How The Almighty Norm Can Dilute Advice We Give and Receive

“Binge-Watching Television Spikes Blood Clot Risk.”

This was the headline of a recent article that came out in MD Magazine.  The researchers looked at over 86,000 participants in regards to their risk of developing blood clots as it pertains to the amount of television they watch.  The average American watches five hours of television a day.  Findings indicate that those who watch television more than five hours a day are twice as likely to suffer a fatal blood clot as those who do not.  Noted in the official press release was that for people under the age of 60 who watch at least five hours of daily television, there was a six times greater risk of a fatal pulmonary embolism when compared to those who watch less than 2.5 hours.  This was independent of many other health factors, such as smoking status, blood pressure, diabetes, and certain lifestyle indicators, such as level of activity.

The article ended with the following acknowledgement and advice:

With the increasing use of technological devices, sitting in front of the computer or other visual based media devices for long periods of time has become the norm. As such, experts urge individuals to simply take breaks:  stand up, walk around, and drink more water—prevention is the key.

If you are like me, multiple aspects of this advice seem lacking. The first is the apparent resignation (e.g., “sitting for long periods of time…has become the norm.  As such…”) that societal shifts of the past couple of decades are something that we should just accept, even if they clearly defy a healthy, productive existence.  Second, the final statement—“prevention is the key”—seems contradictory to the advice that is being offered.  I agree that we should all take more breaks, move around, and drink more water.  But this isn’t prevention; it is accommodation.  Prevention would involve actually looking at the practices in the first place (i.e., television watching and other sedentary activities involving devices) that are causing the problems, and offering solutions that would sustain a more healthy lifestyle.  The authors’ advice given is analogous with telling smokers that in order to reduce their risk of lung cancer, they should walk more, eat more natural foods, and improve sleep habits.  There is nothing wrong with the advice; the problem is that it does nothing to address the core problem:  smoking cigarettes.

I use this example to illustrate a larger trend, one which happens every single day. We as patients as well as we the experts repeatedly give way to an “almighty norm” that often contradicts a healthy, productive life.  In some ways, it is understandable.  We all are a part of trends that heavily influence how we live.  We all engage in certain practices that are more convenient and trendy than they are healthy and good.  I am not asking that we divorce ourselves from the society that we live in.  Still, I am concerned that we are getting to the point where the certain “norms” of today are becoming so widely accepted, despite their contraindications to our well-being, that we are at great risk of losing sight of the health and contentment that is available to us.  I will leave further judgments regarding the five hours of television per day to each of you reading this article.  But if we were to have a discussion about goals of health, social engagement, productivity, and community involvement, I think we would all have a hard time rationalizing just how this societal “norm” fits well into our aims for each of these domains.

Some of you may think that I am quibbling over trivial matters. But I would contend that the ways in which we the experts describe (or do not describe) findings and societal trends make a tremendous difference over time in regards to what we as people come to accept, and what we are willing to change.  There is a significant body of research that demonstrates that even small alterations in wording impact how a message is received, and then how people and societies use these messages to guide actions.  By simply implying that a practice is the “norm”, even if in fact it is an unhealthy “norm”, young and old people alike will often perceive that positive change is either unlikely or regressive, not certainly not progressive.

Come back to the original article for a moment. I will surmise just what I think the experts might have said if they were being completely forthright in their advice.  I’d like to think it might have looked something like this:

Many people today are using technological devices at high rates, which has resulted in extended sitting or other sedentary behaviors that are unhealthy. Taking breaks to move around and drinking more water can help decrease the risk of blood clots; however, the best prevention is to significantly reduce the amount of sedentary time by limiting the use of electronic devices, especially those that are optional.  Substituting active choices in place of television watching is one of the best ways to do this.

Just as it is important for us to be honest with ourselves, it is really important for us in expert and leadership positions to be candid with others, even when it does not coincide with the almighty norm. It is also important that we as parents and patients are careful readers of the advice we are given.  The more both of these things occur, the more we all will begin to see that alternate, healthier pathways are really available no matter what others are choosing.

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