The QALY tells us to do what brings about the greatest health benefit, irrespective of where that benefit falls. Usually, for a given quantity of resources, we will do more good if we help those who are worst off, because they have the greatest unmet needs. But occasionally some conditions will be both very severe and very expensive to treat. A QALY approach may then lead us to give priority to helping others who are not so badly off and whose conditions are less expensive to treat. I don’t find it unfair to give the same weight to the interests of those who are well off as we give to those who are much worse off, but if there is a social consensus that we should give priority to those who are worse off, we can modify the QALY approach so that it gives greater weight to benefits that accrue to those who are, on the QALY scale, worse off than others.
In many cases, long familiarity between foods and their eaters leads to elaborate systems of communications up and down the food chain, so that a creature’s senses come to recognize foods as suitable by taste and smell and color, and our bodies learn what to do with these foods after they pass the test of the senses, producing in anticipation the chemicals necessary to break them down. Health depends on knowing how to read these biological signals: this smells spoiled; this looks ripe; that’s one good-looking cow. This is easier to do when a creature has long experience of a food, and much harder when a food has been designed expressly to deceive its senses — with artificial flavors, say, or synthetic sweeteners.
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Any discussion of the language of madness needs to include a mention of how Martin Luther King, Jr., in over ten of his speeches and essays, said he was proud to be psychologically "." It is highly recommended that everyone who cares about change in the mental health system become familiar with Martin Luther King's use of this term "maladjusted." For at least a decade, he said in a variety of ways, "Human salvation lies in the hands of the creatively maladjusted." In fact, he even repeatedly said the world was in dire need of a new organization, the "International Association for the Advancement of Creative Maladjustment" ().
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To medicalize the diet problem is of course perfectly consistent with nutritionism. So what might a more ecological or cultural approach to the problem recommend? How might we plot our escape from nutritionism and, in turn, from the deleterious effects of the modern diet? In theory nothing could be simpler — stop thinking and eating that way — but this is somewhat harder to do in practice, given the food environment we now inhabit and the loss of sharp cultural tools to guide us through it. Still, I do think escape is possible, to which end I can now revisit — and elaborate on, but just a little — the simple principles of healthy eating I proposed at the beginning of this essay, several thousand words ago. So try these few (flagrantly unscientific) rules of thumb, collected in the course of my nutritional odyssey, and see if they don’t at least point us in the right direction.
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5. Pay more, eat less. The American food system has for a century devoted its energies and policies to increasing quantity and reducing price, not to improving quality. There’s no escaping the fact that better food — measured by taste or nutritional quality (which often correspond) — costs more, because it has been grown or raised less intensively and with more care. Not everyone can afford to eat well in America, which is shameful, but most of us can: Americans spend, on average, less than 10 percent of their income on food, down from 24 percent in 1947, and less than the citizens of any other nation. And those of us who can afford to eat well should. Paying more for food well grown in good soils — whether certified organic or not — will contribute not only to your health (by reducing exposure to pesticides) but also to the health of others who might not themselves be able to afford that sort of food: the people who grow it and the people who live downstream, and downwind, of the farms where it is grown.