politics/federal/a-total-shambles-new-literacy-and-numeracy-test-for-teachers-frustrates-students-educators-20160901-gr6hi7.html">expensive for students to access</a>. </p>
<p>This means students who don’t have the means to pay the A$185 fee (up to three times) will be barred from registration, regardless of their efficacy as a teacher. It also doesn’t test for a range of <a href="https://cdn.theconversation.com/static_files/files/449/2_TEMAG_Submissions_AustralianCouncilofDeansofEducation_16072014_TEM1400196.pdf?1547689792">personal attributes</a> essential to good teaching, including interpersonal and communication skills, resilience and passion for teaching. And it measures their test-taking ability, not their ability to teach that knowledge in practice.</p>
<p>Increased attention on how we select teachers for initial teacher education programs and employment is needed. <a href="https://www.aitsl.edu.au/deliver-ite-programs/learn-about-ite-accreditation-reform/understand-ite-student-selection">Research</a> shows we need to pay attention to both academic <em>and</em> non-academic capabilities to recruit the most appropriate teachers. </p>
<p>Ensuring initial teacher education programs are effective and high quality are now <a href="https://www.aitsl.edu.au/deliver-ite-programs/learn-about-ite-accreditation-reform/improving-ite-assessment">national education priorities</a>. But there has been little systematic focus on how we make decisions about choosing teachers for the classroom, or students for initial teacher education programs. </p>
<p>Teacher effectiveness can only be measured by <a href="https://www.rand.org/education-and-labor/projects/measuring-teacher-effectiveness/teachers-matter.html">how they support their students’ achievement</a>. A new teacher needs job opportunities and colleagues who support their teaching. <a href="http://comments.bmartin.cc/2016/05/19/practise-and-keep-practising/">Research</a> shows practise is far more important than natural talent. </p>
<p>It takes <a href="https://www.aitsl.edu.au/lead-develop/develop-others/support-new-teachers">time, practice and support</a> for a new teacher to fully understand the demands of the profession and become an effective teacher. The personal attributes of the person selected, their development and commitment to improvement, teaching opportunities and guidance are crucial to good teaching. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/254007/original/file-20190115-152974-14ozv7q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/254007/original/file-20190115-152974-14ozv7q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/254007/original/file-20190115-152974-14ozv7q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/254007/original/file-20190115-152974-14ozv7q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/254007/original/file-20190115-152974-14ozv7q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=473&fit=crop&dpr=1 754w, https://images.theconversation.com/files/254007/original/file-20190115-152974-14ozv7q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=473&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/254007/original/file-20190115-152974-14ozv7q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=473&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Testing prospective teachers for literacy and numeracy alone is not enough.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<hr>
<p><strong>Nan Bahr:</strong> The vital life skills of literacy and numeracy are learned and honed at school and they must be taught and demonstrated by every teacher. Send away applicants for teacher registration who can’t meet the mark. Link them up with support programs for literacy and numeracy, and only provide provisional registration when they have met the standard. We know <a href="https://www.couriermail.com.au/news/queensland/lack-of-qualified-maths-teachers-causes-fraction-friction-in-high-schools/news-story/f822338b7c36a5facc0d0b66035e3d21">parents expect it</a>.</p>
<p>If we want our children to be fully literate, and numerate, they need to be taught by people who have a high level of personal skill. The <a href="https://teacheredtest.acer.edu.au/results/re-sit">literature</a>, <a href="http://63angel.blogspot.com/2012/05/teachers-who-cant-spell.html">social media</a> and intuition tell us how important it is for teachers to have strong personal literacy and numeracy capabilities. They’ll struggle to employ the required skills for instant feedback in spotting basic errors and appropriately correcting them: fundamental for enhancing learning. It’s unlikely they’ll be able to unpick complex texts, problems, and ideas with their students. </p>
<p>As teachers, they need a deep understanding of what it means to be literate and how they can lead learners to their own <a href="https://www.tandfonline.com/doi/abs/10.1080/00377990309600190?journalCode=vtss20">functional and critical literacy</a>. Without this, our children will not be enabled to be effective communicators of their ideas or self-reliant as functional adults.</p>
<p>These capabilities are <a href="https://ro.ecu.edu.au/cgi/viewcontent.cgi?referer=https://scholar.google.com/&httpsredir=1&article=8136&context=ecuworks">important life skills</a>. Without numeracy and critical literacy skills, a person will struggle. A calculator won’t help without a conceptual understanding of what needs to be calculated and why. A spell check won’t help comprehension of the messaging in written communication. A grammar check won’t help anyone be a powerful writer capable of advocating for themselves or their families. </p>
<p>If we want these capabilities for our children, teachers must have them. Some might say to leave it as a requirement only for the English and maths teachers, but functional and critical literacy and numeracy are a feature of <a href="http://discovery.ucl.ac.uk/10005332/2/Casey2002-03New1.pdf">every discipline area</a>. </p>
<p>The Literacy and Numeracy Test for Initial Teacher Education regularly identifies pre-service teachers <a href="https://www.couriermail.com.au/news/queensland/trainee-teachers-fail-spell-maths-test/news-story/87175c3ac7c418abc6bcd302f42eeb76">who struggle</a>. There is an opportunity to <a href="https://teacheredtest.acer.edu.au/results/re-sit">re-sit the tests</a> multiple times. But if a pre-service teacher can’t pass, they’re clearly not ready to oversee student literacy and numeracy development. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/254008/original/file-20190115-152962-130uk1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/254008/original/file-20190115-152962-130uk1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/254008/original/file-20190115-152962-130uk1p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/254008/original/file-20190115-152962-130uk1p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/254008/original/file-20190115-152962-130uk1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/254008/original/file-20190115-152962-130uk1p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/254008/original/file-20190115-152962-130uk1p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If a student teacher can’t pass the test, they’re clearly not ready to oversee student literacy and numeracy development.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<hr>
<p><strong>Lynn Sheridan:</strong> The literacy and numeracy test (LANTITE) is a useful indicator of a graduate teacher’s ability to pass a year nine NAPLAN style test. It’s only a very simplistic “first pass” instrument to determine suitability of students for the teaching profession.</p>
<p>The LANTITE test does not determine a teacher’s level of personal skills, intuition or life skills. It simply tests baseline literacy and numeracy skills at a year nine level only.</p>
<p>Current <a href="https://lsia.acu.edu.au/graduatetpa/">research</a> suggests it would be better to assess a graduate teacher’s suitability for teaching based on their teaching performance and teaching degree results.</p>
<p>Much more is required to develop quality graduate teachers. Firstly, they should be selected on both academic and non-academic attributes, then supported in their education and into the teaching profession. Through this coordinated, long-term approach, student teachers can develop as effective teachers.</p>
<hr>
<p><strong>Nan Bahr:</strong> There is definitely <a href="https://www.teachermagazine.com.au/articles/dr-seuss-and-quality-teaching-part-1-today-you-are-you">more to teaching</a> than <a href="https://www.teachermagazine.com.au/articles/dr-seuss-and-quality-teaching-part-2-there-is-fun-to-be-done">functional</a> personal literacy and numeracy. I also agree tests are inexact measures for understanding the deep and nuanced dimensions of critical <a href="https://www.alea.edu.au/documents/item/1196">literacy</a> and <a href="http://www.statvoks.no/EMMA/MvG_Functional_Numeracy_2003.pdf">numeracy</a>. But we shouldn’t forgive people who have not yet demonstrated functional literacy and numeracy and allow them to be registered teachers anyway.</p>
<p>A teacher’s perceived professionalism is <a href="http://63angel.blogspot.com/2012/05/teachers-who-cant-spell.html">undermined</a> if their written communication is poor, or if they can’t do simple calculations. Even apart from the classroom context, a teacher’s letter to parents peppered with spelling errors, or assessments with miscalculated grades undermine the professional perceptions of the capabilities of teachers to teach complex ideas.</p>
<p>The profession’s reputation and status can’t withstand such a body blow. We should fully support the requirement for teachers to demonstrate basic literacy and numeracy skills prior to professional registration.</p><img src="https://counter.theconversation.com/content/109882/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Changes to the literacy and numeracy standards for new teachers in Victoria have raised questions about what makes a ‘good’ teacher.Lynn Sheridan, Senior Academic Professional Studies, University of WollongongProfessor Nan Bahr, Deputy Vice Chancellor (Students)/ Dean of Education, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/795642017-07-05T20:07:46Z2017-07-05T20:07:46ZViewpoints: should euthanasia be available for people with existential suffering?<figure><img src="https://images.theconversation.com/files/174113/original/file-20170616-519-10jl6t1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Existential suffering refers to an individual experiencing a lack of meaning or sense of purposelessness in life.</span> <span class="attribution"><a class="source" href="https://unsplash.com/search/beach?photo=zUI1hH5uXgE">Zack Minor/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Euthanasia debates often focus on people experiencing unbearable physiological or psychological suffering. But <a href="http://www.nejm.org/doi/full/10.1056/NEJMms1700606">research suggests</a> “loss of autonomy” is the primary reason for requesting euthanasia, even among patients with terminal cancer. <a href="http://jme.bmj.com/content/37/12/727.short">There have also been suggestions</a> existential suffering could be one of the main motivations behind such requests. </p>
<p>Existential suffering refers to an individual experiencing a lack of meaning or sense of purposelessness in life. Such sentiments bring feelings of weariness, numbness, futility, anxiety, hopelessness and loss of control, which may lead a dying patient to express <a href="http://www.sciencedirect.com/science/article/pii/S0272735807001341">a desire for death</a>. </p>
<p>Some <a href="http://jme.bmj.com/content/40/2/104.short">bioethicists argue</a> it is inconsistent to allow euthanasia for terminal illness but not for existential suffering, as both are a source of profound pain and distress. While existential suffering usually tracks closely with catastrophic illness, it’s worth considering a situation in which there are no motivating medical reasons for a request for euthanasia or assisted suicide. Should a person be eligible purely on the basis they no longer wish to live?</p>
<p><a href="http://www.independent.co.uk/life-style/health-and-families/health-news/gill-pharaoh-healthy-former-nurse-75-takes-own-life-at-assisted-dying-clinic-after-deciding-old-age-10433954.html">A case in point</a>: a largely healthy retired palliative care nurse in the UK who ended her life at an assisted suicide clinic in Switzerland. Should she have received medical aid in dying based on her carefully considered decision that she did not want to subject herself to the perceived awfulness of the ageing process?</p>
<hr>
<h2>The case against</h2>
<p><strong>Xavier Symons, Research Associate, University of Notre Dame Australia</strong></p>
<p>Some may think people who request euthanasia do so because of excruciating and unremitting pain. The reality is almost always more complex. <a href="https://www.ncbi.nlm.nih.gov/pubmed/19771571">Literature</a> on <a href="https://www.mja.com.au/journal/2017/206/8/euthanasia-and-physician-assisted-suicide-focus-data">assisted dying</a> suggests individuals who request euthanasia are typically suffering from a profound sense of purposelessness, loss of dignity, loss of control, and a shattered sense of self. </p>
<p>A 2011 study of Dutch <a href="https://www.ncbi.nlm.nih.gov/pubmed/21947807">patients who requested euthanasia</a> indicated that “hopelessness” – the psychological and existential realisation one’s health situation will never improve – was the predominant motivation of patients who requested euthanasia. </p>
<p>And a recently published Canadian study of <a href="http://www.nejm.org/doi/full/10.1056/NEJMms1700606">requests for medical assistance in dying</a> stated “loss of autonomy was the primary reason” motivating patients to end their lives. Symptoms also included “the wish to avoid burdening others or losing dignity and the intolerability of not being able to enjoy one’s life”.</p>
<p>One option to address such requests is to establish a state apparatus to assist patients in ending their lives. An alternative, and one I would advocate, is to address deficiencies in health care infrastructure, and attempt to alleviate the unique suffering that drives patients to request euthanasia in the first place. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/176564/original/file-20170703-32638-1foib3v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/176564/original/file-20170703-32638-1foib3v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/176564/original/file-20170703-32638-1foib3v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/176564/original/file-20170703-32638-1foib3v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/176564/original/file-20170703-32638-1foib3v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/176564/original/file-20170703-32638-1foib3v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/176564/original/file-20170703-32638-1foib3v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/176564/original/file-20170703-32638-1foib3v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Spiritual or existential care can help someone who feels their life has lost meaning.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>New approaches to end of life care, such as <a href="https://theconversation.com/spiritual-care-at-the-end-of-life-can-add-purpose-and-help-maintain-identity-55636">spiritual or existential care</a>, engage at a deep level with the complexity of the suffering of patients with terminal illness. And, as has been stressed by <a href="http://www.abc.net.au/news/2017-05-26/calls-to-prioritise-palliative-care-before-passing-euthanasia/8561960">several</a> <a href="http://www.theaustralian.com.au/opinion/columnists/paul-kelly/legalise-euthanasia-and-compassionate-society-dies-too/news-story/edac86177f0480632d02da83a2225c6d">commentators</a>, there is a need to improve access to palliative care in poorer regions, and provide optimal symptom management for patients wishing to die at home. </p>
<p>We could hypothesise about various situations where a person might request euthanasia without having a medical condition. Someone might wish to hasten their death because they are <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8519.2007.00535.x/full">tired of life</a> or <a href="http://www.bbc.com/news/uk-england-london-33759490">afraid of ageing or death</a>. </p>
<p>These cases are interesting insofar as they are not motivated by an underlying pathology. Yet there is much reason for concern. </p>
<p>Sanctioning euthanasia for the tired of life veers too close to a government endorsement of suicide. Where the state has a significant stake in suicide prevention, sanctioned euthanasia for existential suffering is not only counterproductive, it’s dangerous. Fundamentally, we would erode any meaningful difference between cases of suicide we regard as acceptable, and those we see as regrettable and befitting state intervention. </p>
<p>We might regard it as regrettable that an educated, wealthy 30-year-old takes their own life due to an existential crisis. Yet it is difficult to say how this is different in morally relevant respects from a 75-year-old who feels their life is complete and is undergoing an existential crisis. </p>
<hr>
<h2>The case for</h2>
<p><strong>Udo Schuklenk, Professor and Ontario Research Chair in Bioethics, Queen’s University, Canada</strong></p>
<p>This discussion is mostly hypothetical. There seem to be few, if any, <a href="https://www.rijksoverheid.nl/binaries/rijksoverheid/documenten/rapporten/2016/02/04/rapport-adviescommissie-voltooid-leven/01-adviescommissie-voltooid-leven-voltooid-leven-over-hulp-bij-zelfdoding-aan-mensen-die-hun-leven-voltooid-achten.pdf">real-world cases</a> where a competent person’s request for an assisted death is not motivated by an irreversible clinical condition that has rendered their lives not worth living in their considered judgement.</p>
<p>For instance, <a href="https://www.rijksoverheid.nl/binaries/rijksoverheid/documenten/rapporten/2016/02/04/rapport-adviescommissie-voltooid-leven/01-adviescommissie-voltooid-leven-voltooid-leven-over-hulp-bij-zelfdoding-aan-mensen-die-hun-leven-voltooid-achten.pdf">in the Netherlands</a>, most people who ask for euthanasia and who are not suffering from a catastrophic illness, typically experience a terrible quality of life that is caused by an accumulation of usually age-related ailments. These involve anything from incontinence to deafness, blindness, lack of mobility and the like. </p>
<p>We do not give up on life for trivial reasons. Just think of the many refugees who – on a daily basis – are willing to risk their lives to escape an existence they do not consider worth living. Ending their lives is not typically on top of their to-do list. </p>
<p>The case of the anti-choice activists – who deny there is ever a justifiable reason for euthanasia – has been <a href="http://onlinelibrary.wiley.com/doi/10.1111/bioe.12372/full">intellectually and politically</a> defeated. None of the jurisdictions that have decriminalised assisted dying have reversed course, and more jurisdictions are bound to make this end-of-life choice available. </p>
<p>Public support remains strong in each permissive jurisdiction, particularly so in <a href="https://link.springer.com/article/10.1007/s00038-013-0461-6">Belgium and the Netherlands</a> where the majority of citizens support the existing laws.</p>
<p>Inevitably the question of scope must be addressed: who ought to be eligible to ask for and receive assistance in dying? If a competent person wishes to see their life ended for non-medical reasons, and asks for assistance to do so, I think <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-8519.2011.01939.x/abstract">a just society</a> ought to oblige him or her if the following conditions are met: </p>
<ol>
<li>the person has decisional capacity (is of “sound mind”)</li>
<li>the decision is reached voluntarily (without coercion)</li>
<li>no reasonable means are available, that are acceptable to the person, that would render their lives worth living again in their own best judgement</li>
<li>based on everything we know, the condition that motivated their request is irreversible.</li>
</ol>
<p>The view that medicine is a profession aimed only at maintaining life, regardless of a patient’s quality of life, <a href="https://us.macmillan.com/books/9780312144012">is dying its own death</a>. If a clinical, psychological or other professional intervention does not benefit a patient to such an extent that they consider their continuing existence worthwhile, by definition that is not a beneficial intervention. </p>
<p>Equally, if an intervention, at a burden acceptable to the person, renders in their considered judgement their lives worth living again, they will not ask for an assisted death.</p>
<p>In most corners of the world people have fought hard to increase their individual freedoms to live their lives by their own values. A significant state interest is harmed if the state wishes to infringe on such autonomy rights.</p>
<hr>
<p><strong>Xavier Symons</strong></p>
<p>It is true the health system, and indeed the state, should respect patient autonomy. Yet in practice we often put other considerations ahead of concerns like autonomy. Patients may not receive the treatments they request for a variety of reasons, like they may be prohibitively expensive, have a negligible chance of success, or no medical justification. </p>
<p>I believe if it is harmful to the interests of the state to legalise euthanasia for patients without a terminal illness, then the state has a right to refuse. </p>
<p>Significantly more research needs to be conducted on the social impacts of euthanasia, and physician assisted suicide, for patients without a medical condition. In this case, we have no <a href="http://www.oregon.gov/oha/ph/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx">“Oregon model”</a> – an assisted suicide regime seen by many as an example of a safe and well-regulated system – to confirm or assuage our concerns. Jurisdictions such as Oregon only allow assisted suicide for patients with a terminal illness.</p>
<hr>
<p><strong>Udo Schuklenk</strong></p>
<p>I echo Xavier’s plea to improve health care in order to improve our quality of life, and, as a likely corollary of this, to reduce the number of requests for medical aid in dying. However, even in the best of all possible health care worlds, unless unbearable suffering itself has been eliminated, some patients will ask for an assisted death. No amount of “dignity therapy” rhetoric and references to small-scale studies changes that fact of the matter. </p>
<p>Xavier correctly mentions some reasons for doctors justifiably not providing certain patient-requested medical care. They are all based in different ways on harm-to-others justifications such as resource allocation rationales, or are futility-related (arguably also a case of harm-to-others given the reality of limited health care resources). This reasoning is not applicable to the case under consideration given the self-regarding nature of the request. </p>
<p>Xavier is correct that the state would be under no obligation to legalise euthanasia for not catastrophically ill patients if that was significantly harmful to the interests of the state. However, there is no evidence that the availability of euthanasia is harmful to state interests.</p>
<hr>
<p><em>If this article has raised issues for you or anyone you know, call or visit Lifeline 13 11 14 <a href="http://www.lifeline.org.au">www.lifeline.org.au</a>, or the Suicide Call Back Service 1300 659 467 <a href="http://www.suicidecallbackservice.org.au">www.suicidecallbackservice.org.au</a></em></p><img src="https://counter.theconversation.com/content/79564/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Udo Schüklenk received funding from the Royal Society of Canada while he chaired the work of an international expert panel tasked with drafting a report on end-of-life decision-making in Canada.</span></em></p><p class="fine-print"><em><span>Xavier Symons does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Imagine this situation: a person has no medical illness but wishes to end his or her life purely because he or she no longer wishes to live. Should they be eligible for euthanasia or assisted suicide?Xavier Symons, Research Associate, University of Notre Dame AustraliaUdo Schüklenk, Ontario Research Chair in Bioethics and Public Policy, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/766982017-05-08T19:46:03Z2017-05-08T19:46:03ZViewpoints: is saturated fat really the killer it’s made out to be?<figure><img src="https://images.theconversation.com/files/167121/original/file-20170428-15112-137ejx9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A controversial editorial has questioned whether saturated fats really clog up your arteries and put you at risk of heart disease. But can it really overturn decades of research?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/99621002?src=jxTPXTYXmpHsEfNjNB44hA-2-42&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>A recent editorial in the <a href="http://bjsm.bmj.com/content/early/2017/03/31/bjsports-2016-097285">British Journal of Sports Medicine</a> dismissed the widely held belief that a diet rich in saturated fats increases our risk of heart disease as “just plain wrong”.</p>
<p>The authors concluded we have been concentrating on reducing one type of fat in our diet when instead we should be promoting a <a href="https://theconversation.com/what-is-the-mediterranean-diet-and-why-is-it-good-for-you-12656">Mediterranean diet</a>, exercise and reducing stress to reduce our chances of heart disease.</p>
<p>So, is saturated fat really the killer it’s made out to be. Or, as the editorial suggests, have we really got it all wrong?</p>
<hr>
<h2>The case for saturated fat’s role in heart disease</h2>
<p><strong>David Sullivan, Clinical Associate Professor, University of Sydney</strong></p>
<p>According to evidence collected over more than five decades, the level of saturated fat in our diet is one of the most powerful environmental risk factors for the inflammatory process in the artery wall that leads to <a href="http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2530902">heart attack and stroke</a>. </p>
<p>Science and medicine have never suggested saturated fat <em>itself</em>, for instance from a diet rich in fatty meat or processed foods, blocks your arteries (vessels that carries blood from the heart to other organs).</p>
<p>What we know is eating too much saturated fat raises levels of blood cholesterol, in particular the type commonly called “bad” cholesterol, <a href="https://www.heartfoundation.org.au/your-heart/know-your-risks/blood-cholesterol">low-density lipoprotein cholesterol</a> or LDL.</p>
<p>LDL and related particles enter the artery wall where they are chemically modified, triggering a vicious cycle of inflammation and cholesterol accumulation. It is this cycle of inflammation and cholesterol accumulation that leads to heart disease and stroke.</p>
<p>That’s why doctors like to keep an eye on your blood cholesterol levels, as part of assessing your risk of heart disease.</p>
<p>But it’s not just LDL particles that contribute to the inflammatory process; other related particles do so too. So doctors look beyond simple measures of LDL cholesterol to measure your risk. It’s <a href="http://www.sciencedirect.com/science/article/pii/S1933287408002742">better</a> to start with your total level of blood cholesterol, then take away levels of so-called “good” cholesterol – the high-density lipoprotein or HDL cholesterol. This gives you an idea of the level of damaging particles (or non-HDL cholesterol).</p>
<p>If we understand that raised blood cholesterol levels (in particular, raised LDL) increase your risk of heart disease and stroke, then it stands to reason that reducing their levels might decrease your chances.</p>
<p>This is exactly what two <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1410489#t=article">recent</a> <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1615664#t=article">studies</a> showed. These provided the highest form of evidence in over 40,000 patients; they looked at how two cholesterol-lowering drugs significantly reduced cardiovascular events, like heart attacks and stroke.</p>
<p>Neither drug has anti-inflammatory effects. Instead, their success is attributed to reduced levels of harmful cholesterol-carrying particles, including LDL cholesterol.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/167125/original/file-20170428-15091-h7013r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/167125/original/file-20170428-15091-h7013r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167125/original/file-20170428-15091-h7013r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167125/original/file-20170428-15091-h7013r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167125/original/file-20170428-15091-h7013r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167125/original/file-20170428-15091-h7013r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167125/original/file-20170428-15091-h7013r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In one study, participants swapped butter for polyunsaturated margarine as a way of reducing their saturated fat intake.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/514088740?src=Ju6y5EkxtXFJhD6TABFPOw-1-57&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>So, what role does diet play in all this? Two <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1200303#t=article">landmark</a> <a href="http://circ.ahajournals.org/content/103/13/1823">studies</a> in people who ate Mediterranean-style diets show what happens when you eat less saturated fat. Replacing saturated fat in the diet with foods containing healthier unsaturated fat, like the fats in nuts, extra virgin olive oil, polyunsaturated margarine – but not processed carbohydrates – reduced levels of heart attacks and premature death.</p>
<p>Downplaying the role of dietary saturated fat in heart disease prevents health care workers from managing cardiovascular risk using diet. Any recommendation to not be so focused on saturated fat will therefore increase population levels of blood cholesterol, increasing the need for statins and other cholesterol-lowering drugs.</p>
<hr>
<p><em><a href="https://theconversation.com/some-things-you-should-know-about-statins-and-heart-disease-19655">Some things you should know about statins and heart disease</a></em></p>
<hr>
<p>The implication, that one of the most thoroughly researched areas of medical science – that excess saturated fat puts you at risk of heart disease and stroke – is a hoax, misrepresents the evidence.</p>
<hr>
<h2>The case against labelling saturated fat ‘bad’</h2>
<p><strong>Yutang Wang, Senior Lecture at Federation University Australia</strong></p>
<p>Saturated fat (for instance high in fatty meat or full-fat dairy) is thought to clog the arteries and increase the risk of heart disease. But currently available evidence does not support these common beliefs.</p>
<p>First, let’s look at whether saturated fat really clogs the heart’s arteries leading to coronary <a href="https://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis">atherosclerosis</a> (when plaque builds up inside your arteries, in time hardening and narrowing them). In a surprise finding, one study in women who had been through the menopause found a diet richer in saturated fat was linked with <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1270002">less, not more</a>, progression of coronary atherosclerosis.</p>
<p>Second, whether eating saturated fat increases your chances of dying from heart disease. When researchers combined the results from 41 research papers published from 1981 to 2014, eating saturated fat <a href="http://www.ncbi.nlm.nih.gov/pubmed/26268692">was not linked</a> with dying from heart related diseases, like heart attack, stroke or type 2 diabetes.</p>
<hr>
<p><em><a href="https://theconversation.com/health-check-are-saturated-fats-good-or-bad-21524">Health Check: are saturated fats good or bad?</a></em></p>
<hr>
<p>Many of us think saturated fat is bad for us because it increases levels of low-density lipoprotein cholesterol or LDL in our blood. But is LDL-cholesterol really that bad?</p>
<p>When researchers studied all the research papers written in English that investigated the effects of LDL-cholesterol on the deaths in people over 60, they had some surprising results. In most of the papers (representing 92% of participants), LDL-cholesterol was linked with a <a href="http://bmjopen.bmj.com/content/6/6/e010401">lower death rate, and there was no link</a> in the remaining 8% of participants.</p>
<p>It is not the level of LDL <em>itself</em> that predicts people’s risk of heart disease, but the ratio of total cholesterol and another type of cholesterol, high-density lipoprotein (HDL) cholesterol, that’s the key.</p>
<p>While LDL is largely responsible for delivering cholesterol to cells around the body, HDL cholesterol transports extra cholesterol back to the liver for recycling. So LDL and HDL work together to ensure cells in our body maintain the right levels of cholesterol.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/167307/original/file-20170501-12987-asrrpr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/167307/original/file-20170501-12987-asrrpr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/167307/original/file-20170501-12987-asrrpr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/167307/original/file-20170501-12987-asrrpr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/167307/original/file-20170501-12987-asrrpr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/167307/original/file-20170501-12987-asrrpr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/167307/original/file-20170501-12987-asrrpr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Eating three eggs a day increased levels of HDL cholesterol in the short term.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/596694929?src=xlRooFpchhtbJK_CxPPEMw-1-0&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>A higher ratio of total cholesterol against HDL-cholesterol is commonly associated with <a href="http://www.ncbi.nlm.nih.gov/pubmed/7944071">higher incidence</a> of heart disease because a higher ratio reflects that more cholesterol will be deposited into the blood vessel and less will be removed from it.</p>
<p>But when we eat saturated fat, both LDL and HDL cholesterol levels increase. So, eating normal amounts of saturated fat <em>will not</em> tip the balance. We need saturated fat in our diet to form the building blocks for the cells in our body and to help our cells communicate with each other.</p>
<p>The long-term effect of eating too much cholesterol on the ratio of total against HDL cholesterol is not clear. A short-term study <a href="https://www.ncbi.nlm.nih.gov/pubmed/18203890">suggests</a> eating moderately high levels of cholesterol may not be bad. Researchers found that eating three eggs a day (containing 640 mg cholesterol) for 12 weeks did not increase LDL-cholesterol. </p>
<p>Instead it significantly increased HDL-cholesterol by 20% compared to those who ate an egg substitute without cholesterol.</p>
<p>So, we may need to stop thinking about “bad” saturated fat and “bad” cholesterol. Rather, we should enjoy our meals containing moderate amounts of saturated fat and be physically active. That will be more effective in keeping us healthy.</p>
<hr>
<p><strong>David Sullivan:</strong></p>
<p>The author mentions the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1270002/">study of progression of artery disease in women who have gone through the menopause</a>. This shows women with the highest saturated fat intake had the lowest LDL cholesterol levels (despite taking less lipid-lowering treatment). This might be explained, <a href="https://doi.org/10.1016/j.cell.2012.03.001">as some researchers suggest</a>, by genetic factors that allow some people to tolerate saturated fat better, leading to a lower LDL and a reduced risk of heart disease.</p>
<p>And rather than eating moderate amounts of saturated fat, as the author suggests, there is ample evidence for <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2012.02553.x/abstract">avoiding saturated and trans fats, replacing them</a> with healthier ones and <a href="https://www.heartfoundation.org.au/images/uploads/publications/CON-084.v3-HealthyEating-LR-secure.pdf">reserving saturated fats as treats</a>.</p>
<p>We also differ in our opinions of the best marker of heart-disease risk that your doctor might consider when analysing blood test results.</p>
<p>Use of the total cholesterol to HDL ratio, as the author proposes, has declined because levels of HDL cholesterol itself may not be a marker of <a href="https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2011-1846">heart disease protection</a>. And raising HDL <a href="https://www.ncbi.nlm.nih.gov/pubmed/28099220">has not reduced the risk</a> of heart disease. Instead, non-HDL cholesterol has been introduced as a superior measure to LDL, as I have mentioned.</p>
<p>Finally, there’s confusion over how the terms cholesterol and saturated fat are used. Saturated fat is chain-shaped and consumed in much greater amounts than the ring-like <a href="https://www.nhlbi.nih.gov/health/health-topics/topics/hbc">cholesterol</a>. And it’s saturated fat in the diet that’s the main determinant of cholesterol levels in the blood.</p>
<hr>
<p><strong>Yutang Wang:</strong></p>
<p>Despite decades of research on whether eating saturated fat increases our chances of dying from heart disease, the results are not consistent. Some show eating high <a href="http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2530902">saturated fat is bad</a>, whereas others <a href="http://www.ncbi.nlm.nih.gov/pubmed/26268692">do not</a>. </p>
<p>For instance, as recently as 2016, a study showed higher total saturated fat intake was linked to <a href="http://ajcn.nutrition.org/content/early/2016/01/20/ajcn.115.122671">lower levels of heart disease</a>. </p>
<p>Yes, LDL cholesterol can be chemically modified and involved in the inflammation process. However, this does not mean non-modified LDL cholesterol in the blood <a href="http://bmjopen.bmj.com/content/6/6/e010401">is bad</a>.</p>
<p>There is no doubt that cholesterol-lowering drugs <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1615664#t=article">can lower</a> your risk of a heart attack or stroke. These drugs can decrease LDL-cholesterol. However, the beneficial effect of cholesterol-lowering drugs may be largely because of the favourable change in the balance between total cholesterol and HDL-cholesterol, rather than lowering “harmful” LDL-cholesterol alone.</p><img src="https://counter.theconversation.com/content/76698/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Richmond Sullivan received funding to support diet studies involving chocolate, plant sterols and pork. </span></em></p><p class="fine-print"><em><span>Yutang Wang does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We need to eat a healthy diet, do some exercise and avoid stress rather than blame saturated fat for heart disease, says a recent editorial. But does the evidence stack up?David Richmond Sullivan, Clinical Associate Professor, University of SydneyYutang Wang, Senior Lecturer, Federation University AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/631132016-08-21T20:04:24Z2016-08-21T20:04:24ZViewpoints: is addiction a disease?<figure><img src="https://images.theconversation.com/files/134380/original/image-20160817-13707-163bo14.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We've long heard we can't blame people for their addiction because it's a disease, but is it? </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><h2>The case against</h2>
<p><strong>Nicole Lee, Associate Professor at the National Drug Research Institute, Curtin University</strong></p>
<p>We used to think of “addiction”, or what we now call dependence, as a moral failing. This had the result of blaming the person who was addicted – it was a matter of willpower and they just weren’t trying hard enough. So the obvious solution was shaming and scolding until they did.</p>
<p>In the mid-20th century, a new movement started: the recovery movement, led by peer organisations such as Alcoholics Anonymous. This signalled a shift towards a focus on disease. This shift was important in understanding drug use as a health issue and focusing responses towards support rather than blaming.</p>
<p>The downside to this way of thinking is that it conceptualises drug use and dependence as a problem you have no control over – it needs someone or something to “fix” it (typically a medicine). The first step in the 12-step movement demonstrates this well: “I admit that I am powerless over alcohol/drugs.” The pendulum had swung in the opposite direction.</p>
<p>But what is a disease? Traditional definitions refer to a failing or problem with cells, tissues or organs – an illness of some sort. The organ in question here is the brain. </p>
<p>Many <a href="http://scholar.google.com.au/scholar_url?url=https://www.researchgate.net/profile/Miguel_Perez-Garcia/publication/6884468_Executive_dysfunction_in_substance_dependent_individuals_during_drug_use_and_abstinence_An_examination_of_the_behavioral_cognitive_and_emotional_correlates_of_addiction/links/09e4150fee0125a130000000.pdf&hl=en&sa=X&scisig=AAGBfm22AhDVWPlZbr2cvdu96C02kE69fQ&nossl=1&oi=scholarr&ved=0ahUKEwiQ_uOw97rOAhWMkZQKHV7_A4sQgAMIHSgBMAA">studies</a> demonstrate cognitive deficits among drug users, but there is little evidence those brain deficits occurred <em>before</em> drug use. Some cognitive risk factors increase the likelihood of a drug or alcohol problem, but no-one has done a study that has measured babies’ brain structure and function, and then looked at who developed problems with drugs 15 to 20 years later to see whether there are particular brain deficits that “cause” drug dependence.</p>
<p>A broader definition of a disease would be an “abnormal” condition of some sort – which would also place mental health issues in the category of disease. We don’t usually consider mental health problems, such as depression or anxiety, as a disease, even though they have biological (including neurological) aspects to them.</p>
<p>Modern understanding of brain plasticity shows repeated behaviours form strong paths in the brain. This suggests drug problems might be more of a habit ingrained in the brain by repeated reinforcement of behaviours. Those behaviours are influenced by factors such as biology, the social and environmental situation, and upbringing. </p>
<p>There’s no evidence anyone has become addicted to a drug on the first use (they might like it a lot on first use – enough to do it over and over until they become dependent). The disease model doesn’t account very well for people who use drugs but aren’t dependent (about 90% of people who use alcohol or other drugs), or people who use drugs and have problems other than dependence (about 20% of that 90%).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134734/original/image-20160819-12274-1pwmmgj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If people see their addiction as a learnt behaviour, will it be easier for them to stop?</span>
<span class="attribution"><span class="source">from ww.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Addiction as a learnt behaviour (that can be unlearnt), with multiple influences, can better account for the wide range of ways people use alcohol and other drugs, and also for the path to dependence.</p>
<p>We know there are multiple factors that increase risk of a) drug use, b) drug-related problems and c) drug dependence. Some of them are probably biological, but we haven’t found a gene or biological cause.</p>
<hr>
<h2>The case for</h2>
<p><strong>Femke Buisman-Pijlman, Senior Lecturer in Addiction Studies, University of Adelaide</strong></p>
<p>Our understanding of addiction or dependence is still growing and with it we change the way we describe it. A model to explain dependence can be useful to help a user or family member understand the illogical behaviour or help the general public understand the need for a specific treatment. </p>
<p>I find the disease model useful in explaining how dependence is different from other excessive alcohol or drug use. </p>
<p>A disease can be defined as a set of symptoms caused by external or internal factors. Dependence is not like a virus or infection, but more like a chronic disease. You may have a predisposition to it, but it will not manifest itself until it is triggered. </p>
<p>Our behaviour, whether it is drug-taking, over-eating or lack of exercise, may increase the chance of developing a disease. As with a chronic disease, long-term management may be necessary to get the best outcome, but relapses may still occur. I find this model helps people understand the long-term perspective of a person who is struggling to manage dependence. </p>
<p>Only repeated use of alcohol or drugs lead to dependence, so I agree a person is not powerless in this. Although it is difficult to control the behaviour, a person needs to learn to manage it. </p>
<p>There is no easy fix, like with many diseases. Just taking away the drug will not cure the “disease”. A range of approaches is needed to help people cope with life in different ways and connect to healthy habits and people. </p>
<p>Specific medication can be useful during withdrawal to manage the physical side of dependence or to support a person in the long term to decrease the risk of relapse. The medications to support long-term relapse prevention have rates of success similar to those for other chronic health problems (low to moderate). But we have hardly any effective medications to support people to manage amphetamine and cannabis dependence in the long term. </p>
<p>Psychological support should be a vital part of the support to help people increase motivation for change and give them the tools to manage their use. As with chronic health problems, the person has an important role, but they can be supported by professionals. We know the success rate of attempts to quit smoking without any support are <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2004.00540.x/full">very low</a>. Medication and social support can increase this.</p>
<p>Addiction or dependence is characterised by a large range of changes in behaviour; it is unlikely we will find one gene that is responsible for this. There are large individual differences in how we respond to drugs, whether we continue after negative effects arise and how we handle reduction in use.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/134735/original/image-20160819-12274-o550os.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The disease model is useful in explaining how dependence is different from other excessive alcohol or drug use.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/kphotographerrr/4505714773/in/photolist-7S9Y2t-9ju8xz-94Sx1A-gnnXbh-aitkxg-qu73p6-9fV5xi-gwmAC2-oNQBYF-7sZRqK-oaHWKu-27yd4y-2jsiBz-9WKkti-L1qNq-gwmN7H-fd4kgb-nbdfPZ-q27rVB-abrdvT-nHEVtP-gPy47D-pUzb-AkcbB-bvc7PH-oaK8sB-dpvkD8-bAJDSn-6HTERN-bCYuAM-8Dvf6G-6tDtwJ-6j1BHH-diqnZK-cinZEN-fPs3U5-d71ZCN-etybU-bCYuxX-eegnmy-qYrtkW-4N11am-foVw6v-5S9BtN-ieDvcK-a3se4R-edZStq-damued-A8zQK-foWNhF">Kphotographer/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Some of these changes <a href="http://www.ncbi.nlm.nih.gov/pubmed/24056025">may rely on genes</a> or psychological factors (impulsivity or coping skills), others may be dependent on our “environment” (trauma or abuse). <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2008.02213.x/full">Twin studies</a> and cohort studies are useful in identifying biological factors and looking at cause and effect.</p>
<hr>
<p><strong>Nicole Lee</strong></p>
<p>Even people who are heavily dependent can often control their alcohol or other drug use when they need to, which suggests a disease model is not a good fit as an explanation. We all know someone who can resist drinking at a party, but if they start to drink they may get out of control. </p>
<p>I ask my clients to make an effort not to come to counselling in an intoxicated state. Most are able to stop or reduce their use in response to that, or in order to look after children, or when they need to go to work. The biological drive to use can be strong, but it can also be managed.</p>
<p>Medications to actually treat dependence are really only modestly effective for most alcohol and other drug issues. Replacement pharmacotherapy for <a href="http://www.cochrane.org/CD011117/ADDICTN_opioid-maintenance-medicines-treatment-dependence-opioid-pain-medicines">opiate dependence</a> and for nicotine dependence has the best evidence. The outcomes of pharmacotherapy for other drugs, such as <a href="http://www.cochrane.org/CD004332/ADDICTN_acamprosate-for-alcohol-dependent-patients">alcohol</a>, are fairly modest.</p>
<p>Only a relatively <a href="https://theconversation.com/you-dont-have-to-go-off-the-grid-to-get-treatment-for-drug-dependence-50075">small number</a> of people become dependent on alcohol or other drugs (between 5% and 20% depending on the drug), suggesting the alcohol or drugs themselves are not the primary cause of the problem.</p>
<p>The search for the underlying mechanism that causes some people to become dependent, and others not, has been one of the drivers of the disease explanation.</p>
<p>But the broad range of factors that both explain alcohol and other drug dependence and seem to maintain it, suggests the disease model on its own has significant limitations as an explanation. Psychological factors, such as coping skills and resilience; biological factors, such as genetics and tolerance; and social factors, such as abuse or trauma, low socio-economic status and poor community connectedness, all contribute to both the development and maintenance of alcohol and other drug problems.</p>
<p>Any single-factor theory to explain alcohol and other drug use and dependence will inevitably fall short. We would do better looking at the full range of factors that enable problems with alcohol or drug use. Dependence is a complex problem with no simple solution.</p>
<hr>
<p><strong>Femke Buisman-Pijlman</strong></p>
<p>I agree a single-factor theory is not helpful to explain addiction behaviour. Many diseases are similar in this, having a large number of risk and contributing factors. Addiction can be viewed as a treatable disease, but the person is central in managing the behaviour. </p>
<p>Continued drug use has a complex impact on our brain. Only a multi-disciplinary approach will help us fully understand what these impacts are and help us provide optimal support.</p><img src="https://counter.theconversation.com/content/63113/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant to public, private and not for profit services to support best practice treatment and policy. She has previously been awarded grants by the Australian Government, NHMRC and other public funding bodies for drug research.</span></em></p><p class="fine-print"><em><span>Femke Buisman-Pijlman is affiliated with Virginia Commonwealth University as Affiliate Graduate Faculty. She teaches the Master of Science in Addiction Studies with VCU and King's College London. Reckitt-Benckiser Pharmaceuticals offers partial merit based scholarship to students in this degree.
Femke has received funding from governments in Australia, The Netherlands and the USA to support teaching, research and travel. Her PhD project was funded in a collaboration between Utrecht University and Solvay Pharmaceuticals (now Abbott)
She works as an educational advisor for PwC and several schools.</span></em></p>Some think labelling it a disease is a helpful way to think about addiction; others think this makes the addict helpless in their fight against addiction. Two academics debate both sides of the coin.Nicole Lee, Associate Professor at the National Drug Research Institute, Curtin UniversityAssociate Professor Femke Buisman-Pijlman, Senior Lecturer Addiction Studies, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/575582016-04-12T04:37:31Z2016-04-12T04:37:31ZWhy Australia does not need a royal commission into the banking industry<p>Is a royal commission into banking required? I think not. There have been many problematic incidents adversely affecting customers in the banking and financial sector in Australia – although whether they are more frequent and more substantive than elsewhere is open to question. </p>
<p>Moreover, examining those incidents, determining whether there are systemic causes, and identifying possible solutions can be done in simpler and potentially more effective ways. Indeed, even to the extent that the objective is to pinpoint responsibility for past wrongdoings, it is not clear that a royal commission has advantages over investigations by well-resourced and empowered financial regulators.</p>
<p>Royal commissions are likely to work best when there is one specific major issue to be addressed or where there is some substantive matter of policy formulation on which a primarily legal, inquisitorial, analysis can shed light. The current and recent concerns involve a wide range of different types of problems resulting in financial consumer detriment. </p>
<p>They involve actions of individuals within various types of financial organisations as well as how the objectives, culture, ethics and governance of the organisations themselves encourage, induce or incentivise particular types of behaviour.</p>
<p>These are not topics that are best addressed from a primarily legal perspective, or analysis of which requires the trappings and powers, and costs, of a royal commission. Rather, there is a need for analysis of what gives rise to these perceived problems and what policy (legislative or regulatory) changes might be made to reduce such problems. </p>
<p>And ultimately, some form of (at least implicit) cost-benefit analysis is warranted since the bad behaviour of concern is a byproduct of institutional arrangements and structures for providing financial services and products to meet the needs of consumers. Designing policy to balance efficiency and fairness in provision with mitigation of adverse effects is not a simple task.</p>
<p>Identifying problems and designing policy solutions can be done either via existing financial regulators with their existing (or enhanced) powers or through some other form of less costly and disruptive method of inquiry. </p>
<p>The recent David Murray-led Australian Financial System Inquiry (of which I was a member) examined the financial sector from a very broad perspective. Its terms of reference included reference to corporate governance and implications for outcomes for consumers of financial products and services consumers. But this was only one item on a long list of issues required to be investigated within a very short time frame.</p>
<p>The Murray Inquiry made a number of recommendations related to improving outcomes for consumers of financial products. One could argue that it would make sense to see whether the recommendations of the Murray Inquiry (once fully implemented), together with ongoing changes in global financial regulatory standards, improve the performance of the financial sector in this regard before undertaking another major review.</p>
<p>On the other hand it might be argued that the Murray Inquiry did not, reflecting the constraints of its terms of reference and short time frame, delve far enough into issues of ethics, culture, and governance. While these were front of mind in its deliberations, its approach was to design policy recommendations which would induce better outcomes. </p>
<p>These included addressing incentives created by conflicted remuneration arrangements, introducing manufacturer and distributor responsibilities for appropriate design and marketing of financial products and services, and improved resourcing and powers of financial regulators. That approach reflected a view that “good” ethics and culture cannot be created by regulation, that they are the responsibility of the leadership of financial institutions, but that policy settings can influence incentives to create and maintain good ethical standards and culture.</p>
<p>If it is believed that the problems are more deep seated, then perhaps further inquiry is warranted – but on topics which hardly warrant or need a royal commission. A number of issues come readily to mind. One is whether enforced structural separation of financial institutions would facilitate improved governance, risk-taking, staff-customer interrelationships, and remuneration and incentive structures. </p>
<p>Another is whether requiring directors of banks to put interests of depositors ahead of shareholders (much as occurs in insurance where policy holders interests are legally accorded priority). Yet another would be what increase in penalties for wrongdoing and increased resourcing for investigation by regulators would appropriately limit wrongdoing while not unduly harming efficient and innovative supply of financial services.</p>
<p>These types of issues require “research” more than “inquiry”. They are not the sorts of questions that a royal commission process is suited to answer. Calling for a royal commission looks to have been a smart political move. But like the Abbott Government’s Royal Commission into Trade Unions it would be tainted by political overtones associated with the inquisitorial nature of the process. </p>
<p>Far better to find an approach that will be seen to reflect the more explicit analytical approach necessary to answer the very complex questions involving the interplay between ethics, culture, incentives, governance and behaviour.</p><img src="https://counter.theconversation.com/content/57558/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kevin Davis was a member of the Australian Financial System (Murray) Inquiry which reported to the Treasurer in November 2014</span></em></p>Royal Commissions work best when one specific issue can be addressed, rather than a wide range of problems.Kevin Davis, Research Director of Australian Centre for FInancial Studies and Professor of Finance at Melbourne and Monash Universities, Australian Centre for Financial Studies Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/423482015-05-26T20:10:08Z2015-05-26T20:10:08ZViewpoints: should universities accept funding from industry?<figure><img src="https://images.theconversation.com/files/82919/original/image-20150526-24748-bbccw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Direct links between universities and industry funders pose significant risks – but can they be managed?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/shannonkringen/5182061073/">Shannon Kringen/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>The University of Sydney has just announced it’s establishing a new research position in integrative medicine funded by a A$1.3 million donation from the Blackmores Institute. It says the Maurice Blackmore Chair in Integrative Medicine (a blending of evidence-based conventional and complementary medicine) will add to the university’s current research in the field. </p>
<p>But does the move give rise to questions about whether research linked to industry will be compromised? In this Viewpoints, Paul Komesaroff argues working with industry doesn’t have to be a problem for universities while Ken Harvey says there’s a better way.</p>
<hr>
<p><strong>Paul Komesaroff</strong>: The propriety of industry support for research in universities has long been debated. During the Vietnam War, for instance, controversy was generated in the United States about the role of universities in developing chemical and anti-personnel weapons. And, more recently, relationships with pharmaceutical companies have come under close scrutiny. </p>
<p>The issue has become still more complicated by the transformations universities have been forced to undergo over the last few decades. </p>
<p>For better or for worse, universities are not ivory towers and researchers are not disinterested searchers after truth. Scientists are motivated as much by personal ambition and advancement as they are by the pursuit of knowledge and derive their incomes from ever-shrinking grant sources that are themselves controlled by government and subject to partisan social policies. </p>
<p>Universities now operate as businesses and have limited commitment to the traditions of radical critique. And there’s no doubt direct links between universities and industry funders pose significant risks. These include the possibility of the research agenda being distorted in favour of commercial interests, of unpopular viewpoints being suppressed for fear of offending benefactors, and of the very concept of free inquiry and possibility of independent scholarship being placed under challenge from crudely commercial managerial imperatives. </p>
<p>Indeed, there’s ample evidence that all of these possibilities have to some extent been realised. But this doesn’t amount to an argument that all relationships between industry and universities should be proscribed. </p>
<p>What it means is that such relationships must be carefully regulated according to clearly defined values. There must be irrefragable guarantees of independence, both from industry funders and from university management themselves. There must be vigorous debate about where the limits to external support should be set and which industries should be excluded altogether. </p>
<p>Universities should adopt clear charters and codes of ethics that guarantee their founding ethos, which should be genuinely enforceable. </p>
<p>The case of complementary medicine raises special issues. Mainstream medicine remains well represented in the universities while only limited research funds are made available for complementary medicines, in spite of the fact that a high proportion of Australians use these products on a daily basis. The conduct of high-quality research in this area is undoubtedly in the public interest. Risks can be mitigated if the guidelines suggested here are followed. </p>
<p>Universities are not pure centres of thought, and nor should they be. Constructive engagement between educational institutions and industry is desirable, but it needs to be subject to rigorous controls. This applies to all research partnerships, including those with the pharmaceutical and complementary medicine industries, and other commercial entities. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/82922/original/image-20150526-24745-1iyc8pp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/82922/original/image-20150526-24745-1iyc8pp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/82922/original/image-20150526-24745-1iyc8pp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/82922/original/image-20150526-24745-1iyc8pp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/82922/original/image-20150526-24745-1iyc8pp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/82922/original/image-20150526-24745-1iyc8pp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/82922/original/image-20150526-24745-1iyc8pp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Integrative Medicine is a blending of evidence-based conventional and complementary medicine.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/genphys/17308685382/">General Physics Laboratory (GPL)/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Regulatory processes should include clearly articulated principles that define what is acceptable and what is not, along with mechanisms for public scrutiny and effective enforcement. The task may be a complex one, but there is no reason why it’s unachievable.</p>
<hr>
<p><strong>Ken Harvey</strong>: It’s my view that this question cannot be answered without first addressing fundamental problems in the Australian regulatory system of complementary medicines, which is what is at stake in this instance. The vast majority of complementary medicines on the Australian market are listed by the Therapeutic Goods Administration (TGA) rather than registered. Listed products are not evaluated by the TGA to see if they work.</p>
<p>While the product’s sponsors, which are usually its manufacturers or licensed local distributors, are meant to hold evidence of efficacy, this is often found to be unsatisfactory when <a href="http://www.tgacrp.com.au/index.cfm?pageID=13&special=complaint_single&complaintID=2678">complaints are made</a>. Or when the TGA conducts limited <a href="https://www.tga.gov.au/complementary-medicines-compliance-reviews-outcomes-2014">post-marketing reviews</a>. In addition, there are no effective sanctions to deter such behaviour.</p>
<p>The end result is a market flooded with products of dubious efficacy promoted <a href="https://www.youtube.com/watch?v=12ww26sQF7E&feature=youtu.be">with hype and celebrity endorsement</a> rather than scientific research. Indeed, <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/Expert_Review_Submissions-container1/$FILE/Flordis%20submission.pdf">a company</a> that has financed the research necessary to produce evidence-based (TGA registered) complementary medicines complain they haven’t garnered a useful return on their investment as the public doesn’t understand the difference between listed and registered products. </p>
<p>But what does this mean for the incumbent of the Maurice Blackmore Chair in Integrative Medicine? First of all, she will need to be aware that the majority of complementary medicine products in the Australian marketplace are not evidence-based. And that includes those of the company funding her chair. </p>
<p>This could cause a number of potential conflicts of interest. The company concerned may have expectations that the research conducted will validate its products, which it may not do; there may be subtle pressures on researchers from vice chancellors and university business managers to not be critical of complementary and alternative medicine products so as not to upset the funder; researchers may be tempted to game their work to produce pleasing results by, for instance, testing the effect of multivitamins on cognition by performing numerous psychometric tests on small numbers of subjects. This increases the likelihood that one or two will prove “statistically significant” by random chance.</p>
<p>And then there’s the danger that the funder may magnify or cherry-pick positive results – or both – without waiting to see if these can be replicated. </p>
<p>Companies may also refuse permission to publish negative results. They will almost certainly use their association with the university for marketing purposes. And this may cause problems for the university if <a href="http://www.tgacrp.com.au/index.cfm?pageID=13&special=complaint_single&complaintID=2678">the company’s views on marketing differs from those of regulators</a>.</p>
<p>Most of these potential problems can be minimised by clear agreement that the university will be in complete control of the research questions, the methodology, and ethics approval and publication rights. But <a href="http://www.dailymail.co.uk/news/article-2918600/Top-scientist-claims-lost-job-Prince-Charles-wanted-silence-criticising-report-alternative-medicine-commissioned-royal.html">Professor Edward Ernst’s experience at Exeter University</a> provides a cautionary tale of the problems that can emerge. </p>
<p>From 1993, Ernst held the first chair of complementary medicine in the United Kingdom. His research showed that while some complementary modalities worked, many more didn’t. In 2005, Ernst dismissed as “complete misleading rubbish” a report commissioned by the Prince of Wales, which claimed complementary and alternative medicine was cost-effective. His university investigated him after a complaint about his early disclosure of the report’s contents and his funding dried up despite the lack of findings against him. He retired early and his department was closed. </p>
<hr>
<p><strong>Paul Komesaroff</strong>: I agree with many of the concerns about the regulation of complementary medicines expressed by Ken Harvey. The current system encourages the sale of products that have been subjected to inadequate testing and tolerates inaccurate or even false promotional claims about them. And the distinction between listing and regulation of medicinal products has generated perverse incentives that operate against public interest. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/82923/original/image-20150526-24740-1efcsol.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/82923/original/image-20150526-24740-1efcsol.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/82923/original/image-20150526-24740-1efcsol.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/82923/original/image-20150526-24740-1efcsol.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/82923/original/image-20150526-24740-1efcsol.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/82923/original/image-20150526-24740-1efcsol.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/82923/original/image-20150526-24740-1efcsol.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Australia’s current regulatory system encourages the sale of products that have been subjected to inadequate testing and tolerates inaccurate or even false promotional claims about them.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/healthgauge/10134733936/">Health Gauge/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>But surely this is an argument for more research, not less - for increased support for the generation of high-quality data, and for open, critical reflection and debate. It’s an argument in favour of bringing complementary medicines in from the cold so they can be subject to the same standards and scrutiny as pharmaceuticals and other fully regulated medicinal products. </p>
<p>I also agree that research funding poses risks, including those associated with conflicts of interests, pressure on researchers and the institutions themselves. And there’s the risk that funders may use their support to bolster commercial activities, and may even seek to suppress unfavourable research outcomes. </p>
<p>These risks are real but they are all also foreseeable. And in each case, it is possible to devise effective strategies to avert them. </p>
<p>It’s in the public interest for complementary medicines to be subjected to rigorous research and for reliable, trustworthy information to take the place of exaggerated and unsubstantiated claims. One of the most effective ways in which this can be achieved is through careful, properly regulated, fully transparent relationships between industry and academia. </p>
<p>If the chair at the University of Sydney satisfies these criteria it should receive our full support. </p>
<hr>
<p><strong>Ken Harvey</strong>: The best way for a company to sponsor high-quality research into complementary medicine without any possible conflict of interest is for them to provide a hands-off, anonymous donation to the National Health and Medical Research Council (NHMRC) that would add to the existing (small) pool of money provided for competitive, peer-reviewed research grants in this area. </p>
<p>The NHMRC has already researched <a href="https://www.nhmrc.gov.au/health-topics/complementary-medicines/homeopathy-review">some complementary medicine modalities</a> and has also provided <a href="https://www.nhmrc.gov.au/health-topics/complementary-medicines/talking-your-patients-about-complementary-medicine-resource-cl">educative material</a> for medical students and practitioners. </p>
<p>And the report of the <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/phi-natural-therapies">Review of the Australian Government Rebate on Private Health Insurance for Natural Therapies</a> (currently with the health minister) will provide additional information on the evidence base of many more complementary or natural therapies. </p>
<p>Hands-off industry support to the NHMRC is a better way to proceed than financing an eponymous chair because it still ensures we’re researching complementary medicines but mitigates all the risk that the latter entails.</p><img src="https://counter.theconversation.com/content/42348/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Komesaroff is a former colleague of Dr Lesley Braun who is now Director of the Blackmore Institute. </span></em></p><p class="fine-print"><em><span>Dr Harvey has accepted travel expenses only to talk about problems of complementary medicine regulation to pharmaceutical companies and industry associations. He has also been paid travel expenses and sitting fees for his involvement with government inquiries and working groups concerning the promotion and regulation of complementary medicines. He is regarded by some section of industry as a serial complainant.</span></em></p>The University of Sydney’s announcement of a role funded by the Blackmores Institute raises perennial questions about whether industry-funded research can be truly independent.Paul Komesaroff, Professor of Medicine, Monash UniversityKen Harvey, Adjunct Associate Professor, School of Public Health and Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/284102014-08-27T02:55:25Z2014-08-27T02:55:25ZViewpoints: should Australia lift its ban on e-cigarettes?<figure><img src="https://images.theconversation.com/files/57453/original/wqxf3jms-1409104278.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A World Health Organisation report says e-cigarettes should be regulated, but they are banned in Australia.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/roborodent/14645855344">Lucas Hayas/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span></figcaption></figure><p>The World Health Organisation has just released a <a href="http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf">report on electronic nicotine delivery systems</a> that calls for their global regulation in the interests of public health. The most well-known such devices are electronic cigarettes or e-cigarettes, which are currently banned in Australia. </p>
<p>In this Viewpoints, Wayne Hall calls for the ban to be lifted, while Ross MacKenzie presents the case for retaining it.</p>
<hr>
<p><strong>Wayne Hall:</strong> Australia has banned the sale of a potentially less harmful way of obtaining nicotine while allowing the most dangerous form – cigarettes – to continue to be sold in convenience stores. </p>
<p>Vapour from electronic delivery systems, or e-cigarettes as they’re popularly known, has been shown to contain fewer carcinogens and less particulate matter than smoked cigarettes. </p>
<p>E-cigarettes have been shown in a <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61842-5/abstract">randomised controlled trial</a> to have similar efficacy to nicotine replacement products when used as a quitting aid. They may also prove to be a safer longer-term alternative to smoking. </p>
<p>The ban on their sales should be lifted to allow research on the possible public health benefits of these products. But as today’s WHO report says, their sale must be regulated. </p>
<p>They should be sold under tighter restrictions than apply to tobacco until better data are available on their safety and efficacy. And only a limited number of sellers and suppliers should be licensed to sell approved products, allowing for control over quality and safety. </p>
<p>What’s more, all media marketing should be banned to prevent their promotion to children and adolescents.</p>
<p>E-cigarette users should receive product information that clearly explains the uncertainty about their long-term health effects. This would encourage their use for quitting smoking and discourage dual use, that is, using e-cigarettes while continuing to smoke cigarettes. </p>
<p>The sales ban in Australia leaves product quality, marketing, product information and sales to the black market. </p>
<p>Suppliers should be obliged to facilitate research that answers questions essential in developing policy, such as:</p>
<p>• who uses e-cigarettes and for how long; </p>
<p>• how many use them to quit smoking, as a complete substitute for smoking, or only when (and where) smoking is prohibited; and </p>
<p>• how does regular e-cigarette use, alone or in combination with cigarettes, affect the health of users over time. </p>
<p>If e-cigarettes fail to reduce tobacco harm-related harm, as their critics predict, then the sooner we discover this, the better. Meanwhile, we should lift the ban to enable us to properly evaluate their possible value.</p>
<hr>
<p><strong>Ross MacKenzie:</strong> Supporters claim that e-cigarettes represent an important advance in <a href="http://nicotinepolicy.net/documents/letters/MargaretChan.pdf">harm reduction</a> and are an effective means of <a href="http://onlinelibrary.wiley.com/doi/10.1111/add.12623/abstract">quitting smoking</a>, despite a near-complete absence of research into these claims, or into <a href="http://tobaccocontrol.bmj.com/content/23/suppl_2/ii36.abstract">their safety</a>. </p>
<p>There is a growing body of literature on health risks linked to nicotine, the key component of e-cigarettes. <a href="http://www.nature.com/nrc/journal/v14/n6/abs/nrc3725.html">These include</a> head and neck, liver and kidney cancer, among others, as well as impacts on the lung and vascular systems that can have implications for those exposed to <a href="http://trstmh.oxfordjournals.org/content/100/4/291">tuberculosis</a>. </p>
<p>Given these concerns, and nicotine’s well-established <a href="http://www.surgeongeneral.gov/library/reports/50-years-of-progress/50-years-of-progress-by-section.html">addictive properties</a>, it seems an unlikely substance to position at the centre of harm-reduction or smoking-cessation strategies.</p>
<p>The greatest threat to public health associated with e-cigarettes, however, is the <a href="http://www.theaustralian.com.au/media/marketing/e-cigarettes-the-new-market-for-big-tobacco/story-fna12mff-1226731436710?nk=3c8b51ebcb3bf818a03e164a74908592">entry of the tobacco industry</a> into the market, as the WHO report notes.</p>
<p>This, coupled with regulatory uncertainty in some countries, has enabled leading cigarette manufacturers such as British American Tobacco, Lorillard, Reynolds American and Altria to aggressively <a href="http://www.usatoday.com/story/news/nation/2014/06/02/e-cigarettes-tv-ads-youth/9760425/">promote electronic products</a> that are <a href="http://mashable.com/2014/06/18/e-cigarette-brands-marketing/">designed and packaged</a> to look remarkably like traditional cigarettes. </p>
<p>In the United States, e-cigarette advertisements have been accused of <a href="http://tobacco.ucsf.edu/fda-should-restrict-e-cigarette-marketing-protect-youth-part-currently-proposed-regulation">targeting</a> adolescents and children, <a href="http://pediatrics.aappublications.org/content/early/2014/05/27/peds.2014-0269.full.pdf+html">millions</a> of whom have been exposed to advertisements on television and other media. </p>
<p>Resolution of the current debate has enormous consequences for public health. If not regulated as traditional cigarettes, the promotion of e-cigarettes has the very real potential to re-normalise smoking, undoing decades of progress in tobacco control, which has led to declining smoking prevalence in many countries. </p>
<p>At this point, the risks associated with e-cigarettes far outweigh any ostensible benefit.</p>
<hr>
<p><strong>Wayne Hall:</strong> The dogmatic certainty of those who support e-cigarette sales bans is remarkable given their claim that we lack any evidence on the safety of these products. </p>
<p>They already claim to know that the risks will outweigh the benefits. And they want to insulate their beliefs against being tested by advocating for a ban. </p>
<p>This will make it difficult to discover if anything except tobacco industry-owned e-cigarettes are effective cessation aids. And it will make it even more difficult to discover if they are a safer way of obtaining nicotine in the long term than cigarettes.</p>
<p>While I support the regulation of e-cigarettes as tobacco products, that’s not the policy we have in Australia. Instead, our policy absurdly treats e-cigarettes like illicit drugs: it prohibits their sale and prevents smokers from using them except by black market purchases. </p>
<p>I share the concerns of the WHO and the public health community about tobacco industry involvement in the e-cigarettes business. But I believe these concerns are better addressed by regulation than a prohibition supported by dogmatic claims that undermine the public health community’s assertion to pursue evidence-based policies. </p>
<hr>
<p><strong>Ross MacKenzie:</strong> Another way of saying that Australia has banned a potentially less harmful way of obtaining nicotine is that a product has been prohibited because its potential health impacts are unknown, and its value as means of harm reduction and cessation unproven. </p>
<p>I agree that cigarettes should not be sold in convenience stores and should be much harder to obtain. This is a policy area that the public health community should be advocating for, rather than bringing another, controversial nicotine-delivery system onto the market.</p>
<p>Calls to regulate e-cigarettes offer little comfort given that the marketing, purchase and use of traditional cigarettes is well-regulated, but smoking still causes some 15,000 deaths every year in Australia. </p>
<p>As for smuggling, that’s a criminal issue to be dealt with by appropriate authorities. Arguing that the ban on e-cigarettes will lead to black market sales is uncomfortably reminiscent of tobacco industry arguments that raising cigarette taxes and plain packaging would lead to increased levels of contraband.</p>
<p>Finally, growing evidence that nicotine is tumour-promoting and linked to at least ten types of cancer makes current lobbying to allow another nicotine-delivery system onto the market a decidedly curious initiative.</p><img src="https://counter.theconversation.com/content/28410/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wayne Hall is an investigator on a clinical trial of e-cigarettes for smoking cessation that is funded by the National Health and Medical Research Council. He has no interests in or associations with e-cigarette companies and he does not receive funding from the pharmaceutical industry. </span></em></p><p class="fine-print"><em><span>Ross MacKenzie has received funding from the Rockefeller Foundation, and the National Institutes of Health.</span></em></p>The World Health Organisation has just released a report on electronic nicotine delivery systems that calls for their global regulation in the interests of public health. The most well-known such devices…Wayne Hall, Professor and Director, Centre for Youth Substance Abuse Research, The University of QueenslandRoss MacKenzie, Lecturer in Health Studies, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/240642014-03-09T19:33:23Z2014-03-09T19:33:23ZViewpoints: should ratings agencies be responsible for inaccurate ratings?<p>One of the world’s largest ratings agency, Standard & Poor’s, is <a href="http://www.abc.net.au/news/2014-03-03/standard--poors-appeals-landmark-ruling-in-favour-of-councils/5293740">back in court</a> appealing the Federal Court’s <a href="http://www.abc.net.au/news/2012-11-05/councils-to-recoup-gfc-loses-after-court-ruling/4353000">landmark decision</a> that it was responsible for the losses incurred by 13 New South Wales councils.</p>
<p>The local councils made losses on investments in complex instruments that had S&P’s coveted AAA rating. But the company told the ABC it was “not responsible for investment decisions and investors need to do their own analysis”.</p>
<p><em>In this Viewpoints, Binoy Kampmark argues investors should know ratings aren’t guarantees on risk; while Gail Pearson makes the case that investors expect the ratings to have a reasonable basis.</em></p>
<hr>
<p><strong>Binoy Kampmark:</strong> The question here is one of accountability, and what generates it. These are both ethical and legal questions. Credit rating agencies pride themselves on setting measurements about the financial health of assets, and more broadly, of a financial system. </p>
<p>These can have considerable economic impacts, none of which directly affect the ratings agency in question.</p>
<p>During the global financial crisis it became clear that these financial assessments were made without oversight. But is relying on these assessments without due diligence irresponsible in its own right? </p>
<p>It was clear that the credit mechanism being used in this case – the Constant Proportion Debt Obligation notes (CPDOs) – was unstable. <a href="http://www.federalreserve.gov/pubs/feds/2010/201005/201005pap.pdf">Even economists at the US Federal Reserve admitted as much</a>. </p>
<p>That these local councils were relying on just these assessments as statements of fact rather than assertions of opinion should itself be a cause for concern.</p>
<p><strong>Gail Pearson:</strong> The issue of the reliance of the local councils is very important. But what were they relying on? They were relying on the expertise of their investment adviser – who was not the ratings agency – and they were also relying on the AAA rating given by the ratings agency. </p>
<p>I’m not sure about Binoy’s distinction between opinion and fact. The local councils knew there was risk in investing. They knew that there was a potential for loss. So they were relying on an assessment by the ratings agencies about the nature of that risk.</p>
<p>Part of the question is whether they were in a position to assess the risk of these very complex products for themselves. They weren’t. </p>
<p>It seems there was nothing in the documentation they received that indicated the extent of the risk. Assessment of investment risk is highly complex and technical. This is why investors rely on ratings agencies.</p>
<p>In any case, the distinction between fact and opinion is not very helpful to those who provide opinions that are not based on reasonable grounds. </p>
<p>We have, in Australia, a very well developed jurisprudence around the prohibition on conduct that is misleading or deceptive or likely to mislead or deceive. This prohibition exists in a number of pieces of legislation.</p>
<p>You fail to live up to this norm of conduct if you express an opinion without reasonable grounds for that opinion. If investors rely on the opinion of those who provide investment advice or those who grade an investment product, they are entitled to assume that the persons providing that opinion have a reasonable basis for what they are saying.</p>
<p>So the question comes back to whether ratings agencies, when they provide a particular rating, have a reasonable basis for saying that it has three gold stars or none. </p>
<p>It is not unlike ratings given in other contexts – think hats for restaurants or stars on travel websites. There must be a reasonable basis for the opinion. That was the issue here.</p>
<p><strong>Binoy Kampmark:</strong> Gail makes the vital point on reliance. What were the local councils relying on? Advice from investment advisors, and the AAA rating from S&P. </p>
<p>It is true that opinion matters, and that opinion can then cause the person investing to rely upon it. In that sense, an opinion or a fact is one of those fabulously opaque areas of legal deliberation.</p>
<p>But we should be careful that, in so doing, we are not painting the councils involved as vulnerable and entirely at the mercy of an S&P rating. </p>
<p>While the entire business of ratings is shoddy, they are not, <a href="http://www.standardandpoors.com/regulatory-affairs/ratings/en/us">in the words of S&P’s disclaimer</a>, “statements of fact or recommendations to buy, hold, or sell any securities or make any other investment decisions”.</p>
<p>There may be more to be said about the specific parties who marketed the CPDOs and gave undertakings about their reliable value. That would just be patently silly, but it does happen in the world of finance.</p>
<p>The assessment of investment risk is highly complex. But converting assessments into guarantees is as reliable as astrology. </p>
<p>We can choose to pay for those services, but we cannot hope that those predictions will come true. There are simply too many factors at stake. </p>
<p>The law on deceptive conduct is highly developed in Australian commercial law, but there are also instances where a person was irresponsible to be deceived in the first place. </p>
<p>Public bodies like local councils, using the money of ratepayers, must also be wary of the sorts of investments they seek. </p>
<p>The financial crisis, with its revelations of the risk in highly complex investment structures, showed how flawed government and private institutions could be in their decisions. S&P’s ratings work is but a symptom of that culture.</p>
<p><strong>Gail Pearson:</strong> But were the local councils irresponsible? It is easy to say in retrospect when they lost a lot of money that they did not do the right thing. </p>
<p>The local councils did understand that they were investing in a product with risk. They believed they were receiving sound advice from a trusted advisor and that this advice was reliable as it was linked to a rating from one of the world’s leading bodies that rates risk in investment products. </p>
<p>To say they were irresponsible might be to say that we can never trust or rely on any expert of whatever kind – very hard in most contexts.</p><img src="https://counter.theconversation.com/content/24064/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>One of the world’s largest ratings agency, Standard & Poor’s, is back in court appealing the Federal Court’s landmark decision that it was responsible for the losses incurred by 13 New South Wales…Gail Pearson, Professor, Business School, University of SydneyBinoy Kampmark, Lecturer in Global Studies, Social Science & Planning, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/228192014-02-18T19:10:11Z2014-02-18T19:10:11ZViewpoints: should penalty rates be abolished?<figure><img src="https://images.theconversation.com/files/41308/original/pxdwd3jw-1392161022.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tony Abbott has claimed penalty rates force businesses to close their doors </span> <span class="attribution"><span class="source">AAP</span></span></figcaption></figure><p><em>With a major <a href="http://www.fwc.gov.au/index.cfm?pagename=awardsmodernFourYr">review</a> of workplace awards underway, the Federal Government has <a href="http://www.abc.net.au/news/2014-02-04/coalition-questions-relevance-of-modern-awards/5238298">asked</a> the Fair Work Commission to consider whether penalty rates and other minimum conditions are still relevant.</em></p>
<p><em>In this Viewpoints Phil Lewis argues penalty rates don’t suit today’s labour market; while Bill Mitchell makes the case that penalty rates protect the living standards of low-paid workers.</em></p>
<hr>
<p><strong>Phil Lewis:</strong> The name “penalty rates” suggest businesses must pay a penalty for imposing conditions which disadvantage employees. However, penalty rates have their origins in the early 1900s in a labour market quite different to that of much of the Australian labour market today. </p>
<p>The Australian economy used to be characterised by mostly males working full-time in industrial jobs. There was little part-time or casual work. Working married women and jobs with flexible hours were rare. Most retail outlets shut at midday on Saturday and reopened on Monday. The weekends were for many the only time available for socialising, recreation, participating in sport and worship.</p>
<p>Who would benefit from reducing penalty rates? Businesses would increase turnover and would be better able to manage in a more efficient way. There would be more employment as turnover increased. There would be greater choice of shifts available. There would be more employment opportunities for the unemployed. </p>
<p>For many employees, although their wage rate would fall, they would receive higher total earnings since the potential to work a greater number of hours would increase. </p>
<p>The biggest beneficiaries from removing penalty rates would be consumers. They would pay lower prices, and be able to buy goods and services such as restaurant meals at times which better suit their lifestyle.</p>
<p><strong>Bill Mitchell:</strong> While perceptions of standard and non-standard working hours have evolved, the overwhelming majority of people still work standard working weeks and require weekends to rest, socialise, play and worship.</p>
<p>Studies show that extending weekend work compromises these non-work activities and reduces quality of life. </p>
<p>Penalty rates ensure that employers can attract staff in non-standard hours under terms that society considers to be reasonable given the required sacrifices involved. There has been no abandonment of long-held cultural and social arrangements with respect to the standard and non-standard work division.</p>
<p>The trend to two-income families as mortgage debt has risen to record levels has forced families to compromise some of their traditional leisure time to make ends meet. While casual work provides flexibility for some workers, working non-standard hours in precarious, low-paid and disagreeable working environments becomes a necessity for many given the deficient overall jobs growth. Penalty rates help protect living standards of these low-paid workers.</p>
<p>Textbook models that predict employment will grow if wages are cut have no evidential basis. Employment is driven by the strength of spending. Wage cuts reduce income and undermine spending.</p>
<p><strong>Phil Lewis:</strong> While the majority may work standard hours and the weekends are the traditional periods for “socialising, recreation, participating in sport and worship”, this is not true for a large minority of workers. The <a href="http://www.abs.gov.au/ausstats/abs@.nsf/cat/4153.0">ABS Time Use Survey</a> indicates that even under this extremely broad category of sport and outdoor activity, the time spent, even on weekends, is not large and pales into comparison with other activities. For most people, working on weekends would not significantly impose on their time spent on sport and outdoor activities.</p>
<p>The view that somehow unavoidable economic circumstances “has forced families to compromise some of their traditional leisure time to make ends meet” implies that households are somehow irrationally drawn to make decisions on work and leisure and if only we stopped them making these decisions then they would be better off. I find this somewhat condescending.</p>
<p>Businesses make decisions of how much to produce, when to produce, how to produce; and how much labour to employ on the basis of what is most profitable. Higher wages, such as penalty rates, make otherwise profitable activities unprofitable and so businesses reduce output and employment.</p>
<p><strong>Bill Mitchell:</strong> The ABS Time Use Survey was misused by employers in the recent penalty rates case. They argued that because an “average” person allocates only small amounts of time per weekend on “social and community interaction” or “recreation and leisure” that more work would not compromise them. The other time uses (rest, sleep, hygiene, homework, housework, child care, shopping, etc) were ignored in their submission, assumed to be expendable.</p>
<p>But the “average” is meaningless. For example, the average male spends 34 minutes at the weekend on “sport and outdoor activity” and 7 minutes on “religious activities”.</p>
<p>But each individual has to choose between discrete time allocations across activities at weekends with dichotomised choices. A “footy-loving heathen” will spend all afternoon at the MCG, while the church-goer is at the temple. Adding extra hours of casual work wipes out the basic social and recreational activity for most people. That sacrifice requires penalties to be paid.</p>
<p>Employment decisions by firms are not solely based on costs. Businesses supply output and hire workers in response to sales. Cut income and spending and employment fall.</p>
<p>As evidence, the <a href="http://www.fwa.gov.au/documents/modern_awards/award/ma000119/default.htm">Restaurant Award</a> was significantly restructured in 2010 and penalty rates were retained. Employment growth and profitability in relevant sectors exposed to these rates continued to grow post 2010. There was no discernible negative impact of the Award change.</p>
<p>The OECD, a long advocate of the views proffered by the employers, has in more recent years recanted in the face of overwhelming evidence that these views are erroneous. In the<a href="http://www.oecd.org/els/emp/36889821.pdf">2006 Employment Outlook</a> it concluded, after an exhaustive examination of the research literature, that “The level of the minimum wage has no significant direct impact on unemployment” and “Highly centralised wage bargaining significantly reduces unemployment”.</p>
<p>In other words, rejecting all the theoretical causality that employers propagate.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/41735/original/62pwpkwr-1392681647.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/41735/original/62pwpkwr-1392681647.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/41735/original/62pwpkwr-1392681647.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/41735/original/62pwpkwr-1392681647.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/41735/original/62pwpkwr-1392681647.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/41735/original/62pwpkwr-1392681647.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/41735/original/62pwpkwr-1392681647.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Would winding back penalty rates lead to more employment, or harm vulnerable workers?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-121648084/stock-photo-woman-working-professional-maid-cleaning-and-washing-floor-with-machinery-in-industrial-building.html?src=csl_recent_image-1">Shutterstock</a></span>
</figcaption>
</figure>
<p><strong>Phil Lewis:</strong> A low average in the ABS Time use Survey indicates that a large proportion of the sample, from which the average is calculated, have low amounts of time devoted to that use. The point is that for those who work Monday to Friday full-time, having to work on weekends will disrupt their leisure patterns and leisure time. But for many people working weekends allows them to earn income from paid employment while meeting commitments to unpaid activities such as study or household duties.</p>
<p>It is difficult to infer anything from the introduction of the 2010 Restaurant Award since, with all the other economic factors at play, such as changes in income and consumer sentiment, (including the fiscal stimulus) it would be difficult to identify any positive or negative effect of the introduction of the Award. Also, the conditions in the 2010 Award for some states were not much different to the pre-2010 conditions.</p>
<p>The model of labour demand, whereby there is a negative relationship between wages and employment, has been the subject of much research both in Australia and overseas for decades. More recently <a href="http://mitpress.mit.edu/books/minimum-wages">Neumark and Wascher (2008</a>) have compiled the results of a very large number of research papers on labour markets as diverse as the USA, Indonesia and Spain which validate the basic neoclassical model of labour demand. A closer reading of the <a href="http://www.oecd.org/els/emp/36889821.pdf">OECD report</a> reveals that high labour costs (which includes wages and other employer on-costs such as taxes) are a major impediment to employment. The OECD suggests that measures to reduce labour costs for low-skilled workers should be a high priority for policymakers.</p>
<p>A penalty rate of 150% for Sunday work and 250% for public holidays certainly represents a significant increase in labour costs</p>
<p><strong>Bill Mitchell:</strong> Time use is indivisible and there is diversity. While all people might attend a sporting event, on “average”, for a small time per weekend, actual spectators at each event spent a large chunk of time there.</p>
<p>Many social activities also require people to engage in them together, further reducing flexibility. Adding extra casual weekend work wipes out basic social and recreational activity for most people, even those already engaged in part-time employment at weekends.</p>
<p>The claim that employment is negatively related to wage rates is tantamount to religious doctrine for mainstream economists. </p>
<p>The link has also been categorically dismissed several times by the Full Bench of the Australian Industrial Relations Commission. The 1999 Reasons for Decision (<a href="http://www.airc.gov.au/safetynet_review/decisions/R1999.htm">Living Wage Claim Dec 384/99 V</a>) concluded that “the increases we propose to award … will do little or nothing to diminish job prospects”.</p>
<p>The Full Bench in the <a href="http://www.airc.gov.au/fullbench/PR002004.htm">2004 Safety Net Decision</a> rejected Professor Lewis’s evidence that predicted a wage rise would result in a “significant fall in employment”.</p>
<hr>
<p><em>This is the third piece in our Insecure work series. Click on the links below to read the other pieces.</em></p>
<p><a href="https://theconversation.com/workplace-flexibility-on-insecure-ground-22005">Workplace ‘flexibility’ on insecure ground</a></p>
<p><a href="https://theconversation.com/is-job-insecurity-becoming-the-norm-for-young-people-22311">Is job insecurity becoming the norm for young people?</a></p>
<p><a href="https://theconversation.com/online-labour-marketplaces-job-insecurity-gone-viral-20020">Online labour marketplaces: job insecurity gone viral?</a></p><img src="https://counter.theconversation.com/content/22819/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Phil Lewis is Director of the Centre for Labour Market Research and Professor of Economics at the University of Canberra. He provided evidence to the Fair Work Commission enquiry into penalty rates for the restaurant, cafes and catering industry.</span></em></p><p class="fine-print"><em><span>Bill Mitchell is Professor of Economics at Charles Darwin University and the University of Newcastle and Director of the Centre of Full Employment and Equity (CofFEE). He occasionally provides expert consulting services to trade unions, whose membership benefit from the retention of penalty rates. He occasionally receives funding from the ARC, other national competitive grant agencies, government departments, private benefactors and various trade unions.</span></em></p>With a major review of workplace awards underway, the Federal Government has asked the Fair Work Commission to consider whether penalty rates and other minimum conditions are still relevant. In this Viewpoints…Phil Lewis, Professor of Economics, University of CanberraWilliam Mitchell, Professor of Economics, Charles Darwin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/185392013-10-16T19:39:15Z2013-10-16T19:39:15ZViewpoints: can you be healthy at any weight?<figure><img src="https://images.theconversation.com/files/33174/original/ftq3rxtz-1381968837.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If we're fit, does it matter what we weigh?</span> <span class="attribution"><span class="source">Image from shutterstock.com</span></span></figcaption></figure><p><em>Australians are getting heavier and, as a result, are more likely to suffer life-threatening illnesses such as heart disease, diabetes and strokes.</em> </p>
<p><em>But should we be worried about a bit of excess weight? After all, isn’t it better to focus on exercise so we can be healthy, whatever our size?</em> </p>
<p><em>Today’s Viewpoints: can you be healthy at any weight? Tim Olds argues we can; while Anna Peeters outlines why we shouldn’t give up on keeping our weight in check.</em> </p>
<hr>
<p><strong>Tim Olds</strong>:</p>
<p>A study <a href="http://aje.oxfordjournals.org/content/early/2013/09/07/aje.kwt179.abstract">published earlier this month</a> followed up 9,538 Americans born between 1931 and 1941. It asked a very simple question: who are the least likely to die? </p>
<p>The authors considered the weight status of the participants at age 51 or over, and how their weight changed in the subsequent 16 years or until their death. At entry into the study, they were classified as normal weight, overweight, obese, or very obese. In the intervening years they were classified as either increasing weight, staying stable, or losing weight.</p>
<p>So which group was the least likely to die? Not, as we might expect, the normal weight participants who were weight stable, or lost weight. It was overweight participants who remained overweight, followed by overweight participants who became obese. Apart from the very obese who became ever more obese, those <em>most</em> likely to die were normal weight participants who lost weight.</p>
<p>It seems counter-intuitive, but there has been a flood of studies among <a href="http://www.ncbi.nlm.nih.gov/pubmed/22773710">Americans</a>, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3368492/">Norwegians</a>, <a href="http://www.aweighout.com/wp-content/uploads/2012/04/Canadian-Study.pdf">Canadians</a>, <a href="http://www.nature.com/ijo/journal/v36/n8/abs/ijo2011194a.html">Hispanics</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/21829217">Europeans</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/20370857">older Australians</a> with similar findings: overweight people live longer. </p>
<p>Rather than worrying about getting fat, we should all relax a bit and focus on being healthy at any weight.</p>
<hr>
<p><strong>Anna Peeters</strong>: </p>
<p>We know that excess weight and obesity lead to <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2011.00970.x/abstract">many chronic diseases</a>, ranging from diabetes through to cardiovascular disease and cancer, to sleep apnoea and musculoskeletal disease. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/33128/original/kngrstpd-1381896428.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/33128/original/kngrstpd-1381896428.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/33128/original/kngrstpd-1381896428.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/33128/original/kngrstpd-1381896428.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/33128/original/kngrstpd-1381896428.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/33128/original/kngrstpd-1381896428.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/33128/original/kngrstpd-1381896428.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Young adults are gaining around 0.5kg a year.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>We and others have shown that the <a href="http://www.nature.com/ijo/journal/v36/n9/full/ijo201299a.html">overall impact</a> of these health risks is more disability in old age. We also looked at middle-aged Australians and found that those who were even mildly overweight were at greater risk of disability later in life than those of a normal weight.</p>
<p>The <a href="http://aje.oxfordjournals.org/content/early/2013/09/07/aje.kwt179.abstract">results</a> Tim discusses above are significant and reflect the importance of maintaining, not gaining, weight as we age. They also show the risks of unintentional weight loss as we age, usually a sign of losing muscle rather than fat. </p>
<p>As individuals, we should definitely focus on being healthy at any weight. But as a society we should not lose sight of the fact that most Australians are continuing to gain weight. The <a href="http://www.bakeridi.edu.au/Assets/Files/Baker%20IDI%20Ausdiab%20Report_interactive_FINAL.pdf">latest analysis of the Australian Diabetes Obesity and Lifestyle cohort</a>, found young adults were gaining 0.5kg per year, or around 7kg over the 12 year study. </p>
<p>In this context, it would be irresponsible not to work together to improve our nutrition and activity environments, and prevent more weight gain.</p>
<hr>
<p><strong>Tim Olds</strong>:</p>
<p>Anna is quite right on two points, and here we can agree: adults everywhere are getting fatter (though this is <a href="http://www.ncbi.nlm.nih.gov/pubmed/21838570">not true</a> of kids). And fatter people are more likely to suffer from a wide range of diseases, including diabetes, arthritis and cardiovascular disease.</p>
<p>Now let me ask another question. Which is more important: fatness or fitness? Should we spend limited health dollars trying to get people to lose weight, or to get active? I’ll argue here for physical activity.</p>
<p>First, people who are fat but active have a much lower risk of death than people who are fat but inactive. Second, people who are <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2009.00653.x/full">fat but active</a> have about the same, or lower, risk of death than people who are lean but inactive. Third, if you exercise, you’ll <a href="http://diabetes.publicaciones.saludcastillayleon.es/content/28/5/1195.full">be healthier</a> even if you don’t lose weight</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/33134/original/h9tnmk2r-1381898528.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/33134/original/h9tnmk2r-1381898528.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/33134/original/h9tnmk2r-1381898528.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/33134/original/h9tnmk2r-1381898528.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/33134/original/h9tnmk2r-1381898528.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=464&fit=crop&dpr=1 754w, https://images.theconversation.com/files/33134/original/h9tnmk2r-1381898528.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=464&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/33134/original/h9tnmk2r-1381898528.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=464&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s better to be fat and active than lean and inactive.</span>
<span class="attribution"><span class="source">Flickr/pennstatenews</span></span>
</figcaption>
</figure>
<p>But does fitness trump fatness? A <a href="http://www.hindawi.com/journals/eri/2013/437465/">study published this month</a> may help to answer that question. It followed 11,240 Americans for 12 years and calculated the percentage of deaths attributable to fitness, fatness, diet and smoking. The greatest contributor to deaths was low fitness (6-7%), followed by smoking (5%), diet (3%) and fatness (0%).</p>
<p>We have an epidemic of inactivity. Low fitness is a stronger predictor of overall mortality than fatness. Weight loss among overweight and healthy obese people is a failed concept both in terms of evidence and in terms of <a href="http://www.ncbi.nlm.nih.gov/pubmed/22586192">implementation</a>.</p>
<p>So why on earth are we focusing so much on fatness, and so little on physical activity?</p>
<hr>
<p><strong>Anna Peeters</strong>:</p>
<p>There is no debate about the importance of aerobic fitness for health, quality of life and survival. But fitness is a marker of your capacity for activity, not your current physical activity levels, and it’s also <a href="http://circ.ahajournals.org/content/127/5/652.long">affected by</a> sex, age, ethnicity, obesity, activity and poor health.</p>
<p>While Tim’s point that fitness matters more than weight is true, the same article also shows that weight matters more than physical activity. </p>
<p>But it should not be a competition. Healthy diet, activity and weight all work together to improve our fitness. </p>
<p>Tim mentions that obesity rates are no longer going up in kids. Well, <a href="https://theconversation.com/lessons-for-australia-from-us-reversal-of-childhood-obesity-17895">in the US</a>, the rate of childhood obesity is declining, thanks to strong government action to improve food and activity standards in children’s setting. This <a href="http://www.rwjf.org/en/blogs/culture-of-health/2013/08/another_sign_of_prog.html">action</a> came about to combat the obesity epidemic.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/33133/original/xkcyc24s-1381898453.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/33133/original/xkcyc24s-1381898453.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/33133/original/xkcyc24s-1381898453.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/33133/original/xkcyc24s-1381898453.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/33133/original/xkcyc24s-1381898453.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/33133/original/xkcyc24s-1381898453.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/33133/original/xkcyc24s-1381898453.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A better diet is just as important for weight loss as exercise.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>We need strong advocacy if we are to smarten up the food choices available to us in Australia. </p>
<p>The focus now needs to be on the healthy environments and behaviours, and obesity remains an important marker of our progress. If we normalise obesity we’re missing our chance to prevent premature chronic disease for our children, and our children’s children.</p>
<p>Yes, increasing activity and avoiding inactivity has the potential to improve health in everyone. But achieving that is just as hard as improving diet, or any combination of the two, which is the general aim of weight loss strategies. </p>
<hr>
<p><strong>Tim Olds</strong>:</p>
<p>Anna is quite right when she says the stabilisation and decline in obesity in kids is most likely the result of repeated messages at all levels. But kids are the low-hanging fruit of the obesity tree, because parents act as gatekeepers for their exercise and dietary behaviours. Unfortunately, parents aren’t as good at regulating their own behaviours.</p>
<p>Weight loss attempts by adults have a poor success rate. Take [this 2005 Danish study](<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1160579/">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1160579/</a> which followed a large cohort of adults over six years. At the start, about 36% said they intended to lose weight. At the end of the study, 38% of those intending to lose weight actually had lost weight. That doesn’t sound too bad, until you know that 38% of those <em>not</em> intending to lose weight had also lost weight!</p>
<p>We also know that over the long term (i.e. years) only about 5-10% of those trying to lose weight maintian their weight loss. </p>
<p>Studies have <a href="http://nutrition.otago.ac.nz/__data/assets/file/0013/5233/thomas2008livedexperienceobesity.pdf">also shown</a> that in the face of public health “weight scare” messages (such as the <a href="http://www.measureup.gov.au/internet/abhi/publishing.nsf/content/home">Measure Up ads</a>), overweight people think that the messages don’t apply to them — only to <em>really</em> overweight people — while obese people simply pull down the shutters and block their ears.</p>
<p>Weight loss is a laudable goal, but we’ll end up with a healthier (and probably leaner) population if we shift the emphasis from weight loss to healthy lifestyle, and tell people that exercise and a good diet are more important and more achievable goals.</p>
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<img alt="" src="https://images.theconversation.com/files/33129/original/jjhtc78r-1381896708.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/33129/original/jjhtc78r-1381896708.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/33129/original/jjhtc78r-1381896708.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/33129/original/jjhtc78r-1381896708.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/33129/original/jjhtc78r-1381896708.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/33129/original/jjhtc78r-1381896708.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/33129/original/jjhtc78r-1381896708.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">One in four Australian children is overweight or obese.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
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<p><strong>Anna Peeters:</strong></p>
<p>In Australia, more than six in ten adults and one in four children are overweight or obese. To deal with this we need to promote and facilitate healthier nutrition and activity, enable those at risk of further weight gain to maintain weight and manage weight and health complications in those living with obesity. </p>
<p>Clearly, advocating healthy lifestyles is one part of the solution, but education alone will not be sufficient. We need to enable those living with obesity to maximise their health and well-being, and [access treatment](<a href="http://www.nhmrc.gov.au/media/releases/2013/new-clinical-practice-guidelines-managing-overweight-and-obesity">http://www.nhmrc.gov.au/media/releases/2013/new-clinical-practice-guidelines-managing-overweight-and-obesity</a>.</p>
<p>We also cannot ignore the role of the environment we live in. So, instead of debating fitness versus fatness, we need to shift from a focus on individuals to a focus on society. Then healthy choices – both activity and diet – can become the easy choices for everyone.</p>
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<p><em><strong>Can you be healthy at any weight? Share your comments below.</strong></em></p><img src="https://counter.theconversation.com/content/18539/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Peeters receives funding from the National Health and Medical Research Council, Australian Research Council, Australian National Preventive Health Agency and VicHealth. She is President of the Australian and New Zealand Obesity Society.</span></em></p><p class="fine-print"><em><span>Tim Olds has received: four NHMRC, two ARC Linkage and two ARC Discovery Grants; about $10 million in other Commonwealth, State and NZ government grants; various smaller grants from organisations such as Beyond Blue, Australian Sports Commission, National Stroke Foundation, Channel 7, Healthway, DSTO, Physiotherapy Research Foundation. He is involved in a 12-nation study funded by Coca-Cola through the Pennington Biomedical Research Center in the US and Coke once sent him a nice basket of fruit as thanks for a talk he gave to some execs.</span></em></p>Australians are getting heavier and, as a result, are more likely to suffer life-threatening illnesses such as heart disease, diabetes and strokes. But should we be worried about a bit of excess weight…Anna Peeters, Head, Obesity & Population Health, Baker Heart and Diabetes InstituteTim Olds, Professor of Health Sciences, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/184022013-09-20T02:28:07Z2013-09-20T02:28:07ZViewpoints: the promise and perils of three-parent IVF<figure><img src="https://images.theconversation.com/files/31637/original/sn7vcgm8-1379574080.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Three-parent IVF is about allowing women who carry genetic diseases in their mitochondria to avoid passing them on to their children.</span> <span class="attribution"><span class="source">Glenn/Flickr</span></span></figcaption></figure><p><em>Far from creating designer babies, <a href="https://theconversation.com/meet-mama-papa-and-mama-how-three-parent-ivf-works-15725">three-parent IVF</a> is about allowing women who carry genetic diseases in their mitochondria to avoid passing them on to their children. The process involves replacing the mitochondria from the ovum of a woman who has a mitochondrial disease with one from a healthy donor.</em></p>
<p><em>It’s controversial because it requires a third “parent”, a woman who can donate a healthy mitochondria. The technology is currently prohibited throughout the world although the UK government has <a href="http://www.bionews.org.uk/page_318118.asp">announced its intention</a> to draft proposals allowing it.</em> </p>
<p><em>The technology could work in two ways – transferring the chromosomes from the mother into an egg from a healthy donor that has only the mitochondria (with other chromosomes removed) before fertilisation. Or we could take all the chromosomes out of a fertilised egg and put them into a donor egg that, again, has been “emptied” apart from the mitochondria.</em></p>
<p><em>An article published in the journal Science today raises some potential concerns about the technique. Here, one of the authors of the paper, Damian Dowling explains some limitations of the process. And professor of mitochondrial genetics Justin St John responds.</em></p>
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<p><strong>Damian Dowling:</strong> Our article outlines key research findings, as well as the outcome of a public consultation by the UK Human Fertilisation and Embryology Authority (HFEA) into the safety and ethics of mitochondrial replacement, which is also known as mitochondrial replacement-assisted IVF, or popularly as three-parent IVF. We believe the technique holds exciting promise for prospective mothers suffering from mitochondrial disease. </p>
<p>We talk about a body of scientific literature that is highly pertinent to the technology, but has been by-and-large overlooked in the scientific and public forums of this debate.</p>
<p>People have different nuclear genomes (genetic make-up) and different mitochondrial DNA sequences (mtDNA or haplotypes). How we make energy is determined by how these genomes work in tandem with our mitochondrial haplotypes. Indeed, experimental research on model organisms, ranging from mice to insects, indicates that how the mitochondrial DNA interacts with the genome is tightly preserved by natural selection – nature’s quality control process. </p>
<p>This interaction (mito-nuclear) is salient to life as we know it because it regulates much of our energy production. </p>
<p>When researchers have used mitochondrial replacement-type techniques to mix-and-match different combinations of putatively healthy mitochondrial haplotypes and nuclear genomes, they have typically found that new mito-nuclear combinations change how organisms function – from altering development rates to cognitive ability, reproductive success to life expectancies. Sometimes, this is for the worse.</p>
<p>Mitochondrial replacement-assisted IVF can make novel combinations of mito-nuclear interaction in ways that normal sexual reproduction cannot. </p>
<p>Under normal conception, a copy of the mother’s nuclear genome is transmitted to her children in 100% of cases, along with her mitochondrial genotype. This gives natural selection the fuel to preserve optimally functioning mito-nuclear gene combinations, perpetually across generations.</p>
<p>In public discussions of this technology, mitochondria have been likened to batteries in a camera; it doesn’t matter what brand of battery you use, the camera will function well. The body of research we bring to the table suggests this analogy needs rethinking – the brand can affect the expression of many health-related traits.</p>
<p>We don’t want to block the transition of this technique to the clinic. But, we feel it’s our obligation to bring to the discussion the research that has been overlooked. This research should be considered by the authorities involved in bringing mitochondrial replacement-assisted IVF to the clinic, who should decide how relevant the results and principles highlighted in this literature are to humans. </p>
<p>Ultimately, it will be difficult to predict how relevant this all is to the human case.</p>
<p>Women who suffer mitochondrial disease and might benefit from this technique should at least have access to the full array of evidence. They should understand its potential implications, so they can make an informed choice that is right for them and their situation.</p>
<p>While we don’t claim that this is the whole solution, perhaps matching mitochondrial haplotypes of the donor and mother would make sense and should be explored further. This option has been discussed by the HFEA.</p>
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<p><strong>Justin St John:</strong> The authors of the Science piece mention that the research they are highlighting hasn’t been included in the public debate. It’s important to note that it has not been overlooked by the scientists working on the technology or the agencies involved.</p>
<p>For quite a while now, scientists have been trying to develop approaches to prevent future generations from inheriting diseases associated with the mitochondrial genome. </p>
<p>Proposed assisted reproductive technologies offer the opportunity to prevent these diseases from being passed from one generation to the next. This is a highly worthwhile pursuit, but there are a number of safety issues that still require further explanation. </p>
<p>The most important issue that Damian Dowling raises above is that research he is drawing attention to has been considered by the Human Fertilisation and Embryology Authority (HFEA). I have also previously argued this case in the scientific literature. </p>
<p>I would even go a step further and suggest the technology needs an all-round safety assessment, which is also the view of the UK’s Nuffield Council on Bioethics and the HFEA. It’s important to note that the HFEA is the only body in the world considering proceeding with the technology.</p>
<p>I want to be sure that there’s no accompanying mutated mitochondrial DNA introduced into the egg when the chromosomes from the mother are transferred into the donor egg. Modifications to this technology could prevent that.</p>
<p>I would also want to ensure that there are no other abnormal processes resulting from the transfer. It has previously been argued that the transfer of chromosomes from one egg to another could affect chromosomal gene expression patterns through <a href="https://theconversation.com/explainer-what-is-epigenetics-13877">epigenetic factors</a>.</p>
<p>To overcome these concerns, we are currently developing technologies to prevent the transfer of accompanying mitochondrial DNA. Once we have perfected this, we will test the outcomes in model systems.</p>
<p>That data would be available to the scientific community and the regulatory authorities, and it would enable informed decisions to be made about safety. </p>
<p>Sometimes, the public debate about complex science is simplified but that doesn’t mean that the science has been simplified, careless or rushing ahead heedless of negative consequences. It’s good that as we move closer to using this technology that the public debate becomes deeper, but that doesn’t mean that this depth is new in scientific circles. </p>
<p>We all seek to ensure that this area of research doesn’t generate another problem while solving one.</p><img src="https://counter.theconversation.com/content/18402/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Damian Dowling receives funding from the ARC.</span></em></p><p class="fine-print"><em><span>Justin St. John receives funding from NHMRC, which looks at mitochondrial mutations and previously held a grant from the UK MRC, which looked at cloned embryos and mitochondrial inheritance.</span></em></p>Far from creating designer babies, three-parent IVF is about allowing women who carry genetic diseases in their mitochondria to avoid passing them on to their children. The process involves replacing the…Damian Dowling, Senior Research Fellow , Monash UniversityJustin St. John, Professor and Director, Centre for Genetic Diseases, Monash Institute of Medical Research, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.