Nannies gone wild

“I’m from Canada,” my friend told a new acquaintance on a tour of South Africa. “Oh,” said the man. “The nanny state.” It took me a minute to realize what he meant. Canada, with our mandatory seat belts and helmet laws. Canada, where it’s against the law to drink and drive or drive and text.* It had never occurred to me to call those bad things. Nay these decrees be evidence-based. Proven to save lives and prevent morbidity. Just like vaccines.** But South Africa had a more wild west mentality, which meant people rebelled against rules. They demanded more freedom even if it meant they smashed their heads. Read: Falling out of an airplane with no parachute I didn’t get it. But now I do, a little bit. Medicine is a nanny state. We weigh the evidence and then we issue commands. Thou shalt not smoke. Thou shalt not take street drugs. Thou shalt not drink more than than twice a week. “Everyone laughs when I tell them about the new alcohol rules. Young, old, doesn’t matter,” said my nurse friend. I know the more stringent guidelines reduce cancer risk. Does that mean people will follow them? “Everything gives you cancer,” my husband has said ever since we first started dating at age 18, and now our kids repeat it too. Read: Wrath and incompetence I’ve tried to explain that we don’t issue commands against vegetables and exercise. Although many worry about pesticides, and athletes do get injured (sometimes spectacularly). But yeah, otherwise it seems like everything is dangerous. So patients start to rebel against all the rules, and doctors and nurses feel robotic endlessly discussing the risk/benefit ratio of formerly innocuous things like going outside (UV rays, skin cancer). Especially when it’s not actually 100% evidence. Science means constant investigation and re-evaluation as the evidence mounts, sometimes more convincingly than others.*** Case study: Thou shalt not drink for nine months if thou gets pregnant. Anecdotally, some take a glass during pregnancy without causing fetal alcohol syndrome, but we want to prevent all cases, so the only foolproof thing to do is ban alcohol completely during pregnancy. But if men got pregnant, we’d probably see a rule that allowed some use of judgement instead of a blanket ban. I reflected on this as part of my new novel, Sugar and Vice, where I explore gluttony. Our society has a dichotomous relationship with food. Either we supersize all-you-can-eat extravaganzas (gluttony), or we completely ban the demon of the day. “I don’t eat sugar.” “I don’t eat red meat.” “I’m gluten-free.” “Paleo.” “No carbs.” “Glycemic index.” “Raw diet.” Low fat has fallen out of fashion, as they all seem to eventually. People jump on the next bandwagon, and the next, and the next. We all know the downsides of gluttony, but we don’t work on the real problems of poverty and lack of access to fruits and vegetables. Easier to blame the poor people for their diabetes or obesity. I personally glaze over when people talk about their diets and intolerances. Fine, customize your diet, but don’t evangelicize about it to me. Please. So boring. Where is the joy? How do you evoke genuine pleasure and well-being and connection either in the nanny state or in the wild west? When I read up on the Mediterranean diet, I already knew about eating vegetables, fish and nuts. No one emphasized that the people ate together, that literally breaking bread over the same table is part of that way of life and therefore may be crucial. We want the quick fix (Drink red wine. No, don’t!) and ignore the same lessons over and over: eat fresh, whole foods, mostly vegetables, with people you love. Move your body. But have fun. No matter where you fall on the nanny/wild spectrum, try to find some joy without hurting others. Otherwise, you risk living a long but dreadful, sanctimonious life. Bon appétit! Signed, Joyful Melissa *I accidentally wrote drink and text at first. No laws against that yet! ** Bring on the hate mail *** Still very strong evidence for vaccines Melissa Yuan-Innes is an emergency physician in Alexandria, Ontario and the author of Sugar and Vice.

Nannies gone wild

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Dr. Melissa Yuan-Innes

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