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is devoted to informative articles and news items about exercise physiology.
It is a monthly magazine of news, opinions, exercise physiology professionals,
and events that shape exercise physiology. While it contains views and
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how to think vs what to think!
Boone, PhD, MPH
anyone who clicks on the ASEPNewsletter, please bear in mind that this
medium is open to you. Don't assume only the members of ASEP have the opportunity
to publish their thoughts or state their mind on whatever issue that is
exciting or troubling to them. We are reconciled to publishing most any
theme, particularly if it has some underlying principle or value to exercise
physiologists today and tomorrow. We have only a short time to live, why
not get excited and serious about expressing your thoughts, ideas, dreams,
hopes, and frustrations here on the ASEPNewsletter website. I can see the
web clickers thinking that the script is written, but it isn't. This is
not and should not be a singular experience, however motivated a person's
mission. So, in keeping with the opening statement, assume some responsibility,
interest, and involvement in helping this organization to succeed. Step
forward and state your case, offer your ideas, or your commitment to something,
and don't apologize -- just get involved. We are not in a changeless society.
We can make a difference! Your thoughts are important to us and to those
among us who have not started to think yet. Share your ideas with ASEP
members and world by sending in your ideas via e-mail to me and I will
copy and paste your comments in the next ASEPNewsletter. Until then, I
have two final thoughts to share with you: (1) something Bruce Barton said,
"Sometimes when I consider what tremedous consequences come from little
things.....I am tempted to think there are no little things. AND, (2) to
stretch your thinking, I have written a little piece to help us face up
to the need to learn "how to think" versus "what to think."
Teacher's Accountability for Classroom Content:
Interdependence Ethics Perspective
Boone, PhD, MPH
of Exercise Physiology
of St. Scholastica
WALKING BY A CLASSROOM, I heard the teacher tell the students that they
could prevent a heart attack by lowering cholesterol. A compelling and
popular notion, but is it true? Perhaps, the answer lies in college classrooms
where the future teachers regard textbooks and professors as bearers of
"truth." If cholesterol doesn't cause heart attacks, why is there the discontinuity
between rhetoric and reality? Several scholars have recognized this deficiency
and have attempted to remedy it by creating classroom opportunities to
develop certain critical thinking capacities (Browne et al., 1995).
all of our upbringing, suggests that we have made many decisions and have
acted on them without the critical thinking skills to reduce our vulnerability
to manipulation. In that "ethics" is about giving guidance regarding the
rightness and wrongness of an action (Nephew, 1996), it would appear unethical
to teach in a manner that would adversely affect someone's well-being.
That is, an ethical way of teaching ought not to ignore the importance
of respect for students, and their means for distinguishing the reasonable
from the unreasonable.
his novel, Brave New World, Aldous Huxley suggests that we live in a perpetual
state of ignorance (Huxley, 1989). So, is it appropriate to concede that
future teachers can't be held accountable for the accuracy of their lectures
if the information they were given as students was not reliable or because
they have not thought critically to gain an understanding of the cholesterol
and heart disease knowledge? The short answer is "no" and, therefore, the
paucity of rational thought and the mindless absorption of ideas without
merit deserves our attention.
students understand the relationship between cholesterol and heart attacks,
they are empowered to make correct decisions. They are, to argue from an
ethical point of view, free and fully functional human beings. Then, why
do cardiologists, epidemiologist, and health educators continue to endorsed
the belief that, in light of the Interdependence Ethics theory (Nephew,
1996) that individuals are interdependent, continue to stifle provocative
questions about cholesterol and heart disease? Just as every person depends
on every other person, and just as no person can cut the ties binding all
of us in interdependence, then it follows that we must have consideration
for each other's beliefs, actions, and lifestyle.
stated, is it in the best interest of the students to present mis- information?
No! The fact that we are interrelated does not make it right to commit
an action out of fear of lack of information. What makes life worth living
is our relationship with each other (Nephew, 1996). To be sure, whatever
the reason within the teacher to have the students believe heart disease
is caused by cholesterol, the students' education is incomplete. Most fundamentally,
the students' are not being helped in asking critical questions to define
specific issues, explain relationships, or evaluate the teacher's argument.
In short, the students' fundamental need of a full and complete cognitive
development isn't being met. It isn't the students' fault, to be sure,
it is the teacher's fault. The teacher is responsible for the situation,
and the non-satisfaction of the fundamental need of the joy of discovery.
main flaw with the teacher's lack of provocative questions of scientific
information is that the students are not given a chance to make any decisions.
Everything is, in essence, forced onto the students. The result is frustration
and a truncated looked at cholesterol. Therefore, from the students' perspective,
their irresponsible behaviors result in bad health such as when they fail
to modify lifestyle factors thought to contribute to the prevention of
coronary artery disease (CAD). Although this concept of personal responsibility
for health is deeply embedded in our educational system, much of what society
believes may be little more than wishful thinking (Oliver, 1986).
lack of an understanding and getting beneath the mere obvious suggest that
the teacher was either poorly prepared to lecture on CAD or failed to look
at all the scientific data. As I determined later, the teacher firmly believed
that cholesterol causes CAD. I tried to introduce the notion that CAD is
a multifactorial problem not monofactorial, and that its complexity requires
the willingness to understand that individual prediction for CAD (or heart
attack) is very weak. The teacher's comment was, "It's my class, and I'll
teach it the way I want to." While that was the end of our conversation,
I continued to think about what had happened.
have a problem with taking care of one's self. It makes sense that we do
have some influence on the quality of our health, although admittedly less
than generally believed. There is a problem, however, when statements are
made to students (and even the public at large) as though they are 100%
agreed upon by all interested thinkers, researchers, and educators. The
implied message behind such statements is simply, "Well, if you don't listen
to me and you have a heart attack, it's your fault." This sort of moral
dogma would appear to be inappropriate in classrooms. Without human caring
for what one presents, given our absolute interconnectedness, the message
floats to the surface as being more important than the audience; hence,
the notion of rights gone mad (Nephew, 1996). Yet, there is no justification
in setting up students to be victimized by the presentation of health related
materials where fear becomes the motivator. Without a straight forward
and critical analysis of the entire subject matter, society demonstrates
lack of caring in fostering and maintaining relationships.
is the teacher's responsibility to discuss health issues critically, to
intelligently contrast theories and research data, and to avoid using the
classroom to confirm personal bias while failing to seek disconfirming
evidence. Students are owed a measure of consideration, and thus can assert
a claim on every teacher to present their lectures with honesty and fairness
to the different sides of an issue (however sensitive). Teachers, therefore,
are accountable for class content. They cannot present inaccurate information
and unwarranted generalizations simply because no one is monitoring what
proof has not been obtained for most health related problems, particularly
the risk factors for CAD or its manifestations (chest pain or heart attack),
and since a great many people have heart attacks with no known risk factors
for CAD, there is reason for caution (especially when expectation exceeds
reality). To determine the extent to which other teachers considered CAD
a preventable disease, I asked them about the likelihood of preventing
a heart attack by modifying just one risk factor -- cholesterol. Their
response was, "Of course CAD is preventable." They thought I was joking
with them or involving them in some trick.
they did not know that there is no absolute assurance that low cholesterol
protects against CAD, that CAD therefore cannot be prevented, and that
it cannot be predicted per individual because the cause(s) is still unknown
(Gotto, 1985). The notion of multivariate thinking versus univariate thinking
in regards to causes(s) had not hit home. They had little understanding
of the limitations of population-based statistics (as in the case of epidemiological
research), and that they are used to compute averages and probabilities
may not realize that they have rights, but they do nonetheless. They have
the right to articulate the claim that health information is presented
"without deception by omission." Teachers should not be part of the problem
in understanding the threadlike connections between health and disease.
It is their duty to recognize limitations in scientific analysis and, if
they choose not to, then they must be held accountable for the mixed messages.
Why? Because all teachers are obligated to do what is right, given the
interdependent relationship between teachers and students. When the teachers
fail to distinguish truth from falsity, insight from prejudice, and accurate
concepts from misconception (Paul, 1993), then everyone suffers.
while cholesterol may contribute to CAD in some individuals, the "prevention"
of CAD or a heart attack by lowering cholesterol (as a general statement
to all students) is either a misunderstanding of the literature or a desire
to teach whatever a teacher deems appropriate. Neither example should be
allowed to occur. The teacher is responsible to the institution, the students,
their parents, and society at large to examine and present all relevant
and scientific information. The content of the lecture must be accurate
and complete. It must not be politicized or presented in a biased manner.
The evangelical approach to health and disease is not an education. It
is indoctrination that leaves the student confused and anxious (Boone,
on health issues must be based on sound scientific data. Teachers must
be nonjudgmental and slow to structure a rigid perspective on health topics.
They should not personalize information just because they consider it in
the best interest of the students. Healthy choices mean just that! How
else can students decide the appropriateness of one style of living versus
another if not given a choice. The answer is they cannot and, too often,
the "believe it because I said so" way of relating to students results
in unnecessary fear and anxiety.
need informed and educated teachers. They need open- minded teachers for
continued reflection and growth about essential health matters. They need
more access to a variety of ideas on any given topic. They need exposure
to the research community, particularly journal publications, and then
they need to read the articles. If it is too challenging for the student,
it should be the teacher's responsibility to clarify the authors' purpose
and conclusions, particularly since concluding remarks are often suspect.
the measurement of cholesterol. Most teachers would not suspect that a
problem exist with the measurement itself, which would certainly make the
interpretation more difficult if not incorrect. Yet inaccuracy in the measurements
of LDL-cholesterol is a problem of some significance. As an example, the
College of American Pathologists surveyed 5004 laboratories and found a
range in cholesterol responses from 101 to 524 mg/dl (Current Status of
Blood Cholesterol Measurement in Clinical Laboratories in the United States:
A Report, 1988). The actual value submitted to the laboratories was 263
mg/dl, which was confirmed by the Centers for Disease Control. How can
researchers conclude a relationship between cholesterol and CAD when the
measurements vary so greatly? This is not a new problem.
are other problems, too. Single measurements of total cholesterol and HDL-cholesterol
may not be reliable for diagnosis or therapy (Roeback et al., 1988). There
are seasonal patterns that exist for cholesterol of which there are no
clear-cut reasons (Gordon et al., 1987). The hopeful benefits of high HDL-cholesterol
are still encapsulated in an unresolved "hypothesis" that remains largely
a mystery (Miller and Miller, 1975).
these concerns (and there are others), teachers must be critical thinkers.
It is the only way to avoid what is known as the Post hoc ergo propter
hoc fallacy (i.e., following-after-therefore-caused-by). It is also
an excellent way to get rid of the negative labeling associated with specific
risk factors. This is an important point for students with poor self-esteem,
yet who are told to be concerned about their cholesterol and CAD. As these
students become better thinkers, they will very likely experience less
physical complaints, less anxiety, and less depression.
in mind that within the medical-scientific community there are researchers
and academicians who believe that too many changes in lifestyle have been
suggested without sound medical and scientific documentation (Becker, 1987).
So where to from here? The way forward is to tell the truth that, although
certain scientific findings appear to demonstrate an important relationship
between cholesterol and CAD, the data are woefully inadequate.
need to know that the relationship is a statistical relation, which is
true on the average for the population. It may not be true for each individual
in the population and, as stated earlier, even the absence of risk factors
does not mean that CAD will not occur. A person does not have to smoke
or have high cholesterol or blood pressure to develop CAD. This is the
complexity of the disease and, therefore, any teacher's intent to embrace
causation via one factor is difficult if not impossible.
teachers at all levels should consider presenting health issues in a way
that is less frightening to students. Consider, for example, the common
tendency to present the ratio of risk of CAD in one group with low cholesterol
to the risk of CAD in another group with high cholesterol (i.e., relative
risk) versus the actual number of individuals who are likely to get CAD,
called absolute risk (Boone, 1992).
stage is set for increasing the students' anxiety and apprehension, particularly
if the cholesterol related risk for development of CAD is viewed in relative
terms. As an example, while I did not hear the teacher say, "even a slight
elevation in cholesterol doubles the risk of dying of CAD in the next six
years" -- it is logical that it occurred. If so, I can see the students
sitting in their chairs sweating about having doubled their chances of
dying from CAD. But, is the concern valid and should the data be presented
in relative terms. I do not think so.
the teacher made the statement in terms of absolute risk, it would have
been considerably less frightening and less misleading. In fact, given
the same theme with my age group (between 35 and 57 years of age with a
cholesterol of 170 mg/dl) my chances of dying of CAD in the next six years
is 4 in 1,000. If my cholesterol were to increase to 230 mg/dl, my chances
of dying of CAD in the next six years is 8 in 1,000. The absolute (annual)
probability of dying is increased from 0.00067 to 0.00133 -- not much of
a reason to be anxious and scared.
crucial point is that teachers should not have the right to create a false
belief upon which an action may be predicated, thus compromising free behavior
(Nephew, 1996). Consequently, a misleading statement or misrepresentation
of scientific conclusions is deception and is not morally acceptable. The
worry is that too often teachers have considered misinterpretations as
reasonable and in the best interest of students. But, when students are
persuaded to believe something that is not true, the end result is an uneducated
population without the ability to critically evaluate what they read or
experience. Their mental and emotional unpreparedness leaves them with
little hope of building the capacity to engage in higher-order thinking,
and there is little to no satisfaction of their fundamental human needs
to avoid undue suffering.
is the answer? We need critical thinking teachers who are held accountable
for the scientific accuracy of their health related lectures, and we need
more constructive discontent thinkers who require an analysis of all the
evidence before accepting on face value claims made by a particular researcher
or educational program. The students' derived obligation is not developed,
and they have little knowledge of choosing paths to bring about consequences
that are sought (Nephew, 1996).
this view, teachers should avoid teaching practices that result in a type
of personal aggrandizement (with all of its limitations and pitfalls) and,
instead, teach with an attitude of friendship and love as obligations to
their students. While doing so, they will simultaneously preserve their
professional integrity as well as uphold the doctrine of beneficence. Also,
as the teachers engage in critical thinking, they (and their students)
will develop a sense of wonder, questioning, and skepticism. The result
will be an increasingly more sophisticated and accurate understanding of
what constitutes being healthy. This morally right action will give rise
to increased opportunities to challenge assumptions, negotiate ideas, visualize
perspectives, evaluate the correctness and quality of health related information.
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Internal Medicine, 196: 623-625.
M.N., Hoag, J.H., & Berilla, B. (1995). Critical thinking in graduate
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G.J. & Miller, N.C. (1975). Plasma-high-density-lipoprotein concentration
and development of ischemic heart disease. Lancet, January 4: 16-19.
A. (1996). Interdependence Ethics. Duluth, MN: CSS Publishing.
M.F. (1986). Prevention of coronary heart disease - propaganda, promises,
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R.P. (1993). Critical Thinking: How to Prepare Students for a Rapidly Changing
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J.R., Christenson, R.H., Watson, T.E., & Hla, K.M. (1988). Reliability
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Well. Chicago, Illinois: Nelson-Hall, Inc., Publishers.
it was Oliver Wendell Homes who said, "What lies behind us and what lies
before us are tiny matters compared to what lies within us." In your mind's
eye, can you walk the walk I did in the above paper or is your walk altogether
different AND WHY?
a bonus, if you are willing to write your version of what I said in the
above paper and publish it in the ASEPNewsletter,
ASEP will send to you a very nice, smooth ink flowing, high quality pen
with a rich lacquer finish. The pen is a gift of hours of work by the employees
of Myron Manufacturing Corporation. Mike, the President, tells me that
it is the gift of good taste for every occasion. Naturally, it will have
the American Society of Exercise Physiologists engraved on it in crisp
and permanently etched letters.
not give it a try? Publishing your thoughts, and thus a paper in the ONLY
online electronic exercise physiology newsletter in the world! Your efforts
will become part of what is now becoming the "end of the beginning" as
the history of Exercise Physiology" is being literally rewritten.
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