Our main problem in health policy is overemphasis on medicine (2007) • Hacker News Board

Re: Our main problem in health policy is overemphasis on medicine (2007)

#41

Post by Robotbeat » Fri, Dec 03, 2021, 9:11 PM UTC

RobertRoberts wrote: post #38

bpfrh wrote: post #21

Earlier quoted context omitted.

But vaccines ARE the miraculouse cure, at least in my country the high case load is because of unvaccinated or not fully vaccinated people. If about 80% of the population took it, we wouldn't have any problem. Of course previous health issues matter when you get sick and of course we should encourage healthier living, but we won't change this in the next 6 Months, for that we have a vaccine.

Vaccines won't help _at all_ if your immune system is completely compromised by other health issues.

They absolutely help if everyone else gets vaccinated, which is what the person you’re replying to said.

Re: Our main problem in health policy is overemphasis on medicine (2007)

#42

Post by lambdaba » Fri, Dec 03, 2021, 9:11 PM UTC

whoopdedo wrote: post #39

lambdaba wrote: post #14

Earlier quoted context omitted.

But those "fit, healthy" (the genuinely so, I'm not sure I even agree with the characterization for many of the mediatized cases), are OUTLIERS. Yes, you are never invincible, but it's 100% correct to characterize Covid as a disease of the metabolically dysfunctional. Sadly, this is a HUGE percentage of the population of the world nowadays, which seems to be the point of the article (disclaimer: in true HN tradition,…

> this is a HUGE percentage of the population of the world nowadays, And thus make up a sizeable amount of COVID patients. I see nothing noteworthy here. Having a preexisting condition makes you suffer more when you contract an infectious disease. I'd expect the same things you said could be repeated for influenza, pneumonia, or anything else. For that matter, how much worse do obese patients fare when recovering fro…

What's noteworthy is *vascular* health is particularly important, thus chronically-elevated blood sugar which is *eminently* resolvable by lifestyle intervention, is the main culprit. So I don't follow your comment.

Re: Our main problem in health policy is overemphasis on medicine (2007)

#43

Post by tsimionescu » Fri, Dec 03, 2021, 9:16 PM UTC

lambdaba wrote: post #33

brigandish wrote: post #30

Earlier quoted context omitted.

> Most obese people find it extremely hard to stop being obese and often fail despite immense effort. I used to help out at a slimming group. Like many self-improvement quests, the effort waxes and wanes. Much as I wished for people to achieve their dream of being slimmer, and even though their wishes and often their attempts were laudable, I wouldn't call them "immense". They're people, most wanted an easy fix and s…

This. It's not hard to make the necessary changes if sufficiently motivated. In fact, formulating the motivation is kind of the only step, everybody, and I mean *EVERYBODY* can achieve appropriate weight and even above-average fitness if following the right precepts.

Why do you assume this is a matter of motivation, or that motivation is not itself a component of obesity as a disease?

Our urges to eat and be lazy are also a consequence of our health and diet. They are not coming out of some pure rational willpower plane.

Re: Our main problem in health policy is overemphasis on medicine (2007)

#44

Post by tsimionescu » Fri, Dec 03, 2021, 9:18 PM UTC

908B64B197 wrote: post #31

orborde wrote: post #15

Earlier quoted context omitted.

The US adult obesity rate is 42.4% [1]. To get to 75% of deaths being obese people, you'd need about a 4x death rate of obese people compared to non-obese people. Most obese people find it extremely hard to stop being obese and often fail despite immense effort. Meanwhile, getting a COVID vaccine reduces the chance of death by >10x at a cost of [1] https://www.cdc.gov/nchs/products/databriefs/db360.htm

> Most obese people find it extremely hard to stop being obese and often fail despite immense effort. Calories in vs calories out. Simple as that.

Ok, how does that explain why some people want to eat even when they're full, while others feel full after eating a grape (exaggerating)?

Re: Our main problem in health policy is overemphasis on medicine (2007)

#45

Post by tsimionescu » Fri, Dec 03, 2021, 9:20 PM UTC

lambdaba wrote: post #42

whoopdedo wrote: post #39

Earlier quoted context omitted.

> this is a HUGE percentage of the population of the world nowadays, And thus make up a sizeable amount of COVID patients. I see nothing noteworthy here. Having a preexisting condition makes you suffer more when you contract an infectious disease. I'd expect the same things you said could be repeated for influenza, pneumonia, or anything else. For that matter, how much worse do obese patients fare when recovering fro…

What's noteworthy is *vascular* health is particularly important, thus chronically-elevated blood sugar which is *eminently* resolvable by lifestyle intervention, is the main culprit. So I don't follow your comment.

Jumping from vascular health to blood sugar level is a non-sequitur. There are many other aspects of vascular health.

And nothing is easy about a lifestyle intervention, it is in fact one of the hardest and least likely to hold kinds of medical treatment.

Re: Our main problem in health policy is overemphasis on medicine (2007)

#46

Post by gahn » Fri, Dec 03, 2021, 9:21 PM UTC

lambdaba wrote: post #27

danachow wrote: post #26

Earlier quoted context omitted.

> and this is someone working in the medical field Well, yes, even a crackpot can claim to be working in the field. This in no way supports your claim of “routine” cures through diet. There is no evidence that a fucking keto diet will cure cancer* and it doesn’t pass any sniff test as at the end of the day your body still runs on glucose. This is pretty much an insult to anyone not fortunate enough for their cancer t…

I am only replying to your incendiary comment to say that your characterization is insulting and wrong, "fucking keto diet"(s) are having results for many people, whether you like it or not Others, please research this person further, he's not a "loon" / "crackpot" just a regular smart young person who also happens to be a cancer researcher. BTW, keto also cures epilepsy, and that's known since the early 20th century…

Had to login just to counter the epilepsy part of this comment, though I think it applies to the rest of the topic wrt cancer as well. Keto diets can, in some cases, help epilepsy patients, particularly those with certain seizure types or genetic basis. But, like with cancer, epilepsy is complicated both in presentation and cause and to pretend that keto is any way a cure for epilepsy outside of a small minority of patients isn't true. See https://www.epilepsy.com/learn/treating-seizures-and-epileps... for high level overview.

Re: Our main problem in health policy is overemphasis on medicine (2007)

#47

Post by lambdaba » Fri, Dec 03, 2021, 9:24 PM UTC

tsimionescu wrote: post #43

lambdaba wrote: post #33

Earlier quoted context omitted.

This. It's not hard to make the necessary changes if sufficiently motivated. In fact, formulating the motivation is kind of the only step, everybody, and I mean *EVERYBODY* can achieve appropriate weight and even above-average fitness if following the right precepts.

Why do you assume this is a matter of motivation, or that motivation is not itself a component of obesity as a disease? Our urges to eat and be lazy are also a consequence of our health and diet. They are not coming out of some pure rational willpower plane.

Sorry, I'm not sure I expressed what I meant clearly so I'll try again: I mean that it's sufficient to be motivated WHEN armed with the proper knowledge; I think many people fail DESPITE being motivated because they are simply misinformed as to what works.

Yes, reading my comment again it doesn't seem I was saying that. Anyway, I don't think that much motivation is required, and if a diet / lifestyle change is hard to stick to, it's often because it's a misguided strategy. For illustration, counting calories while not making qualitative changes in the composition of the diet is just simply never going to work, long-term. Some foods are just too hyperpalatable, too prone to form emotional / addictive associations, but conversely that also implies those dietary changes will have to confront some emotional regulation issues as well. It sounds complicated, but I don't know, I think looking at how widespread the overweight issue is nowadays we have to conclude almost all of us are doing something wrong wrt to diet and lifestyle.

Re: Our main problem in health policy is overemphasis on medicine (2007)

#48

Post by nradov » Fri, Dec 03, 2021, 9:27 PM UTC

NoPie wrote: post #13

dang wrote: post #7

Earlier quoted context omitted.

Those aren't good reasons to reject an article. Would you mind reviewing the site guidelines? Note that they include: " Please don't post shallow dismissals, especially of other people's work. A good critical comment teaches us something. " Also: " Don't be snarky. " Older articles and historical material are always welcome on HN, if they're interesting. Often they're more interesting than the latest $thing about $cu…

14 years old article is a good reason to take note of it as it shows it is not just some fad but important long-term issue. I don't think the issue itself is controversial. I was taught at university that our life expectancy is determined roughly speaking one third by our genes, one third by our lifestyle and one third by healthcare. And then it became apparent that most healthcare interventions (childhood vaccinatio…

I generally agree but public sanitation measures including water purification, food inspection, garbage disposal, and sewers also have a huge impact on average life expectancy. Maybe even more than healthcare.

In other words, vaccines are wonderful but if I had to pick between vaccines and clean water I'd take clean water every time.

Re: Our main problem in health policy is overemphasis on medicine (2007)

#49

Post by RSZC » Fri, Dec 03, 2021, 9:27 PM UTC

colinmhayes wrote: post #37

michaelbuckbee wrote: post #35

Earlier quoted context omitted.

This is tricky to implement as it introduces other perverse incentives: namely that health care providers stop treating very sick people. You see this in some cases with surgeons already that have a very high success rate. They'll only opt for surgery if it's a relatively minor need, but if it's complicated or there are potentially complicating issues they'll pass.

Outcomes for very sick people being worse is taken into account so providers aren't punished if their success rate is lower for those patients. We have all the data we need to know what the outcomes should be for a provider over the course of a year. Anyway, providers have to precommit to their pool of patients, so it's not like they can just pick the lucky ones. Capitation is admittedly a much more complicated way t…

Huh, I didn't expect to come across something I have such direct knowledge of.

I used to work with this data directly - I worked with MACPAC to prepare reports for the CBO on the efficacy of pay-per-performance programs, especially as it pertained to the possibility of switching Medicaid from a fee-for-service model to a pay-for-performance model. (6-9 years ago)

I just wanted to chime in on this one quote:

> We have all the data we need to know what the outcomes should be for a provider over the course of a year.

The data here is exceedingly low quality, especially for Medicaid. Medicare is in a better state due to being centrally administered. We do *not* have all the data we need to make pay-for-performance more than an extremely rudimentary approach. Is that rudimentary approach still better than fee-for-service? Maybe - that's a complicated question I let the public health PHDs write very long reports on.

Re: Our main problem in health policy is overemphasis on medicine (2007)

#50

Post by gahn » Fri, Dec 03, 2021, 9:28 PM UTC

lambdaba wrote: post #14

tux3 wrote: post #12

Earlier quoted context omitted.

Fit, healthy, people are dying left and right. There are risk factors, but don't start thinking you're invicible for not having them. The adaptive immune system is slow, vaccines prime it to react faster with more specific antibodies. Dying of pneumonia does not feel good. It makes grown men cry and beg. Strongly recommend against.

But those "fit, healthy" (the genuinely so, I'm not sure I even agree with the characterization for many of the mediatized cases), are OUTLIERS. Yes, you are never invincible, but it's 100% correct to characterize Covid as a disease of the metabolically dysfunctional. Sadly, this is a HUGE percentage of the population of the world nowadays, which seems to be the point of the article (disclaimer: in true HN tradition,…

What lifestyle diseases are you thinking of that are commonly treated with immunosuppressants? Diseases like psoriasis and rheumatoid arthritis are commonly treated with immunosuppressants and are not considered lifestyle diseases.