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This idea is the natural conclusion of interventionist medicine culture where preventative measures and working the root causes are both disliked. It has been

by caseyy 2y ago

This idea is the natural conclusion of interventionist medicine culture where preventative measures and working the root causes are both disliked. It has been shown, for example, that statins prevent much of the heart disease that kills middle-aged people, but this medication needs to be taken for decades before. And yet in many countries, although it is a known fact and statins are safe, doctors don’t prescribe it until people have heart failure and it won’t help much anyways. Our approach to pain management has also shifted a lot in the last 2-4 decades. Managing pain was about finding the root cause and treating it. Now its about hiding the symptoms with paracetamol and ibuprofen. Exercise is a known and very effective treatment for obesity. Many cultures in the East accept it and group exercises in public are common. We in the West also know the science, but more often than appropriate make fun of Asians exercising in the parks every morning. Then we medicate for all the symptoms of diseases that obesity brings. Doctors do not even prescribe exercise to most obese people. That is a prescription which is very effective with $0 monthly costs. The goal is not quality of life. It is not to prevent disease, or to holistically treat it. The goal is to do interventions to prevent death. And maybe that’s more liberal in a way — people can live their lives more consequence-free, enjoy unhealthy habits, and know that some % will be bailed out of their coffins just before things get bad enough. Ozempic is such a bail-out. Yes, Ozempic is an effective drug in reversing obesity. It is a great drug. It will give people back many years of their lives that would have been lost to obesity. Maybe it is even as effective as good exercise habits, which cost $0 and have about 0 side-effects. It is definitely not a better option than exercise for most of the population. But if it’s the only option possible in our healthcare culture, then it is still very valuable. It just won’t end the obesity epidemic. A health culture that only prevents death simply does not concern itself with improving the quality of life. Unfortunately, we are also quite proud to have such a dysfunctional culture.

logicchains 2y ago
Statins don't prevent "much of the heart disease", they have a modest effect of reducing mortality by around 1%: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790055 https://jamanetwork.com/journals/jamainternalmedicine/fullar...
- caseyy 2y ago
  Yes, exactly right. Because they don’t work that well in this interventionist mode when they are prescribed to already treated patients. The study you shared talks about primary and secondary prevention in a clinical setting. So this is for people who either have heart disease or are likely going to develop it. At that point, it seems like it is already too late and I would say primordial prevention[0] is better. When I say prevention, I speak as not a medical professional, and I mean it in the common sense of the word, which aligns with primordial prevention. There seems to be extensive research that they work well if prescribed preventatively decades in advance, and it’s covered in a few recently popular books by doctors on the topic of lifespan vs. healthspan. For example, Outlive: The Science and Art of Longevity by L. Attia. Moreover, the study you quoted shows a 9-29% relative reductions of the outcomes. About 1% is absolute. For the entire population, 1.3% fewer will die from a myocardial infarction. But it is a 29% reduction in the sub-population that would die from it. And those are fantastic results with only primary and secondary prevention. Unless I misunderstand something. The study you provided is relevant and valuable for critical reading of such books as the aforementioned. Thank you. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349501/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349501/
throwaway2037 2y ago
> Exercise is a known and very effective treatment for obesity. Many cultures in the East accept it and group exercises in public are common. The second sentence. What does this mean? Are you talking about elderly Chinese people doing Tai Chi? It is neither building muscle (resistance training) nor improving cardiovascular health. Sure, it might help with mental health, like yoga, but not for muscles/heart/lungs. And the rest of "the East"? Have you seen India? There are an incredible number of obese people in that country. I would guess that Korean, Japanese, and Vietnamese have lower obesity rates because of portion control and caloric density in their traditional diets. However, in the urban populations of Korea and Japan, obesity is rapidly increasing as processed food increases in their diets.
- caseyy 2y ago
  I was not taking about specifically Tai Chi. But I remember from public health classes in medschool that it is known for increasing flexibility and mobility, as well as improving balance and reducing falls in elderly. I also remember something about backwards walking/sageru exercises in Japan, but it is difficult for me to find much online about it. I was talking about the broader culture that values Tai Chi. Tai Chi is one of “morning exercises” in China. Others include just walking. But my point was about a culture that incorporates morning exercises as a norm. Japan has “radio taiso”, which is a similar phenomenon. I think the West had a similar culture in the 80s and 90s. I was actually growing up in the Central Europe then, and it was normal in elementary and middle school to start the day with a 30-minute exercise lead by school staff. I don’t know how to label this culture but “culture where it is the norm to exercise daily”. Yes, as you say, obesity also has many, many other causes. And many other cures. It’s definitely not so one-dimensional. But exercise is very effective, and a culture that promotes exercise daily for everyone, at all paces, would benefit us a lot in the West. I think people tremendously underestimate what 30 minutes of daily body weight exercises like push-ups, squats, and sit-ups, plus a little bit of walking can do for the said weight. There are many, many technology workers that now just work from home and barely walk at all. Not the majority, but many. There are many more office workers that just commute to work with their cars and never walk more than that demands. In that context, 30 minutes of morning exercise is quite a lot.

by caseyy 2y ago

logicchains 2y ago

Statins don't prevent "much of the heart disease", they have a modest effect of reducing mortality by around 1%: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790055 https://jamanetwork.com/journals/jamainternalmedicine/fullar...

caseyy 2y ago
Yes, exactly right. Because they don’t work that well in this interventionist mode when they are prescribed to already treated patients. The study you shared talks about primary and secondary prevention in a clinical setting. So this is for people who either have heart disease or are likely going to develop it. At that point, it seems like it is already too late and I would say primordial prevention[0] is better. When I say prevention, I speak as not a medical professional, and I mean it in the common sense of the word, which aligns with primordial prevention. There seems to be extensive research that they work well if prescribed preventatively decades in advance, and it’s covered in a few recently popular books by doctors on the topic of lifespan vs. healthspan. For example, Outlive: The Science and Art of Longevity by L. Attia. Moreover, the study you quoted shows a 9-29% relative reductions of the outcomes. About 1% is absolute. For the entire population, 1.3% fewer will die from a myocardial infarction. But it is a 29% reduction in the sub-population that would die from it. And those are fantastic results with only primary and secondary prevention. Unless I misunderstand something. The study you provided is relevant and valuable for critical reading of such books as the aforementioned. Thank you. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349501/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349501/

throwaway2037 2y ago

> Exercise is a known and very effective treatment for obesity. Many cultures in the East accept it and group exercises in public are common. The second sentence. What does this mean? Are you talking about elderly Chinese people doing Tai Chi? It is neither building muscle (resistance training) nor improving cardiovascular health. Sure, it might help with mental health, like yoga, but not for muscles/heart/lungs. And the rest of "the East"? Have you seen India? There are an incredible number of obese people in that country. I would guess that Korean, Japanese, and Vietnamese have lower obesity rates because of portion control and caloric density in their traditional diets. However, in the urban populations of Korea and Japan, obesity is rapidly increasing as processed food increases in their diets.

caseyy 2y ago
I was not taking about specifically Tai Chi. But I remember from public health classes in medschool that it is known for increasing flexibility and mobility, as well as improving balance and reducing falls in elderly. I also remember something about backwards walking/sageru exercises in Japan, but it is difficult for me to find much online about it. I was talking about the broader culture that values Tai Chi. Tai Chi is one of “morning exercises” in China. Others include just walking. But my point was about a culture that incorporates morning exercises as a norm. Japan has “radio taiso”, which is a similar phenomenon. I think the West had a similar culture in the 80s and 90s. I was actually growing up in the Central Europe then, and it was normal in elementary and middle school to start the day with a 30-minute exercise lead by school staff. I don’t know how to label this culture but “culture where it is the norm to exercise daily”. Yes, as you say, obesity also has many, many other causes. And many other cures. It’s definitely not so one-dimensional. But exercise is very effective, and a culture that promotes exercise daily for everyone, at all paces, would benefit us a lot in the West. I think people tremendously underestimate what 30 minutes of daily body weight exercises like push-ups, squats, and sit-ups, plus a little bit of walking can do for the said weight. There are many, many technology workers that now just work from home and barely walk at all. Not the majority, but many. There are many more office workers that just commute to work with their cars and never walk more than that demands. In that context, 30 minutes of morning exercise is quite a lot.