Text­book calls cancer a ‘disease of choice’

The Charlotte Observer (Sunday) - - Front Page - BY JANE STANCILL js­tan­[email protected]­sob­server.com

A text­book for a re­quired fit­ness class at UNC-Chapel Hill calls cancer a disease of choice, de­scribes a the­ory that Holo­caust vic­tims failed to tap into their in­ner strength and main­tains that “many if not most women” who are ob­sessed with weight have be­come ha­bit­ual di­eters.

The on­line text­book, “21st Cen­tury Well­ness,” also in­cludes stan­dard in­for­ma­tion about fit­ness, nu­tri­tion and health. It is read by stu­dents in a one-credit hour course called Life­time Fit­ness, re­quired of all un­der­grad­u­ates at UNC. Each year, nearly 5,000 un­der­grad­u­ates take the class, which is aimed at teach­ing stu­dents about healthy life­styles while in­cor­po­rat­ing a phys­i­cal ac­tiv­ity such as ten­nis, soc­cer or run­ning.

Skye Golann, who grad­u­ated from UNC in May, took the class in the fall of 2017. He made an A, and said he en­joyed the phys­i­cal ac­tiv­ity twice a week as part of the class.

But he said the on­line course read­ing ma­te­ri­als were “be­yond bad.” He said he would some­times read his girl­friend pas­sages of “the cra­zi­est thing I found in the book that week.”

Golann said the book gives short shrift to ge­netic or so­ci­etal fac­tors that af­fect peo­ple’s health — for ex­am­ple, a lack of ac­cess to health care and good nu­tri­tion for many lower-in­come peo­ple. “There’s an ex­treme em­pha­sis on per­sonal re­spon­si­bil­ity that pretty much ex­plic­itly blames peo­ple in poor health,” he said, “which I thought was very prob­lem­atic.”

Call­ing cancer, di­a­betes and car­dio­vas­cu­lar prob­lems dis­eases of choice goes too far, Golann said.

“Who doesn’t know some­one who is a sur­vivor or some­one who died of cancer?” Golann added. “I re­mem­ber think­ing about, read­ing it – we have a huge cancer hospi­tal less than a mile away.”



The book was writ­ten by two pro­fes­sors of ex­er­cise science at Brigham Young Uni­ver­sity, in­clud­ing Bar­bara Lock­hart, a for­mer Olympic speed­skater who has taught mind/body in­te­gra­tion, ac­cord­ing to bi­o­graph­i­cal in­for­ma­tion of the au­thors. The book ex­plores the power of pos­i­tive think­ing, tra­di­tional Chi­nese medicine and mak­ing nat­u­ral choices about health, as op­posed to “surgery, drugs, or other means to achieve your de­sired ends.”

Co-author Ron Hager de­fended the book, say­ing its aim is to pro­mote an ac­tive and healthy life­style.

“One of the over­rid­ing pur­poses of our text is to en­cour­age and em­power in­di­vid­u­als to take re­spon­si­bil­ity for their own good health through the every­day choices they make,” he said in an email. “We fo­cus on help­ing in­di­vid­u­als gain a per­spec­tive of in­her­ent self-worth that can mo­ti­vate them to make the best choices and op­ti­mize their po­ten­tial for a healthy and long life (com­pres­sion of mor­bid­ity) es­pe­cially when com­bined with solid healthre­lated in­for­ma­tion sup­ported by re­search.”

He said some of the crit­i­cisms do not con­sider the full breadth of the text. Hager said he too had strug­gled with the la­bel of “dis­eases of choice.”

“I se­ri­ously doubt any­one would say they choose cancer or heart disease or type 2 di­a­betes, etc.,” Hager’s email said. “But with­out ques­tion, choices can and do have consequences and there is am­ple ev­i­dence of var­i­ous kinds... that show cer­tain be­hav­iors within our con­trol can con­trib­ute to in­creased risk of disease, and not at a mi­nus­cule level.”

Christo­pher Johnson, the de­vel­oper of the on­line course as part of a com­pany called Bear­face In­struc­tional Tech­nolo­gies, said the in­for­ma­tion was peer re­viewed by pro­fes­sors across the na­tion and by UNC fac­ulty be­fore the course book adop­tion.

Johnson left the pub­lisher’s par­ent com­pany, In­di­anapo­lis-based Per­ceivant, last year and formed a new higher ed­u­ca­tion tech­nol­ogy startup. He ac­knowl­edged that there had been some neg­a­tive feed­back about some el­e­ments of the book, but said sci­en­tific ev­i­dence backs up in­for­ma­tion that per­sonal choices such as smok­ing, drug use and poor nu­tri­tion cre­ate risk fac­tors for disease.

“Nowhere do we make char­ac­ter judg­ments,” Johnson said. “In fact, one of the ap­proaches of the book is to re­ally help stu­dents un­der­stand to build a sense of in­trin­sic mo­ti­va­tion, that they need to get their source of en­ergy and value from within, and not to say, be­cause you’re over­weight you’re not a good per­son. ... In our so­ci­ety to­day, the dis­eases that kill most peo­ple — a vast ma­jor­ity are be­cause of peo­ple’s be­hav­iors.”

UNC adopted the on­line course ma­te­ri­als a few years ago, said Darin Padua, chair of ex­er­cise and sport science, though the Life­time Fit­ness course has been in ex­is­tence for nearly 15 years.

Life­time Fit­ness re­placed the uni­ver­sity’s re­quired tra­di­tional phys­i­cal ac­tiv­ity cour­ses. Padua said the change was made to give stu­dents more of an ed­u­ca­tion on fit­ness and healthy liv­ing, as op­posed to one stand­alone sports class that would be less likely to have a long-term ben­e­fit for stu­dents.

The course mod­ules re­volve around ba­sic themes of how to have a healthy life­style, in­clud­ing car­dio­vas­cu­lar fit­ness, mus­cles, en­durance and strength, flex­i­bil­ity, nu­tri­tion and weight man­age­ment, Padua said.

He said UNC seeks stu­dent re­views on its classes, and the strengths and weak­nesses of how the con­tent is pre­sented.

“Each year we get feed­back and we try to keep things up­dated as in­for­ma­tion changes,” Padua said, adding, “We work with the pub­lish­ing group, Bear­face, to make mod­i­fi­ca­tions on a reg­u­lar ba­sis.”


“When you’re hav­ing over a thou­sand stu­dents through a course each year, you’re go­ing to def­i­nitely get crit­i­cisms, and we take those very se­ri­ously be­cause we want to make sure we’re pro­vid­ing the best ed­u­ca­tional con­tent out there,” he said.

Padua said he wasn’t fa­mil­iar with spe­cific pas­sages that the stu­dent critic men­tioned and could not speak to them. But he said he would take a look at it. “Ev­ery­one re­al­izes that there are a lot of fac­tors that are re­lated to disease, and it’s not a per­sonal choice,” he added. “Peo­ple have op­por­tu­ni­ties to main­tain a healthy life­style but there are cer­tain things that set peo­ple up to make that more dif­fi­cult, for sure, based upon their sur­round­ings and the environment and ge­net­ics.”

On­line course­ware is big busi­ness, and large pub­lish­ing firms are rac­ing to de­velop in­ter­ac­tive ma­te­ri­als to re­place or sup­ple­ment text­books. Per­ceivant sells its health and fit­ness course­ware to 14 uni­ver­si­ties, in­clud­ing Ari­zona State, Ohio State, Ken­ne­saw State and Brigham Young uni­ver­si­ties. Its web­site in­cludes a case study on UNC’s Life­time Fit­ness class, and fea­tures the UNC logo along with those of other uni­ver­si­ties.

In a 2014 pro­mo­tional video, Johnson said the firm wanted to grow rev­enue ag­gres­sively. That year, the com­pany had $1 mil­lion in rev­enue but aimed for $36 mil­lion by this year, if it could spread the cour­ses to 200 cam­puses. “Be­cause fac­ulty make the text­book adop­tion de­ci­sion and stu­dents are re­quired to make the pur­chase, we need to tar­get the in­di­vid­ual fac­ulty who con­trol the largest adop­tion pro­grams,” he said in the video.


Joel Davis, direc­tor of col­le­giate part­ner­ships at Per­ceivant, said the com­pany has struc­tured its con­tracts with au­thors to al­low for cus­tomiza­tion based on each uni­ver­sity’s needs. So, for ex­am­ple, at Ken­ne­saw State in Ge­or­gia, the “21st Cen­tury Well­ness” book was al­tered, with nine chap­ters writ­ten by the school’s own fac­ulty and the other eight chap­ters from the orig­i­nal au­thors.

Davis said aca­demic de­part­ments might view con­tent and ter­mi­nol­ogy dif­fer­ently.

“It’s not go­ing to be a one size fits all,” Davis said. “Some peo­ple are go­ing to not want this chap­ter but they’re go­ing to want that chap­ter.”

Another ad­van­tage, Davis said, is that pro­fes­sors can mon­i­tor stu­dents’ en­gage­ment with the on­line class ma­te­rial and in­ter­vene if stu­dents ap­pear to be in dan­ger of fail­ing. In UNC’s class, fac­ulty can collect ag­gre­gated stu­dent data to see stu­dents’ fit­ness and learn­ing out­comes.

The cour­ses fea­ture in­ter­ac­tive el­e­ments, in- clud­ing a self as­sess­ment on fit­ness. Stu­dents can check their progress in the course, and they do the test at the end to see whether their fit­ness im­proved.

“It helps stu­dents un­der­stand, in a very per­sonal way, how the aca­demic con­tent im­me­di­ately im­pacted them,” Johnson said.

Johnson said the on­line course ma­te­rial is pur­chased for about $36 per stu­dent, much less than most text­books. That in­cludes the book, in­ter­ac­tive soft­ware and other el­e­ments.

Golann said a re­quired health class in col­lege makes sense, and stu­dents want more in­for­ma­tion about men­tal health in par­tic­u­lar. But UNC’s on­line course had the feel of a class out­sourced to a pri­vate com­pany.

The con­tent, he said, was not up to UNC’s stan­dards.

“It is the only re­quired text­book that ev­ery UNC stu­dent has to take,” he said.

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