When he was diagnosed with pancreatic cancer, he decided to forgo the aggressive medical treatment advised by doctors, opting instead of acupuncture & fruit juices.
Acupuncture and fruit juices are just as effective, with a much lower incidence of side effects. I’d choose that treatment option as well. There’s nothing unethical about palliative care.
He had a much rarer form of pancreatic cancer that is treatable and has much better survival rates.
Pallatiative care is making the choice to travel to end of the line. I am currently going through making that decision. If i do, bring on the tasty juices and accupuncture to make me feel relieved at the time. But i am not delusional, it's not treatment. It is not going to fix anything or even stall it
Not just lets them get away with it, actively encourages them to use practically toxic amounts of high fructose corn syrup by subsidizing the grain.
Ethics and morality used to be a cornerstone of medicine.
Every legitimate long term study of non surgical weight loss shows that it doesn't happen for the vast, vast majority of people.
1) ["In controlled settings, participants who remain in weight loss programs usually lose approximately 10% of their weight. However, one third to two thirds of the weight is regained within 1 year, and almost all is regained within 5 years. "](http://www.ncbi.nlm.nih.gov/pubmed/1580453)
2) Giant meta study of long term weight loss: ["Five years after completing structured weight-loss programs, the average individual maintained a weight loss of >3% of initial body weight."](http://ajcn.nutrition.org/content/74/5/579.full)
3) Less Scientific: [Weight Watcher's Failure - "about two out of a thousand Weight Watchers participants who reached goal weight stayed there for more than five years."](https://fatfu.wordpress.com/2008/01/24/weight-watchers/)
4) [The reason why it's impossible seems to be that although calories in < calories out works, the body of a fat person makes it extremely difficult psychologically to eat less.](http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-...) This is borne out by the above data.
5) [The only thing that does seem to work in the long term is gastric surgery.](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421028/)
Moreover, you won't find any reputable study on the web where the average person lost 10%+ of their body weight and kept it off for five years. Not even one.
He returned in 3 months, and shocked the nutritionist is he was exactly on the target weight and had followed the plan. She remarked that nobody had ever followed her plans before.
He never regained the weight.
I've seen statistics that only 5% of dieters keep the weight off more than 5 years. It's not impossible, but it is unusual. I've known a couple others who've done it, too.
I suspect for some people they just gained a little weight cumulatively over time due to a slightly fattening eating habit, and for those it's probably not that big an ask to change/fix.
But for many of the overweight/obese people I know, their eating is a straight up dysfunctional drug abuse-style addiction. Predictably it's as difficult to change these behaviors as it is to get a drug addict to quit their drug of choice.
The whole dogmatic war-on-drugs attitude creates this imaginary boundary around "food" which for many I suspect green-lights abuse of "food" because it's not "drugs".
It makes me wonder how much our societal obesity problems would change if the prevailing attitude towards drugs became more factual and nuanced. If people understood better that cocaine isn't as problematic as psilocybin in terms of addiction, maybe they'll also start thinking more critically about candy bars vs. oranges. Perhaps my optimism is showing.
If combined with a confined window of eating, like 11am to 5pm, you'll lose weight faster.
If I saw people permanently ban junk/fat/sugary food from their homes, do at least 3 hours/week of complete training (weights and cardio), and not being able to stay fit, I would believe that weight loss/being fit is a serious physiological and psychological challenge.
What I observe though, starting from mid-30s, is that the vast majority of people keeps junk food at home (which is, no wonder, "extremely difficult psychologically" not to eat) and/or doesn't do traning (let alone complete training). And invariably blames it on genetics and aging.
(I don't doubt that there is a minority of the people that has serious metabolic disorders, but that's not the general case)
In other words, if you're a doctor, go ahead and tell all your patients the above. You will see negligible impact on their weight, so your advice was useless (worse than useless, since you come across as an asshole).
As an aside, conscientiousness/willpower is highly heritable (as much as height and IQ), so if you're especially good at sticking to a diet, that's also genetics.
Also, who is saying we are calling patients weak willed losers? Should we not tell patients to stop smoking, or to quit heroin, because they might think that we think of them as "weak willed losers"?
*edit for ambiguous wording: By this I mean it seems to work for at least 50% of people, with the average being 3% weight loss.
For the weak willed comment, that was a reference to Pizza234's comment I was responding to earlier, not yours.
It more points to the limitations of studies like these than it does an incontrovertible fact. Some people who are highly internally motivated can lose weight and keep it off.
Losing it is easy.
I’ve lost 100lbs five times in my life.
It’s fucked.
It's not impossible; some people do it. But it's not easy to change how you think about food and your body, especially when you're surrounded by your old habits every day.
Sci hub up this paper and check out the citations too.
Source 1 seems to be from a conference, and they don't list specific numbers or cite sources, so I have no idea what "almost all" means.
"5) [The only thing that does seem to work in the long term is gastric surgery." That study says that gastric surgery works, it says nothing about the other methods for weight loss.
Everything (hyperbole) you can buy in a supermarket is meant to make you feel full for an hour and then hungry again.
An alternative to surgery would be to just to continuously monitor blood glucose. The patient would immediately know when the food they are eating is messing up their body and the doctor can control the diet of the patient.
The GLP1s have proven to have excellent efficacy for weight loss (and cardiovascular mortality in diabetics). Their numbers approach bariatric surgery (>10% body weight in the obese).
People keep the weight off too. Here's one study showing 5kg on average weight loss at 5 years according to this study: https://www.mdpi.com/1660-4601/17/1/207/pdf
https://www.nature.com/articles/ijo201094
>More than one out of every six US adults who has ever been overweight or obese has accomplished LTWLM [1y] of at least 10%.
review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777230/
As far as the doctor's advice is concerned, focusing on weight loss as the sole outcome is misguided. The typical trajectory of an obese individual is to keep gaining weight; if doctors could even make their patients stop gaining weight, that would already be a major development in standards of care.
It's also important to consider the limitations of the metric. Studies don't evaluate sustained cultural shifts like "do doctors regularly talk to the patients about nutrition", because it's hard enough to track a patient for five years, let alone get a doctor to do blinded controlled interventions for five years. So what the study tests is a controlled diet for a short period followed by a period of unsupervised maintenance (with a recipe book), not the consistent availability of nutrition guidance over a period of years.
It's perhaps more important to note that while the results in adults are quite bad, it has been shown possible for adolescents to drop by more than a standard deviation in BMI after an intervention and maintain this for two years:
https://www.sciencedirect.com/science/article/pii/S002234760...
https://www.sciencedirect.com/science/article/pii/S1054139X1...
Professional interventions for weight loss and/or maintenance aren't infeasible, they're just hard, and it pays to start early. It's not too surprising that older people are more reluctant to change their habits.
[fuller2014]: Finds that Weight Watchers underperforms standard national guidelines: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282338/
https://www.cdc.gov/nchs/images/databriefs/351-400/db360-fig...
Those studies on adolescents is heartening though.
The following comes from a study on T2D reversal where bariatric surgery was one aspect of the study:
“Furthermore, microbial changes in the human gut have been linked to obesity, and surgical alterations to gastrointestinal anatomy have been associated with dramatic changes in gut microbiota populations with reversion from an “obesogenic” to a lean bacterial population [13,14,16,19,23,24].”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520897/
It’s a relatively new science and area of study but some of it is fascinating if not hopeful. One in particular looked at identical twins where only 1 suffered from malnutrition finding in all such cases the microbiomes were different between the twins and the malnutrition was successfully treated via the microbiome.
This mostly reflects on what doctors recommend rather than blanket discipline failure across a broad population. I can tell you what my local Kaiser recommended for T2D and obesity:
1) they send you to a Registered Dietician who shows you a modernized food pyramid based heavily on grains. Minimize animal fats, replacing with seed oils. 70% calories as carbohydrate.
2) MD flat tells you "you MUST eat 6 small meals a day so you never get hungry."
What was done instead: Time Restricted Feeding, 4-6 hour window, low carb, limiting to mostly keto first half of window. A1C dropped over 3 points (10.3 to 7) by next labs.
Crazy, that's what I would recommend if you want to become obese.
>2) MD flat tells you "you MUST eat 6 small meals a day so you never get hungry."
I guess that MD really wants his patients to become insulin resistant and eventually develop diabetes.
https://www.europeanpharmaceuticalreview.com/news/165203/weg...
Giving a diet plan for weight loss is basically an equivalent of giving an exercise plan for depression.
Right, except they'll still be homeless, poor, mentally unstable, or all of the above. Drug use is often the symptom, not the root cause.
It's similar with food. For many people, food becomes the primary source of joy in life. And just like with drugs, the joy shrinks, the high gets shorter, and the health side effects soon start outweighing the benefits. But it's still quite hard to go cold turkey, and just like a recovering addict, even years after establishing a healthy diet it becomes really easy to fall off the wagon.
We can moralize about how starving children in africa have things much worse, but human happiness is contextual to the reality we know. And life in modern western society has a lot of pitfalls, anxiety, and depression. Obesity is in many ways a side effect of people's lived experience.
Unfortunately, in modern times the days of short rations never come, at least in First World countries.
That drive functions at a neural level way below the level of the rational mind.
People often make poor choices vis-a-vis sexual activity, too, and for much the same reason.
They passed it on to us before there was a chance to introspect the nutritional and psychological realities of food.
My partner and I are both overweight and we are trying to do a better job with our child - giving them healthy but delicious options, while also not turning any junky food into a reward or a mystery that must be guarded or doled out in careful portions.
So far, we're okay. Not sure how this is going to last once the kid gets into school age...
So why do i care about the cause again? I dont. it was a non reversible event
It's great that this doctor can share his experience but why is he posting this on Reddit? Why isn't this information available from trusted media sources? And for that matter, why aren't there any such trusted sources that everyone can agree is acting in their best interests and providing them with worthwhile and pertinent news?
Democracies can not survive without functional news and media sources.
Because doctors are people, and they just wanted to get the experience off their chest without any personally identifying information being disclosed?
I don't find the post itself to be political at all though. It's the recount of a doctor's recent experience being physically assaulted after refusing to treat an unvaccinated covid patient with ivermectin and vitamin-c, believing that the former may be actively harmful to their health, and the latter simply ineffective.
The post isn't political. It only seems political because the rejection of modern science is along a political line.
If this doctor believes that ivermectin is "harmful", the doctor was so poorly informed that medical fact was mixing up with something he saw on CNN. The assertion about effective dosage being lethal, in particular, was completely fictional -- I don't believe that it works, but the people advocating for it aren't talking about crazy doses.
Ivermectin is a very safe drug. It is given to millions of people a year to prevent parasitic infections. There is a large RCT underway to see if is an effective therapeutic for Covid-19. We should all hope that it works. This incessant political polarization of science has to stop.
Everything in this reads like a low-quality re-hash of click-bait headlines from the last year, several of which were completely debunked.
>This incessant political polarization of science has to stop.
Lol. In comments to a post about a doctor venting about being assaulted for not giving into conspiracy theorists demands re: treatment, and people say he's making it "political". Anyone can doubt the veracity all they want, there's 1000 more stories just like this.
Didn't I write that I don't believe it's effective? I'm not sure who you think you're arguing with, here.
The point is, this person made a specific claim -- that the "effective dose" would be so high as to be fatal. That claim is so laughable and baseless in fact that it calls into question the credibility of the entire story. No informed doctor would say such a thing. We simply don't know what the "effective dose" is (if any), but we know what other people are recommending as effective doses, and these are not toxic.
When "doctors" go on QAnon forums on reddit, and post things that sound like re-mixes of CNN headlines while making egregious mistakes of medicine, at the very least it should make you question their objectivity, if not the credibility of the claim.
If you don't want to be banned, you're welcome to email [email protected] and give us reason to believe that you'll follow the rules in the future. They're here: https://news.ycombinator.com/newsguidelines.html.
I don't know enough to evaluate any of the claims, I only wish to note the logic is pretty easy to follow.
I suspect you already understood all of this and chose to misunderstand to ... "win" the argument?
People learn faster when they get to choose their own options.
A conversation centered around the identity of the person is much less interesting than a conversation about the contents of their post.
Q is fake, but there’s a whole subset of seemingly rational people who are being sucked into the void of this cult.
I mean, look at the subreddit this was posted in.
So if you find what I have to say ignorant and unhelpful, so be it. My words are not here for you. If you truly have a life experience with Q then I am sorry to hear that but please understand I cannot blindly accept what you say (As I don't expect you to accept on faith what I say).
So maybe I am in the magic land where the Q never travels, or maybe this whole Q thing is blown out of proportion. I do not know but my ignorant anecdote may make someone else like me ask the same question of why they don't know any Q either.
The follow-up is: what is your sociocultural environment? I'm also in the world Q never travel on my mother's side (all conservative, some could be considered liberal by US standards, but right-leaning at least). The far-right conspiracy don't touch them. They are doctors, CEOs (and retired CEOs), insurance VPs. Amongst the younger generation some are also nurses and physiotherapists, or work in marketing. Not one single conspiracy freak. Some weird claims at the beginning of the pandemic, but since one of them worked in the first national Covid "hotspot" and asked us to limit our travel 5 days before any EU government instaured a lockdown, i think any weird reactance was quashed before it could ever change how we acted.
But amongst my friends who never left my rural hometown? We don't have Q out here but this is the same type of far-right/authoritarian ethos. "We are better than the others, but the others have more money/power/education than us. This can only be because of a conspiracy led by [LGBT lobbies/jews/islamists/atlantists (aka pro-Otan/pro-US)] that we need to fight against, else our kind will die".
Conspiracy theories are not reserved to to working class, it is the whole environment that make them emerge. And i'm not saying they are reserved to the right either (hence the "atlantist" talking point), but that their talking points ethos are usually associated to the far-right. Even if far-left figures used the same (Stalin, Mao).
I started a digression on spinoza but that was only muddying the water, so i'm cutting it here.
They didn't frame the post as something that should be bringing about any change. It's literally just a person sharing their story to get a sympathetic ear. Because sometimes humans need that to keep going.
Exacerbating, btw.
> 'Society's advancement is measured by that which it may take for granted' I forgot! Help! (until it cant/that fails)
> "Every gain made by individuals or societies is almost instantly taken for granted. The luminous ceiling toward which we raise our longing eyes becomes, when we have climbed to the next floor, a stretch of disregarded linoleum beneath our feet." -Aldous Huxley
> "The true measure of any society can be found in how it treats it's most vulnerable members." -Mahatma Ghandi
But this sometimes requires not just aiding them, treating them well, but re-socializing them, re-educating them, informing them, breaking them out of their ignorance & failings.
To simply say that we must
> [re-]"engineer our environments so unhealthy choices are [not] so easy to make"
feels a folly to me. We must socialize. We must foster an aware, awake, able society. Striving to simply prevent all faults is not how we achieve success; it results in a vision of domineering & the absolute & fixedness: it bespeaks a belief that there is one true path for society & that we need only set it out & all will walk this course. It's singular utopian, a singular destiny, not a polytopia, not letting us many people discover & hunt for our own ends. Imo society must remain a dialectic, a conversation, a hunt. We must encourage growth & awareness & hunts for meaning, without insisting on a systematic & singular top choice.
I don't think social media is a part of this question:
> "Everyone believes whatever they want to,"
is a false Boogeyman, a false god, a Fear Uncertainty & Doubt (FUD), meant to scare us. We have to allow plurality, we have to allow polytopianism, we have to allow many systems, many beliefs. But we can still in aggregate steer towards informed, towards good beliefs, towards healthy ends. Trying to demonize the availability of voices & options- "safetly cocooned in their own social media echo chambers"- just misses the real point: that society doesn't have a progressive vision at large, that basically no one has a real bead on a healthy, progressive, gainful society. Everything is beset by conflict, and we are trying to make choices with very biased, limited, local regards. And there are very few clear paths, very few regardable winners.
For sure, much of what presented in the world is faulty & awful. But this too feels like a part of evolution. Simply wishing for authoritarianism, for everyone to make the right choices, for everyone to accept good dogma in the place of bad dogma: it's a disaster. And I don't think "Everyone believes whatever they want to", I think they have complex experiences which shape what they are most susceptible to, and I think most of us lack good positive role models & experiences to shape us properly forward. The world does not reward the just & righteous, it doesn't promote the healthy: it showcases greed & taking & exploitation, it showcases narcisim & delusion. It shows us an all too recent history of medical abuse & experimentation of our minorities. These aren't social media problems, these are the actual world: the actual evidence of the actual world is unclear, is deeply shadowy, is ghastly.
"The longer this state of affairs persists the worse things will get". Such appeal to authority & Fear. Such terror!!! "Inability to deal with a pandemic is just the tip of the iceberg" it itself a promise of horror & terror, it insists on & demands we obey or conform, & demands that anything else we do, any other permissiveness we permit only Immenatizes the Eschaton. To me, this high capitol fear uncertainty & doubt is the chief Immenatizing of the Eschaton there is. I don't like what people pick. I think people are incredibly stupid & full of shit. But I don't see that conformity & authority are the reagents here, I don't see that a more structured society that informs what decisions we must make will help. I believe society from the top needs to demonstrate better health, needs to make better choices easier to pick, needs to make better icons & references we can respect, that will inform what choices we freely make. Right now society simply lacks meaning. That social media is out there making it complicated is merely incidental, a scape goat, a convenient anti-authority to blame this all upon, but authority itself is shit, useless, cowards, good for nothing, and no one respects it, rightfully. Make a social contract worth believing in, society.
Arden authoritarianism is far worse than the too many choices of the very very young ur-connected world we have recently arrived at. We do need to surface & democratize better choice-making, create better supporting info-networks & options of choice. But recognize first that the 4th age information society is very young, and that simply wishing to stuff it back in the bottle/box, blaming it, & being upset we don't do better is not going to help. And recognize that there are so many 1st 2nd & 3rd age society problems still dogging us, still making things enormously difficult, and recognize that those need remedy & addressal to before society can ever really right itself & find progress. Fearing pop-culture society, it's superficial glam, is a misdeed: what is really weak is society itself, is the unhelpful, unprogressive, un-gainful world that has failed to create better circumstances. I don't blame the people. I don't think we must outmanuever people, to make unhealthy choices impossible/harder. To me, it's less about trying to fight against the baleful/evil, and more about creating the construtive/positive. Social media will spread the good too, will snuff out the darkness, if we have it, if there's the sunlight to spread.
The combination of freedom, capitalism, and greed. This is why I can't be entirely sure that China's approach isn't potentially longer term sustainable, as much as I disagree with it - it might actually be a better way to deal with the stubborn-ness of stupidity that's so inherent to humanity (to be fair, all these traits must have served us well when Pringles and Pop Tarts weren't cheap and easily available).
Cigarettes. How did they become a thing? What, ever, was their redeeming feature? At least Pringles and Pop Tarts taste nice.
Social media is just a more-efficient distillation of what traditional media has profited from since it began. It's not new human-hacking, it's just an efficiency bump that's actually more facilitated by the internet and pocket-portable devices with access to it.
Really? Last I heard, life expectancy in the USSR was quite a bit worse.
> Cigarettes. How did they become a thing?
Nicotine. Not hard at all to understand. Personally, I've always liked the smell of cigarettes. I never smoked, because I knew I'd really like it. Cigars, though, make me want to puke.
> deal with the stubborn-ness of stupidity that's so inherent to humanity
Most evil in the world is not perpetrated by evil people, but by good people believing they know what's best for everyone else, and forcing it on them.
> believing they know what's best for everyone else, and forcing it on them.
Agree, to an extent. Forcing things on people is required of a functioning society. Government and laws and whatnot.
I genuinely don't know where the lines should be drawn on the entire spectrum. Law of unintended consequences and all that.
The government's proper role is to prevent people from using force on each other. It is not forcing things that the government imagines are good for people on them.
For example, I believed for decades the advice from the government that margarine was better for me than eggs. That turned out to be backwards.
I don't think you can necessarily separate those two things from one another so simply, except in the most extreme of examples.
> For example, I believed for decades the advice from the government that margarine was better for me than eggs. That turned out to be backwards.
I'm just going to assume you chose a bad example here. There's no force at play, you're free to choose your thing, you can even have both at the same time. Freedom!
2. not a bad example - what if the government forced me to use margarine instead, secure it its rectitude? That's the point.
Also monoamine oxidase inhibitors, a class of compounds that are effective against depression, panic disorder, and social phobia.
Some think that the absence of the MAO inhibitors are why nicotine replacement therapies (gum, patches) aren't really all that great at getting people to stop smoking.
I don't know. But I do know that people were much worse off economically in the USSR than in the US. This impacts longevity.
> They had pretty good doctors as far as I know.
I recall reading in a thread on Chernobyl where people who lived there at the time of the disaster were commenting. One comment stood out - root canals were free, but there was no anesthetic available. Having had a root canal myself, I can't imagine sitting in that chair for several hours getting drilled without anesthetic.
And guess what? They say “that medicine is poison, I use tumeric”. Then in a few years they are dead, or blind or have both legs amputated.
Humans make horrible health choices all the time. Maybe the difference is just the scale at this point.