The Breakfast Table

Is Childhood a “Condition”?

Dear Atul,

Ah, yes, the glorious glut of science and medicine stories on Tuesdays; even the Washington Post has its health section. And just to make one last point about the scientific journals and the stranglehold they have on how the news is reported: Despite their imperiousness, the journals want coverage of their reports, no doubt about it. Thus, not very long ago the Proceedings of the National Academy of Sciences, or PNAS, changed the day and time when it’s OK for reporters to break the code of silence about its contents to Monday evenings—the better, we reporters all assumed, to place stories in those generous Tuesday science news holes. Poor PNAS does have to sing very hard for its status; maybe you’ve heard some scientists joke that the initials mean “Post-Nature And Science,” the place you turn to for publication when the big guys have rebuffed you. (Personally, I love PNAS; there’s lots of quirky stuff inside.)

Just as I did yesterday, I’ll work my way upside down. I only have preliminary gossip about the possible changes in the rules for including children in experiments and clinical trials. Current rules require that kids be diagnosed with the condition being studied, and that participants stand a chance, however slim, of benefiting from the experimental therapy in question. Well, it seems there might be a change in the way we define “condition.” For example, there was a somewhat contentious study that looked at possible intervention programs for the siblings of juvenile delinquents. The reasoning of the researchers was that these siblings have a “condition”—a higher than average risk of becoming delinquents themselves. However, the kids had never been diagnosed with anything. So the question arose: Is it acceptable to do studies on minors who are at a small risk of a “condition”—juvenile delinquency—before they have the condition, or any particular brand-name at all?

Apparently the advisory panel to the Human Research Protection Agency thinks the answer is yes. Moreover, it has even considered the idea that childhood and adolescence are themselves “conditions.” That a kid’s very kid-ness puts him or her at comparatively greater risk of all sorts of things. What happens when you’re a kid resonates throughout your life. This goes for things like obesity, too. Early-onset obesity is a much greater threat to one’s health and prospects than late-onset obesity. Which means that it’s more imperative to intervene if a kid is fat than if an adult is, although, as you pointed out, weight loss decreases blood pressure and the risk of diabetes and heart attacks in anybody, young or old.

Anyway, I started mulling over this notion that childhood is a condition. And though at first I rejected the idea with a snort—once again, the psycho-medical community trying to medicalize everything!—I realized there’s something to it. Almost anything bad that can happen to you as an adult is worse if it happens when you’re a kid. You’re vulnerable; you’re at risk. I have to remind myself of this all the time with my own Kindergarten-age daughter. I can’t say to her all the flip, snarky things that come to mind. I have to hold them back and save them for … my mother! Of course, it’s an entirely different matter whether the vulnerability of children means they should be treated and diagnosed at the slightest opportunity or enrolled in a trial that could leave little scars of its own. Because as you know, I’m a medico-phobe.

When did the Times decide it was acceptable to use the term “fat people”? I’m not sure, but I do know that the paper sometimes frowns on euphemism, but also tends to let the people with the condition call the shots. So if somebody is in a wheelchair, we say the person “uses a wheelchair,” rather than is “confined to a wheelchair.” The National Association to Advance Fat Acceptance uses the term “fat people” itself.

But still, I wouldn’t call an obese kid Fatso.