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Its not actually less useful, because typically very few people follow through on lifestyle improvements. When I went through medical school they did not skip t

Its not actually less useful, because typically very few people follow through on lifestyle improvements. When I went through medical school they did not skip this -- we were all taught well how much of an impact lifestyle change would affect outcomes across various diseases, and even then how little change was required (e.g. 10 lbs lost makes a drastic difference for those overweight). There is simply a very low uptake of lifestyle change and even then, a large percentage who reject it outright (e.g. the number of people who reject that calories are the primary determinant of weight). Its a cultural thing in that, in America at least, we don't have good cultural norms around food and activity that promote a healthy lifestyle. Which is unfortunate, given that is the primary influence (that we can control, obviously genes matter more) of many chronic health conditions.

westoncb 6y ago
Interesting to hear that confirmed. (I do mention that it was my best guess in my original comment ;). It still seems problematic to have it just missing from the presentation of options[0] merely because most people won't follow through, though. The ones who are willing to follow through (probably the ones who care most deeply about resolving the thing) aren't given a fair opportunity. Additionally, it seems like a self-perpetuating problem: I would bet a significant part of the unwillingness to make lifestyle changes in order to treat medical conditions is a consequence of Americans' expectation that illnesses are treated by medications (which comes in a large part from doctors emphasizing this). The entire situation has a kind of consumerist framing: you get sick, you purchase a thing which you then consume which treats you. That kind of perspective was strongly instilled in me until my experience with type 1 diabetes. Growing up in the U.S., I just thought that's how things worked: our medicine was that good, and it covered most illnesses. If you go into it with that kind of expectation, it comes off as a very tall order to say, give up pizza. There's this feeling of, "I took my time and money and paid for a doctor, they didn't give me anything, and now they're asking me to do work?" So maybe it's just a kind of a broken, self-reinforcing cycle. But I suspect it's a little more insidious than that too: there is an obvious financial incentive for things to be structured this way. I have a hard time imagining that has no impact. [0] Not that it wasn't "brought up," it was in both of my cases. But: not only was it relatively un-emphasized, it was described as "possibly having an effect". The accurate presentation would have been: this can be much more effective than the medicine I can prescribe—but it will also require much more effort from you.
teslabox 6y ago
One of medical practitioners' patient compliance problems is you've built an aura around your profession as miracle workers with magic bullets. And while sometimes you swing and hit a grand slam, more often than not you hit the ball foul. Which is okay, as long as you keep working with the patient to find a solution to their complaint. Slow and steady usually wins the race, but magic bullets pay better. Look at the rebellion that doctor started in New York, with his youtube videos about how futile and absurd it was to ventilate lucid/non-distressed SARS-CoV-2 patients, solely on the basis of their oxygen saturation meter readings. Later reports from the front line said 'hey we're doing much better not ventilating our COVID-19 patients even when their oxygen saturations are super-low...' > and even then, a large percentage who reject it outright (e.g. the number of people who reject that calories are the primary determinant of weight). /methinks it is simplistic and wrong to decree that a calorie is a calorie. My working hypothesis is that bad medical advice is the primary etiological factor behind most cases of morbid obesity. Decades ago the medical industry decreed saturated fats as the cause of heart disease, and advocated fat-free diets, or low-saturated-fat diets failing that. Butter has been vindicated of the charges against it, but I have yet to see an official apology for giving bad advice. Indeed, the heart profiteers are still [1] flogging a dead horse [2]. My retired-MD uncle recently came to visit, and shared that he now makes his own salad dressing to avoid the cheap oils in commercial salad dressings. He had some great stories of patients he'd helped (trauma from car accidents and knifings), but also of exercises in medical futility (e.g. cancer). Why doesn't conventional medicine warn patients of the hazards of cheap oils? Now is the perfect time. You could refer to Wikipedia's article on Prostaglandins [0], and speculate that minority America's overconsumption of Omega-6 oils is one factor in their susceptibility to the SARS-CoV-2 (emotional stress is another factor). [0] https://en.wikipedia.org/wiki/Prostaglandin https://en.wikipedia.org/wiki/Prostaglandin [1] https://www.heart.org/en/news/2018/05/01/advisory-replacing-saturated-fat-with-healthier-fat-could-lower-cardiovascular-risks https://www.heart.org/en/news/2018/05/01/advisory-replacing-... [2] https://en.wikipedia.org/wiki/Flogging_a_dead_horse https://en.wikipedia.org/wiki/Flogging_a_dead_horse

westoncb 6y ago

Interesting to hear that confirmed. (I do mention that it was my best guess in my original comment ;). It still seems problematic to have it just missing from the presentation of options[0] merely because most people won't follow through, though. The ones who are willing to follow through (probably the ones who care most deeply about resolving the thing) aren't given a fair opportunity. Additionally, it seems like a self-perpetuating problem: I would bet a significant part of the unwillingness to make lifestyle changes in order to treat medical conditions is a consequence of Americans' expectation that illnesses are treated by medications (which comes in a large part from doctors emphasizing this). The entire situation has a kind of consumerist framing: you get sick, you purchase a thing which you then consume which treats you. That kind of perspective was strongly instilled in me until my experience with type 1 diabetes. Growing up in the U.S., I just thought that's how things worked: our medicine was that good, and it covered most illnesses. If you go into it with that kind of expectation, it comes off as a very tall order to say, give up pizza. There's this feeling of, "I took my time and money and paid for a doctor, they didn't give me anything, and now they're asking me to do work?" So maybe it's just a kind of a broken, self-reinforcing cycle. But I suspect it's a little more insidious than that too: there is an obvious financial incentive for things to be structured this way. I have a hard time imagining that has no impact. [0] Not that it wasn't "brought up," it was in both of my cases. But: not only was it relatively un-emphasized, it was described as "possibly having an effect". The accurate presentation would have been: this can be much more effective than the medicine I can prescribe—but it will also require much more effort from you.

teslabox 6y ago

One of medical practitioners' patient compliance problems is you've built an aura around your profession as miracle workers with magic bullets. And while sometimes you swing and hit a grand slam, more often than not you hit the ball foul. Which is okay, as long as you keep working with the patient to find a solution to their complaint. Slow and steady usually wins the race, but magic bullets pay better. Look at the rebellion that doctor started in New York, with his youtube videos about how futile and absurd it was to ventilate lucid/non-distressed SARS-CoV-2 patients, solely on the basis of their oxygen saturation meter readings. Later reports from the front line said 'hey we're doing much better not ventilating our COVID-19 patients even when their oxygen saturations are super-low...' > and even then, a large percentage who reject it outright (e.g. the number of people who reject that calories are the primary determinant of weight). /methinks it is simplistic and wrong to decree that a calorie is a calorie. My working hypothesis is that bad medical advice is the primary etiological factor behind most cases of morbid obesity. Decades ago the medical industry decreed saturated fats as the cause of heart disease, and advocated fat-free diets, or low-saturated-fat diets failing that. Butter has been vindicated of the charges against it, but I have yet to see an official apology for giving bad advice. Indeed, the heart profiteers are still [1] flogging a dead horse [2]. My retired-MD uncle recently came to visit, and shared that he now makes his own salad dressing to avoid the cheap oils in commercial salad dressings. He had some great stories of patients he'd helped (trauma from car accidents and knifings), but also of exercises in medical futility (e.g. cancer). Why doesn't conventional medicine warn patients of the hazards of cheap oils? Now is the perfect time. You could refer to Wikipedia's article on Prostaglandins [0], and speculate that minority America's overconsumption of Omega-6 oils is one factor in their susceptibility to the SARS-CoV-2 (emotional stress is another factor). [0] https://en.wikipedia.org/wiki/Prostaglandin https://en.wikipedia.org/wiki/Prostaglandin [1] https://www.heart.org/en/news/2018/05/01/advisory-replacing-saturated-fat-with-healthier-fat-could-lower-cardiovascular-risks https://www.heart.org/en/news/2018/05/01/advisory-replacing-... [2] https://en.wikipedia.org/wiki/Flogging_a_dead_horse https://en.wikipedia.org/wiki/Flogging_a_dead_horse