Last updated on: 6/27/2017 9:21:03 AM PST
Is Obesity a Disease?
General Reference (not clearly pro or con)
Marianne J. Legato, MD, FACP, Professor Emerita of Clinical Medicine at Columbia University College of Physicians and Surgeons, in a June 2013 statement to a Prevention Magazine article titled "Is Obesity a Disease? Prevention Experts Weigh In," available at prevention.com, stated:
"Obesity is a complex entity that can have many causes; some are endocrine (like thyroid malfunction or hyperfunctioning of the adrenal gland-Cushing's syndrome [sic]) but often the condition is from a combination of inactivity and overeating. For others, there are genetic factors that produce a tendency to overweight even with the consumption of what would be for most people an appropriate number of calories...
Whether the causes are hormonal, genetic or reside in the brain (its reward system or the circuitry that underlies habit, perception of portion size, the choice of food, etc.) is often difficult to sort out."
June 2013 - Marianne J. Legato, MD, FACP
Alfonso Torquati, MD, MS, Chairperson of the Rush University Medical Center Department of Surgery and Director of the Rush University Center for Obesity, states in the April 11, 2017 article "Obesity Is Not a Character Flaw, Expert Says," available at medicalxpress.com:
"Obesity is absolutely a disease that requires a range of interventions and medical management... People may say 'just eat less, have will power' but they just don't understand that simply does not work for many people.
Successfully treating obesity shouldn't just be measured in lost pounds, but in not escalating to other diseases. Obesity is a base condition that then leads to or worsens so many others diseases like diabetes, high blood pressure, cardiovascular disease, sleep apnea, arthritis, and even cancer."
Apr. 11, 2017 - Alfonso Torquati, MD, MS
The European Association for the Study of Obesity (EASO) stated in the Oct. 16, 2015 "Childhood Obesity Is a Chronic Disease Demanding Specific Health Care – a Position Statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO)," available at easo.org:
"Childhood obesity is indeed associated with bodily abnormalities and failures to function properly. Some but not all cases of childhood obesity are characterized by increased tendency towards tissue-specific resistance to the actions of insulin, increased mechanical stress on joints, and impaired cardiovascular function. These may manifest as abnormal glucose tolerance, dyslipidemia, varying degrees of hypertension, orthopedic complications, and the presence of early atherogenesis. Importantly, childhood obesity is commonly associated with a reduced quality of life and impaired social functioning of the child.
Thus, obesity in childhood or adulthood fulfills the dictionary definition of a disease to its fullest. According to the US National Center for Health Statistics, a chronic disease is one lasting 3 months or more, cannot be prevented by vaccines or cured by medications, nor does it just disappear. In addition, a disease can be considered as a chronic if it is an illness persisting for a long time or constantly recurring. Thus childhood obesity is not simply a disease; rather it is a chronic disease."
Oct. 16, 2015 - European Association for the Study of Obesity (EASO)
Michael Gonzalez-Campoy, MD, PhD, Medical Director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology, states in his article titled "The Birth of Bariatric Endocrinology and the Coming of Age of Obesity Medicine" published in the Dec. 2016 issue of US Endocrinology:
"Obesity is a chronic, genetically programmed disease. The environment in which we live, referred to as an obesogenic environment, certainly plays a major permissive role in the expression of the many genes that lead to the accumulation of fat mass. As with any other chronic disease, obesity may be treated, managed, controlled, and even put into remission. But it cannot be cured. Patients need to understand this premise, because the treatment of obesity is life-long. The implementation of models of chronic disease management for the treatment of obesity provides the appropriate framework for success. Thus, obesity treatment should include all available treatment modalities, from lifestyle changes that include better nutrition and more physical activity (NOT diet and exercise), to pharmacotherapy, to the use of devices, and surgery for weight loss."
Dec. 2016 - Michael Gonzalez-Campoy, MD, PhD, FACE
Pamela M. Peeke, MD, MPH, FACP, President of the Peeke Performance Center for Healthy Living and Clinical Assistant Professor of Medicine at the University of Maryland, in a June 2013 statement to a Prevention Magazine article titled "Is Obesity a Disease? Prevention Experts Weigh In," available at prevention.com, stated:
"Does obesity fit the strict definition of a disease? According to Mosby's Dictionary of Medicine, Nursing, & Health Professions, a disease is: 1. a condition of abnormal vital function involving any structure, part, or system of an organism; 2. a specific illness or disorder characterized by a recognizable set of signs and symptoms attributable to heredity, infection, diet, or environment. Answer? It fits.
Moreover, as a physician who, like my medical brethren, has had to resort to creative diagnostic coding to work with people in the field of weight management, I'm hoping that now, with a disease designation, these people will be able to have insurance to help defer some of the costs associated with obesity. This is particularly true of those who, on paper and exam, do not yet have the metabolic syndrome, but are clearly obese and seeking help.
Further, it is important that the medical community as well as the public and insurers drop their stereotypic perceptions of those who are obese, and elevate the obese condition to that of other disease conditions along with respect for those who are suffering."
June 2013 - Pamela M. Peeke, MD, MPH, FACP
The American Medical Association (AMA) in a May 16, 2013 policy change, available at ama-assn.org, stated:
"Whereas, Our American Medical Association's Council on Science and Public Health Report 4, A-05, has identified the following common criteria in defining a disease: 1) an impairment of the normal functioning of some aspect of the body; 2) characteristic signs or symptoms; and 3) harm or morbidity...
RESOLVED, That our American Medical Association recognize obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to advance obesity treatment and prevention."
May 16, 2013 - American Medical Association (AMA)
Tasneem "Taz" Bhatia, MD, CEO, Medical Director and Founder of the Atlanta Center for Holistic and Integrative Medicine, in a June 2013 statement to a Prevention Magazine article titled "Is Obesity a Disease? Prevention Experts Weigh In," available at prevention.com, stated:
"Obesity, like alcoholism, depression, and anxiety, is a disease. There are definite medical patterns: hormone imbalances, neurotransmitter deficiencies and nutritional exhaustion that all contribute to obesity. Many of my patients that are obese have underlying medical issues that need to be addressed.
I agree that there are behavior patterns that contribute to obesity, but these same behavior patterns are rooted in other biological factors. Stress, the standard American diet and the industrialization of food have all been blamed in the obesity epidemic. While all of these factors contribute to being obese, they also create critical biological imbalances that people cannot overcome, or do not have the tools or knowledge to understand how to change.
Diets and exercise regimens often fail simply because the underlying medical pathology has not been addressed. My approach is to evaluate a patient fully, including family history, exhaustive hormone evaluation, nutrient status, and life inventory to understand where to begin in treating this disease. There is no quick weight loss for the obese."
June 2013 - Tasneem "Taz" Bhatia, MD
American Academy of Family Physicians (AAFP), in their 2013 publication "Diagnosis and Management of Obesity," available at aafp.org, stated:
"Overweight and obesity are chronic diseases with behavioral origins that can be traced back to childhood."
2013 - American Academy of Family Physicians
The World Health Organization (WHO), in its 2000 report "Obesity: Preventing and Managing the Global Epidemic," available at who.int, wrote:
"Obesity is a chronic disease, prevalent in both developed and developing countries, and affecting children as well as adults. Indeed, it is now so common that it is replacing the more traditional public health concerns, including undernutrition and infectious disease, as one of the most significant contributors to ill health."
2000 - World Health Organization (WHO)
Arthur Frank, MD, Founder and Co-Director of George Washington University Weight Management Program (GWUWMP), stated in the Nov. 10, 2003 Washington Post article "Is Obesity a Disease?":
"There's no question that obesity is a disease... Obesity is a disease where there's a disregulation of eating - just like diabetes is a disease where the system of controlling blood sugar is not functioning properly."
Nov. 10, 2003 - Arthur Frank, MD
The National Heart, Lung, and Blood Institute (NHLBI), in its Sep. 1998 publication "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults," available at nhlbi.nih.gov, wrote:
"Obesity is a complex, multifactorial disease that develops from the interaction between genotype and the environment. Our understanding of how and why obesity occurs is incomplete; however, it involves the integration of social, behavioral, cultural, and physiological, metabolic, and genetic factors."
Sep. 1998 - National Heart, Lung, and Blood Institute (NHLBI)
The American Obesity Association (AOA), now known as The Obesity Society (TOS), provided on the AOA's "Obesity Is a Chronic Disease" page (accessed Jan. 8, 2010):
"The American Obesity Association (AOA) believes that obesity is a disease. We want obesity understood by the health care community and patients as a serious disease of epidemic proportions.
First, let's define our terms. Dictionaries agree: obesity is excess body fat. It is not defined as a behavior. However, many people use the term obesity as short-hand for overeating or lack of exercise. But that is not its definition.
Consider this: most people can distinguish between smoking and lung cancer. One is a behavior and one is a disease. Or problem drinking of alcohol and liver disease. One is a behavior and one is a disease. Sunbathing without protection is a behavior; skin cancer is a disease.
Second, obesity - the excess accumulation of body fat - fits all the definitions of 'disease.' How is 'disease' defined? Most dictionaries, general as well as medical, define a disease as an interruption, cessation or disorder of a bodily function, organ or system. Obesity certainly fits this definition."
Jan. 8, 2010 - American Obesity Association (AOA)
José F. Caro, MD, Vice President of Global Diabetes Care at Eli Lilly, wrote in his McGraw-Hill's AccessScience Encyclopedia of Science & Technology article "Obesity Pathophysiology" (accessed Jan. 13, 2010):
"[O]besity is one of the most frequent and serious metabolic diseases. Furthermore, strategies for long-term reduction of body weight are largely ineffective. More than 90% of people who lose weight eventually regain it.
[H]uman obesity belongs to a large group called complex diseases. Included in this group are type II diabetes, hypertension, and ischemic heart diseases (characterized by deficient supply of blood to cardiac muscle). The inheritance of these diseases is different from the classic mendelian mode of transmission of monogenic diseases (related to or controlled by one gene). The phenotype of complex diseases reflects the multifactorial effect of all contributing genes (polygenic) and all environmental factors."
Jan. 13, 2010 - José F. Caro, MD
Louis J. Aronne, MD, Clinical Professor of Medicine at Weill Cornell Medical College, Donald S. Nelinson, PhD, President of InterQuest Medical & Scientific Communications, and Joseph L. Lillo, DO, Assistant Professor of Family Medicine at Arizona College of Osteopathic Medicine (AZCOM) at Midwestern University, in their 2009 Clinical Cornerstone article "Obesity as a Disease State: A New Paradigm for Diagnosis and Treatment," wrote:
"Obesity meets all accepted criteria of a medical disease, including a known etiology, recognized signs and symptoms, and a range of structural and functional changes that culminate in pathologic consequences. Excess adipose tissue acts as an endocrine organ to produce excess free fatty acids, as well as tumor necrosis factor-á, interleukin-6, leptin, and plasminogen activator inhibitor-1. These bioactive molecules are associated with hyperinsulinemia, hyperglycemia, insulin resistance, development of diabetes, endothelial damage, and the onset and progression of atherosclerotic lesions."
2009 - Louis J. Aronne, MD
Antonio Rene, PhD, Associate Professor of Epidemiology and Biostatistics at Texas A&M Health Science Center, and Baqiyyah Conway, PhD, Research Fellow in Epidemiology at Vanderbilt University, wrote in their May 2004 Obesity Reviews article "Obesity as a Disease: No Lightweight Matter":
"Contrary to just being a medical condition or risk factor for other diseases, obesity is a complex disease of multifaceted aetiology, with its own disabling capacities, pathophysiologies and comorbidities. It meets the medical definition of disease in that it is a physiological dysfunction of the human organism with environmental, genetic and endocrinological aetiologies. It is a response to environmental stimuli, genetic predisposition and abnormalities, and has a characteristic set of signs and symptoms with consistent anatomical alterations. Excess adipose tissue increases the work of the heart and leads to anatomical changes in this organ. It alters pulmonary, endocrine and immunological functions, all with adverse effects on health. Some of the complications of obesity include cardiovascular disease, non-insulin-dependent diabetes mellitus, obstructive pulmonary disease, arthritis and cancer. Given the excess mortality, substantial morbidity and the economic toll of obesity, this is a disease that warrants serious attention by the medical community."
May 2004 - Antonio Rene, PhD
Ian McColl, MD, Surgeon and former Shadow Minister of Health in the United Kingdom, states in his Oct. 11, 2016 article "There Is One Cure for Obesity and One Only: Eat Less. It's That or the Fatness Epidemic Will Kill More than Spanish Flu," available at telegraph.co.uk:
"[T]here is one cause of obesity and one only – eating too many calories. Certainly different bodies deal with food in different ways – some people seem able to eat a lot and stay thin whereas others appear to eat little and be overweight. But the fact remains that it is impossible to be obese unless one is taking in too many calories.
Genetic, psychological and metabolic factors have all been blamed for obesity. But while these may help to explain why people eat too much, none of them are the cause. There are no medical conditions that cause obesity. Thyroid deficiency does leads to weight increase but, again, only if too many calories are eaten...
We need an obesity strategy. It should say simply this: OBESITY IS KILLING MILLIONS, COSTING BILLIONS and the CURE is FREE. EAT LESS."
Oct. 11, 2016 - Ian McColl, MD
Dimitrinka Atanasova, PhD, Lecturer in Intercultural Communication at Lancaster University, in a Sep. 8, 2016 article, "Should We Classify Obesity as a Disease?," available at the London School of Economics and Political Science LSE blogs, stated:
"Considering obesity a chronic disease is a change from the current definition of it as a contributor to chronic diseases, such as diabetes – a change that has already happened in the US in 2013 and in Canada in 2015...
Arguments against classifying obesity as a chronic disease include the point that people would have to be treated only because their Body Mass Index is above a certain threshold, even though they may be perfectly healthy. This weakness of basing decisions about one’s health on BMI has, in fact, received much popular attention and was among the main arguments against declaring obesity a chronic disease presented by the American Medical Association’s own Council on Science and Public Health. Evidence has also emerged that individuals can be 'fat but fit.' Finally, in more severe cases, once obesity is seen as a chronic disease, individuals may be denied employment or insurance.
Classifying obesity as a chronic disease appears to be based on a flawed BMI tool that is ill-equipped to measure fat tissue versus muscle mass; the argument also seems to rest on the unsupported premise that calling it a disease will automatically reduce, if not remove, the stigma. Against this background, it might be wiser to stick with the status quo."
Sep. 8, 2016 - Dimitrinka Atanasova, PhD
Gary Johns, PhD, Adjunct Professor at QUT Business School and a columnist for The Australian, stated in his Oct 5, 2016 editorial, "Obesity Is a Personal Responsibility, Not a Disease," available ttheaustralian.com.au:
"Public health officials want obesity categorised as a disease. What follows is that Medicare will cover the condition and you and I will pay for it...
Yet the solution to obesity requires one simple exercise: push the chair away from the table. Unfortunately, too many fail to exercise this restraint. As a result, nearly 64 per cent of adult Australians are overweight or obese. More than 27 per cent of Australian children aged five to 17 are overweight or obese. The figures in Britain and the US are similar...
Obesity is a big problem. An existential problem. Libertarians are in denial and the Left sees an opportunity to control the lives of all. The middle will muddle through, but the buck has to stop with you and your mouth — and your medical bills."
Oct. 5, 2017 - Gary Johns, PhD
David L. Katz, MD, MPH, FACPM, FACP, Founding Director of the Yale Prevention Research Center at the Yale University School of Medicine and Editor-in-Chief of Childhood Obesity, in an Apr. 22, 2014 interview with Yale Daily News, "Obesity 'Disease' Discourages Prevention, Katz Argues," available at yaledailynews.com, stated:
"I often compare obesity to drowning. Would we consider it a disease if a person were drowning? When someone is drowning, it's not a problem with their body: Humans cannot be in the water for an arbitrary amount of time, so the problem is a mismatch between the body and the body's environment.
I think drowning and obesity share many important characteristics. Both are about an interaction between a perfectly healthy body and the challenge of an environment in which they are maladapted. In both cases, you're exposed to something that's initially a good thing, but you're exposed to too much of it for too long. In the case of water, you need it, but too much of it for too long and you drown. In the case of food, if you eat too much of it for too long, then you get fat.
In both cases, absolutely everybody is vulnerable, but people are vulnerable to varying degrees. If we're put underwater, eventually all of us will drown, but some of us are able to hold our breath longer than others. I think that's true about obesity: About 80 percent of the adult population of the United States is either overweight or obese. That indicates that essentially, we're all vulnerable, but we're not all vulnerable to the same degree.”
Apr. 22, 2014 - David L. Katz, MD, MPH, FACPM, FACP
Keith Ablow, MD, psychiatrist, in a June 20, 2013 article, "Dr. Keith Ablow: Obesity Is Not a Disease - and Neither Is Alcoholism," available at foxnews.com, stated:
"The American Medical Association (AMA) has decided to classify obesity as a disease. This decision is another example of inventing illnesses - a favorite pastime of the American Psychiatric Association (APA) - and another step towards eroding people's autonomy and making them passive participants in their health. It is also an example of how the medical establishment is laying the groundwork to bill Medicare and Medicaid for every bad choice anyone makes, ever.
With the exception of when obesity is caused by a known pathology, such as hypothyroidism (which, while making weight loss more difficult, would certainly not completely prevent it), it is largely caused by poor decisions—like binging on food or eating lots of candy, ice cream or Cheetos...
Last time I checked, there was no known gene that would make people veer off into the McDonald's drive-through lane or direct them to choose whole milk over 1 percent milk. No known gene can make you raid the refrigerator at midnight. No known gene can make you drive past six gyms on your way to work and stop at none of them…
The AMA, in classifying obesity as a disease, furthers the dependency, disempowerment and entitlement culture that is eroding scientific truth and personal autonomy in America."
June 20, 2013 - Keith Ablow, MD
Richard B. Gunderman, MD, PhD, Professor of Radiology, Pediatrics, Medical Evaluation, Philosophy, Liberal Arts, and Philanthropy, and Vice Chair of Radiology at Indiana University, in a June 24, 2013 Atlantic article, "Is theatlantic.com, stated:
"When we meet obese people, should we cast them a knowing glance of concern and ask how they are doing? Should we send flowers and 'get well soon' cards to obese family members and friends?...
If obesity truly is a disease, then over 78 million adults and 12 million children in America just got classified as sick... Everyone has friends and acquaintances who now qualify as diseased.
Yet many sensible people, from physicians to philosophers, know that declaring obesity a disease is a mistake. Simply put, obesity is not a disease. To be sure, it is a risk factor for some diseases. But it would be as false to say that everyone who is obese is sick as to say that every normal-weight person is well."
June 24, 2013 - Richard B. Gunderman, MD, PhD
Max Pemberton, MD, Psychiatrist in the National Health Service (NHS) and Journalist, in an Oct. 12, 2013 Spectator article, "Obesity Is Not a Disease," available at spectator.co.uk, stated:
"Doctors should be required to tell patients a blunt truth: if you're fat, eat less, exercise more, or both. And if you keep guzzling the tasty treats, you will die earlier. It's not a disease, it's a mindset — and that means it can be changed. We doctors need to be a little less understanding, a little more judgmental, and realise [sic] that our oath — 'do no harm' — must come before our desire to save the feelings of our patients. The truth can be the hardest drug to administer."
Oct. 12, 2013 - Max Pemberton, MD
Andrew Weil, MD, Director of the Arizona Center for Integrative Medicine at the University of Arizona, in a June 2013 statement to a Prevention Magazine article titled "Is Obesity a Disease? Prevention Experts Weigh In," available at prevention.com, stated:
"I do not consider obesity a disease. It is a condition, which may be associated with increased risk of certain diseases. It is possible to be obese and healthy, if one eats a balanced diet, gets regular physical activity, attends to other aspects of lifestyle that influence health, and makes use of appropriate preventive medical services."
June 2013 - Andrew Weil, MD
J. Eric Oliver, PhD, Professor of Political Science at the University of Chicago, wrote in his 2006 book Fat Politics: The Real Story behind America's Obesity Epidemic:
"[A]s a disease, obesity is a flawed construct. Consider, for a moment, some of the awkward questions that arise when you call obesity a disease: is someone who is slightly overweight, only slightly diseased? Can someone catch or 'come down' with obesity? Can obesity really be 'cured'? If these questions seem ludicrous, it is because obesity does not readily meet the criteria of disease. According to Stedman's Medical Dictionary, a disease is 'an interruption, cessation, or disorder of body function, system, or organ.' By this definition, if obesity is a disease, then we must assume that, at some level, body fat is pathological. Yet... there is no clear evidence about what level or even how, exactly, adipose tissue is harmful to our health. For some extremely heavy people, their body fat may disrupt their ability to function, particularly their ability to exercise, but for most people their fatness is not a disorder. Indeed, body fat on some parts of the body, such as the thighs, can actually be helpful to sustaining our health. Even Stedman's Medical Dictionary does not call obesity a disease; it is simply known as 'excess subcutaneous fat in proportion to lean body mass' or, at worst, 'a public health problem.'"
2006 - J. Eric Oliver, PhD
Richard Berman, JD, Executive Director of the Center for Consumer Freedom (CCF), in the July 16, 2004 article "Obesity Is Not a Disease" posted on CCF's website, stated:
"The pharmaceutical and weight loss industry have manufactured an 'epidemic' to have the cost of their weight loss drugs and treatments underwritten by taxpayers... Obesity is not a 'disease' if it can be cured by taking regular walks and eating less... We need to be careful not to dumb down the definition of the term disease at the expense of taxpayers."
July 16, 2004 - Richard Berman, JD
South Carolina's Department of Health and Human Services (DHHS), in its Jan. 1, 2010 "Hospital Services Provider Manual," provided on dhhs.state.sc.us, stated:
"Obesity itself cannot be considered an illness. The most common cause is caloric intake that is persistently higher than caloric output. Reimbursement may not be made for treatment of obesity alone since this treatment cannot be considered reasonable and necessary for the diagnosis or treatment of an illness or injury. However, although obesity is not in itself an illness, it may be caused by illnesses such as hypothyroidism, Cushing’s disease, and hypothalamic lesions. In addition, obesity can aggravate many cardiac and respiratory diseases as well as diabetes and hypertension. Therefore, services related to the treatment of obesity could be covered services when such services are an integral and necessary part of a course of treatment for one of these illnesses."
Jan. 1, 2010 - South Carolina's Department of Health and Human Services (DHHS)
Allen Steadham, Founder and Director of the International Size Acceptance Association (ISAA), in the Oct. 2004 DOC News article "Obesity Is Not a Disease," wrote:
"The term 'obesity' has metamorphosed over the years from simply describing a state of fatness to now being synonymous with disease and death. A thorough and unbiased closer look, however, reveals that obesity is, in fact, not a disease at all.
First of all, many of the medical conditions, including mortality, associated with obesity are actually a result of sedentary lifestyle and poor food choices...
Second, a significant source of decreased health on the body is cyclical weight-loss dieting and fad diets... In contrast, increased mobility through mild but maintainable activity, in combination with improved food choices, decreases stress and increases health and energy, whether or not actual weight is lost."
Oct. 2004 - Allen Steadham
Paul F. Campos, JD, Professor of Law at the University of Colorado at Boulder, wrote in his 2004 book The Obesity Myth: Why America's Obsession with Weight Is Hazardous to Your Health:
"From the perspective of a profit-maximizing medical and pharmaceutical industry... the ideal disease would be one that never killed those who suffered from it, that could not be treated effectively, and that doctors and their patients would nevertheless insist on treating anyway. Luckily for it, the American health-care industry has discovered (or rather invented) just such a disease. It is called 'obesity.'
The reasons why the disease of obesity doesn't kill those who suffer from it and why it remains impossible to cure are one and the same: Because it doesn't exist.
...Most groups of people categorized as 'overweight' and 'obese' do not suffer from poorer health or higher mortality than 'ideal weight' individuals. In many of the largest-scale studies, groups of people currently categorized as overweight have better mortality statistics than anyone else."
2004 - Paul F. Campos, JD
Mike Adams, Editor of NaturalNews.com, wrote in the July 18, 2004 article "Medicare Declares Obesity to Be a Disease, Stripping Away Patient Responsibility and Power" on naturalnews.com:
"Is obesity really a disease?... I argue that it's not a disease at all but rather the natural result of a person making extremely poor decisions about food choice and physical exercise. It's something that can be entirely reversed in virtually 100% of the cases by changing these two simple things. As a result, it rests firmly under the control of the patient, especially if they are educated about healthy nutrition and how to make intelligent choices about what foods and groceries they consume.
To call obesity a disease is a 'dumbing down' of the very idea of what a disease is. And unfortunately, it implies that the patient is helpless to do anything about it."
July 18, 2004 - Mike Adams