I loved the list of 40 things you can stop doing right now. It included peeling vegetables before you cook them (duh) but also a bunch of personal health related things such as getting eight hours sleep all in a row (it’s okay to wake during the night and go back to sleep, in two stages), drinking eight glasses of water, and flossing. My favourite that is all on all of these “don’t bother” lists is stretching.
I loved the list because we all think there are so many things we all think we have to do when it comes to our own personal health. The health related personal demands on the individual are pretty high right now, whether it’s getting 10,000 steps, or eating 10-12 servings of fruits and vegetables a day. Call this list of demands the health imperative. It’s a feature of the society in which we live. It’s about individual responsibility for maintaining a healthy body and it’s a lot of work.
We assume there is good evidence for disciplining our bodies in all these many ways, but what if the evidence for a practice just isn’t there?
In August, the British Dental Association’s scientific adviser declared flossing to be pointless, adding that all floss-based studies of the past 25 years have been of “very low quality”. If you’ve never flossed your teeth, you were right all along. Go out there today and flash the world that foul-smelling, grey-green smile of yours. You’ve earned this. (from the 40 things list)
Here’s the LA Times piece on flossing,
When the federal government issued its latest dietary guidelines this year, the flossing recommendation had been removed, without notice. In a letter to the AP, the government acknowledged the effectiveness of flossing had never been researched, as required.
The AP looked at the most rigorous research conducted over the last decade, focusing on 25 studies that generally compared the use of a toothbrush with the combination of toothbrushes and floss. The findings? The evidence for flossing is “weak, very unreliable,” of “very low” quality, and carries “a moderate to large potential for bias.”
What does this mean for you? Well, floss if you want to but don’t do it because you think you ought to. You get no credits in the self-care column when it comes to flossing. Maybe you just like the feeling of clean spaces between your teeth (I get that) but if you’ve been doing for reasons of dental health and hating it, now might be the time to stop.
Rebecca Kukla (who guest blogs here) recently posted to Facebook about flossing when the dentist was busy advising her son to floss. She admitted she was tempted to give the dentist a lecture about evidence-based medicine and about patronizing science-free advice that impedes epistemic agency.
Frankly, I was surprised at the many defenders of flossing who cropped up. Not defenders of the practice (it’s okay, floss if you want to, see above) but defenders of the imperative, the claim that we ought to floss. After all the articles above don’t say that flossing doesn’t work, only that the studies that it set out to show that it benefits offered very little proof. It still might be the case that flossing is really important. (Of course, it might also be really important to hop on one foot and howl at the moon. We just don’t know. The evidence is weak but ti still might be true.)
The debate on Rebecca’s page went on, so many defenders of flossing, and I loved her response and I’m quoting it here with permission.
“People who are standing up for something like the “floss because it can’t hurt and maybe it will help even though science hasn’t managed to show it” line: If you like flossing (I do after corn or bbq!) then by all means enjoy it. But here is the problem. Medical and other institutions are constantly adding countless things that we ‘should’ do ‘just to be safe’ despite minimal or no evidence of benefit, and then these get weirdly moralized, so you’re an irresponsible person/parent (especially parent!) if you don’t do them. Each one may be small but we can’t POSSIBLY do all of them. We would have no life. They accumulate. So at some point you have to recognize that through sheer number they become micro-aggressions, in effect. If there is no evidence for something helping, the most you should say is “Well it seems unlikely to hurt [assuming that’s true; it isn’t always] but it’s really up to you.” This ‘It’s important that you do it just in case it helps’ bullshit has got to stop. And it is disproportionately directed at mothers of course.”
That’s what I like about the 40 things list. It urges us to relax, and to push back against the health imperative. And for good God, stop measuring all the things–drinking EIGHT glasses of water, sleeping EIGHT hours a night, eating TEN TO TWELVE servings of fruits and vegetables, walking TEN THOUSAND steps, flossing ONCE a day and so on and so on. Also, for God sake, stop with all the measuring! Enough! (Don’t get me started on weight, percent body fat. and BMI. See this a guest post from this weekend about all that.)
I had a roommate in grad school who every night confronted her own personal health imperative dilemma, sits ups or flossing? Every night we’d finish our work, work some TV, and then the debate would begin, which would she do, sit ups or flossing? She’d committed to one or the other each night. Luckily the standard issue sit up has also been debunked so now she can relax.
How do you feel about the very long list of health related things we all ought to do? Do you agree with Rebecca that the list of demands hits mothers worst? What, if anything, are you knocking off your list?
All I can say for sure is I am a mother and these things do disproportionately fall in my shoulders for knowing/enforcement and of course…blame. Thinking about this as I write, I also notice that these things we are supposed to be DOING don’t help us figure out how are can best BE WITH the people we are enforcing all these good practices upon. The obsession with hitting the markers often obscures what is important underneath. I don’t make my kids floss, although they sometimes do. I don’t make them eat 10 servings of fruits and veg although they seem to be growing fine. I do embed these care taking messages in a broader attention to them, their moods, needs and stories. So far, it seems to be okay and I’m escaping most of the guilt.
Additionally, I get super worked up about an establishment that “recommends” things that are unattainable for large segments of the population. By that I mean sleep for shift workers or the poor and marginally employed, the issue of food deserts in low income neighbour hoods, the cost of fresh food in general, the lack of coverage for dental care…I could keep going. I’m lucky I can choose to ignore advice. Some people don’t even have the option.
I know this comment is waaaay off on a tangent. But somehow it seems related in the moment. I did not floss today, BTW.
I agree with what Rebecca says about how things move from “do it if you want” to micro-aggressions. I know flossing is different because it’s not a public health issue, but I’ve heard similar arguments this year about the flu shot — that is, that it’s a personal choice, it’s up to each person to weigh the science, etc. I’ve even had more people responding to my “it can’t hurt, but can only help” point with “actually, it CAN hurt–anecdotal reports from a health care professional I know about cases of Guillain-Barre syndrome and Bell’s palsy as a result of the shot. I still got the shot, but this is the first year that I’ve felt conflicted about my moralistic attitude and that maybe the personal considerations can, for some, counterbalance the public health considerations, given that the science shows the flu shot to be imperfect in other ways as well (to be clear: I’m talking only about the flu shot, not about vaccines in general). And I’m going to keep flossing.
The flu shot feels different to me because it’s not my health that’s the source of the moral imperative but the health of vulnerable others. What gets me is turning personal health into a source of moral obligation. The health of others I’m okay with thinking in moral terms. Think that health might be a great topic for a paper on the difference between duties to self and duties to others.