I wonder how many of these are absolute benefits but not strictly needed to survive.
For example, allergy meds greatly improve my life on an ongoing basis, but I could do without them if I was willing to have messy sinuses and a headache on and off for a good part of the year. I was using over-the-counter meds but those stopped working and prescription ones do seem to work as replacements.
I wouldn't be surprised if many of the voluntary prescriptions have benefits that far outweigh their downsides.
I think you're going to find that a lot of these are actually drugs like statins and metformin, which _are_ "strictly needed to survive" in the sense that the main thing they're doing is preventing early death.
People hear "prescription modifications" and think of things like SSRIs, allergy meds, opioids, etc., but the vast majority of the top 10 medications taken in the US[0] are statins, diabetes drugs, blood pressure medications - things which prolong life.
This is especially apparent when you look at the graph in the paper for what percentage of people are taking medication by age. I'm curious about the drop off at 85+ though.
If you're healthy enough to live past 85 you're more likely to have lifestyle and inherited factors that increase the odds of you being able to need fewer or no medications even into old age. Modern medicine helps counteract poor health but only so much.
I'm a bit skeptical about that, because at some point, the older you get the poorer your health become even if it used to be stellar.
I'm lucky enough to come from a family with very good health expectancy (all 4 great grandmother lived past 90, and all my 4 grandparents are on track to be there as well), but beyond a certain age in their 80 they all started to take meds even though they were still in very good shape.
Diabetes is clearly identified by ancient Egyptian writings, and described in detail by Hippocrates in Ancient Greece several thousand years ago. Looks like someone in China even around 1500BC. Among many others. Type 1 and type 2.
That's true, but people with type 1 diabetes or genetic predisposition to heart disease will still need these drugs. My father, who is in fantastic physical shape and works out almost every day, has the same cholesterol as me, and I am quite overweight and don't eat well. I can increase my chances of long life with diet and exercise. He needs a statin or he will die young.
But also, if you have a person who needs a statin or what have you because they live unhealthily, and you can extend their life by X years by giving them a pill that costs a few dollars a month, why not? There's nothing immoral about helping someone live longer even if it isn't through lifestyle changes.
And also post-cancer meds. Since we are treating cancers rather successfully and in high numbers now, instead of letting those people die, these people usually need to take some medicine for the whole remaining life to compensate for the failing organ.
Dr Paul Mason claims that he has reviewed the studies on statins and found the only statistically significant effect was one study showed a 1 day shortening of life. e.g. https://www.youtube.com/watch?v=I7r4j1u42V8 is one of his presentations.
Slightly aside - I've been trying to work out if the "Low Vitamin A" diet of Grant Genereux has anything to it. If someone cites his work, he's a random Joe Bloggs engineer with no medical credentials, so can't have an opinion. If someone cites a Dr such as Garret Smith, that's are arguing by authority and so it doesn't hold water. If someone cites papers, that's cherry picking. If someone argues with biochemical pathways and effects, they know the words but how can I verify if they understand them or are doing a human ChatGPT. If they argue from trial and effect, that's anecdotal and doesn't count. If they argue that big companies are lying for money, we agree that happened with tobacco and with DuPont and Teflon manufacture, but that's no proof it's happening in this specific case. If we argue from vegetarian vs carnivore that's argument from literary genre. If we argue from "ancestral" paleo scenarios, that's argument from story telling and fictional paradise. If we dismiss because it's conspiratorial quackery, we risk throwing the gold out with the riverwaters. If we find one or two flaws in the reasoning, that doesn't mean the whole thing has no substance. If we stand back and say "eat a balanced diet" that's a cop-out which assumes that there can be such a thing, and that we know what we are trying to balance, and have enough information to be able to do it.
It's rather difficult to decide anything as a layperson, other than "go with the mainstream recommendation" - except then Gell-Mann amnesia comes in. We know the "best practices" in computing are really more like the "cover your ass" recommendations of "nobody got fired for buying IBM" and inviduals can do much better than "best practices" in specific areas, but then turn to another area and we can't do better than go with the crowd ... except in nutrition terms, the crowd doesn't have a good consensus. Most people who eat a Standard American/Western Diet (SAD) are ill, as per the article here.
> Most people who eat a Standard American/Western Diet (SAD) are ill, as per the article here.
This seems to be a fairly poor analysis. By your definition someone who treats a condition having nothing whatsoever to diet is ill if he takes a prescription but well if he does not. A good example would be allergy medication.
More ridiculous yet if said medication became available over the counter it would magically make him well again. It's not like other metrics aren't available to more directly measure.
The honest truth is you can be fairly healthy just by doing the things we already know are unambiguously true. Eat reasonable portions. Don't eat the shit tons of sugar we all eat. Exercise. Don't live on obviously unhealthy fast food. Don't smoke or vape. Maintain a healthy weight which is nearly entirely a function of getting enough exercise and not eating too many calories.
To the degree that we are unhealthy it is 99.9% a function of simple things on which there is no complexity nor disagreement.
> "To the degree that we are unhealthy it is 99.9% a function of simple things on which there is no complexity nor disagreement."
What would you expect to see different in the world if that wasn't true, how would you know? You accept that smoking causes slow cumulative damage which doesn't show until decades later, and maybe that sugar in the diet can(?) but you reject the idea that something else in food could be doing the same? Why do you claim there is no disagreement when there's clearly a lot of disagreement about dietary and nutritional advice, and part of that is because it is complex?
For one slightly off-topic example, common advice is to eat fibre to cure constipation. Yet here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435786/ in the World Gastroenterology Journal is a study of 63 people who reduced dietary fibre and improved their constipation. Not only that, the authors say ""Whilst it is often stated in physiology textbooks that bulking agents improve peristalsis, there is no proof of this in practice nor experimentally.". It's 2023, it shouldn't be possible to have such a disagreement, and you can't get away from it by just saying "there is no disagreement".
> "By your definition someone who treats a condition having nothing whatsoever to diet is ill if he takes a prescription but well if he does not. A good example would be allergy medication."
These are of course biased self-interested self-promotional sites, but if allergies have "nothing whatsoever to do with diet" these shouldn't exist at all, there should be no results from studies microdosing kids with peanut protein, and nobody would be testing that because eating peanuts can't cause or cure allergies. Certainly there's a non-trivial amount of people who think allergies can be affected by diet. Where's the convincing, conclusive, studies that say it can't be? Can there even be such studies proving a negative? Food is the main way we put things into our bodies, enormous numbers of molecules of it every day, the idea that such a thing couldn't affect our body's reaction to things is odd.
> "More ridiculous yet if said medication became available over the counter it would magically make him well again. It's not like other metrics aren't available to more directly measure."
Taking OTC medications wouldn't magically make him well again, nor did I say it would, what are you talking about?
> "The honest truth is you can be fairly healthy just by doing the things we already know are unambiguously true. Eat reasonable portions. Don't eat the shit tons of sugar we all eat. Exercise. Don't live on obviously unhealthy fast food. Don't smoke or vape. Maintain a healthy weight which is nearly entirely a function of getting enough exercise and not eating too many calories."
In the USA there are 28 million diabetics, 96 million pre-diabetics, 14 million with severe depressive episodes in a year, 23 million people with autoimmune conditions. 240 million overweight. 100 million obese. The USA has 7% of population with an autoimmune condition, Japan has 2%. And Japan's population skews older. You might expect exercise to improve diabetes, but not to prevent or cure autoimmune conditions, right? Yet anecdotally people do cure 'incurable' diseases with diets - carnivore or vegan or fruitarian being the most common extreme ones but also ones which don't work for a lot of people.
Your answer is like the "I became rich, and if I can, anyone can. I started with an ice cream van" of millionaire Duncan Bannatyne. Yes, nobody else had thought of running an ice cream van before, it's so easy. Yours is the "I exercise and eat kale and I'm healthy, so everyone who doesn't is just lazy and impulsive". Ignoring that there are lots of other people who do, and aren't. Like the original guy I mentioned who bicycled to work every day, ate vegetables, didn't smoke or vape or binge drink, and became increasingly ill and then chronically ill and tried to fix it by eating more vegetables and drinking more dairy and exercising more (until he couldn't anymore).
> Most people who eat a Standard American/Western Diet (SAD) are ill, as per the article here.
You are proving that most who eat a "Standard American Diet" are sick based on an article specifying what percentage of Americans take a prescription medication but that is a useless metric because its poorly correlated with illness. The example I gave was someone who suffers from seasonal allergies. They would by this metric be classified as ill or sick depending on whether they chose to suffer or medicate and whether their preferred solution was OTC or prescription.
Another good example is early detection of cancer. By your definition Americans who don't die of cancer but live more years would "prove" that people were less healthy by not dying.
This isn't to say that people who eat the standard American diet aren't sick. They are because the standard American diet involves a shit ton of McDonald's, an absurd amount of salt and sugar, and more calories than needed for our sedentary lifestyle.
It is broken in so many obvious ways that wondering if we should change the balance of vitamin A for most folks would be like wondering if a person with a gunshot wound to the forehead ought to do a few more push ups now and again.
* Efficacy vs mechanics
Fiber pretty definitively seems to ease constipation even if our analysis of the mechanism is imprecise or even wrong. Sadly this is not uncommon in medicine. Our understanding is still evolving
* Folk wisdom vs actual wisdom
The peanut thing is a known way to treat allergies but in particular its of very dubious benefit as it is very expensive and requires if I recall complex compliance that parents are liable to fuck up and you are still allergic to peanuts so you STILL have to practice the same behaviors. It's not clear on net that its worthwhile for most parents to use.
> if allergies have "nothing whatsoever to do with diet" these shouldn't exist at all
Any complex condition with substantially divergent outcomes between people is subject to people assigning causation to any irrelevant factor. If they blog about it and 100,000 people try it and 10,000 of them are expected to have substantial improvements if they did nothing you can get yourself 10,000 converts and a line of products.
If I can digress for instance my wife has Rheumatoid arthritis a complex auto immune disorder where the body attacks itself especially the joints having little to do with the common osteoarthritis save for the concurrent effects of one on the other.
A massive number of people know one weird trick the doctors don't want you to know about up to and including drinking your own pee. The truth is that we do know how to slow the progression of the disease but outcomes are wildly divergent between people or even in the same person at different times for reasons we don't understand well. If you convinced enough folks to drink their own pee you would have a certain number whose conditions improve it doesn't mean urine is medicine.
> Yours is the "I exercise and eat kale and I'm healthy, so everyone who doesn't is just lazy and impulsive".
I'm an asthmatic who doesn't get much exercise since I started working from home who drinks about 6-7 mugs of sugary coffee. I'm not fighting the battle of the bulge only because I have always had pretty great metabolism. I like most Americans know my diet and habits aren't very healthy.
Instead of wondering whether I should follow this or that fad I really ought to like most folks do the obvious things.
> "A massive number of people know one weird trick the doctors don't want you to know about up to and including drinking your own pee. The truth is that we do know how to slow the progression of the disease but outcomes are wildly divergent between people or even in the same person at different times for reasons we don't understand well. If you convinced enough folks to drink their own pee you would have a certain number whose conditions improve it doesn't mean urine is medicine."
Agreed, and then we get back to my original comment: we could assume that literally none of the weird tricks have any value to them. You say "Our understanding is still evolving" so perhaps you agree it could be possible that one of the weird tricks has a kernel of truth to it? If so, if it was obvious then the weird trick wouldn't be a weird trick, it would be well known. So it will not be a glaring light in the sky. If it's coming from a lay-person it probably is not the full understanding - like adding a randomised delay can 'cure' a race condition, that's not a good fix but it's sure in the right area of the problem. How would we identify that trick from the others? Can we, as lay people? Well, perhaps if it had mechanisms of action, explanations or plausible stories for common phenomena, relevant studies and citations?
Do the "drink pee" people have studies and citations, proposed mechanisms of action, proposed tests, correlations from multiple angles, logical arguments, anecdotes? Because the anti Vitamin A people have, enough that piecemeal make up a case for Vitamin A being more harmful than is commonly believed - if not a glaring light in the sky. They also have kooky beliefs. But they have collectively more convincing hints and arguments than "drink pee". The first book here: https://ggenereux.blog/my-ebooks/ e.g. page 125 (PDF page 139) has references for Vitamin A (retinol) being converted to retinoic acid in the body. The next page has a proposed way for retinoids to enter cells. And a way for them to trigger an immune response. It's 400 pages, skim read it - it's not "drink pee, the idea came to me in a dream", it's not the ravings of Gene Ray about four dimensional timecube. NB. the intro page warns "I was still quite unwell as I wrote this book, It is too long, rambling, and has many typos and grammatical errors. If you can get past that, there’s probably still some worthwhile information in it. It makes a very strong case that vitamin A is at the root cause of many of our chronic inflammatory diseases.".
> "It is broken in so many obvious ways that wondering if we should change the balance of vitamin A for most folks would be like wondering if a person with a gunshot wound to the forehead ought to do a few more push ups now and again."
Unless the extra body fat is a defensive storage mechanism against excess dietary vitamin A. Unless Vitamin A is damaging body cells and causing a lot of the type 2 diabetes epidemic. Unless Vitamin A is causing the lethargy and fatigue which is leading to people wanting to drive everywhere. Unless Vitamin A is causing the lowered concentration and motivation, and increasing the depression, leading to people taking the easier fast food option rather than planning a better meal. Are these in the crank territory or in the random-delay-for-race-condition territory or in the obvious-in-hindsight-in-100-years territory? How would we know? We know that acute vitamin A overdose can cause all of those things. Declared side effects of Vitamin A therapies can look like all those things. Is it impossible that eating Vitamin A can lead to a chronic increase in all those things?
For anyone mildly curious, the weak version (easier to accept) is: Vitamin A (retinol compounds like Retinoic Acid and its precursors like Beta Carotene) are harmful in very low amounts above the daily recommended value. In America where dairy must be fortified with them, and flour and breakfast cereals often are, it's very easy to go way over the daily recommended value, the damage builds up over years and decades, and it's a big contributor to diseases of "old age" and autoimmune diseases. The mechanism of harm is cumulative damage, the damage is retinoic acid's effects on epithelial cells and stem cells causing skin damage, and its effects on DNA mechanisms causing misformed proteins.
The original anecdote is that Grant was diagnosed with chronic kidney disease in around 2007, given five years to live, three or four years later he had chronic fatigue, concentration problems, memory problems, was severely disabled, was trying an "athlete" diet of lots of fruits and vegetables and milk, developed eczema, came up with the idea to try avoiding Vitamin A, and after a three or four weeks of eating lean beef and white rice ... his decade of knee pain disappeared along with the brian fog and memory and concentration problems. So he stuck with it, his gum disease and dry eyes cleared up, his eczema cleared up, his kidneys stopped failing, and he's 16 years on from his 5 year life expectancy.
The strong (harder to accept) version is that retinol compounds should never have been classified as vitamins at all, the 'deficiency' symptoms are not right, the original 1920s studies were not conclusive and the most prominent one saying they are vitamins was bad science which poisoned the rats with retinoic acid overdoses and then took those symptoms as deficiency symptoms. Grant is now stronger at the gym age 62 than he was at 22 despite exercising only weekly, his greying hair has darkened again, his liver spots and skin blemishes and varicose veins have cleared up and his eyesight has improved.
The possible reasons to believe there's something to it is that other people have tried it, and seen their skin conditions improve, their joint pain, posture, vision, memory, insomnia, digestion, body fat, people have found plenty of papers of biological damage evidence, or studies on people contradicting the normal expected outcomes. There is claimed correlation of vast increases in serious health conditions matching the 1970s fortification of dairy with retinol compounds in the USA, and decreases in serious health conditions in Eastern Canada following the 1992 closure of a cod fishing plant, with correlations to oily fish and cod liver oil. Retinol compounds in the form of Isotretinoin were used as chemotherapy agents because they are so harmful to cells, and in the form of Accutane they're used for acne medication which has as its known side effects the symptoms of most autoimmune diseases, which happen in far more people who take it than you'd expect for a common medication.
Possible reasons to believe there's nothing to it is that other people have tried it and found no improvement, sometimes worsening. Many of the people who tried it were seriously ill and trying everything they could think of, including lots of vitamin and mineral adjustments and gut microbiome adjustements and other treatments, so there's too much in play to be sure of cause and effect, and anyway it's all self-selected confirmation bias and anecdotes and correlation != causation and anyway engineers thinking someone else's field is easy and simple is a common trope, besides with so many people researching nutrition wouldn't this be well known by now? The dose makes the poison and of course "too much" is harmful, who would expect otherwise? (See weak version: perhaps "too much" is far lower quantities than commonly thought, but the effects take years to show up?). Or that this study showing diabetes mellitus makes a foetus more vulnerable to retinoic acid damage and birth defects[1] is a study in mice, not humans. There isn't a single cause of disease, no lead bullet (but this isn't claiming it's the only cause).
The crazy (internet kook) version is that chronic Vitamin A toxicity is a significant contributer to all autoimmune diseases, Alzheimers/dementia, type 2 diabetes, autism, ADHD, it's the real cause of Scurvy (but the cause and effect is non-trivial, ascorbic acid is good at calming the symptoms rather than curing the disease), that Scurvy is very close in symptoms to Type 2 Diabetes because they have the same root cause, that retinoic acid is a contributer to male pattern baldness as well as "old age" gray hair, that retinoic acid is documented as affecting 500 gene expressions but that's really a misunderstanding, what it's doing is random chaotic damage, that the documented Vitamin A defficiency eye conditions are all in people with very unbalanced diets with a lot of other defficienies...
----
You can see on his blog and forum anecdotes like user YH: https://ggenereux.blog/discussion/topic/nearly-7-months-prog... who says their eyesight is improved, back pain is gone, humpback has gone, chapped lips and dry skin are healed, new hair growing on their balding crown, skin condition is improved, hand-eye coordination in sketching has improved, depression has gone.
Or PuddleDuck who improved from years of chronic fatigue on it: https://ggenereux.blog/discussion/topic/puddleducks-progress... who says "I know this post is going to be so long, but since Grant’s theory is the only one I’ve ever read that MIGHT explain why the heck that happened to me, I feel compelled to share in detail.".
Or El: "it's been six months since i read gareth and grant has been on this diet for almost close to seven months. It changed my life. I had chronic fatigue, dizziness, eye pain, muscle pain, blurred vision. hearing loss" - https://ggenereux.blog/discussion/topic/hi-2/
Or BodeFofinho who developed Latent Autoimmune Diabetes in Adults in his 30s, and after a year of no/low Vitamin A reversed it ... but then after two years found the diet worsening his health and moved away from it: https://ggenereux.blog/discussion/topic/my-diabetes-type-i-r...
Or if you don't want the rah-rah versions, "Why I don't think this is a valid theory anymore", and in the middle of that pay attention to Johannes-2 posts which are full of biochemistry with study citations and references: https://ggenereux.blog/discussion/topic/why-i-dont-think-thi...
Or if you want more details of mechanisms of action, this https://ggenereux.blog/discussion/topic/biotransformation-of... which I can't read and says "It is now no longer difficult to imagine how retinoic acid could cause auto-immune disease, since the data appears to show that retinoic acid is essentially a pro-inflammatory cytokine that is stored in the liver and, once the liver is saturated, in different types of tissue all over the body, especially in epithelial cells that constitute blood–tissue barriers".
Or if you want reasons to dismiss it as all nonsense, look only for the COVID/vaccine claims, the guy who dismisses vitamin supplements because they're made in Chinese factories, the people who wear Electro-Magnetic Field blocking clothes, the guy who thinks dust in bottled water made him ill but raw ocean water up his nose didn't ... it's really really easy to dismiss this all as crank bullshit.
... Except, the arguments are interesting and pointing from many directions, and the claimed mechanisms of action are far more plausible than - say - claims of how the Pyramids were electrical energy collectors. And there certainly are many health crises around. And it's pretty clear that some food can be harmful, short and long term. And that grouping food by (plant/animal) or (low fat/high fat) or (low carb/high carb) or (processed/unprocessed) isn't enough, and the argument that we need to look at the molecular content of foods rather than where they came from is reasonable.
Nearly all prescription medications have benefits that far outweigh their downsides, at least at a population level.
I do understand to some degree the growing skepticism around prescription medications, especially because of some high profile over-prescription events, but the gains achieved in quality of life and longevity due to prescription medications are huge.
Put another way: I'm quite sure that the _overwhelming_ majority of prescription medications are a net benefit to the patient. This stat is in no way a bad thing.
Almost certainly both. The prevalence of prescription contraceptives would support your conjecture, while that of diabetes medications would support mine.
I do find the statistic intuitively astounding given what I know of friends and family. Unless elderly or on the pill, use of prescription medications seems low. I am not in the US though.
I think it's just kind of a lot to think about. Glass half full: medication improves quality of life. Glass half empty: Quality of life is dropping such that more prescription medication is necessary to maintain an average quality of life.
We are living longer partially as a result of treating issues that would previously have gone untreated or poorly treated. Most things we treat with medication we treat because they have negative health outcomes otherwise like earlier deaths. Longer lifespan on medication = more percentage of life on medication, but of course people would typically rather have that than a shorter un-medicated life.
I think there probably is a factor of quality of life dropping due to things like obesity raising in prevalence, but I think what I stated above could be the more likely/common explanation that doesn't require the "glass half empty" view. One other factor is we are able to treat more things each year than ever before. There are numerous diseases that have gone from death sentence to a mostly normal life with the help of medication. This would also influence the percentage statistic.
I guess to me if you’re attributing a nontrivial portion of the rise in medication use to things like diabetes and obesity, you are agreeing that it is indeed a negative root cause for our society.
I am on asthma meds. I don't need them to live, but I did like to breathe when I was younger. Ozempic is offering people painless weight loss that actually works. ADHD meds aren't needed either, but do improve concentration.
> Ozempic is offering people painless weight loss that actually works.
The medicine may work, unlike those stomachs which experience gastroparesis upon taking it as a side effect. I'm not so sure I'd describe some of that as painless, though.
I only know 2 people taking Ozempic and while it is working great for their weight, their quality of life is affected. It removes the want to eat so you almost have to force yourself to eat to get the bare minimum calories. Drinks they have been consuming almost daily for their entire life needed to be cut out (coffee and tea) due to nausea. The doctors just keep increasing the dosage making them feel even more depressed. Not to mention studies show that when they stop taking it they could see their weight go back to pre-Ozempic levels.
Allergy shots are a pretty good example when discussing continuous medication.
They have been shown to have durable long term effects once you go off of them are close to the efficacy of continuing treatment.
You can take allergy shots for for your entire life and the current recommendation is monthly. Or you can stop after 2-3 years and get ~80% of the benefit for the rest of your life.
The freedom from medication happens after the course of shots is over, and lasts for many years, in many cases for life.
The shots are simply extracts of the things you are allergic to in extremely small amounts, which, sure, you can classify as medication although I think most people would draw a distinction between that and something like diphenhydramine or fluticasone.
After the first few months the shots are taken only once per month and typically do not have any side effects, very unlike antihistamines or other daily allergy medications. (In the first few months only while updosing the side effects are typically local itchiness akin to an insect bite).
The freedom from medication happens after the course of shots is over, wise guy. And even during the treatment for several weeks in between each monthly shot, unlike other allergy medications taken daily.
I'm perfectly happy taking my current medication for my entire life, it completely changed everything for the better.
I was diagnosed late with ADD (26) and despite being considered gifted throughout my childhood, starting around 17 years old it was getting harder to just get started, let alone be consistent. There was nothing more frustrating than knowing I'm smart but to keep failing without knowing why.
Doctor prescribed Concerta and the mental fog went away immediately and I felt like my younger self again, brain ready to attack any task without needing the stimulation of an imminent deadline.
Recently I realized through psychology sessions and introspection that I had a blanket of anxiety covering me constantly for the past 6-7 years. It fueled me to always do more and perform better but it was a negative source of motivation and it burnt me out. I had trouble sticking to anything long term or even keeping my house clean often because I wanted to go back to distracting myself to avoid being alone in my thoughts. Countless hours wasted on my phone and on Reddit.
I wanted to try an SSRI because things got bad and after discussion with my doctor, she prescribed Escitalopram (Lexapro, Cipralex). The effect has been mind boggling, as in I can't believe how I was able to tolerate my previous state of mind for so long.
The weight of anxiety has been lifted from my shoulders almost completely. For so long I thought my ADD was the only thing stopping me from being consistent in long terms task but it was the anxiety that really paralyzed me.
I'm finally doing all the things I always knew I fundamentally wanted but kept trying and failing to keep going.
I'm working out again with amazing consistency, weightlifting/rowing/yoga. I'm fully enjoying the workouts too because I'm not anxious to go back to a safe space like my phone. I'm tracking my calories and losing weight and it's a pleasure. I'm cooking and cleaning, my place looks amazing. I'm going to sleep every day early because I'm no longer wasting time on my phone until I'm so tired that I drop the phone on my face. I'm reading books again too and meditating daily.
I had been stuck in these loops of knowing what I wanted and making insignificant progress. I never stopped wanting these things and now I can finally have them.
Obviously it would be better to function normally without medication but I have no issues with continuing.
That's truly awesome to hear. It's truly "crazy times" we're living in now and we all have to figure out how to deal with it.
Years ago I realized that watching the "News" was getting to me. I'd get up in the morning and go to work and felt fine but after watching the "News" I felt like shit.
Basically I was consuming all the horrendous tragedies in the city, State, U.S., and the rest of the world for an 1-1/2 hours every evening and it was very depressing. I realized that I, myself, had it pretty good and for the most part so did all of those I knew and were close to. So I quit watching the news everyday and that made a big difference.
Now I monitor the news, as opposed to consuming like it effects me personally, when in fact it mostly does not, or is beyond my reach of influence.
I was angry for four years during the Trump presidency .. and that's as a Canadian! I couldn't look away from the news and was expecting him to be stopped at some point and it just never happened.
To your first point, it's definitely very interesting to have to figure out this reality of ours and work on ourselves, it's a privilege to have the time and resources to do it effectively, I can't even imagine how many people are suffering without even realizing that their daily struggle could be anything else.
Only if they _choose to_. One of the lessons in becoming a modern adult is that you have the option of telling a doctor "no, i won't take that." That's your choice, not the doctor's. Period, end of story.
There are obviously exceptional cases - diabetes immediately comes to mind - where it's a "do or die" decision, but those are the minority. Even so, it's your choice, not a doctor's.
There are standard cases that any rational person would see taking the medication as a win. The most prescribed class of medication in the article is antihypertensized. Thiazides are a frontline intervention for hypertension. Thiazide's reduction in all-cause mortality is clinically significant(HR approx: 0.51).
> The risk of primary outcome events[all-cause mortality] was significantly lower in patients taking thiazides (model 1: HR 0.51 [95% CI, 0.36–0.72]; P=0.0002; model 2: HR 0.56 [95% CI, 0.38–0.83]; P=0.004; [1]
There are of course downsides to taking any medication or medical intervention, but a HR 0.51 in mortality is such a large reduction that the risks would need to be equally significant.
I'm not sure why diabetes should get any special treatment other than there is simply more public awareness of the risks of untreated diabetes. Are the HR reduction in all-cause mortality with insulin treatments above a particular threshold of importance? Does diabetes the primary cause of mortality in more patients than hypertension? Some other factor? Happy to hear some of the reasoning behind it.
Wait. You can survive with T1 for two years without insulin, 50% chance? Your pancreas must be still working, but when it totally stops producing insulin, I'd give you maybe a week before going to a coma.
If I unplug my insulin pump, I will feel very sick after 24 hours and probably go to a coma from ketoacidosis after a few days.
That's data from early 20th century, so take it with some grain of salt. Nobody would redo proper double-blinded trials nowdays :) Maybe it was measured from the onset, when you still had some b-cells active? Furthermore, people live with 20-30 mmol/L, so it might be not a week even with zero production - our body's adaptability is huge.
Is there a threshold you're using for non-intervention mortality and why did you choose it as the only factor?
Additionally, most people would seem to account for several inputs, HR for all-cause mortality seems like a pretty good indication, but you've chosen to reject it. Any reason?
Diabetes isn't that exceptional in our population. And not that exceptional as a "do or [suffer extreme consequences]" medication. Statins, antipsychotics, epilepsy medications, even sleeping pills, can literally save lives if taken on an ongoing basis.
>diabetes immediately comes to mind - where it's a "do or die" decision, but those are the minority.
The rate of diabetes is exploding.
>37.3 million people, or 11.3% of the U.S. population, have diabetes. An estimated 28.7 million people – had diagnosed diabetes. Approximately 8.6 million people have diabetes but have not yet been diagnosed.
Oh, and what about high blood pressure.
>About 70% of Americans will have high blood pressure in their lifetimes. What's more, only 1 in 4 patients with hypertension have their blood pressure under control. And because high blood pressure usually has no symptoms, you can have it without knowing it.
Why does this matter?
>About 697,000 people die of heart disease in the United States every year–that's 1 in every 5 deaths.
I would like to add, diet doesn't fix getting old. One thing I've not seen in this thread is demographic shifts from the majority of the population aging and the percent of youth dropping significantly.
You're thinking about type 2. Type 1 is fairly stable around 1%. Type 2's, if they're lucky and disciplined (emphasis on the lucky), can get away without needing insulin.
> How do you get around requiring everyone to be an expert in all things?
i simply hope for them to make their own choices. If that choice means following a doctor's advice, that's fine. (Admittedly, 9 times out of 10 or more, that's what i'll do - the doctor is the subject-matter expert.)
Anecdote: as a recovered throat cancer patient, if a doctor were to tell me that the cancer is back and i had to undergo Treatment X or die, i'd start getting my affairs in order. In the 17 years since my cancer treatment, the only side-effects i still live with are side-effects of the _treatment_, not the cancer. e.g. i haven't slept a full night of 8 hours uninterrupted in 17 years because of side-effects of the radiation treatments, not the disease, and i'm unwilling to undergo further quality-of-life degradation caused by medical treatments. If it comes down to that, i'd choose my dignity and quality-of-(what remains of my)-life over a longer life suffering yet more side effects.
Granted, not all would make such a choice, but i inherited stubbornness from both of my parents and got a double dose of it genetically, so i don't expect to represent a majority opinion.
And eg most doctors will laugh at you if you said that T2 diabetes can be put into remission with diet: but it can for at least 50% of people. And the other 50% will at least drasticly lower their need for medication.
Also notice the word "remission": they can't admit that you actually healed T2 diabetes, so they use the word remission to gaslight you into thinking that "you didn't even heal it, you're just lucky and it's gonna come back".
You aren't healed if you need to remain on that diet to keep the T2 away. You still need to actively treat your condition. So remission seems like a reasonable thing to say about it.
This doesn't square with the fact that the standard American diet is known to be unhealthy and a cause of pre-diabetes.
If I eat something allergenic, start experiencing a reaction, then later cut the offending food out of my diet, it doesn't mean I am in remission from my allergy; it means I am avoiding the cause of an allergic reaction.
The British Museum had an art exhibit showing the prescription medicine taken by a typical person. It was kind of shocking to see a 14-meter long table covered with 14,000 pills, arranged according to the course of someone's life. I'm not saying that this medicine is bad, of course, but it was a striking presentation that comes to my mind years later.
> Between 1997 and 2016, medical marketing increased from $17.7 to $29.9 billion (Schwartz and Woloshin 2019). Prescription drug advertising was a key driver of this expansion, with 4.6 million advertisements (including 663,000 TV commercials) amounting to $6 billion spent in 2016 alone (Schwartz and Woloshin 2019).
I'm reading this thread as I see at least one prescription drug advertisement every commercial break while watching Sunday football in the US.
> From 1997 through 2016, the number of consumer and professional drug promotional materials that companies submitted for FDA review increased from 34 182 to 97 252, while FDA violation letters for misleading drug marketing decreased from 156 to 11. Since 1997, 103 financial settlements between drug companies and federal and state governments resulted in more than $11 billion in fines for off-label or deceptive marketing practices.
Plenty of ads for drugs and limited regulation oversight. How does this compare to more regulated countries?
>while FDA violation letters for misleading drug marketing decreased from 156 to 11.
As an interesting aside, it is my understanding that legislation is often written by lobbyists and industry groups rather than by our elected officials and their staffers, especially with legislation that relates to large and complex industries/institutions. The general concept is that politicians and their staff are more generalists and technocrats of the political process so they lack the knowledge, time, resources, and expertise to craft complex legal frameworks. Certainly problematic, but it's kind of how our system has evolved to work. Ok.
On top of that, there are significant cases ahead facing our conservative supreme court that aim to "reign in" federal regulatory agencies, for instance by giving judges much more power to undermine their interpretation and enforcement of federal law [0]. Namely, consumer protection and finance agencies in the executive branch. Although the EPA tends to draw the most ire from conservative judges, the FDA also falls into this category.
Perhaps the FDA will skirt some of this scrutiny by such policies as reducing the issuance of violation letters for misleading marketing by 93% over a 20 year stretch, despite a significant growth in the amount and kinds of advertising taking place during the same period. Of course it's possible that medical marketing has simply become that much more ethical during this time, all but eliminating the need for the issuance of violation letters. However, if it is true that the FDA has effectively clamped down on misleading marketing, this now represents a significant financial incentive to try and have much of that progress to be undone by industry-friendly judges as well as those who oppose federal regulation on ideological grounds, since they would have far more leeway to defang the FDA should to be so inclined.
Anyway, those situations - medical industry writing laws for themselves and federal regulators losing their teeth - represent two major checks in our system that are at risk of being substantially compromised when it comes to oversight of medical marketing for the good of individual consumers and the wellbeing of our nation.
I could imagine, for example, medications prescribed to improve health that today would not even be considered a problem. Maybe to correct various imbalances resulting from individual genetics?
Or that some medication readily available today becomes prescription over time.
Or that people become more aware / better tested of their health problems as time progresses and start taking medication earlier, before their problems become acute issues.
Anyway... why I think it is true is because of couple really sad factors:
* People seeking comfort and less able to exercise discipline. For example, even bikes which were supposed to be healthy option today mostly have little motors built into them...
* Disinformation. People seek shortcuts and there is a huge industry that exploits it that nobody really attempts to deal with. For example, dieting has been shown to not work (on its own) and yet any obese person is bombarded with information about dieting but not really any useful recipes how to deal with their problem. It does not help that most health professionals do not really know how to deal with obesity, either (for example, claiming that dietary fat is responsible for it when the opposite is true (dietary fat is necessary to help losing weight)).
* Education and popular culture pushing the idea that being fat is somehow OK (no, it is not healthy and should never be accepted as a good example). People with obesity pick up on any shred of support and tend to ignore any information that will conflict with it.
* Medical establishment continuing to only deal with symptoms, not causes of problems. People should seriously understand that sugar is far more dangerous and insidious than tobacco. Or that bad dietary habits is what is causing most of our health problems (including most types of cancer, heart disease, etc.) The issue here is that treating a disease is much, much, much more expensive that it would cost to prevent it (for example educate people, ensure healthy food available, provide guidelines, do medical checkups regularly, etc.)
I can easily see this being 80-100% of the population in a few years.
The human body is not some miracle or well oiled machine. It is a poorly and erratically manufactured product done in inconsistent environments. As we learn more about our bodies, we will regularly discover things that should be fixed or optimized.
I have asthma. Only in childhood did it threaten my life, but why wouldn't I want to breathe well all the time? A friend has ADHD. Sure, he can do ok without the meds, but is now a superstar with them. Birth control can eliminate all sorts of annoying fertility issues for women beyond simply not getting pregnant.
But I disagree on one thing, I do think human body is a miraculous, well oiled machine. It is just that we tend to misuse the machine and do things to it that were not foreseen by the manufacturer, so to speak. You void the warranty if you sit by the computer all day, move only with your car and then ensure there is something sugary in your mouth for 16 hours a day.
I did have a lot of health problems which I corrected once I put enough (a lot, actually) effort into understanding and correcting them. I am not saying that all health problems can be resolved this way, but a lot of them can be solved with simple lifestyle changes. Especially if you live in a western world and have income to be free in choosing what you eat and able to have a good night of sleep and spend a part of the day in exercise.
On the other hand there's an entire industry around selling placebos of various shapes and sizes; and even the meds that are functional often ruin your kidneys and other organs over time. Medication, while useful in many cases, is often a double edged sword we use too liberally and irresponsibly overall.
> It is a poorly and erratically manufactured product done in inconsistent environments. As we learn more about our bodies, we will regularly discover things that should be fixed or optimized.
This is a poor model for understanding the human body.
The body is a massively high dimensional chemical and physical system where there is no objective function that will maximize performance in all possible environments. Every new environment will have new challenges and a new objective function to maximize. The common denominator that reflects our last global optimum is our genetics and epigenetics, which has some randomness but is not at all erratic.
Most bodily processes are some kind of trade-off. You can have faster metabolism but you will age quicker. You can have a strong type I immune defense against infection but you will be more prone to autoimmunity. You can have greater anabolism and become stronger but that will compete with catabolic pathways and increase the risk of cancer. Nothing is free.
Medication is the same way. For people with a moderate or serious condition, any downsides are worth it, but there are always side effects. No bodily system exists in isolation.
Does 80% of the population really need prescription medicine to optimize their health? People currently can already improve a lot of their problems by working out and eating healthier.
Of course if you have a health issue like asthma then you should take the medicine. But 80% of the population sounds a bit high.
My nephew was diagnosed with type 1 diabetes at 8 - I'm hoping he spends over 90% of his lifetime on prescription meds, assuming he doesn't at some point get an artificial pancreas or some future magic technology. 100 years ago that wouldn't have been imaginable for him.
GP is not necessarily wrong on the overall points, but they are a little bit all over the place.
Leading with e-bikes being a sign of the decline of our discipline and health kind of threw me. I wonder, have they ever tried pedal assist for 5 miles or so? It's actually spot on for the 30ish minutes of daily light to moderate exercise that is more strongly correlated with longevity than any other type of exercise (at least from what I was reading a few years back).
It's actually far better for most people, especially those trying to get back into exercise in middle age and beyond, to go nice and easy while setting themselves up to be consistent about it.
As for the dieting thing, we can charitably interpret them to be highlighting the important distinction between focusing on dieting vs changing one's diet. Dieting (ie short term, often trendy, extreme, not always backed by any science, sometimes outright silly) absolutely doesn't work as shown by a great deal of scientific literature, and can cause serious harm. On the other hand, changing one's diet in thoughtful and strategic ways absolutely does. Some people rather successfully argue the latter is by far the best way to successfully lose weight and improve health outcomes in the long term.
That pedal assist is just a gateway drug. It is not something that is used by people who require it -- I don't think there is many people who can't ride a bike but pedal assist somehow enables them to do it -- those people are usually driving cars anyway.
My friends who got e-bikes all had no trouble riding regular bikes but after some time discovered the convenience of it and followed with more powerful models with more durable batteries. They are essentially riding electric scooters now, no health benefits compared to driving a car. And the teens and twentysomethings pretty much only use scooters to get around here -- no longer walking anywhere. If B is two intersections from A, they will look for a scooter to cross the distance while being able to look on their phone.
It is not better for most people. Instead, it robs people of the few occasions they could actually be walking around, as if we had too much of it already.
People seek comfort and large portion of population is either unaware of the benefits, or unable to exercise willpower to decline comfortable scooters lying around on the sidewalks.
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And as to dieting, I should point out that words "diet" and "dieting" have completely different meanings and at least in my mind are entirely separate and independent. So I have no trouble saying you need to pay a lot of attention to your diet and at the same you should completely discard most of dieting advice. There is no logical problem at all.
The goal is to fix your life habits around your food (aka "diet") and start eating healthy food, in a healthy way on a daily basis vs going for interventions aimed at quickly bringing down your weight (aka "dieting") when your weight starts causing you physical or mental discomfort, with no or a halfhearted plan for any long term followup.
Remember, weight is only an indicator. By the time your weight is up, you have already disregulated, damaged a lot of things in your body. Our bodies can take a surprising amount of metabolic damage before our weight starts going up -- that's why young people seem to be relatively healthy while having very unhealthy habits. Just like with cigarettes and lung cancer, you have to do it for long enough time before you get sick. So you are 20-something and you feel fine, then sometime in your 30s or 40s, without change in your habits your weight starts steady climb up. The way to understand it is you were eating shit food all your life, but it took until 30s or 40s before your body got damaged enough for this to start visible, long term decline in health.
Interventions, aka "dieting" does not work. Because it can bring down the weight (and most of the time it even can't do that). But the weight is only an indicator, bringing down the weight does not magically fix your body yet. It takes sustained effort over long time to undo most of the damage and couple of months of dieting is not going to do it.
The only way your dieting can bring you any results is if it a part of a sustained effort to change your life habits. It is a necessary step to get better -- but most popular advice does only consider one goal -- weight loss. There is no plan for what to do afterwards. There is no plan what to do with your cravings for the food you liked. There is no plan how to deal with our self sabotage.
You can get prescribed SSRI, ADHD, anti-anxiety related drugs in under 30 mins with ease across the US. There's also a big industry of doing it over video calls now too with cute web apps that make it easy, full of commercials with celeb actors. In the commodified hell we live in, this is hardly a shock. The number of young adults being tricked into thinking they have some mental disorder is alarming. There is almost no energy put into other forms of discipline and self-improvement.
Reminds me of a doctor saying that his french peers were much more reluctant than USA ones to give mental medication to children, due to the unknown long term effects on these young and developing minds.
A startling revelation in the article for me was that drug companies that produce SSRI's do not publish (easily accessible) guidance for stopping them. That made me deeply suspicious because to my layman's perspective of pharmaceuticals, it is as if the companies do not intend for a person to stop taking them.
It gets worse because yes, you are expected to keep taking them.
After stopping, some five years after stopping, I tried to get a medical to become a pilot. The FAA told me that they wanted me back on the SSRI that I had been taking in order to get a medical.
That's pretty crazy. Back in the `80s I listened to the head of the USC Med school on the radio talk about doctors graduating who just barely passed the grade and then said "going to the doctor was the #1 cause of avoidable deaths". I read a few years ago that it's now the #3 cause of avoidable death, but that's still very high.
I'm 63 now and I've only went to a doctor 3 times in the past 40 years. All of those were for lung infections from a "cold" that was going around and I asked for and got a shot of penicillin.
The last time was about 10-12 years ago and I asked for a shot of penicillin and the "Nurse practitioner" that saw me got all snippy with me, told me "You can't come in here and tell us what to prescribe!". That just cracked me up. Everyone I knew at the time who'd got that crud was getting prescribed a "z-pac antibiotic" and it was making them all sick af and I told her that, and that I wouldn't take it.
She ran to the Doctor to tell on me and they told her to give me the penicillin. I was feeling better the next day. Haven't been sick since. I didn't get infected with covid either, but I did mask up and keep a distance and got vaxxed and boosted asap for that.
For example, allergy meds greatly improve my life on an ongoing basis, but I could do without them if I was willing to have messy sinuses and a headache on and off for a good part of the year. I was using over-the-counter meds but those stopped working and prescription ones do seem to work as replacements.
I wouldn't be surprised if many of the voluntary prescriptions have benefits that far outweigh their downsides.