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Jul. 12th, 2001 01:48 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
libertangoThe phenomenon of seeing two (or more) articles in the press that seem almost as if they were written at the same time is not uncommon. In short-deadline news, it usually happens because someone broke a story, and then the editors whipped their reporters to come up with a follow-up. In Hollywood, it usually happens because a particular special effects technology becomes available (hence, two volcano movies, two ocean wave movies, etc.)
When it happens in somewhat more high-falutin' journals, it's probably just dumb luck, after which The Wilson Quarterly will write a gang review. (Either that, or the well-known research firm of Lobachevsky & Lehrer is skulking about.)
But since I haven't received a copy of The Wilson Quarterly for a while, and it appears I'm developing an audience, and I've noticed a pair of articles...
To wit: In the Spring 2001 issue of The American Scholar, we have "Fat", by Spencer Nadler. Mr. Nadler, we are told, is a surgical pathologist. He has a great opening: "I spend much of my life looking at cells through a microscope. Of all the cells I see, few are as distinctive as the human fat cell."
Anne Fadiman, editor of the Scholar, clearly has a jones about biology. Her predecessor as editor, Joseph Epstein, made a point of only rarely having a writer appear for a return visit (other than his own finely crafted opening essays for the magazine). Fadiman, on the other hand, has enlisted a handful of writers to be regular voices, and among the first was a doctor, Sherwin Nuland. Nadler, like Nuland, has the voice of a practitioner, leavened by good humor: "...when I look through my microscope, my eye often glosses over (fat cells). Seeking treachery, I am trained to look for more likely cellular culprits."
Nadler uses this base of pathology to jump into the consequences of great accumulations of fat cells. That is, people who are morbidly obese, and one of the more invasive methods of becoming less so: the Roux-en-Y gastric bypass. Nadler outlines a case study of a woman who had her stomach shrunken from 1700 milliliters to 35 milliliters.
He then goes on to tell the cellular mechanisms by which his subject had her body weight cut by more than half, to 169 pounds.
If Nadler is seeking the "how", Atul Gawande is seeking the "why".
Gawande's article is "The Man Who Couldn't Stop Eating," in the 9 July 2001 issue of The New Yorker. Gawande is a surgical resident in Boston, and he opens with a description of a Roux-en-Y, one that he assisted on:
Gawande was clearly deeply affected by helping in this operation. He visited the patient, whom he calls Vincent Caselli, a number of times afterward, keeping an eye on him, even taking him to a Boston Bruins hockey game. Gawande also started looking not so much at the mechanics of fat cells, as what the nature of appetite is, and how it can become a deadly burden if unchecked.
There are two ways that people can consistently eat beyond what they need. The first, Gawande tells us, is to eat too much for too long at a single sitting, repeatedly. This is what people with Prader-Willi syndrome do -- it's a rare disorder that results in the patient never feeling full.
For most people, though (including, presumably, myself) what happens is a set of conflicting pieces of information. Our stomachs tell us we're full, but our mouths tell us, "This stuff is great! Gobble up all you can!" Gawande calls this "the appetizer effect". "The tastier the food, the faster we eat...", overwhelming the ability of our bodies to signal satiety to us.
He follows this with an extremely spooky report. An experiment was done in 1998 to two men who, as in the film Memento, had severe amnesia of their short-term memory. For three days they were each served a standard lunch. One would always finish, the other couldn't quite.
Then, ten to thirty minutes later, they were fed again.
And then again.
Each time, they each ate to their regular pattern -- BR finishing everything, RH not quite able to do so. On a few occasions, they tried giving RH a fourth meal, and it was only then that he'd decline, saying he was full.
Gawande tells us, "...in the absence of a memory of having eaten, social context alone -- someone walking in with lunch -- was enough to re-create appetite."
He is of the opinion that appetite is so complex that the usual approaches to controlling it -- diet, drug-based suppressants, etc. -- have failed through being not comprehensive enough. Thus the push to surgical means such as the Roux-en-Y. Even then, the operation has a 5 to 20 percent failure rate. He gives us an example of someone for whom the operation didn't curb his appetite, despite considerable pain and gastric distress from his markedly smaller stomach.
A very good combination between the two essays, especially since they treat virtually the same subject with such disparate methods.
When it happens in somewhat more high-falutin' journals, it's probably just dumb luck, after which The Wilson Quarterly will write a gang review. (Either that, or the well-known research firm of Lobachevsky & Lehrer is skulking about.)
But since I haven't received a copy of The Wilson Quarterly for a while, and it appears I'm developing an audience, and I've noticed a pair of articles...
To wit: In the Spring 2001 issue of The American Scholar, we have "Fat", by Spencer Nadler. Mr. Nadler, we are told, is a surgical pathologist. He has a great opening: "I spend much of my life looking at cells through a microscope. Of all the cells I see, few are as distinctive as the human fat cell."
Anne Fadiman, editor of the Scholar, clearly has a jones about biology. Her predecessor as editor, Joseph Epstein, made a point of only rarely having a writer appear for a return visit (other than his own finely crafted opening essays for the magazine). Fadiman, on the other hand, has enlisted a handful of writers to be regular voices, and among the first was a doctor, Sherwin Nuland. Nadler, like Nuland, has the voice of a practitioner, leavened by good humor: "...when I look through my microscope, my eye often glosses over (fat cells). Seeking treachery, I am trained to look for more likely cellular culprits."
Nadler uses this base of pathology to jump into the consequences of great accumulations of fat cells. That is, people who are morbidly obese, and one of the more invasive methods of becoming less so: the Roux-en-Y gastric bypass. Nadler outlines a case study of a woman who had her stomach shrunken from 1700 milliliters to 35 milliliters.
He then goes on to tell the cellular mechanisms by which his subject had her body weight cut by more than half, to 169 pounds.
If Nadler is seeking the "how", Atul Gawande is seeking the "why".
Gawande's article is "The Man Who Couldn't Stop Eating," in the 9 July 2001 issue of The New Yorker. Gawande is a surgical resident in Boston, and he opens with a description of a Roux-en-Y, one that he assisted on:
"And so, although (the patient) was afraid of surgery, he had come for a Roux-en-Y gastric-bypass operation. It is the most drastic treatment we have for obesity. It is also among the strangest operations surgeons perform. It removes no disease, repairs no defect or injury. It is an operation that is intended to control a person's will -- to mainpulate his innards so that he does not overeat -- and it is soaring in popularity. Some forty-five thousand patients underwent obesity surgery in 1999, and the number is expected to double by 2003."
Gawande was clearly deeply affected by helping in this operation. He visited the patient, whom he calls Vincent Caselli, a number of times afterward, keeping an eye on him, even taking him to a Boston Bruins hockey game. Gawande also started looking not so much at the mechanics of fat cells, as what the nature of appetite is, and how it can become a deadly burden if unchecked.
There are two ways that people can consistently eat beyond what they need. The first, Gawande tells us, is to eat too much for too long at a single sitting, repeatedly. This is what people with Prader-Willi syndrome do -- it's a rare disorder that results in the patient never feeling full.
For most people, though (including, presumably, myself) what happens is a set of conflicting pieces of information. Our stomachs tell us we're full, but our mouths tell us, "This stuff is great! Gobble up all you can!" Gawande calls this "the appetizer effect". "The tastier the food, the faster we eat...", overwhelming the ability of our bodies to signal satiety to us.
He follows this with an extremely spooky report. An experiment was done in 1998 to two men who, as in the film Memento, had severe amnesia of their short-term memory. For three days they were each served a standard lunch. One would always finish, the other couldn't quite.
Then, ten to thirty minutes later, they were fed again.
And then again.
Each time, they each ate to their regular pattern -- BR finishing everything, RH not quite able to do so. On a few occasions, they tried giving RH a fourth meal, and it was only then that he'd decline, saying he was full.
Gawande tells us, "...in the absence of a memory of having eaten, social context alone -- someone walking in with lunch -- was enough to re-create appetite."
He is of the opinion that appetite is so complex that the usual approaches to controlling it -- diet, drug-based suppressants, etc. -- have failed through being not comprehensive enough. Thus the push to surgical means such as the Roux-en-Y. Even then, the operation has a 5 to 20 percent failure rate. He gives us an example of someone for whom the operation didn't curb his appetite, despite considerable pain and gastric distress from his markedly smaller stomach.
A very good combination between the two essays, especially since they treat virtually the same subject with such disparate methods.
