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Letters to the Editor



At the Mercy of “Death Merchants”

I have just finished reading the Spring 2003 edition of your magazine brought to my office by a friend. I read with pain and a special cry for humanity the story titled “Smoke Out!” which chronicled the staggering effects of tobacco on human life. However, of particular interest to me and my organization is the relentless effort of Dr. Jonathan Samet of the Institute for Global Tobacco Control. I want to commend the Institute’s work in developing nations, but I am sad that while NGOs in other developing nations are being assisted in terms of funding for projects and research, Nigeria is left to face the hardship posed to life by tobacco multinationals. British American Tobacco in Nigeria last week established a new manufacturing company on land freely provided by the Nigerian government. See how our lives are in the hands of the death merchants?

Adeola Akinremi
Project Director, Journalists Advocacy for
Safe Environment & Tobacco Eradication
Lagos, Nigeria

Jonathan Samet and his dedicated team underscore one of the Mt. Everest global challenges in public health. What is seldom added up is shocking: Smoking kills more people than alcohol, AIDS, car crashes, illegal drugs, murders, and suicides combined! The challenge I’d like to add to this domestic and global epidemic is how to design a behavioral and mass media strategy that successfully answers cigarettes’ social allure, low cost, and immediate gratification, and big tobacco’s marketing prowess. We need something more powerful than, “Do not smoke; it causes cancer.”

Roberto Anson
Montgomery Village, Maryland

Solving Health Disparities

I applaud Thomas LaVeist, Dorothy Browne, Jean Flagg-Newton [of the National Institutes of Health], and colleagues for tackling the issues of health disparities among African Americans [“Race to Health,” Spring 2003]. I have embarked on the same objective in Washington, D.C., after finding harrowing statistics on race disparities in health. The state of health for African Americans is disconcerting, and chronic disease has an excessive impact on minority and low-income populations. The African-American community appreciates committed community leaders like LaVeist, Browne, and Flagg-Newton.

Chasta Jones
Founder, o.c.e.a.n.s. vision
Washington, D.C.

The Business of Health Care

Dr. Weiner has an excellent solution to the American health care problem [“The Case for a Health Care Fed,” Fall 2002]. However, the more I read about solutions for the problem, the more I see the lack of realization that change starts with public education. If we do not educate the public about all the prescription drug advertisements, the problem will continue to exist. An educated public can make better judgments about what is offered and how much they will end up paying for it, directly or through higher premiums and [less] care. Moreover, our health care professionals should share some of the blame for our higher health care costs for not educating their patients. Another element that blocks any change to our system is the fact that health care is a business in America. As long as health care is a business, then politicians can be influenced by business lobbies.

Mojgan Sanepour Haji, RPh
Shrewsbury, Massachusetts

Seeking the “Magic” Answer

“Off the Scale,” Spring 2003, like other articles dismissing low-carb diets, ignores the “magic” of Atkins-type ketogenic diets. Low-calorie diets make Americans ravenous, elevating triglycerides and other lipids, [causing them to] succumb to hunger and binge on both high-fat and high-carb foods—a dangerous combination.

Artisit: Joe Cepeda

I have seen both sides of the research, and tried both methods. The ketogenic diet is the favorable option if one can stay on it. I am able to eat more calories than I ever have (2,500 to 3,500 per day vs. 2,100 or less, recommended for my weight and sedentary lifestyle) and actually struggle to keep from losing too much weight, as my BMI is now in the healthy range (23).

My advice is to go back and review journal research, even if you have to go to to find the references.

Andrew Zukoski
Port Jefferson, New York

I lived in Tokyo for 11 years. People there regularly walk and ride bicycles quite a bit in the course of a day, including walking up lots of steps in the subway. You are surrounded by low-fat, delicious food choices—great fish and vegetable dishes are available at convenience stores, for example. Restaurant portions are very small compared  to [those in] the U.S., and most “sweets” are not nearly as sweet.  Also, food is too expensive to eat a lot [of]!  So it is easy to stay slim there. 

I agree that we need  to change our whole social environment, or this obesity epidemic is going to swamp us. If we can tax cigarettes, why not tax high-fat food?  

Diane Cripps
Hockessin, Delaware

Like most people, I have struggled with my weight. I tried every diet known to man and still ended up fat. At my largest I was 290 pounds. I had gastric bypass surgery in January 2002. I have lost 138 pounds. I don’t feel 100 percent, but I definitely feel better than before. What are the pros and cons of that surgery?

Paula Akers
Baltimore, Maryland

Lawrence J. Cheskin, MD, associate professor, International Health, and director of the Johns Hopkins Weight Management Center, replies: Gastric bypass, a procedure that creates a smaller stomach and bypasses the first part of the small intestine, is currently the surest method of losing a substantial amount of weight, but it has limitations. First, [the procedure] is riskier than standard diets and entails a permanent change in one’s anatomy and absorption of certain nutrients. Second, the weight loss obtained after surgery, just like a diet, will not last unless the person is committed to making permanent changes in diet and related behaviors.

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