11 ms·

> I had stumbled across Helen's blog last year. As a physician, I was unnerved by her approach and agreed with her doctors: Multiple myeloma requires an aggress

by wisty 11y ago

> I had stumbled across Helen's blog last year. As a physician, I was unnerved by her approach and agreed with her doctors: Multiple myeloma requires an aggressive, chemotherapeutic strategy, especially in someone so young. Skipping chemo in favor of a dietary cure would almost certainly reduce her chances of survival—not unlike doing nothing at all to address the disease. Yet throughout medical history, renegades like Helen have given us plenty of insights about how diseases work, and how they might be better treated. Could Helen be onto something? Might the Western diet be responsible for more than the obesity epidemic? Could food be both the cause and the cure of some of our modern diseases? OK, so the article is being provocative. The author knows that eating lettuce won't cure cancer, but is dismayed by the lack of focus doctors have on diet. I think that's partly wrong. Any doctor will tell a patient to eat more veggies and get more exercise, and if you've got some specific issue they might get more specific (or refer you to an expert). Most patients don't need to even go to a doctor to know they are eating shit foods. The larger problem is FDA standards, vs the usual standard of proof. The FDA has its weaknesses, but it's rigorous. Anything not regulated (including surgery!) is a barely-scientific mess. There's no regulator demanding companies prove that spinach is healthy, and side effect free. They pretty much only regulate pills and devices, not surgery, and certainly not foods. Obviously, the lack of a patent holder is an issue here - no-one owns the patent for spinach, so the FDA can't find a target to force to pay for the studies.

saosebastiao 11y ago
Very few foods are unequivocally bad. The FDA shouldn't tell people in general to avoid calorie-dense diets...they have to figure out how to tell just overweight people to avoid calorie-dense diets, because if they accidentally tell an athlete, or a nursing mother, or someone with ALS, they could end up doing them a lot of harm. And they can't tell people in general that lots of Tomatoes or Spinach are good, because some people would end up with Barrett's Esophagus, Acid Reflux, or Kidney Stones. The problem the FDA has with regulating unhealthy food is similar to one the EPA has with regulating CO2, because the goal isn't complete avoidance, it is maintaining a safe equilibrium. But with the EPA, they have all the tools at their disposal to monitor the environment (and we are so far gone at this point that there is little risk to treating all CO2 like a bad thing). The FDA still has to rely heavily on doctors and other health professionals to make recommendations on top of their recommendations, because they don't have the tools to monitor health. Maybe devices are what we actually need. A device that could monitor someone's actual health and diet and provide daily recommendations would be an amazing thing for the FDA to work towards.
- nitrogen 11y ago
  The FDA shouldn't tell people in general... Sounds like a good argument for personalized medicine, either in the form of a device as you suggest, or better processes used by physicians, or both.
- orky56 11y ago
  If we were able to socialize healthcare to a greater degree, we could regulate it on a regional basis as we do with districts for education. The same way we provide standard curricula to teachers and administration & then evaluate/incentivize them based on the performance of their students, there must be a similar method we could use for health and wellness. We have superintendents responsible for arbitrary school districts, post offices for zip codes, etc. If we had a public health official or body in charge of a region, they would be responsible for the health of their constituency. They could administer the right combination of food & drugs to ensure that wellness was being achieved. At the end of the day, we know CO2 is something that affects everyone so it needs to be regulated. We are at the point where public health & preventive epidemics such as childhood obesity do affect everyone and society at some level, even just due to the interconnected nature of the cost of insurance, drugs, and various externalities.
  - wisty 11y ago
    There's problems with top-down incentives, if they aren't well thought-out - http://highered.blogspot.hk/2009/01/well-intentioned-commissar.html http://highered.blogspot.hk/2009/01/well-intentioned-commiss... Optimisation can be a literal genie, even when it's humans doing the optimising.
bunderbunder 11y ago
> Any doctor will tell a patient to eat more veggies and get more exercise, and if you've got some specific issue they might get more specific (or refer you to an expert). Yep. But they won't be very forceful about it, because they know all about the research showing that people don't really give a rat about their doctor's urgings to eat a healthy diet. And they also know about all the more recent research showing just how poor the effectiveness of dietary intervention really is, largely because the percentage of people who stick with them is statistically comparable to zero. That said, pulling back a bit, I find it fascinating that doctors can spend decades publishing guidelines about the importance of diet and exercise without anyone paying attention, but as soon as someone with a "NOT A DOCTOR" shingle hanging outside their office suggests maybe lightening up on the Whoppers it's suddenly this revolutionary idea that somehow threatens to upset the medical industry.
- DanBC 11y ago
  > Yep. But they won't be very forceful about it, because they know all about the research showing that people don't really give a rat about their doctor's urgings to eat a healthy diet. And they also know about all the more recent research showing just how poor the effectiveness of dietary intervention really is, largely because the percentage of people who stick with them is statistically comparable to zero. This is changing with efforts like "make every contact count". http://www.makingeverycontactcount.co.uk/ http://www.makingeverycontactcount.co.uk/ > Making Every Contact Count (MECC) encourages conversations based on behaviour change methodologies (ranging from brief advice, to more advanced behaviour change techniques), empowering healthier lifestyle choices and exploring the wider social determinants that influence all of our health.

by wisty 11y ago

saosebastiao 11y ago

Very few foods are unequivocally bad. The FDA shouldn't tell people in general to avoid calorie-dense diets...they have to figure out how to tell just overweight people to avoid calorie-dense diets, because if they accidentally tell an athlete, or a nursing mother, or someone with ALS, they could end up doing them a lot of harm. And they can't tell people in general that lots of Tomatoes or Spinach are good, because some people would end up with Barrett's Esophagus, Acid Reflux, or Kidney Stones. The problem the FDA has with regulating unhealthy food is similar to one the EPA has with regulating CO2, because the goal isn't complete avoidance, it is maintaining a safe equilibrium. But with the EPA, they have all the tools at their disposal to monitor the environment (and we are so far gone at this point that there is little risk to treating all CO2 like a bad thing). The FDA still has to rely heavily on doctors and other health professionals to make recommendations on top of their recommendations, because they don't have the tools to monitor health. Maybe devices are what we actually need. A device that could monitor someone's actual health and diet and provide daily recommendations would be an amazing thing for the FDA to work towards.

nitrogen 11y ago
The FDA shouldn't tell people in general... Sounds like a good argument for personalized medicine, either in the form of a device as you suggest, or better processes used by physicians, or both.
orky56 11y ago
If we were able to socialize healthcare to a greater degree, we could regulate it on a regional basis as we do with districts for education. The same way we provide standard curricula to teachers and administration & then evaluate/incentivize them based on the performance of their students, there must be a similar method we could use for health and wellness. We have superintendents responsible for arbitrary school districts, post offices for zip codes, etc. If we had a public health official or body in charge of a region, they would be responsible for the health of their constituency. They could administer the right combination of food & drugs to ensure that wellness was being achieved. At the end of the day, we know CO2 is something that affects everyone so it needs to be regulated. We are at the point where public health & preventive epidemics such as childhood obesity do affect everyone and society at some level, even just due to the interconnected nature of the cost of insurance, drugs, and various externalities.
- wisty 11y ago
  There's problems with top-down incentives, if they aren't well thought-out - http://highered.blogspot.hk/2009/01/well-intentioned-commissar.html http://highered.blogspot.hk/2009/01/well-intentioned-commiss... Optimisation can be a literal genie, even when it's humans doing the optimising.

bunderbunder 11y ago

> Any doctor will tell a patient to eat more veggies and get more exercise, and if you've got some specific issue they might get more specific (or refer you to an expert). Yep. But they won't be very forceful about it, because they know all about the research showing that people don't really give a rat about their doctor's urgings to eat a healthy diet. And they also know about all the more recent research showing just how poor the effectiveness of dietary intervention really is, largely because the percentage of people who stick with them is statistically comparable to zero. That said, pulling back a bit, I find it fascinating that doctors can spend decades publishing guidelines about the importance of diet and exercise without anyone paying attention, but as soon as someone with a "NOT A DOCTOR" shingle hanging outside their office suggests maybe lightening up on the Whoppers it's suddenly this revolutionary idea that somehow threatens to upset the medical industry.

DanBC 11y ago
> Yep. But they won't be very forceful about it, because they know all about the research showing that people don't really give a rat about their doctor's urgings to eat a healthy diet. And they also know about all the more recent research showing just how poor the effectiveness of dietary intervention really is, largely because the percentage of people who stick with them is statistically comparable to zero. This is changing with efforts like "make every contact count". http://www.makingeverycontactcount.co.uk/ http://www.makingeverycontactcount.co.uk/ > Making Every Contact Count (MECC) encourages conversations based on behaviour change methodologies (ranging from brief advice, to more advanced behaviour change techniques), empowering healthier lifestyle choices and exploring the wider social determinants that influence all of our health.