16 August 2014

Sub Optimizing Your Health

Those of you who have read my personal blog know that I am interested in planning and real asset portfolio management. When I say portfolio, it is about understanding how assets interact or correlate and how they affect the whole enterprise. For example, if a company is doing a large project, there is a system cost in doing the project that is seldom considered--when you put people or capital into a large project, there are other projects that do not get done or get delayed.

This work has caused me recently to think about a couple of things.

Maximizing the Health of an Individual at the Expense of Society

Years ago, I had a conversation with my dad who was a doctor. I was feeling pretty smug because I had read about how over-prescription of antibiotics was giving rise to the super-bugs. So I asked him what he does when a patient comes in with flu-like symptoms, but nothing definitive (or some such scenario). He said he would prescribe an antibiotic. Aha I said, you are contributing to the rise of superbugs.

His response was a little startling to me. He said that he didn't know about super-bugs, but he did know that he had a responsibility to his patient and that would be the best course of action for her.

I wrote about the super-bugs and this conversation here as well.

In essence his responsibility was to maximize the health of his patient without regard for overall public health.

Maximizing the Health of an Individual Organ at the Expense of the Body

There is a parallel in the medical specialties. Dermatologists recommend people to minimize sun and use high SPF sun block. When people do this, it minimizes the chances of getting skin cancer, especially carcinoma, the most common form of skin cancer. Their focus is on skin health. It makes sense that they would make these recommendations. In our litigious society, we all need to protect ourselves.

But, in avoiding sun, we reduce the production of vitamin D in our bodies. Vitamin D is important for immune function, and there is evidence that adequate levels of vitamin D can help prevent colds, flu, many other types of cancer, including possibly melanoma--the more deadly form of skin cancer.

So your skin might be in better shape if you minimize sun exposure, but you get the flu or something worse. Important: I do not recommend getting sunburned. Sunburn especially for those under 18 does cause damage to the skin without giving any extra vitamin D benefit. People with light complexions need to be especially careful.

The point of this is that like my father who was focused on his patient at the expense of society at large, medical specialists focus on their organ specialty at the expense of the rest of the body. Drugs work the same way. They focus on doing some very specific thing, e.g. lowering LDL in the blood, then create systemic effects. Remember side-effects are effects.

An Important Role of Government

Who then watches over the whole body and the whole of society. Well for society in the US, we have, in theory, the government. Government entities like the EPA ensure that companies and individuals do not, while pursuing their own enrichment, exact cost on the rest of society. I believe that guarding our shared resources to prevent Tragedy of the Commons is an important role of government. We have seen that with previous systems in place, industry poisoned the environment. Was it because of lack of regulation, protection of the culprits through the anonymity of incorporation, government protections such as limitation of liability, greed, or all of the above? I don't know, but it didn't work. EPA seems to be working better.

A Bad Role of Government

When it comes to the whole body though, remember that it is your body. Nobody has a greater stake than you in ensuring that your body's system is in good health and working well. You are responsible and accountable for what goes into your mouth.

The USDA (department of agriculture) is a great example of what government agencies should not be doing. Their main goal historically has been to support the agricultural sector of the US economy. I don't know the rationale for having a department with a cabinet secretary to do that, but whatever. In 1894 they got into the personal nutrition business publishing nutrition guidelines.  Until 1956, grains were just one of 7 food groups given equal weighting. In 1992 the first food guide pyramid came out emphasizing grains. Separately the United States Senate Select Committee on Nutrition and Human Needs, aka the McGovern commission, in 1974, changed the focus of our diet towards carbohydrates and away from fats. The health of our nation has been in decline ever since. Food manufacturers bear blame as well.

Don't even get me started on the FDA.


  1. Systems thinking is important; a holistic perspective can give important insights.
  2. Listening only to experts with a very narrow perspective can lead to sub-optimization
  3. Government tries, with mixed results, to look after the systemic good of our nation.
  4. Some of the agencies in the US government seem very closely aligned with industry to the detriment of individuals.
  5. Ultimately you are responsible for yourself. Consider the source, not just their degrees, but also their incentives in providing advice or guidance.

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