6 ms·

Is Preventive Medicine Its Own Health Risk?

49 points by benbreen 12y ago

npsimons 12y ago
I was afraid this would be one of those pieces that the morbidly obese would cite to say that "preventive medicine" in the form of exercise or just weight loss in general is dangerous, but it's actually a fairly good piece. The statin screening especially hit home for me as I've been threatened with being put on statins myself. I just love how the screening calculator was most likely written by the drug companies (no conflict of interest there) and didn't take into account physical activity level, diet, or even weight! Like the article's author, I would steadfastly refuse to be put on a medication that did very little to decrease my susceptibility to a disease, while hampering more natural ways to prevent the disease (ie, less exercise due to muscle pain from statins).
- debacle 12y ago
  The statin stuff is just bad science. Statins don't have the effect on cholesterol that they are purported to have. They are the product of a time when we still thought that the fat you eat makes you fat. We're beyond that point, but statins are absolutely huge in terms of money.
  - nielsbot 12y ago
    This is interesting--I'd love to read more about it. Can you link some sources? (I'm not being snarky)
    - debacle 12y ago
      http://chriskresser.com/the-diet-heart-myth-statins-dont-save-lives-in-people-without-heart-disease http://chriskresser.com/the-diet-heart-myth-statins-dont-sav... http://articles.mercola.com/sites/articles/archive/2010/09/02/effectiveness-of-statins-called-into-question.aspx http://articles.mercola.com/sites/articles/archive/2010/09/0... http://www.aarp.org/health/conditions-treatments/info-12-2013/can-statins-save-your-life.html http://www.aarp.org/health/conditions-treatments/info-12-201...
      - ZeroBugBounce 12y ago
        For context of anyone reading, the second link (mercola.com) has a ton of nonsense anti vaccination articles on it. That's enough for me to wholesale write off anything else the blogger/site might be commenting on, science-wise.
        debacle 12y ago
        Mercola has a lot of stupid shit on it, but I found no fault in the article (except for a bit of woohoo on energy psychology). It was the only good non-industry source I could find on the Jupiter study.
        hga 12y ago
        Well, to a certain degree the Jupiter study indicts itself, at least at brief glance. It uses a surrogate endpoint, not actual disease or mortality. As I understand it, large dose niacin used to promoted as good for your heart based on more iffy lipid surrogates, but when a real study was done, it turned out to increase mortality. Oops. And while I'm not so influenced by "the drug company paid for it!" bit, Crestor's situation is special, it was introduced when earlier well studied statins had gone generic (or nearly so). It had to muscle its way in, so to speak. So I view it with extra jaundice in my eye (tempered by the fact that it's brand name, so you know you're going to get the real stuff at the right dose, and in my recent study of statins it's clear that bad side effects are very strongly correlated with inadvertent overdosing). Anyway, if an iffy source says something, as long as you can track down what it claims to be quoting then you shouldn't dismiss it out of hand. Given that it's peppered with links to PubMed.... I myself am looking at statins (for primary prevention, pushed by my doctors with some justice) with a jaundiced eye, based on how far their target is from actual cholesterol production. They interfere with a lot more than that.
      - tokenadult 12y ago
        The site mercola.com is basically untrustworthy on all topics related to health and disease, which is about all it ever writes about. http://www.quackwatch.com/11Ind/mercola.html http://www.quackwatch.com/11Ind/mercola.html http://www.alternet.org/personal-health/four-biggest-quacks-plaguing-america-their-bad-claims-about-science http://www.alternet.org/personal-health/four-biggest-quacks-... http://rationalwiki.org/wiki/Joseph_Mercola http://rationalwiki.org/wiki/Joseph_Mercola http://www.sciencebasedmedicine.org/joe-mercola-quackery-pays/ http://www.sciencebasedmedicine.org/joe-mercola-quackery-pay... http://www.sciencebasedmedicine.org/more-breast-cancer-awareness-month-quackery/ http://www.sciencebasedmedicine.org/more-breast-cancer-aware... http://www.sciencebasedmedicine.org/mercola-gardasil-and-toyota/ http://www.sciencebasedmedicine.org/mercola-gardasil-and-toy... http://www.sciencebasedmedicine.org/9-reasons-to-completely-ignore-joseph-mercola-and-natural-news/ http://www.sciencebasedmedicine.org/9-reasons-to-completely-... http://scienceblogs.com/insolence/2012/08/03/15-years-of-promoting-quackery/ http://scienceblogs.com/insolence/2012/08/03/15-years-of-pro...
  - DanBC 12y ago
    We are absolutely not beyond the point of "the fat you eat makes you fat". We might be beyond the point of "the cholesterol you eat is the cholesterol that kills you", but these are very different things.
    - tiglionabbit 12y ago
      Who is We? The general public, your doctor, modern scientists?
  - gmarx 12y ago
    Look at the literature and try to find convincing evidence that high cholesterol causes heart disease. I've never seen it. They keep looking for new fractions of cholesterol that will finally show significance but they never question their Bayesian prior assumption. Many drugs lower cholesterol and show now reduction in mortality. Statins (last I read) were alone in this. The logical conclusion is that statins do not achieve this effect through cholesterol reduction.
    - tiglionabbit 12y ago
      Yeah. I find it weird to see that [Cochrane shows statins prevent heart disease](http://summaries.cochrane.org/CD004816/VASC_statins-for-the-primary-prevention-of-cardiovascular-disease http://summaries.cochrane.org/CD004816/VASC_statins-for-the-...), despite the whole cholesterol debacle. It would be nice if we understood this situation better. We know now that only some types of LDL are dangerous, but how often are people given an LDL particle count? According to Michael Pollan, the whole Fat/Cholesterol thing started when the government found some weak evidence that beef is bad for you, but they blamed it on cholesterol so as not to single out a particular industry. But is beef even bad for you? Or is it something in how hamburger meat is processed? Or what?
    - IndianAstronaut 12y ago
      This makes me wonder if eggs should be considered a health food instead of a health hazard. Anecdotal, but if I eat 4 eggs(~300) calories, I am full for the same period of time as eating ~600-1000 calories of something else. But considering the saturated fat and cholesterol in eggs, they have been considered harmful. Are they?
      - mindcrime 12y ago
        But considering the saturated fat and cholesterol in eggs, they have been considered harmful. Are they? Good question. The author of Living Low Carb[1] argues that it's not "saturated fat" in general that's bad for you, but rather more specifically "trans-saturated fat", or saturated fat consumed along with simple carbs (sugar, etc). He also argues that most dietary cholesterol passes through your system unprocessed, and that serum cholesterol is largely driven by cholesterol manufactured by your liver. [1]: http://www.amazon.com/Living-Low-Carb-Controlled-Carbohydrate-Long-Term/dp/1454903511 http://www.amazon.com/Living-Low-Carb-Controlled-Carbohydrat...
akiselev 12y ago
There's one TEDMED talk about chronic disease [1] in particular that has really stuck with me over the years. At about 2:40 the speaker pulls up a graph compiled from WHO Global Burden of Disease data [2] that shows the occurrence of serious acute (usually communicable) and chronic diseases across countries with high (United States), middle (India), and low (Kenya) incomes. As you would suspect, the United States has significantly fewer acute diseases than India, which in turn has significantly less acute disease than Kenya. BUT for chronic conditions, the numbers (relative to population size) are pretty much the same across the board. The distribution of chronic disease is slightly different depending on wealth (diabetes vs obesity vs malnutrition vs heart/lung disease like cancer vs liver disease from alcohol, etc) but they are almost entirely preventable often with "just" some life style changes (I'm oversimplifying, but the vast majority of the conditions are considered very preventable). With the United States spending nearly a fifth of its GDP on medical care we STILL have just as big a problem with chronic disease as Kenya, a country where the average income is under $10/day. Preventive medicine is almost definitely its own health risk but when you look at what we're trying to combat and just how intractable the problem is here in the US, let alone globally, it starts to look like a very acceptable risk. [1] http://www.tedmed.com/talks/show?id=7333 http://www.tedmed.com/talks/show?id=7333 [2] http://www.who.int/topics/global_burden_of_disease/en/ http://www.who.int/topics/global_burden_of_disease/en/
- npsimons 12y ago
  The problem is twofold in America: first and foremost, no one wants to hear that they need to lose weight and exercise more, they just want a quick fix. Second problem is that there's so much profit motive involved that companies are eager to hype the quick fix, especially in terms of pills that doctors can prescribe in a fifteen minute office visit after plugging your numbers into a company sponsored calculator. Exercise moderately and eat healthier are probably the most important "preventive" means of health care. Even for conditions that aren't directly related to being overweight or lacking exercise, it can help immensely to correct those two issues.
  - Spooky23 12y ago
    Society drives these things. I'd love to hit he market every other day and have lots of good home cooked meals. But my wife and I work 50-60 hours, and need to have the 2 year old in bed by 8:30. That means out the door at 7, home by 5:30, dinner on the table by 6:30. I'd love to cook awesome meals and play old man basketball. When do I do that?
tokenadult 12y ago
The article is interesting, and I see that the author is a science writer who has written a book (which I had not ever heard of before, even though I search library databases for books on that topic all the time). After reading the comments previously posted in this thread, I'll link to some broader context. First of all, it is plain that screening test programs that are not based on "hard endpoints" (actual reductions in all-cause disease or death) often end up being discovered to be wastes of time and money and the cause of needless patient worries. There is a group blog, Science-Based Medicine, with participation by multiple medical doctors, pharmacists, lawyers, and even reformed chiropractors, which examines the issue of the usefulness of screening tests from time to time.[1] An informed patient might well decline many currently offered screening tests, and might also well decline some preventive treatments, for example statin drugs. But the second bit of context to look at is that whatever is being done in public health and medicine in the developed world appears to be working in part, as life expectancy at age 40, at age 60, and at even higher ages is still rising throughout the developed countries of the world.[2] Chances of surviving to healthy old age from middle age have been increasing steadily in the United States and in the whole developed world throughout my lifetime, so I may have to get ready to live as long as some of my aunts and uncles, who are now well into their nineties and still living independently. [1] "Recent Developments and Recurring Dilemmas in Cancer Screening: Colon, Lung, Thyroid" 18 November 2014 http://www.sciencebasedmedicine.org/recent-developments-and-recurring-dilemmas-in-cancer-screening-colon-lung-thyroid/ http://www.sciencebasedmedicine.org/recent-developments-and-... "A Skeptical Look at Screening Tests" 23 July 2013 repost http://www.sciencebasedmedicine.org/a-skeptical-look-at-screening-tests/ http://www.sciencebasedmedicine.org/a-skeptical-look-at-scre... "Screening Tests - Cumulative Incidence of False Positives" 30 June 2009 http://www.sciencebasedmedicine.org/screening-tests-cumulative-incidence-of-false-positives/ http://www.sciencebasedmedicine.org/screening-tests-cumulati... [2] http://www.nature.com/scientificamerican/journal/v307/n3/box/scientificamerican0912-54_BX1.html http://www.nature.com/scientificamerican/journal/v307/n3/box...
- deleted 12y ago
  [deleted]
- mariodiana 12y ago
  > whatever is being done in public health and medicine in the developed world appears to be working "Whatever" is a pretty broad statement. What if we found out that the biggest factor is nutrition and health care while young: in other words, maybe poor health and nutrition while young leaves "scars" of a sort that come back to bite us as we age? I'm not saying that that's the case. I'm just saying that "whatever" is too broad a statement. The piece is about the comparatively superfluous effect of so-called preventative medicine in late middle-age. If we just grant that point, for the sake of argument, then that's a whole bit of "whatever" that we could save our money on and do without.

49 points by benbreen 12y ago

I was afraid this would be one of those pieces that the morbidly obese would cite to say that "preventive medicine" in the form of exercise or just weight loss in general is dangerous, but it's actually a fairly good piece. The statin screening especially hit home for me as I've been threatened with being put on statins myself. I just love how the screening calculator was most likely written by the drug companies (no conflict of interest there) and didn't take into account physical activity level, diet, or even weight! Like the article's author, I would steadfastly refuse to be put on a medication that did very little to decrease my susceptibility to a disease, while hampering more natural ways to prevent the disease (ie, less exercise due to muscle pain from statins).

debacle 12y ago
The statin stuff is just bad science. Statins don't have the effect on cholesterol that they are purported to have. They are the product of a time when we still thought that the fat you eat makes you fat. We're beyond that point, but statins are absolutely huge in terms of money.
- nielsbot 12y ago
  This is interesting--I'd love to read more about it. Can you link some sources? (I'm not being snarky)
  - debacle 12y ago
    http://chriskresser.com/the-diet-heart-myth-statins-dont-save-lives-in-people-without-heart-disease http://chriskresser.com/the-diet-heart-myth-statins-dont-sav... http://articles.mercola.com/sites/articles/archive/2010/09/02/effectiveness-of-statins-called-into-question.aspx http://articles.mercola.com/sites/articles/archive/2010/09/0... http://www.aarp.org/health/conditions-treatments/info-12-2013/can-statins-save-your-life.html http://www.aarp.org/health/conditions-treatments/info-12-201...
    - ZeroBugBounce 12y ago
      For context of anyone reading, the second link (mercola.com) has a ton of nonsense anti vaccination articles on it. That's enough for me to wholesale write off anything else the blogger/site might be commenting on, science-wise.
      - debacle 12y ago
        Mercola has a lot of stupid shit on it, but I found no fault in the article (except for a bit of woohoo on energy psychology). It was the only good non-industry source I could find on the Jupiter study.
        hga 12y ago
        Well, to a certain degree the Jupiter study indicts itself, at least at brief glance. It uses a surrogate endpoint, not actual disease or mortality. As I understand it, large dose niacin used to promoted as good for your heart based on more iffy lipid surrogates, but when a real study was done, it turned out to increase mortality. Oops. And while I'm not so influenced by "the drug company paid for it!" bit, Crestor's situation is special, it was introduced when earlier well studied statins had gone generic (or nearly so). It had to muscle its way in, so to speak. So I view it with extra jaundice in my eye (tempered by the fact that it's brand name, so you know you're going to get the real stuff at the right dose, and in my recent study of statins it's clear that bad side effects are very strongly correlated with inadvertent overdosing). Anyway, if an iffy source says something, as long as you can track down what it claims to be quoting then you shouldn't dismiss it out of hand. Given that it's peppered with links to PubMed.... I myself am looking at statins (for primary prevention, pushed by my doctors with some justice) with a jaundiced eye, based on how far their target is from actual cholesterol production. They interfere with a lot more than that.
    - tokenadult 12y ago
      The site mercola.com is basically untrustworthy on all topics related to health and disease, which is about all it ever writes about. http://www.quackwatch.com/11Ind/mercola.html http://www.quackwatch.com/11Ind/mercola.html http://www.alternet.org/personal-health/four-biggest-quacks-plaguing-america-their-bad-claims-about-science http://www.alternet.org/personal-health/four-biggest-quacks-... http://rationalwiki.org/wiki/Joseph_Mercola http://rationalwiki.org/wiki/Joseph_Mercola http://www.sciencebasedmedicine.org/joe-mercola-quackery-pays/ http://www.sciencebasedmedicine.org/joe-mercola-quackery-pay... http://www.sciencebasedmedicine.org/more-breast-cancer-awareness-month-quackery/ http://www.sciencebasedmedicine.org/more-breast-cancer-aware... http://www.sciencebasedmedicine.org/mercola-gardasil-and-toyota/ http://www.sciencebasedmedicine.org/mercola-gardasil-and-toy... http://www.sciencebasedmedicine.org/9-reasons-to-completely-ignore-joseph-mercola-and-natural-news/ http://www.sciencebasedmedicine.org/9-reasons-to-completely-... http://scienceblogs.com/insolence/2012/08/03/15-years-of-promoting-quackery/ http://scienceblogs.com/insolence/2012/08/03/15-years-of-pro...
- DanBC 12y ago
  We are absolutely not beyond the point of "the fat you eat makes you fat". We might be beyond the point of "the cholesterol you eat is the cholesterol that kills you", but these are very different things.
  - tiglionabbit 12y ago
    Who is We? The general public, your doctor, modern scientists?
- gmarx 12y ago
  Look at the literature and try to find convincing evidence that high cholesterol causes heart disease. I've never seen it. They keep looking for new fractions of cholesterol that will finally show significance but they never question their Bayesian prior assumption. Many drugs lower cholesterol and show now reduction in mortality. Statins (last I read) were alone in this. The logical conclusion is that statins do not achieve this effect through cholesterol reduction.
  - tiglionabbit 12y ago
    Yeah. I find it weird to see that [Cochrane shows statins prevent heart disease](http://summaries.cochrane.org/CD004816/VASC_statins-for-the-primary-prevention-of-cardiovascular-disease http://summaries.cochrane.org/CD004816/VASC_statins-for-the-...), despite the whole cholesterol debacle. It would be nice if we understood this situation better. We know now that only some types of LDL are dangerous, but how often are people given an LDL particle count? According to Michael Pollan, the whole Fat/Cholesterol thing started when the government found some weak evidence that beef is bad for you, but they blamed it on cholesterol so as not to single out a particular industry. But is beef even bad for you? Or is it something in how hamburger meat is processed? Or what?
  - IndianAstronaut 12y ago
    This makes me wonder if eggs should be considered a health food instead of a health hazard. Anecdotal, but if I eat 4 eggs(~300) calories, I am full for the same period of time as eating ~600-1000 calories of something else. But considering the saturated fat and cholesterol in eggs, they have been considered harmful. Are they?
    - mindcrime 12y ago
      But considering the saturated fat and cholesterol in eggs, they have been considered harmful. Are they? Good question. The author of Living Low Carb[1] argues that it's not "saturated fat" in general that's bad for you, but rather more specifically "trans-saturated fat", or saturated fat consumed along with simple carbs (sugar, etc). He also argues that most dietary cholesterol passes through your system unprocessed, and that serum cholesterol is largely driven by cholesterol manufactured by your liver. [1]: http://www.amazon.com/Living-Low-Carb-Controlled-Carbohydrate-Long-Term/dp/1454903511 http://www.amazon.com/Living-Low-Carb-Controlled-Carbohydrat...

akiselev 12y ago

There's one TEDMED talk about chronic disease [1] in particular that has really stuck with me over the years. At about 2:40 the speaker pulls up a graph compiled from WHO Global Burden of Disease data [2] that shows the occurrence of serious acute (usually communicable) and chronic diseases across countries with high (United States), middle (India), and low (Kenya) incomes. As you would suspect, the United States has significantly fewer acute diseases than India, which in turn has significantly less acute disease than Kenya. BUT for chronic conditions, the numbers (relative to population size) are pretty much the same across the board. The distribution of chronic disease is slightly different depending on wealth (diabetes vs obesity vs malnutrition vs heart/lung disease like cancer vs liver disease from alcohol, etc) but they are almost entirely preventable often with "just" some life style changes (I'm oversimplifying, but the vast majority of the conditions are considered very preventable). With the United States spending nearly a fifth of its GDP on medical care we STILL have just as big a problem with chronic disease as Kenya, a country where the average income is under $10/day. Preventive medicine is almost definitely its own health risk but when you look at what we're trying to combat and just how intractable the problem is here in the US, let alone globally, it starts to look like a very acceptable risk. [1] http://www.tedmed.com/talks/show?id=7333 http://www.tedmed.com/talks/show?id=7333 [2] http://www.who.int/topics/global_burden_of_disease/en/ http://www.who.int/topics/global_burden_of_disease/en/

npsimons 12y ago
The problem is twofold in America: first and foremost, no one wants to hear that they need to lose weight and exercise more, they just want a quick fix. Second problem is that there's so much profit motive involved that companies are eager to hype the quick fix, especially in terms of pills that doctors can prescribe in a fifteen minute office visit after plugging your numbers into a company sponsored calculator. Exercise moderately and eat healthier are probably the most important "preventive" means of health care. Even for conditions that aren't directly related to being overweight or lacking exercise, it can help immensely to correct those two issues.
- Spooky23 12y ago
  Society drives these things. I'd love to hit he market every other day and have lots of good home cooked meals. But my wife and I work 50-60 hours, and need to have the 2 year old in bed by 8:30. That means out the door at 7, home by 5:30, dinner on the table by 6:30. I'd love to cook awesome meals and play old man basketball. When do I do that?

tokenadult 12y ago

The article is interesting, and I see that the author is a science writer who has written a book (which I had not ever heard of before, even though I search library databases for books on that topic all the time). After reading the comments previously posted in this thread, I'll link to some broader context. First of all, it is plain that screening test programs that are not based on "hard endpoints" (actual reductions in all-cause disease or death) often end up being discovered to be wastes of time and money and the cause of needless patient worries. There is a group blog, Science-Based Medicine, with participation by multiple medical doctors, pharmacists, lawyers, and even reformed chiropractors, which examines the issue of the usefulness of screening tests from time to time.[1] An informed patient might well decline many currently offered screening tests, and might also well decline some preventive treatments, for example statin drugs. But the second bit of context to look at is that whatever is being done in public health and medicine in the developed world appears to be working in part, as life expectancy at age 40, at age 60, and at even higher ages is still rising throughout the developed countries of the world.[2] Chances of surviving to healthy old age from middle age have been increasing steadily in the United States and in the whole developed world throughout my lifetime, so I may have to get ready to live as long as some of my aunts and uncles, who are now well into their nineties and still living independently. [1] "Recent Developments and Recurring Dilemmas in Cancer Screening: Colon, Lung, Thyroid" 18 November 2014 http://www.sciencebasedmedicine.org/recent-developments-and-recurring-dilemmas-in-cancer-screening-colon-lung-thyroid/ http://www.sciencebasedmedicine.org/recent-developments-and-... "A Skeptical Look at Screening Tests" 23 July 2013 repost http://www.sciencebasedmedicine.org/a-skeptical-look-at-screening-tests/ http://www.sciencebasedmedicine.org/a-skeptical-look-at-scre... "Screening Tests - Cumulative Incidence of False Positives" 30 June 2009 http://www.sciencebasedmedicine.org/screening-tests-cumulative-incidence-of-false-positives/ http://www.sciencebasedmedicine.org/screening-tests-cumulati... [2] http://www.nature.com/scientificamerican/journal/v307/n3/box/scientificamerican0912-54_BX1.html http://www.nature.com/scientificamerican/journal/v307/n3/box...

deleted 12y ago
[deleted]
mariodiana 12y ago
> whatever is being done in public health and medicine in the developed world appears to be working "Whatever" is a pretty broad statement. What if we found out that the biggest factor is nutrition and health care while young: in other words, maybe poor health and nutrition while young leaves "scars" of a sort that come back to bite us as we age? I'm not saying that that's the case. I'm just saying that "whatever" is too broad a statement. The piece is about the comparatively superfluous effect of so-called preventative medicine in late middle-age. If we just grant that point, for the sake of argument, then that's a whole bit of "whatever" that we could save our money on and do without.