I hope that this writing is not representative of your magazine. I came to the website because I was concidering a subscription, but after reading this article, I have to read some more to see if it is worth it. What was the point?

Anna Young

Boston , MA

Blame the victim (and its close cousin, charge the sick more for health insurance premiums) ignores one simple fact: Not everyone with bad behavior gets sick. Let's take the most obvious bad behavior: cigarette smoking. The association between cigarettes and chronic obstructive lung disease is clear. Over 90 percent of chronic obstructive lung disease (emphysema and chronic bronchitis) is attributable to smoking. The converse, however, is just as shocking: only 15 percent of all smokers develop chronic obstructive lung disease! This means that 85 percent of people can smoke and feel "safe" that they won't get this form of lung disease (for the sake of convenience, we'll leave aside cancer and vascular disease and the rest). Does this mean that the people who develop this form of lung disease are "to blame" for it, but that the vast majority of smokers who don't get this disease are without blame? Clearly not. The interactions between environment, genetic predisposition and plain luck that are responsible for the development of any disease are complex and defy the kind of simple one-to-one correlations we imply when we "blame" people for their diseases. Getting sick is bad: bad luck, bad genes, and bad behavior. But blaming people doesn't go very far in finding out how we make people better or prevent bad behavior.

David Kaufman

New York City, NY

Well, this article was about as detrimental as possible.

Its not the amount of fat, its the types of fats that are consumed. There are healthy fats that play an important role in many biological pathways that effect cellular metabolism and the immune system.

Exercise, as has been pointed out in another letter response to this article, need NOT be done in a gym. On the contrary, vigorous walking daily, and a short workout period with light resistance free weights (dumbells or a weighted bar) can do wonders for maintaining a healthy body composition and muscle mass.

What factors determine cancer risk?
?Antioxidant status
?Blood sugar levels
?Methylation reactions
?Stress
?Vitamin D from sunlight exposure
?Liver and GI tract health
?Micronutrient status
?Body composition - lean muscle mass
?Age and
?Genetics and Epigenetics.

Antioxidants determine damage within cells, especially in the nucleus and mitochondria and that is related to energy metabolism....

Blood sugar levels reflect GI tract health and the very important balance between the normal addition of sugar groups to many proteins - especially those of the immune system, the mop up crew for diorganized, irregularly-dividing abnormal cells.

Methylation reactions that occur within our cells regulate gene transcription - the activation of genes. Those methylation equivalents originate from diet - period. They also help regulate the immune system and are directly correlated to nearly all cancers, when methylation targets shift from normal to abnormal targets.

Quite simply, stress causes an increase in cellular energy use (respiration). Low antioxidant status means more cell damage, and excess stress hormone changes the activity of the nervous, endocrine and autocrine systems. That impacts immune health.

Vitamin D is now known to play a crucial role in regulating cellular receptors involved in carcinogenesis. Most of us, through lack of exercise and preference for air conditioning, don't get our quota of sunlight. Couple that will a drastic miscall by medicine on the amount of vitamin D you really need and with impaired liver health (through bad diet, drug, smoking and alcohol use) and you have a major risk factor related to specific types of endocrine cancers.

Diet and lifestyle regulate liver and GI health. They take their "marching orders"' for energy metabolism in all cells from muscle and nervous system activity. Lack of exercise (including hypoxia, poor blood oxygenation), drug/alcohol/smoking and faulty sleep habits and diets lacking essential nutrients and fiber all effect gastrointestinal and liver health. Liver makes a lot of methylation equivalents and antioxidants. Fiber in particular regulates the production of short chain fatty acid byproducts in the lower intestinal tract. One of these changes the way we absorb calcium, magnesium and sodium - which plays a prominent role in disease, including cancer. Another regulates cellular division and programmed cell death in damaged cells. Which one you make, depends on diet.

Micronutrients effect GI health. GI health effects liver and nervous system function - and in particular, blood sugar regulation and immune system health. Certain micronutrients play a crucial role in antioxidant, energy, and immune cell function. They are missing in typical diets lacking vegetable, plant fiber and whole grains.

Body composition limits fat cells that excrete hormone like substances that can stimulate cell division and increase respiration damage. Healthy muscle also uses growth hormones that are produced during times of calorie excess. Lack of muscle means other cells are targeted for growth - and that, coupled with oxidative damage and lack of cell division control, and immune system mop up of damaged cells, is risky business.

Age is the factor that accounts for accumulated damage and reduced cell function efficiency.

Genetics can be thought of as a sliding bar for gene product function. The bar moves from good to poor activity, depending on your family genes--reflecting natural variation in protein/enzyme function. Epigenetics is the change in gene expression within 1-3 generations, the fine tuning of system responses to environmental factors (stress, diet, exercise and sunlight, sleep, toxins and contaminants).

This is not rocket science; its mostly common sense backed by not thousands but hundreds of thousands (nearly a million) of biomedical studies. What has changed is our understanding of something called nuclear receptors, and their regulation of gene product expression. Thats a family of about eighty-five receptors, with about twenty-five to thirty of these playing a crucial role in cellular division and repair.

They are activated by compounds present in diet.

So you see, its lifestyle with the big player being diet, and to a much lesser extent, contaminant exposure, that effects cancer risk.

Dee Smith

Seattle, WA

Our national sport of "pin the blame on the victim" seems to be rooted in a peculiar species of theism that rests upon the following tenets:

(1) God is both all-powerful and good.
(2) All of nature represents the will of God and is therefore good. (3) However, human beings have free will and can therefore be evil.

From these premises, it follows that nothing bad in the world can ever happen unless it is some person's fault. The idea that a sick person is personally responsible for her illness is as old as Job, and I regret very much that Job himself didn't just tell his accusatory "friends" to bug off.

Another source of our difficulty is in failing to see that freedom consists not in having preferences, but in having choices. Freedom is therefore not a thing that we are all born with, but a thing that we as a society provide for each other.

What will people prefer if all they have to choose in their workplace is junk food? Will people get the exercise they need if our transportation system relies nearly exclusively upon automobiles and airplanes, rather than upon public transportation--which encourages more walking and less driving around for a parking spot?

Our poor health is the result not so much of bad individual choices as of how convenient we have made it to choose poorly, and of how inconvenient we have made it to choose well.

Eric Paul Jacobsen

Saint Paul, MN

I have enjoyed Ehrenreich's writing in the past, so this disappointed me. The study cited in the attached MSNBC article was a very focused and limited research project with postmenopausal women, and the researchers' own comments avoid any broad conclusions. If you read it, you learn that it has little to do with any long-term (twenty-thirty year) diet habits. The researchers themselves suggest that the women may have changed their diet too late, or too little.

I have no idea how Ehrenreich got the idea that diet is unrelated to cancer from this article. The study does not purport to discredit the correlation, nor could it, based on an eight-year study. There are far too many more extensive longitudinal studies that show a correlation between diet and cancer.

The comments about the woman and her Doritos is at best unintentionally insulting. People are not passively fed junk food. They go to a store, buy food, and typically have more choices than chips. Despite these choices, many continue to buy corn chips. They are not forced to buy them, however. They choose food, as they might choose a political ideology or representative, that is not in their best interests.

David Carroll

Wrightwood, CA

I beg to differ with you on at least two points of your article:

"So we indulge in self-gratifying contempt for the fat lady scarfing down Doritos. But before you rush to judgment, ask yourself: What nutritional alternatives does she have? (And, yes, I know they have 'salad' at Wendy's now, but they don't offer apples on Amtrak.)"

She has alternatives. For example, she could go to the store and, for less than she'd spend on a bag of Doritos for every two days (that's roughly 3 bags a week at $2.50 a piece), buy enough vegetables to make two weeks' worth of salad, spend 15 minutes each day making a salad (or several days worth of salad at one shot), and bam, she has one alternative. She can buy corn flour for $1.50 and roll out her own tortilla chips (from a full bag of flour, that's a heck of a lot of chips) and fry them in the frying pan with corn oil (a no or low salt, lower fat alternative to Doritios and about 15 minutes worth of work, which is about the same amount of time it would take to go to the convenience store, wait in line, and buy a bag of Doritos) and flavor them with whatever she wants (for $1.25 and 5 minutes worth of work she can have fresh guacamole). These are just two examples. It takes about 15 minutes and very little money to do these things. If travelling Amtrak, she can always bring apples to eat. Lunchboxes are not that expensive at all, brown bags are even cheaper. With the abundance of plastic grocery bags at our disposal, she wouldn't even have to buy a lunchbox or brown bags! As far as time to make the lunch, I wonder how much time she'd have if she didn't plop her butt in front of the TV for hours a day while eating those Doritos.

"As for exercise, gym memberships easily cost $500 a year, and far too many of us are forced to spend ten hours or more a day sitting in a cubicle, a car or a bus. "

Forced? We are not forced. We choose those jobs, choose to live far away from work, and, once we get to work, choose to sit all day rather than go for a walk at lunch and/or eat a light lunch that we prepared the morning or night before from one of those bags I mentioned earlier. There is exercise that doesn't cost anything, no gym membership is needed, no special facilities, nothing. It's called walking. There is also calisthenics, yoga, jogging...oh, the list goes on...playing with your kids is another crazy exercise idea that is good for them and for the adults who are playing with them. She and her family and friends could go for a daily walk in the early morning or late evening. Rather than her kids and friends going about their video games and favorite TV programs, they could all walk (exercise) together. It would be good, quality bonding time and would burn some calories. Also, what about walking or biking to work? Or walking part way (for example to the first bus transfer point)?

So there you have it. Whether or not this would prevent cancer, maybe not, but there is no doubt this would lead to a healthier life for Fatty who is downing the Doritos. A few small changes that she can make might prevent her from having a heart attack and/or developing diabetes. She's happier, her friends and family are happier, and so am I.

Saul Kohl

New York, NY