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> Helping people get a good night's sleep -- without drugs -- would likely help, if only to stave it off in those at risk. Are doctors not already telling peop

> Helping people get a good night's sleep -- without drugs -- would likely help, if only to stave it off in those at risk. Are doctors not already telling people to get good night’s sleep? Are healthy diet and exercise not already universally recommended? Do we not already warn people against smoking and excessive drinking? Have we not implemented sin taxes to disincentive these unhealthy behaviors? Obviously these efforts, while beneficial are not even close sufficient. Thus there is a large unmet need for therapeutic intervention. Whoever is able to meet that need will be handsomely rewarded, and rightly so, because they will have meaningfully improved the health and quality of life of many many people.

eurasiantiger 4y ago
Maybe part of the problem is that we consider these things ”sins”, with all the subconscious burden of suffering for all eternity in a fiery pit thanks to a belevolent god who made that place, and who also loves you.
Teever 4y ago
I hear the exact same hot takes wheb diacussing life extension. 'eat healtheir', exercise more' etc... None of these things are going to make anyone live to 150, and they sure arn't going to make you less frail at 90. What we want are definitive treatments to both prevent and cure alheimers and given the options available in medicine id sure as hell prefer an expensive pharmacutical than something like brain surgery or weekly and exhausting procedures like dialysis. People like to shit talk the pharma industry and theres a lot to shit talk it for but lets be clear here, a lot of pharmacutical solutions are god damned life changing miracles. if someone deserves to be rich for their efforts it sure as shit should be people inventing medicine and not people in marketing or real estate or whatever.
- pwthornton 4y ago
  Diet, exercise, and good sleep are exactly the kinds of things that make people less frail at 90 (or 60 or 50). If you’ve ever met someone who isn’t frail when they are older it’s because they stayed active throughout their life. This doesn’t necessarily mean exercise, but it could mean doing lots of yard work, going on walks, etc. I’ve never met a chronic inactive person who moved well as they aged. We will need the pharma industry to treat Alzheimer’s and related conditions, but it is primarily lifestyle that we need to address to prevent it. Chronic lack of sleep will lead to all kinds of health issues, including dementia.
  - Teever 4y ago
    > Diet, exercise, and good sleep are exactly the kinds of things that make people less frail at 90 (or 60 or 50). To a point. There are diminishing returns where genetics begins to play more of a factor. For many people no amount of exercise is going to help them when they're 90 because they'll die before they turn 90. Jim Fixx[0] is the perfect example of this Unless we develop a cure for Parkinson's disease I doubt Michael J. Fox[1] will live to 90, no matter how much exercise he does, because of the effects that disease has had on his body and the side effects from the treatments that he has received. Another way to look at it is to substitute 90 with 100, 110, or 120. Or to think about what kind of exercise and healthy eating tips that you would recommend to a person with Down's Syndrome to help them live to be 90. People who can should absolutely exercise and eat healthy food but that is no guarantee that they will live full healthy lives. [0] https://en.wikipedia.org/wiki/Jim_Fixx#Death https://en.wikipedia.org/wiki/Jim_Fixx#Death [1] https://en.wikipedia.org/wiki/Michael_J._Fox#Parkinson's_disease https://en.wikipedia.org/wiki/Michael_J._Fox#Parkinson's_dis...
    - _0w8t 4y ago
      I once looked at conditional lifespan data given that one reached a particular age. What was interesting that for India and Mongolia, countries with very different cultures, lifestyle, diet and climate, after 75 years the remaining lifespan was the same. Granted in both countries those who died after 75 lived presumably most of their life a traditional lifestyle with little influence of modern factors like junk food, TV at night, work stress etc. So we cannot conclude that those factors have no influence after 75th birthday. Still people should be rather skeptical about attributing to a particular factor really long life.
  - JackFr 4y ago
    Increasing levels of dementia are likely being observed because we have healthier older people than ever before. Anecdotally I’ve known 3 people with severe Alzheimer’s who were extraordinarily robust - healthy in every other way into their eighties. In a earlier era they likely would have been dead before their dementia became incapacitating.
pwthornton 4y ago
I think the argument here is that recent research indicates that a chronic lack of sleep can cause Alzheimer’s, and I don’t think most people realize that. Beyond that, telling people to try to get more sleep is not really medicine. It’s not really specific or actionable, and it doesn’t help people with understanding how to get more and better sleep. Doctors should ask how much sleep people are getting and recommend sleep studies if there sleep isn’t sufficient. There are also specific things that people can do to make it more likely that they get more and better sleep, and doctors should be going over these. Home sleep trackers are much cheaper and easier to use these days, and it seems that there would be a benefit for everyone to wear one, at least part of the year, to have data to give to their doctor. We now have the means to really see if people are sleeping enough or not, and I suspect the issue in the past is that it is hard for people to accurately judge their own sleep performance. It’s not just sleep length that matters, but rather sleep quality — specifically you want to make sure you are getting enough REM and slow wave sleep. So while we do need therapeutic interventions for people who already have Alzheimer’s, we really aren’t doing anything to prevent people from getting it in the first place. I was listening to a podcast with neurophysiologist Louisa Nicola, and I swear she said that 95% of Alzheimer’s is now seen in people without a genetic predisposition to it. That is to say that people’s lifestyle decisions around sleep, food, and exercise are the issue. Here is a link to the podcast (no transcript unfortunately): https://podcasts.apple.com/us/podcast/whoop-podcast/id1445509665?i=1000566451303 https://podcasts.apple.com/us/podcast/whoop-podcast/id144550...
- agentofoblivion 4y ago
  > Doctors should… > I was listening to a podcast… HN comments in a nutshell.
  - vba616 4y ago
    Remember, anyone can comment here. It doesn't cost a thing and doesn't even require a valid email. Think about that before you go off on your hobby horse about whatever stereotype you despise the most. Anybody you could find on reddit or anywhere else can comment here if they find it and want to. I think it was years before I even knew who Peter Thiel was, and I've never been to California in my life.
suifbwish 4y ago
Whoever agrees with the philosophical idea of “Sin taxes” deserves whatever fascist world they end up creating. The idea that I owe someone because I decide to indulge in something unhealthy for me implies that other people own me.
- Wyoming23 4y ago
  Isn't this a natural aspect of any system of government run "universal" healthcare? If the state is paying for and controlling your access to healthcare, it seems obvious that restricting unhealthy food or behavior as preventative healthcare would go hand in hand.
  - tsimionescu 4y ago
    No, because most states with a state-run healthcare system simply recognize that health is a basic human right. It's not about incentives, or efficiency, it is about basic human decency. Even a drug addict who practices unsafe sex and riding motorcycles to do mountain climbing and ski down the slope deserves Healthcare when something bad happens to them, exactly as much as the fitness yoga guru.
  - zo1 4y ago
    It can occur in free, capitalist societies too. And not in the sense that they "restrict" like an omnipotent government, instead they discourage what is bad and promote what is good. E.g. we have private medical health care here in SA and one of the biggest providers offers all sorts of free goodies and incentives and discounts. They literally partner with stores to get you discounts and points on healthy food choices. Now, I know they also use this data for other purposes but they also happen to help the health of the market. If we can keep it up without having the profit motive distort the benefits too much then its a win win.
  - kwijybo 4y ago
    As a counter example, look at how many countries have state funded healthcare with restricting unhealthy food or behaviour. By my count 66 countries have state funded health care and 0 have restrictions on unhealthy food or behaviour, (I admit my count was limited)
joe_the_user 4y ago
>> Helping people get a good night's sleep -- without drugs -- would likely help, if only to stave it off in those at risk. > Are doctors not already telling people to get good night’s sleep? Are healthy diet and exercise not already universally recommended? Yeah, most people know they need a good night's sleep. Most people who miss sleep aren't willfully choosing to skip it but responding to the constant pressure of things like work and school. Things like 24 hours shifts are awful. Which is to say, people actually need help getting sleep, they can't just be told losing sleep is bad. Jobs that force a lack of sleep should be considered a health hazard and phased out by policy.
RobertRoberts 4y ago
There is no money in preventative health care.
- epicureanideal 4y ago
  Maybe there should be? There’s got to be a startup there. Combine long term health insurance with a research arm that ensures the disease is cured and it never needs to pay out?
  - klabb3 4y ago
    > There’s got to be a startup there. When all you have is a hammer something something.. In all seriousness, the majority of the developed world has solved the incentive problems with preventative care.
    - epicureanideal 4y ago
      Single payer health care seems to be another reasonable way of aligning incentives, although as it’s critics will point out it also has other drawbacks.
- pfisherman 4y ago
  There is plenty of money in preventative care. You should check vaccine sales numbers. A vaccine platform just got acquired by a drug company for over $3B. Wellness - dieticians, massage therapists, smart watches, etc - is a multibillion possibly even a trillion dollar industry.
- TaupeRanger 4y ago
  There is a ton of money in preventative care. But even if you were right, we have no idea if prevention of Alzheimer's is even possible, or what it would take to do so.
aiilns 4y ago
Are doctors not already telling people to eat healthy & exercise? > 12 hours work/day > ads for unhealthy food > lots of cheap tasty unhealthy food products in supermarkets Have we really done the best we can as societies that the only thing left is to find a drug? Within a system that promotes and often demands unhealthy lifestyles, we are doomed to scramble to find ways to battle emerging disease to enable our sick lifestyles.
- TaupeRanger 4y ago
  Even in the presence of healthier lifestyles, the human body would still accumulate problems as part of the normal aging process. It's not like Alzheimer's would just go away if people started going on more walks and ate more vegetables. It's not an "emerging disease".
ninesnines 4y ago
I would like to chime in here! It's not that individuals don't want to sleep, it's that oftentimes AD, PD, etc pts will present with sleep problems over 20 years before disease onset, and it isn't because these patients aren't trying. These patients will present with sleep disorders like REM sleep behavior disorder, and these seem to predate these disease onsets, but may also be a symptom of early stages of the disease. TDLR: its not that people don't want to sleep, its oftentimes that AD pts present with sleep disorders decades before onset

eurasiantiger 4y ago

Maybe part of the problem is that we consider these things ”sins”, with all the subconscious burden of suffering for all eternity in a fiery pit thanks to a belevolent god who made that place, and who also loves you.

Teever 4y ago

I hear the exact same hot takes wheb diacussing life extension. 'eat healtheir', exercise more' etc... None of these things are going to make anyone live to 150, and they sure arn't going to make you less frail at 90. What we want are definitive treatments to both prevent and cure alheimers and given the options available in medicine id sure as hell prefer an expensive pharmacutical than something like brain surgery or weekly and exhausting procedures like dialysis. People like to shit talk the pharma industry and theres a lot to shit talk it for but lets be clear here, a lot of pharmacutical solutions are god damned life changing miracles. if someone deserves to be rich for their efforts it sure as shit should be people inventing medicine and not people in marketing or real estate or whatever.

pwthornton 4y ago
Diet, exercise, and good sleep are exactly the kinds of things that make people less frail at 90 (or 60 or 50). If you’ve ever met someone who isn’t frail when they are older it’s because they stayed active throughout their life. This doesn’t necessarily mean exercise, but it could mean doing lots of yard work, going on walks, etc. I’ve never met a chronic inactive person who moved well as they aged. We will need the pharma industry to treat Alzheimer’s and related conditions, but it is primarily lifestyle that we need to address to prevent it. Chronic lack of sleep will lead to all kinds of health issues, including dementia.
- Teever 4y ago
  > Diet, exercise, and good sleep are exactly the kinds of things that make people less frail at 90 (or 60 or 50). To a point. There are diminishing returns where genetics begins to play more of a factor. For many people no amount of exercise is going to help them when they're 90 because they'll die before they turn 90. Jim Fixx[0] is the perfect example of this Unless we develop a cure for Parkinson's disease I doubt Michael J. Fox[1] will live to 90, no matter how much exercise he does, because of the effects that disease has had on his body and the side effects from the treatments that he has received. Another way to look at it is to substitute 90 with 100, 110, or 120. Or to think about what kind of exercise and healthy eating tips that you would recommend to a person with Down's Syndrome to help them live to be 90. People who can should absolutely exercise and eat healthy food but that is no guarantee that they will live full healthy lives. [0] https://en.wikipedia.org/wiki/Jim_Fixx#Death https://en.wikipedia.org/wiki/Jim_Fixx#Death [1] https://en.wikipedia.org/wiki/Michael_J._Fox#Parkinson's_disease https://en.wikipedia.org/wiki/Michael_J._Fox#Parkinson's_dis...
  - _0w8t 4y ago
    I once looked at conditional lifespan data given that one reached a particular age. What was interesting that for India and Mongolia, countries with very different cultures, lifestyle, diet and climate, after 75 years the remaining lifespan was the same. Granted in both countries those who died after 75 lived presumably most of their life a traditional lifestyle with little influence of modern factors like junk food, TV at night, work stress etc. So we cannot conclude that those factors have no influence after 75th birthday. Still people should be rather skeptical about attributing to a particular factor really long life.
- JackFr 4y ago
  Increasing levels of dementia are likely being observed because we have healthier older people than ever before. Anecdotally I’ve known 3 people with severe Alzheimer’s who were extraordinarily robust - healthy in every other way into their eighties. In a earlier era they likely would have been dead before their dementia became incapacitating.

pwthornton 4y ago

I think the argument here is that recent research indicates that a chronic lack of sleep can cause Alzheimer’s, and I don’t think most people realize that. Beyond that, telling people to try to get more sleep is not really medicine. It’s not really specific or actionable, and it doesn’t help people with understanding how to get more and better sleep. Doctors should ask how much sleep people are getting and recommend sleep studies if there sleep isn’t sufficient. There are also specific things that people can do to make it more likely that they get more and better sleep, and doctors should be going over these. Home sleep trackers are much cheaper and easier to use these days, and it seems that there would be a benefit for everyone to wear one, at least part of the year, to have data to give to their doctor. We now have the means to really see if people are sleeping enough or not, and I suspect the issue in the past is that it is hard for people to accurately judge their own sleep performance. It’s not just sleep length that matters, but rather sleep quality — specifically you want to make sure you are getting enough REM and slow wave sleep. So while we do need therapeutic interventions for people who already have Alzheimer’s, we really aren’t doing anything to prevent people from getting it in the first place. I was listening to a podcast with neurophysiologist Louisa Nicola, and I swear she said that 95% of Alzheimer’s is now seen in people without a genetic predisposition to it. That is to say that people’s lifestyle decisions around sleep, food, and exercise are the issue. Here is a link to the podcast (no transcript unfortunately): https://podcasts.apple.com/us/podcast/whoop-podcast/id1445509665?i=1000566451303 https://podcasts.apple.com/us/podcast/whoop-podcast/id144550...

agentofoblivion 4y ago
> Doctors should… > I was listening to a podcast… HN comments in a nutshell.
- vba616 4y ago
  Remember, anyone can comment here. It doesn't cost a thing and doesn't even require a valid email. Think about that before you go off on your hobby horse about whatever stereotype you despise the most. Anybody you could find on reddit or anywhere else can comment here if they find it and want to. I think it was years before I even knew who Peter Thiel was, and I've never been to California in my life.

suifbwish 4y ago

Whoever agrees with the philosophical idea of “Sin taxes” deserves whatever fascist world they end up creating. The idea that I owe someone because I decide to indulge in something unhealthy for me implies that other people own me.

Wyoming23 4y ago
Isn't this a natural aspect of any system of government run "universal" healthcare? If the state is paying for and controlling your access to healthcare, it seems obvious that restricting unhealthy food or behavior as preventative healthcare would go hand in hand.
- tsimionescu 4y ago
  No, because most states with a state-run healthcare system simply recognize that health is a basic human right. It's not about incentives, or efficiency, it is about basic human decency. Even a drug addict who practices unsafe sex and riding motorcycles to do mountain climbing and ski down the slope deserves Healthcare when something bad happens to them, exactly as much as the fitness yoga guru.
- zo1 4y ago
  It can occur in free, capitalist societies too. And not in the sense that they "restrict" like an omnipotent government, instead they discourage what is bad and promote what is good. E.g. we have private medical health care here in SA and one of the biggest providers offers all sorts of free goodies and incentives and discounts. They literally partner with stores to get you discounts and points on healthy food choices. Now, I know they also use this data for other purposes but they also happen to help the health of the market. If we can keep it up without having the profit motive distort the benefits too much then its a win win.
- kwijybo 4y ago
  As a counter example, look at how many countries have state funded healthcare with restricting unhealthy food or behaviour. By my count 66 countries have state funded health care and 0 have restrictions on unhealthy food or behaviour, (I admit my count was limited)

joe_the_user 4y ago

>> Helping people get a good night's sleep -- without drugs -- would likely help, if only to stave it off in those at risk. > Are doctors not already telling people to get good night’s sleep? Are healthy diet and exercise not already universally recommended? Yeah, most people know they need a good night's sleep. Most people who miss sleep aren't willfully choosing to skip it but responding to the constant pressure of things like work and school. Things like 24 hours shifts are awful. Which is to say, people actually need help getting sleep, they can't just be told losing sleep is bad. Jobs that force a lack of sleep should be considered a health hazard and phased out by policy.

RobertRoberts 4y ago

There is no money in preventative health care.

epicureanideal 4y ago
Maybe there should be? There’s got to be a startup there. Combine long term health insurance with a research arm that ensures the disease is cured and it never needs to pay out?
- klabb3 4y ago
  > There’s got to be a startup there. When all you have is a hammer something something.. In all seriousness, the majority of the developed world has solved the incentive problems with preventative care.
  - epicureanideal 4y ago
    Single payer health care seems to be another reasonable way of aligning incentives, although as it’s critics will point out it also has other drawbacks.
pfisherman 4y ago
There is plenty of money in preventative care. You should check vaccine sales numbers. A vaccine platform just got acquired by a drug company for over $3B. Wellness - dieticians, massage therapists, smart watches, etc - is a multibillion possibly even a trillion dollar industry.
TaupeRanger 4y ago
There is a ton of money in preventative care. But even if you were right, we have no idea if prevention of Alzheimer's is even possible, or what it would take to do so.

aiilns 4y ago

Are doctors not already telling people to eat healthy & exercise? > 12 hours work/day > ads for unhealthy food > lots of cheap tasty unhealthy food products in supermarkets Have we really done the best we can as societies that the only thing left is to find a drug? Within a system that promotes and often demands unhealthy lifestyles, we are doomed to scramble to find ways to battle emerging disease to enable our sick lifestyles.

TaupeRanger 4y ago
Even in the presence of healthier lifestyles, the human body would still accumulate problems as part of the normal aging process. It's not like Alzheimer's would just go away if people started going on more walks and ate more vegetables. It's not an "emerging disease".

ninesnines 4y ago

I would like to chime in here! It's not that individuals don't want to sleep, it's that oftentimes AD, PD, etc pts will present with sleep problems over 20 years before disease onset, and it isn't because these patients aren't trying. These patients will present with sleep disorders like REM sleep behavior disorder, and these seem to predate these disease onsets, but may also be a symptom of early stages of the disease. TDLR: its not that people don't want to sleep, its oftentimes that AD pts present with sleep disorders decades before onset