This article is saying a lot less than the title leads on. The article states half of all cancer deaths are caused by smoking, alcohol, and obesity. Nearly every patient in the developed world is aware that all three of these are bad, but the struggle is in changing course on these three behaviors rather than a lack of knowledge that they're bad.
> Nearly every patient in the developed world is aware that all three of these are bad
Smoking, yes, we seem to have broad support for that one (way beyond what the facts support, even, but that's probably for the best). But the other two? I don't think so. There's a lot of confusion out there about alcohol use. Most people still think small amounts are basically fine (maybe even good!), even though more recent studies [0] suggest that isn't true.
And we're trending the wrong way on obesity, too. [1]
It's practically impossible to to do a controlled study on any of these, so we'll likely never know for sure. If you were tasked with creating a study to determine, for any reasonable definition of "certainty", whether small amounts of alcohol increase or decrease one's lifespan, you'd never be able to come up with anything that passed any sort of moral or practical sniff test.
So what you are left with is trying to tease causation out of relatively loose correlation, which is and always will be so problematic as to be near useless. The results will always just support the researchers' pre-conceived notions.
Smoking is only so obvious because the rates of lung cancer there are an order of magnitude more. 80-90% of lung cancer is in smokers, while only 12% of Americans smoke. No other health issue is so clear, people who are moderate drinkers only have very slightly elevated risks of almost everything, so it could be confounded.
Drinking is the kind of thing where non-obvious long-term effects can only really be determined if any other cause of issues is ruled out. It doesn't seem to have a measurable effect on maximum lifespan (assuming it's not alcoholism), so I'd rate it rather low in the list of priorities.
The article you linked (and in fact , no study exists) to support your claims about small amounts of alcohol. In fact plenty of evidence exists to the contrary.
“The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week.” Seems pretty clear.
It’s likely that the risk of,(e.g.) one drink per month is also very low. What’s not here is the inflection point where alcohol consumption goes from a (subjective) minimal risk to an elevated risk.
I would just note here that the CDC is unequivocal on this point with respect to cigarettes, saying always that there is "no safe level of consumption."
I think that sort of language is basically absurd, but the message it sends is crystal clear: this thing is bad for you, even in small amounts, and you're doing harm when you use it.
I think the CDC could easily settle on the same language with respect to alcohol, if there weren't socio-cultural reasons not to.
Another aspect of this is that we discourage even light cigarette use because of the fear that users might become addicted and escalate their usage. [0] It's interesting how rarely you hear that kind of an argument against drinking alcohol, and yet, unlike with smoking, increased usage can actually be ruinous. On the day you take your first sip of alcohol you're accepting a 1 in x risk that you'll end up a problem drinker (where x is anywhere from 3 or 4 to 20, depending on what definition of "problem drinker" you're willing to accept).
[0] I remember many years ago when I was a very light smoker trying to find statistics online about moderate cigarette use and it was basically impossible, because every single statement about cigarettes was of the form, "you won't be able to only smoke a little, so don't even bother trying."
I know plenty of people who have 1 drink a day, I know absolutely no one who smokes 1 cigarette per day. I’m sure they exist, but not in my n of several hundred, so I’d bet that’s it’s pretty rare.
Smoking is also much more obnoxious and directly harms anyone near. This is a first order effect, not a 2nd order effect like increased risk of car accidents.
And you're arguing against something I'm not saying, which is that people seem to have a harder problem moderating cigarette use, and that cigarettes are more obnoxious to other people.
Sure, a drink or a cigarette a day is not so harmful. I do know people that only have an occasional puff when out socialising and don’t even have one cigarette a day,p.
You chose an unrealistic starting condition for your comparison. I agree one drink a day is surely less harmful than second hand smoking from a pack a day. But choosing those starting conditions makes for an unfair comparison, so I pick different starting conditions, in part because I live in a country where alcoholism is rife and binge drinking is normal. Excessive alcohol consumption directly harms the drinker (accidents, cancer, disease, mental health) and directly harms the family, friends and children of the drinker (alcohol has different harms from second hand smoke, and the secondary impact of an alcoholic person is sometimes more acute than chronic).
Disclaimer: yeah, anecdotal, but across a wide variety of my acquaintances.
Lots of people smoke cigarettes socially. There are in-jokes amongst smokers about the people who "don't smoke" who want to bum a cigarette in the smoking area outside at bars.
It's extremely common.
> Smoking is also much more obnoxious
I'm not sure I've ever disagreed more with a claim than I do this one. People who have consumed alcohol are practically unbearable to the sober. And that's before we get into stuff like the fact that alcohol is implicated in some staggering percentage of all violent crime. Or drunk driving. Etc, etc.
We’re talking about light use here. I very rarely drink, and people who consume a drink or 2 with dinner are totally fine to be around.
On the other hand, a person smoking 1 or 2 cigarettes near me is actively harmful to my health. If you want to find a field somewhere to smoke sure, I won’t find it obnoxious, but no one does that.
>Extremely common
sure I’ve met those people, I’ve never met one who does it anywhere near daily. Also most of the ones I’ve known drift in and out of periods of being heavy smokers.
Again I have met many people who can drink a glass of wine every night. I have never met a single person who smokes a single cigarette after dinner. To me that says there is something different about cigarettes that makes them harder to moderate.
> I have never met a single person who smokes a single cigarette after dinner.
On the other hand, there are people who smoke one cigar occasionally: cigarettes, for whatever reason, seem to be a lot more addictive than other forms of tobacco consumption.
Cigarette breaks are a great -feeling way to punctuate your day because they force you to step outside for a brief moment once in a while with only your thoughts, and so they easily become tremendously habit-forming.
The good thing about cigars is that they're terribly inconvenient. They're harder to acquire, harder to store properly, harder carry around, and they take nearly 10x as long to smoke. I've smoked a few cigars per year for almost 2 decades, and I can't imagine doing the same with cigarettes. Nobody really buys and smokes an entire pack of cigarettes in one night every few months (because it would be insane), but if they did, it's unlikely they'd become addicted.
> cigarettes, for whatever reason, seem to be a lot more addictive than other forms of tobacco consumption.
Excellent observation. What is in cigarettes is not really tobacco.[1] Also, cigarettes are intentionally more addictive than natural tobacco, and far more harmful.
According to the US Surgeon General Report Smoking and Health:
No. 1103, p.112
>Death rates for current pipe smokers were little if at all higher than for non-smokers, even with men smoking 10 pipefuls per day and with men who had smoked pipes for more than 30 years.
No. 1103, page 92
>Among the pipe smokers.... The US mortality ratios are 0.8 for non-inhalers and 1.0 for inhalers.
...which means pipe smokers (smoking natural tobacco) who inhale live as long as nonsmokers, and pipe smokers that don’t inhale live longer than non-smokers.
Smoking anything is bad for you, but national brand cigarettes are deadly. There are over 300 added carcinogens in cigarettes. My personal feeling is it is the added carcinogens that is causing cancer, and not tobacco. So it isn't smoking, per se, that is killing people en masse, but smoking cigarettes made by Big Tobacco, which will be any national brand (other than Natural American Spirits, which guarantees the only ingredients are natural tobacco and water.)
Everyone smoked during the Colonial era, including nearly all the Founding Fathers. Native Americans smoked for centuries if not millennia. Ever heard of a Native American with lung cancer? Only after the Chemical Revolution did smokers begin dying en masse annually.
People feel very strongly about this, and usually the information I provide stirs a strong reaction, because everyone knows smoking kills! But the devil is in the details. Carcinogens cause cancer and kills people in droves. Smoking tobacco, actual tobacco, causes emphysema, not cancer.
There seem to be a plethora of studies showing that hand rolled cigarettes cause lung cancer at similar rates to manufactured ones.
“Native American with lung cancer”
A quick google search shows Native Americans are more likely to have lung cancer.
If you’re talking about pre industrial Native Americans, it’s impossible to tell, because of a relative lack of written records and no accepted standard of what to even call lung cancer.
You’re entire post is so incredibly misleading. Look at the amount of tobacco smoked per capita between 1800 and the peak in the 1960s. The invention of the mass produced cigarette is certainly the cause of the increase in lung cancer deaths, but primarily because it made smoking tobacco much cheaper and therefore drastically increased consumption.
> There seem to be a plethora of studies showing that hand rolled cigarettes cause lung cancer at similar rates to manufactured ones.
That's good news, because it means you will have no issue citing these studies and the cancer rates of smokers of natural tobacco.
> If you’re talking about pre industrial Native Americans, it’s impossible to tell, because of a relative lack of written records and no accepted standard of what to even call lung cancer.
Lung cancer was first described medically in the mid 19th Century, a century before the Chemical Revolution in the 1950's. If smokers were dying as fast as they are today (and have been since the 1950's), someone would have noticed. But smoking only became linked to cancer in the 1950s, the very dawn of the Chemical Revolution.
> You’re entire post is so incredibly misleading. Look at the amount of tobacco smoked per capita between 1800 and the peak in the 1960s. The invention of the mass produced cigarette is certainly the cause of the increase in lung cancer deaths, but primarily because it made smoking tobacco much cheaper and therefore drastically increased consumption.
By the mid 17th Century, tobacco was so overproduced that it cost a penny for a pound of tobacco. Accounting for inflation, that penny is worth $4.29 today when a pound of loose tobacco costs about $15 and the average price of a pack of cigarettes, containing less than half an ounce of tobacco, is $8. Tobacco hasn't gotten cheaper, quite the opposite.
What dramatically increased consumption was that nicotine levels were intentionally drastically increased, and nicotine was intentionally made more addictive by chemically freeing it from its molecular base. Since the 1950's smokers of national brand cigarettes are literally freebasing nicotine. Along with the massive advertising budgets of Big Tobacco, it was a one-two-three punch that caused the peak of "tobacco" use in the 1960's. Mass production was incidental.
Again, let's not equivocate natural tobacco with what is in national brand cigarettes. I repeat, smoking anything is not healthy. But what is in cigarettes is a whole other level of lethal. The lung cancer rates of cigarette smokers is far beyond what it is for smokers of natural tobacco, and this is what the studies show.
And again, these facts disturb many as well as yourself, because Nancy Reagan and the American Lung Association did not discriminate. While a manslaughter is a bad thing, a mass murder is far worse. As we can objectively discriminate between a drunk driving fatality and Josef Stalin, so we also can scientifically discriminate between how lethal different types of smoking are.
For example there are hardly any cases of lung cancer among cannabis smokers, even if we can all agree that smoking anything is not healthy, it is far less lethal to smoke cannabis than it is to smoke, say, Marlboros.
In the same way, it is far less lethal to smoke natural tobacco than it is to smoke any mass produced national brand cigarette produced by Phillip Morris. But let me be clear to the curious: do not smoke. Smoking is very bad, and is made far worse by addiction. Once addicted to the nicotine levels in national brand cigarettes, it overwhelms the individual's agency to choose not to smoke. Nicotine addiction robs you of free will.
The only speculation I have made is why, that I believe the smoking gun for cigarettes causing lung cancer rates to skyrocket among smokers is the intentionally added 300+ known carcinogens, which started in the 1950's.
What is insidious is this all came out in the 1990's government case against Big Tobacco, the production methods and the chemical additives, all of it. Big Tobacco was fined, but they were not restricted in their production methods. They paid some of the fine, but the remainder, iirc more than half, was forgiven in the early 2000's. If the government wanted to make a dent in the cancer rates of smokers, they would have dismantled the industrial processes of producing those weird and bazaar things everyone calls cigarettes and incorrectly believe are filled with tobacco.
Tobacco has been demonized unjustly (and smokers, who are all victims, right along with it), because while tobacco has certainly killed, it's not as many as you think, while the substances that definitely have killed exponentially more continues to slip by unnoticed, the intentionally added chemicals like hydrogen cyanide, formaldehyde, ammonia. Hopefully we can agree that smoking hydrogen cyanide is worse for your health than smoking natural tobacco. And if we can agree on that, maybe we can also agree that it would be better for smokers, if they are unable to stop, to smoke instead just about anything other than national brand cigarettes. Maybe if we're just a little more honest about what has happened and continues to happen, we can reduce suffering and keep these poor souls around a little longer, and even if it is just a little longer.
Lung cancer was linked to smoking well before the 1950s, there were people who noticed the link almost half a century before. If you look at a graph of tobacco consumption per capita from 1900 to 1950, the shift away from chewing tobacco and to smoking tobacco easily explains the rise in lung cancer rates.
>What dramatically increased consumption was that nicotine levels were intentionally drastically increased, and nicotine was intentionally made more addictive by chemically freeing it from its molecular base. Since the 1950's smokers of national brand cigarettes are literally freebasing nicotine. Along with the massive advertising budgets of Big Tobacco, it was a one-two-three punch that caused the peak of "tobacco" use in the 1960's. Mass production was incidental.
Cigarette consumption increased exponentially from 1900-1950 and then the growth dramatically slows starting around 1950. Clearly the acceleration in growth happened and then reversed well before any changes to cigarette manufacture in 1950.
>For example there are hardly any cases of lung cancer among cannabis smokers, even if we can all agree that smoking anything is not healthy, it is far less lethal to smoke cannabis than it is to smoke, say, Marlboros.
Chewing tobacco causes oral cancer, this link was made all the way back in 1903. Clearly there is something different about tobacco, natural or otherwise.
There are precisely zero studies showing that natural cigarettes are less likely to cause lung cancer. The only evidence you have is that lung cancer rates increased after 1950, which is also explained by the dramatic rise in smoking tobacco between 1900 and 1950. "Natural" pre 1950 chewing tobacco was suspected to cause oral cancer in 1903.
"Natural" pre 1950 smoking tobacco was suspected by many to cause lung cancer in the 1930s. In 1939, over a decade before the "chemical revolution" of the 1950s, Franz Hermann Müller, published an epidemiological study linking smoking to lung cancer. In 1943, another larger study by Eberhard Schairer and Eric Schöniger reached the same conclusion.
Clearly smoking cigarettes causes lung cancer, whether they are pre 1950 "natural" style cigarettes or not.
> Lung cancer was linked to smoking well before the 1950s, there were people who noticed the link almost half a century before. If you look at a graph of tobacco consumption per capita from 1900 to 1950, the shift away from chewing tobacco and to smoking tobacco easily explains the rise in lung cancer rates.
https://econpapers.repec.org/article/agsuersja/144742.htm
You are grossly exaggerating with your assertion that any link was noticed "well before the 1950's," when the earliest historical evidence points to the late 1940s. What "people" noticed a link between lung cancer and cigarette smoking in 1850? I believe you invented this out of thin air. The Industrial Revolution also easily and more thoroughly explains the graph in that paper released when? Oh, 1956. Thanks for driving my point home.
> Cigarette consumption increased exponentially from 1900-1950
A four-fold increase indicated by the graph you cited is not an exponential increase. Again, you are exaggerating intentionally and deceptively.
Your claim is again deceptive. The association published in 1903 was between oral cancer, tobacco, and poor nutrition. Regardless, this is a straw man argument, as I've never argued that chewing tobacco causes lung cancer; my argument only concerns smoking what is in national brand cigarettes verses natural tobacco.
>>Results: Under intense smoking conditions, nicotine in smoke of NAS cigarettes averaged 3.3(±0.7) mg/cigarette, compared to 2.4(±0.4) in other brands.
Oddly, the study does not name any of these "other brands," nor defines what intense smoking conditions actually means, but it doesn't sound like average or normal smoker behavior to me. It seems obvious this study was funded by Big Tobacco in order to level the playing field with Natural American Spirits. Big Tobacco has been going after and suing independent natural tobacco producers and retailers ever since they came on the market.
> There are precisely zero studies showing that natural cigarettes are less likely to cause lung cancer.
If true, do you even realize what this means?? Absolutely nothing. But your claim here is, in fact, false. I have already cited the Surgeon General's report, Smoking and Health, which thoroughly proves otherwise.
> The only evidence you have is that lung cancer rates increased after 1950, which is also explained by the dramatic rise in smoking tobacco between 1900 and 1950.
You are deeply confused about the meaning of rates, because your claim makes no sense. Tobacco lung cancer rates prior to 1950 are what they are. Regardless of how many people were smoking, the rates would remain flat had nothing changed. Increasing the number of smokers does not increase tobacco lung cancer rates among smokers. After the 1950s, the tobacco cancer rate itself increased dramatically among smokers. That strongly suggest something changed with the product in the 1950s. Again, more people smoking doesn't increase the possibility of lung cancer in any of them. The chances were what they were, but the odds of a smoker getting lung cancer notably increased in the 1950s.
> "Natural" pre 1950 chewing tobacco was suspected to cause oral cancer in 1903.
I have no idea why you are going on about chewing tobacco other than to advance your straw man arguments.
> "Natural" pre 1950 smoking tobacco was suspected by many to cause lung cancer in the 1930s. In 1939, over a decade before the "chemical revolution" of the 1950s, Franz Hermann Müller, published an epidemiological study linking smoking to lung cancer. In 1943, another larger study by Eberhard Schairer and Eric Schöniger reached the same conclusion.
Again, you are inventing. Every study I have seen spotlights the 1950's, more accurately the period between 1949 and 1956, as when the first valid scientific studies regarding this correlation appear. And who really can tell when Big Tobacco companies began treating their product with deadly chemicals? The 1950's Chemical Revolution was driven by DuPont and pharmaceutical companies, is somewhat specific to the increase in use of prescriptions and plastics. The Chemical Revolution proper has its origins in the 18th Century. Also, not for nothing, that famous Müller study has been debunked.[1]
> Clearly smoking cigarettes causes lung cancer, whether they are pre 1950 "natural" style cigarettes or not.
Not according to the US Surgeon General's report, Smoking and Health, that I have already cited.
Your argument seems to be that smoking natural tobacco is precisely as lethal as smoking a partial tobacco product that has been infused with over 300 known carcinogens, when my argument is the precisely the opposite. My argument boils down to this: more lethal products are more lethal. I am astounded that you can not accept this.
> On the other hand, a person smoking 1 or 2 cigarettes near me is actively harmful to my health.
This would be impossible to verify and strains credulity. People have gotten a little too comfortable making outlandish claims about the effects of secondhand smoke.
This is incredibly easy to verify, and is a daily reality for quite a lot of people. Some of whom I love a lot and I get to see first-hand the impact on their life.
> On the other hand, a person smoking 1 or 2 cigarettes near me is actively harmful to my health.
I think you have a strange way of placing responsibility, because I am nearly certain what is actively harmful to your health is choosing to remain in the proximity of someone that smoked not only one cigarette but more than one. We know why they're smoking: they're addicted to nicotine, and it's unlikely they chose to become addicted. Why would you linger near them? Is it peer pressure?
Because they linger near the entrances of buildings, or are otherwise in a place I would like to be.
If someone walks around swinging a chain, so that everyone who doesn’t want to be hit has to run away from them, would you say that’s is my fault when I get hit?
> Because they linger near the entrances of buildings, or are otherwise in a place I would like to be.
If the smoke doesn't alter your desire to be there, then it is still your choice to be there.
> If someone walks around swinging a chain, so that everyone who doesn’t want to be hit has to run away from them, would you say that’s is my fault when I get hit?
This is both the weak analogy and straw man fallacies in one.
> Talk about victim blaming.
One can believe you were offended, briefly, when they initially lit up, but once you stayed after they continued to smoke near you and completed their smoking, and then smoked a second cigarette, unless you were being restrained and prevented from leaving, then you were not being victimized. Once you chose to remain, you are stubbornly victimizing yourself. It is your choice to be offended when it is easy enough to walk away. Smoking is legal, and there are no stand your ground laws concerning it. If you were legitimately being victimized and you had the ability to move away, if you were rational, that is exactly what you would do. It would be similarly absurd for the smoker to be offended that you stayed within their secondhand smoke. You are in charge of you and not of them.
The fact that I can avoid harm by leaving the place where I otherwise want to be doesn’t mean that the person causing harm bears no responsibility. This is known in my he literature as the “Bart Simpson I’m just walking towards you swinging my arms defense”.
It also doesn’t change the fact that I am annoyed that I have to leave the area I otherwise desired to be in when someone else decides to smoke.
In most of the US smoking near the entrance to a public building is in fact illegal.
If I am waiting under an awning for an Uber in the rain and you decide to light up, you are an obnoxious, asshole, scofflaw who is actively harming me. Despite the fact that I choose to accept that harm rather than stand in the damn rain.
These are all straw man arguments and not mine. And these arbitrary decisions you describe are just as irrational and exhibit just as much entitlement as the smokers that you allow to aggravate your paranoia and are apparently stalking you. I trust you drive an electric car, because if your vehicle has an exhaust, and if you've ever parked with the engine running, the hypocrisy here is overwhelming.
I'm not going to pull up statistics based on arbitrary consumption thresholds, but I would reason there are way more consumers of alcohol around me than smokers. Yet the number of times I've had to bear nuisance from smokers vs from drunkards is higher.
Generally speaking, (here) smoking is forbidden in most indoor-ish spaces - which is the only reason smoking is anywhere close to the same level of nuisance as drunk people. Note that the same people that would enforce "no smoking" can also do something about the "practically unbearable" drunk person. And in outdoor-ish spaces, you can often avoid being affected - except in e.g. restaurants, where someone chain-smoking on the neighbor table can ruin the evening.
Ever met a binge drinker? I have, starting at university. Find one of those people and ask them if drinking one beer makes them want to drink more. I think you might be surprised by the answer.
That does not support the claim that avoiding or stopping drinking lightly/socially will make you less likely to die or less likely to have disease. Drinking at all is associated with other unhealthy behaviors, alcohol drinking is just easy to tease out of data, but not necessarily causal. If you are a healthy person with healthy behaviors who drinks lightly (probably almost everyone reading this thread), there is no evidence that mortality or morbidity are increased with light drinking.
You really believe that light alcohol consumption carries no risk?
For example, no one has ever, in the history of humans, had a single beer which has impaired them enough to get into a fatal crash? Even a single such accident would raise the impact of alcohol above the baseline by some tiny amount.
Perhaps the impact is minimal but it certainly exists.
That's a pretty strong claim there. Yes you are right that alcohol has a role a social lubricant. But to claim not having leads to being lonely at home is extreme.
I’m absolutely not implying in any way that alcohol is needed to make social connections. It’s just a fact, either in scientific research and historical research, that it helps tremendously.
You are fine and that’s nice. But my thinking was about people who struggles to socialize and suffer from it.
From a health perspective, are those people better alone at home or should they profit from the alcohol properties, even at moderate doses to create better connections ?
The question is important because socialization is important for your health. It greatly reduces stress and anxiety, it improves self confidence, and more generally, it gives you more luck in life. COVID lockdowns impacts on mental health are real, for example.
You seem to don’t drink alcohol (which, again, is perfect) so maybe you don’t know that its social lubricant effects (making shy people talk without anxiety, if you want) are effective at really low dose, way before being drunk.
You can socialize without alcohol and you should, like people do literally all the time. Imagine being able to talk to others only when you are "socially lubricated"... a slippery slope for alcoholism.
Struggling with socializing is a matter of being inexperienced at it, like you would struggle to play guitar or to swim if you've never done it long enough to be at least proficient at them. Luckily socializing is one of the few things we've been doing since we were born so we got a degree of experience there.
If the struggle comes from having underlying issues that undermine your ability to socialize, say, lack of self esteem, depression or any other mental health issues, those need to be addressed as well and drinking is not going to solve them.
Actually those conditions will most likely improve by socializing without alcohol. Alcohol is just a false friend.
As a moderate outgoing and sober person, alcohol actually makes me shy, it numbs me down and takes away the edge I've been sharpening all my life. In other words it prevents me from actually be myself.
20 years ago in college and while in the military I drank and partied like everyone else, and have all the stories to go with it -- so I'm extremely aware of the theoretical social benefits
Looking back however, there were really zero added benefits to the relationships that were "lubricated" by alcohol that we couldn't have gotten had we put more effort into doing something creative or actively community building - rather than going out to drink and flirt. All of my best relationships were formed this way.
In fact if I think of times I was aware of or involved in when bad things happened (luckily I never had any problems personally) - alcohol was almost always involved.
At this point I will always prefer figuring out something interesting to do instead of contributing to "drinking culture."
I didn't claim that. We are talking about population level trends, not individual anecdotes. The question is: does light drinking cause people to live shorter or worse lives overall? The answer is: we have no idea, and the answer may be that it has the opposite effect.
You have no idea of the actual baseline though. Perhaps the effects of one glass of alcohol on blood pressure and some random internal protein already give light drinkers an average extra three days of lifespan, which would far outweigh your one time a beer killed someone.
There's reason to believe those earlier studies used flawed methodologies:
> But there was a problem with many of these studies: They compared drinkers to non-drinkers, instead of comparing only lighter drinkers to heavier drinkers. And people who don’t drink are pretty fundamentally different from drinkers in ways that are hard to control for in a study. Their lives probably look dissimilar.
> Most importantly, they may be sicker at baseline (perhaps they quit drinking because of alcoholism, or because of a health issue like cancer). And something in these differences — not their avoidance of alcohol — may have caused them to look like they were in poorer health than the moderate drinkers. (This became known as the “sick quitter” problem in the world of alcohol research.)
> Lately, researchers have been trying to overcome that problem by comparing lighter drinkers with heavier drinkers. And the benefits of modest amounts of alcohol wash away.
And that even moderate amounts of alcohol are harmful:
> Their findings were stark: Drinking more than 100 grams of alcohol — about seven standard glasses of wine or beer — per week was associated with an increased in risk of death for all causes, they concluded. In the US, the government suggests men can drink double that amount — up to two drinks per day — but advise women who are not pregnant to drink up to one drink per day.
> A person’s risk of death shot up as they drank more. The researchers used a mathematical model to estimate that people who consumed between seven and 14 drinks per week had a lower life expectancy at age 40 of about six months; people who drank between 14 and 24 drinks per week had one to two years shaved off their lives; and people who imbibed more than 24 drinks a week had a lower life expectancy of four to five years.
My sort of baseline here is that nobody would think twice about this if they weren't motivated to justify continued consumption. It's fairly obvious that it's bad for you.
That's already heavy drinking in my book; drinking every day of the week, or binge drinking at least once every week? Somebody drinking that much already has a clear habit and is probably developing an alcohol tolerance, a major step towards alcoholism.
To me, a light drinker is somebody who has a drink on special occasions but not otherwise. One drink a week or less, so they're going several days if not weeks between drinking. I suspect the long-term harm from that is next to immeasurable.
Alcohol is enjoyable and I prioritize happiness and satisfaction. I’ll gladly trade in some risk for a delicious beverage and a buzz every once in awhile.
Smoking is also enjoyable and gives people happiness and satisfaction. That isn't the point.
The point is that cancers caused by drinking/smoking/being obese are preventable by behavioural changes.
I’ve seen estimates of the increased risk of cancer from drinking at about 10%.
But it’s really hard to find actual estimates, most web searches just turn up the same ‘all drinking is bad’ message. I suspect the effect is small enough to be difficult to quantify.
Whereas some research puts the risk increase for getting lung cancer from heavy smoking at 2000%, or more. Twenty times the rate of non-smokers.
> And we're trending the wrong way on obesity, too.
It's absolutely creepy how there's a constituency of people who are upset by any scientific possibility that fat people could be relatively healthy, or be made relatively healthy, without losing weight. The desire for fat people to conform or be punished, damn the science, is fetishistic. That's the only motivation I can think of for being upset by the exploration of the precise effects that being fat has on health.
I'm nowhere near fat right now, but if there were an injection that saved fat people from insulin resistance and inflammation, the farthest thing from my mind would be to get upset about it. If you believe that gluttony is a mortal sin, no need to be upset if the only ways fat people are punished on earth are cardiovascularly, through their knees, and through the aggression of bullies; your deity can punish them after death for not eating as moderately as you would have preferred.
I don't necessarily disagree, because yeah, having lots of adipose tissue doesn't necessarily mean anything is wrong at the moment. In my experience, the perpetually healthy fat person is a rarity. The possibility of being fat and otherwise healthy is used as an excuse the vast majority of the time to not actually address one's own health. If someone is fat, it would really be a good idea to get a DEXA scan to confirm that they don't have too much visceral fat. As any one who's pro-fat or body positive if they know what their level of visceral fat is and chances are they couldn't tell you what visceral fat is.
There should be a reasonable medium where fat people aren't outright shamed for being towards one end of the bell curve but red flags for unhealth aren't ignored for the sake of other's feelings. America and now many parts of the west are facing various health crises to such an extent that I don't think obesity should be brushed off as perhipheral to other problems. Being fat has many comorbidities, and just focusing on losing fat is usually the best way to address those issues.
> I'm nowhere near fat right now, but if there were an injection that saved fat people from insulin resistance and inflammation, the farthest thing from my mind would be to get upset about it.
I agree, and there kinda sorta are medications currently available that would tremendously help. Off the top of my head, I don't know what it's called, but I know some people who've been on next-generation medications for obesity that target the ghrelin-leptin balance, basically correcting one's sense of hunger and satiety. Having seen the results myself, it works insanely well.
On the other hand, solving obesity with a pill still has some moral issues. If everyone could just consume anything they want in massive amounts and not get fat, I don't think that's really good for a person's psychology in a similar sense that giving someone a bunch of money often doesn't end well. It's not a scientific argument, but a philosophical one; I know. Such drugs may also give someone the idea that they can just eat whatever they want because they don't gain weight, but just because you don't get fat doesn't mean there aren't other consequences to eating lots of sugar, carbs, odixated oils, etc.
The question should be why we are so fat now. But that would mean believing that experts can be compromised and that a century of nutrition policy has been a failure, which many people aren't ready for. Just my opinion.
Workplace exposure to carcinogens is another major factor, as the article notes:
> "In 2019, half of all male deaths from cancer, and more than one-third in women, were due to preventable risk factors including tobacco and alcohol use, unhealthy diets, unsafe sex and workplace exposure to harmful products, such as asbestos. From 2010 to 2019, global cancer deaths caused by these risk factors increased by about 20%, with excess weight accounting for the largest percentage of increase — particularly in lower-income nations."
> The researchers used ‘unsafe sex’ as a proxy for cancer risks associated with human papillomavirus (HPV) and other sexually transmitted viruses. Cervical cancer, which is caused by certain strains of HPV, is the leading cause of cancer deaths among women in sub-Saharan Africa.
HPV also plays into a variety of other cancers (throat/mouth, anal, penile, vaginal). Though cervical cancer has by far the strongest link.
It's a good thing we have a vaccine for several of the cancer-causing HPV variants now. It's essentially a vaccine against some cancers -- I would get it if you can.
and yet we run into a strong religious resistance because if some skewed logic around HPV vaccine => wanton premartial sex. Once again the patriarchy strikes.
There's quite a long list of viruses which have a knock-on effect of increasing cancer risk, although often by indirect routes. HIV of course damages the human immune system, and one immune function is the detection and elimination of cells that have escaped the normal cell cycle control (i.e. potentially cancerous). Hepatitis damages the liver and (often in conjunction with alcohol use) that can raise chances of cancer. HPV I think has a more direct effect, in that the virus actually can integrate into DNA and potentially (depending on the specific strain) disrupt cell cycle control. Here's a list:
HPV causes a wide variety of cancers, and we are learning more all the time. (I'm still furious that this is not a population wide vaccine, and is so limited in its availability.)
Epstein Barr spreads primarily through saliva, and also causes 1-2% of cancer, the last time I checked. So that could spread from unsafe sex, but it could also come from picking up slobbery toddler's toys.
There's a whole world of virus and infectious disease that is only becoming visible because of the huge advances in nucleic acid sequencing and other massive biotech advances. We may find lots of surprises in the coming decades from this new technology.
I would assume they are talking about HPV which causes cervical, oral, and other cancers effecting men and women.
Condoms are at best ~70% effective at preventing HPV transmission so the “unsafe” part doesn’t really strike me as apt. Generally everyone who is sexually active has at least one strain of HPV.
HPV vaccination seems like the optimal strategy. It’s so weird to me that initially it wasn’t even offered to boys.
I have been smoking for close to 15 years now and I'm 40. I still struggle with quitting smoking even though I tell myself daily today is the last day.
I can recommend to read Allen Carr's "Easyway to stop smoking" if you haven't already. I had been smoking for 15 years total as well, tried to stop at least 6 times (sometimes for 18 months, with the help of Nicorette and e-cigs) and was telling myself "today is the last day" every single day. But I was constantly tempted and was always picking it up again. A lot of ex-smokers I knew kept recommending me this book with almost magical claims.
I finally begrudgingly read it and stopped from one day to the next. The craziest thing is that it was actually easy to stop this time and gave me great satisfaction. I have stopped for 2 years now and am confident that I will never smoke again (contrary to all other attempts).
I'm not a smoker, but know many, many people who are legitimately addicted to tobacco. What is it about the content of this book that made such a change in you? I'd love to hear about your experience - it sounds like an extraordinary approach if it indeed works as well as you're saying, which makes me think it's some kind of written neurolinguistic programming thing, a technique that could be helpful in a lot of other situations.
I don't smoke, but my understanding of that book is that it basically reprograms your associations re: smoking and quitting smoking.
Before you read that book, quitting smoking is perceived as a loss of something that made you feel good. The permanence of this loss -- the anticipation of living the rest of your life without this source of comfort -- leads to cravings.
What the Carr book does is install a new set of associations: smoking is disgusting and your life is going to be so much better once you free yourself from this completely unnecessary weight that's been dragging you down. Instead of viewing quitting as the loss of something good, you learn to view it as the act of freeing yourself from something bad. Now, when you think about a future without smoking, the anticipation is positive: you get to live the rest of your life without this terrible thing intefering with it! And all you have to do is just stop doing it! Sure, you might have a little bit of physical withdrawal for a little while, but isn't that worth it to be permanently free of this awful thing that's been ruining your life?
That's the basic gist, as far as I can tell. In a way, it's just about being optimistic about a life without cigarettes instead of pessimistic.
That's a very good summary of the approach. It stems from the observation that every single smoker already know about all the reasons they should not smoke (health, financial, social,...) yet they still do it.
You know it's probably going to kill you, you know it costs a lot of money and you know it's anti-social. The book wastes no time trying to convince you about those things. However, it dispels in a very systematic and repetitive way all the positive myths you believe (or repeat to yourself) about cigarettes ("the brainwashing"). It does not actually relax you or bring you pleasure, it just relieves a nicotine addiction and allow you to get back to a state you already had before smoking. It does not taste good. It does not help you focus. Nicotine withdrawal is actually extremely mild. Etc.
As the parent comment explains it's a re-framing, a change of paradigm. By the end of the book I could very clearly see that quitting would not be a sacrifice or "a pleasure i would loose" but something that would make my life better. And to be honest, this has felt like magic. A few days after finishing the book I just threw my pack in the trash and it really has been easy and at times actually even pleasant to quit. Every cigarette you do not smoke brings you a feeling of pride, accomplishment and liberation.
Thank you for this comment, as a non smoker, not fat person, this is probably the most helpful comment of the week ! I made a [Ask HN] post [1], to solicit further tips.
I finally quit by using e-cigarettes which allow you to reduce the amount of nicotine gradually. Once you're at zero nicotine it's really just a habit that's quite easy to get rid of. One day you will forget your e-cigarette while going out and, surprisingly, it won't matter any longer.
It's important to switch from cigarettes to e-cigarettes exclusively and abruptly though. I have friends who tried to switch slowly and just ended up smoking both.
Once I used e-cigarettes I quit entirely within months. And it felt easy.
One thing I've seen work for people is making a significant investment into a smoking counter measure. Extreme example, hire a personal trainer for $75/hr and go to the sessions 3x per week.
Now you are investing $225/week into your health, and you're going to want to get maximum ROI from that investment, right? Well, smoking is diminishing that ROI. Secondly, you have someone encouraging you to do the best possible work you can do with your body every time you go to a session. You'll naturally want to avoid disappointing that person. You'll also want to see continued progress in the results they are measuring. Smoking will impede that progress, and again, minimize your ROI.
This worked for someone very close to me after everything else failed. Incidentally, that person stopped going to the trainer after a while, but only after quitting "stuck". Good luck in your journey and never quit quitting.
The older you are when you smoke, the worse it is for you. Smoking in your twenties is far less harmful in terms of its likelihood to cause cancer than smoking in your forties, fifties, or sixties. The damage gets worse with every decade of your life.
Just stop. In five years' time, you'll wonder why you didn't stop sooner.
Not a smoker but my initial reaction to you is probably pretty close to that of a smoker, and not particularly favourable. How can you possibly think that a deeply physiological addiction is going to respond to either logical arguments or simplistic slogans? Once you fix smoking, can you please stop the opioid crisis?
This is like programmers being asked to debug something, sneering back "you think this deeply complicated distributed database problem could be caused by an off-by-one error, pfft, what do you know?" and then just ... not debugging it.
> "How can you possibly think that a deeply physiological addiction is going to respond to either logical arguments"
Would be great if today actually is the last day! Maybe visit this post everytime you get an urge? Don't bring a pack with you. Make it a nuisance to even access one.
I would look into varenicline (chantix), talk with a doctor. I know some people will bring up incredibly rare side effects as reasons not to try, but I think those are sort of like plane crashes, they happen sometimes and cause a very visceral response, but the majority of people will do fine flying on a plane. Also, smoking will contribute to an early death, so the risk benefit calculation makes sense to me.
You have some good news because recent longitudinal studies show a 90 percent reduction in cancer risk if you stop at 50. 80 percent if 50. If you're older than that, your body can't keep up the same.
It seems possible that articles like this which help quantify the risk might do more to change behavior than the vague understanding that smoking, drinking, and being overweight are "bad for you". Many people will have had family or friends who developed cancer and if lucky, endured harrowing treatment and lived. Or did all that and didn't survive. Connecting those dots is a powerful motivator.
Is it? I think in the US that connection is quite well known, and yet I have seen people lose parents and grandparents that way and keep eating McDonald’s at a prodigious rate.
It used to be true that people know these three are bad, but this changed a few years ago when aggressive corporate marketing on the "body positivity" changed the perception about big BMI incredibly, many people these days believe it is perfectly healthy to be seriously overweight. I am quite upset by the marketing around this matter, it is ruining lives.
Smoking and alcohol consumption are behaviors. Obesity is a condition and what behavior can change it is subject to intense debate and not at all settled imo.
Consuming less calories is the behavioural change that will reduce obesity. The problem is that people only do this temporarily and then start eating at a surplus again, which makes them put the weight back on.
If someone quits chain-smoking they'll feel healthier, lose their cough, improve their aerobic capacity etc. If they go back to smoking they'll go back to feeling how they were.
It's the same with obesity - doing short stints of dieting is like quitting smoking for a couple of months and then starting up again.
The reason it's not in there is because almost no one dies of basal cell, the most common skin cancer. Malignant melanoma is another matter, but that is much more rare, and also quite treatable.
I've had several myself and know lots of other people who have, too. They're handled via outpatient surgery and there is no followup.
It could be argued that smoking, alcoholism, and obesity are all means of coping with a high stress lifestyle. I wonder how many more people would die from other reasons if they were no longer able to use those coping mechanisms. Or maybe more importantly, how much total happiness would they have in their life if they had the extra time. I say this as a fairly recent cancer survivor if that matters.
edit:
Does anyone know if psychologists or sociologists have a formula for quantifying happiness? Something like mechanical advantage. It seems intuitive that certain behaviors can act like a fulcrum by increasing happiness now at the expense of sadness later, either born by you or those close to you. I'm sure we've all had smokers joke that you can keep the last 20 years of life, maybe they're on to something.
I think if people didn't have smoking / drinking / overeating as coping mechanisms they might find healthy alternatives like exercise / altruism / creativity. Look at seventh day Adventists in Loma Linda (not a member myself), they live a long time and are very happy. For many, the last 20 years are only miserable because they didn't take care of themselves. It's possible to be 80 and active / healthy/ happy.
As a cancer survivor and former alcoholic, I am one example of a person who has found healthy coping mechanisms.
Instead of coping with alcohol, I read math textbooks and do problems.
This has improved my life dramatically. I feel good. I feel proud. And despite optimizing for happiness as opposed to wealth, this coping strategy has made me loads of money.
I should mention my cancer occurred in my childhood, so it's not as though my drinking was a cause.
>For many, the last 20 years are only miserable because they didn't take care of themselves.
Considering that about 40 million adult Americans are on anti-depressants (smoking and drinking aside), it seems like more of an issue then just failing physical health of the elderly.
Fair, I thought I was replying to the idea that old age must be miserable, but on re-reading I see that the poster I was replying to may have meant something else.
Still, smokers not wanting the last 20 do themselves a disservice by disabling themselves and their hopes of redemption. They often do not die sudden deaths that bring them respite, instead many spend years struggling for breath hooked to oxygen tanks. I think these initially rebellious smokers see themselves as going out in a blaze of glory, but COPD is anything but.
> It could be argued that smoking, alcoholism, and obesity are all means of coping with a high stress lifestyle.
Hate to be that guy, but two of the 3 above are easily handled by simply not starting at all. People who don't start do not get the urge to go to these when under stress.
Addressing stress is a lot more difficult than simply not starting. In the US, the rate of tobacco use continues to drop, and it is an outcome of a fairly significant campaign. Put all those resources into reducing stress and you simply won't move the needle.
Virtually all deaths from solid cancers are preventable with routine scans to find tumors before they metastasize. Doctors have for decades refused to learn to use this technology.[1-4][5-9] *
Meanwhile, population studies like the one this article is based on[10] are horseshit because they are subject to unknown degrees of sampling bias, rely on enormous assumptions (such as linear relationships which may not hold at all being applied over many orders of magnitude), and cannot in any case establish causality.
* Compare the experience of getting an x-ray from a dentist to getting one from a doctor. Or getting an ultrasound from an OB to getting one from any other doctor.
Your first four links are just random ultrasound device companies. Doctors are very well-versed in ultrasound technology so your claim that doctors refuse to learn this is patently false.
Full-body scans have been marketed for years by companies looking to drum up business for their machines, but they mostly lead to false positives. Notice how your fifth link clearly says it has helped people find “warning signs of potential cancer” instead of that it helps people find cancer? These machines are basically false positive generators in most cases. If someone had effectively infinite time and money to dedicate to routine cancer screenings from these machines, they are more likely to end up harmed by unnecessary procedures stemming from false positive results than they are to catch and remove a specific cancer occurring randomly in their bodies.
Contrary to your claims, we do actually screen for certain cancers in cases where a clear net positive benefit can be demonstrated. Mammograms for breast cancer are one common example.
Doctors definitely aren’t just burying their heads in sand. These are common research topics and the tradeoffs of false positives are constantly being investigated. Full-body screenings aren’t necessarily a net benefit.
There's also a lot of politics and social psychology involved in these things. From the government side, it can be decades between arranging, deploying and evaluating large scale, population-wide cancer screenings. These are timescales on which scientific consensus can easily change. Mammograms in particular are a touchy subject, since newer metastudies only show a statistically significant reduction in mortality for women above the age of 50 and below the age of 74 [1]. However, many policy makers still offer screenings starting at the age of 40 with no upper limit, despite evidence that annual mammograms will result in a false positive result over 10 years with up to 61% probability [2]. Below the age of 50, regular mammograms may even increase the risk of dying from breast cancer [3]. Ultrasound screenings on the other hand would be much safer from a radiation-exposure point of view and metastudies suggest they can detect cancers under difficult conditions more reliably, but they also suffer from more false positives [4]. This is where the social aspect comes in, where many woman fear getting their breasts removed for no reason. This is especially concerning when more than 50% of positive results are found to be false positives [5]. To summarize: It's really hard to figure out what amounts to "net positive benefit" when it comes to general public screenings.
> Contrary to your claims, we do actually screen for certain cancers in cases where a clear net positive benefit can be demonstrated. Mammograms for breast cancer are one common example.
Not really; mammograms for breast cancer are commonly seen as an example of overscreening.
What is your medical background? I am a physician and do not agree with your thesis. Linking to ultrasound websites is not really evidence of anything.
There simply isn't good evidence that "all solid tumors caught early are curable." Some cancers, like localized breast cancers and certain renal cancers, are highly curable when caught early. Some other non-solid cancers like certain pediatric leukemias are also extremely responsive to therapy and highly curable. Conversely, some solid tumors, even when caught early, have dismal prognosis due to micrometastasis and the underlying biology of the tumor. I would recommend "The Hallmarks of Cancer" for a high level overview of the current understanding of what drives cancer: https://doi.org/10.1016/j.cell.2011.02.013
He has no actual clue, thats for sure. On top of all correct items you mention, some stuff is completely benign and should be left alone. Nobody will know that until operation or other, very invasive procedures are taken which have their own risks anf consequences.
Especially at older age, many things killing slowly are just too slow and other items will surpass them in achieving that kill, ie prostate cancer in basically all men (according to a close friend who is swiss urology surgeon its only question of time we all males get it, but most of the time you dont know about it and it progresses super slowly).
There are many things like this. That doesnt mean there isnt a room for improvement. I have some bad experiences too, but my wife is a doctor and medicine is HARD, every case properly unique. IT and stuff google et al do is trivial and deterministic by comparison.
We all would like this idea that medicine can cure it all, but we are far, far from it. But some folks apparently just love reading "10 things THEY don't want you to know about XYZ" articles and actually believe them.
Does a physician have a globally optimal understanding?
Do you actively read medical journals? Developments in biochemistry? Even amongst the best read physicians and researchers, I would bet my life that we're doing a lot of things suboptimally or have improper understanding of many diseases.
I'm not trying to belittle your understanding or your credentials, which I understand to be far better than untrained laymen.
The current state of medical care leaves a lot to be desired. We have a long way to go to detect and cure every disease state.
If more money is spent on developing better tooling, assays, imaging, etc. we will undoubtedly improve patient outcomes.
> Does a physician have a globally optimal understanding?
I’m far more inclined to trust a trained physician than a random HN commenter whose first four citations are just random ultrasound device manufacturer websites. The parent comment makes bold claims and tries to overwhelm the reader with non sequitur citations, but it’s clear they don’t actually understand the subject matter.
While I agree with your premise, how the hell do we know the parent is a trained physician? This is an anonymous forum. Without a long, elaborate history on HN or public credentials, to be of meaningful value in terms of trust (in the context we're discussing) the reply needs to bring a lot more to the conversation than a one line statement and claim of being a doctor. Maybe they are a doctor, great: they can add a lot more to the counter reply if so, information that they are in theory particularly equipped to discuss.
> While I agree with your premise, how the hell do we know the parent is a trained physician?
We don't know, but it doesn't matter. We can go to websites like the BMJ and see trained physicians and researchers saying the same thing across a range of different articles.
We can go to research organisations like NICE, or Cochrane, or the UK National Screening Committee to see doctors and researchers saying the same thing. For mass screening, the harm often outweighs the benefits.
A globally optimal understanding would involve far more than biochemistry and medical journals - population analysis, behavioral economics, regular economics, risk analysis, and a crystal ball would all be needed to avoid "doing a lot of things suboptimally". The fact that you haven't even mentioned those fields of study makes it clear you're not familiar with even the scope of the problem, let alone how to solve it.
Hell, we could improve patient outcomes enormously by paying for everyone to receive basic dental care, today.
Routinely scanning people without symptom or otherwise cause for concern is not a good idea. The human body is very messy and variable, and it's hard for anyone or anything to reliably spot thing that are actually worth acting on. If the doctor spots a vague blob - how can they know what it is without any symptoms? The course of action is then "come back in three months for another scan."
Subjecting a population to unnecessary routine full body scans, especially with radiation, will cause harm statistically. There are also countless examples of people undergoing unnecessary operation and suffering complications, like losing a perfectly fine healthy heart and requiring transplant.
We need yearly scans or even monthly scans (MRI) for everyone. Privacy concerns aside, I think we would learn an awesome lot. We could then monitor changes over time and machine-learning could probably get really good at recognizing what changes are harmless and which are harmful and need a doctor to look into.
It's a dream scenario, but maybe some day it will be like that. Or it will be like that and be dystopia. :)
That's not really going to help. For an MRI, you have to lay there being still, and for some you have to hold your breath, all while in a loud little tube. I have to get a couple every year, and I*m lucky not to find them too uncomfortable. Some folks, though, would have serious issues with the cage over your head when you get your brain scanned: Your brain and spinal column will take 45 minutes, as will other areas. You will need to be repositioned often, adding and removing things to get the pictures of all the areas.
In other words, you'll need an entire day off to do this if it is even possible for you to lay there for so long in one event, even if you get breaks. And for some folks it is going to be hours of torture.
Well, I wouldn't call them "fun tests" but otherwise that's true.
However, there is also a chance to save a lot of money by recognizing illnesses early. Sometimes it's possible to prevent a life-long need to take expensive medicamentation or it allows to detect cancer and allow for easy surgery in an early stage allowing for complete cure instead of requiring expensive chemotherapy AND surgery for a long time with a worse outcome. It might also very well prevent people from being unable to work due to illnesses if they are detected early enough.
And that all isn't even considering the changes in quality of life of course.
Yeah I think my last MRI was $800, with insurance. And they didn't find anything. I'm not exactly champing at the bit to spend the money to do that every year.
I've had like 4 MRI's total. The most recent one was I had a scare about a possible aneurism, which is what they didn't find anything for, and then had a couple for looking at my neck and back, where they found two bulging disks, one in the middle of my back and one in my lower back. And they had to check my leg for something once, maybe blood clots? I haven't needed to get one for several years now.
MRI's don't seem that great for an annual preventative check, since they are usually checking a pretty small area (or at least mine were). Like those were 4 different MRI's to check me from head to one of my calves. Getting 4+ of those a year would add up quick. And that's not even taking into account any of a myriad of other tests that could be done every year. I'm sure I could probably take a different test every week of the year, but I'd be bankrupt quick.
Why would you jump to an absurd scenario like one every week?
It would be an enormous benefit to do one MRI a year, rotating between areas of interest, at a relatively negligible cost ($500-1k or so per year - about what it costs for an annual physical).
It's extremely cheap compared to your Dr's hourly billable rate and would get cheaper at scale.
"20% of americans havent even seen a doctor in the last year"
And 80% have. The needs of the 80% are not determined by the behavior of the bottom 20%
Rich people get better everything, including better medical care. The upper 30% or so can afford better diagnostics and they should be getting those better diagnostics.
Many of us in the software industry could afford a few extra thousand a year for preventative care -- but it is very difficult to obtain care commensurate with one's ability to pay. This is a real problem.
> especially with radiation, will cause harm statistically.
Ultrasound is not radiation (as in photons). To the best of our understanding (from a physics/engg perspective) ultrasound imaging capped by appropriate energy/etc limits is expected to be perfectly safe. Likewise with MRI. If we want more pointed study to be sure of this, that's fair, but let's be clear & specific about it and commit to figuring it out one way or another so we don't repeat the same discussion a couple of decades down the line. (We have to think of moving the state of the art forward, instead of festering in unresolved disagreements)
Further, if you're concerned about under-studied possible side-effects of radiation from occasional diagnostic testing, what do you plan to do about being blanketed by mm waves once 5G gets deployed more ubiquitously?
> There are also countless examples of people undergoing unnecessary operation and suffering complications
This sounds far more serious (and fixable) compared to the physics/biology interaction of diagnostic testing. Why do we continue to bury our heads in the sand collectively, instead of trying to fix this with better decision-making tools?
MRI isn't radiation, but is sometimes used with contrast dye. People can be allergic to the dye. For one person this is a small risk. Across a population we'd be causing harm. We'd balance the risks of harm against the benefits, and so far no-one can find a benefit to routine whole body MRI scans. And if the benefit was there the MRI machine companies probably would have found it by now because it'd massively increase the numbers of machines they could sell.
MRI uses electromagnetic radiation. MRI uses a magnetic field with a radio-frequency pulse and then the protons emit a radio-frequency response - that response location is used to synthetically generate the image. MRI does not use ionising radiation. Nice overview here: https://www.nibib.nih.gov/science-education/science-topics/m...
You've misread their reply. MRI's sometimes use contrast dye. I've personally had these sorts of dyes, both on brain and spinal cord scans (I have MS and get these regularly) and for the first scan of my pancreas (non-symptomatic cyst they are watching to be cautious).
Wouldn’t the skill of analyzing scans improve if they were done more frequently?
It seems like you’re promoting a self fulfilling prophecy. Doctors aren’t good at reading scans, so scans will cause false positives.
But doctors are capable of learning and improving their skills. They will surely rapidly learn to screen a lot of false positives, thereby saving lives.
You seem to assume that radiologists currently see patient scans too rarely to deliver accurate diagnosis. That seems very unfounded to me.
"More frequent scans per patient" != "More scans seen per clinician". You would just end up having to hire more clinicians.
(Yes, your family doctor might end up seeing more scans in this scheme, but it is implausible that they would be better at evaluating them than a trained radiologist, which is who this would almost surely be deferred to anyway.)
Is the argument then that scans are intrinsically error prone, as in the noise level is so high that even a team of highly trained radiologists can’t accurately determine if cancer is present from a scan?
It's not the quality of the scan (although that can certainly be a factor). It's that there is a lot of variation in human anatomy, and "these pixels are brighter than the rest" can mean any of many things.
Relatedly, for many types of brain tumors, you simply don't know what exact kind of tumor it is until you actually do a biopsy (= you undergo surgery). This can be important information ("how aggressive is it?"), so in some hospitals it is common practice to send a tissue sample for identification and get back the result while the surgery is still going on.
This is a very naive argument, it assumes the entire problem is lack of skill and that early intervention on positive diagnosis is always a good thing.
Mammography is a really good candidate for random screening and it's still debated because of false positives and the impacts of misdiagnosis.
the screening guidelines take into account those risks and it's still deemed worthwhile because cancer can grow and become lethal despite being asymptomatic. colon cancer is the mid-life killer...plenty of ppl in their 50s or even 40s get it despite no risk factors. Screening is the only option to catch it early.
This is just silly. You are never disadvantaged by knowing more about what's inside your body. What you don't know can easily kill you, though.
Hopefully in the long term future we will have extremely cheap & frequent MRI and blood testing so you can assemble a high resolution digital history of your body. Doctors are generally not very innovative people though and they will probably resist it to the end.
It's not silly. Look at how the mammogram guidelines are set. If the scans are too frequent, the harm done from false positives (unnecessary surgeries and risks from those surgeries) can become too great. The standards were relaxed to include fewer scans in the last few years because of this.
Apply this to more invasive exploratory surgeries, and you see people dying from internal surgery complications for benign cysts and lumps.
That's because single datapoints are used to trigger intervention. We should be intervening based on growth trends from time-series data. Time-series data which can only be collected by... frequent scans.
Don't discount psychological stress. "You have something growing in your breast which might be cancer, just wait a few months and we'll scan again" is not something that gives people a good nights sleep.
So don't tell them. Like I said, a single datapoint by itself is meaningless — so you wouldn't bring it to the patient's attention. Heck, the software shouldn't flag it for the doctor's attention. (Think: metrics-based alerting thresholds in software systems.)
We do have time series data for mammograms. You may think it doesn't meet whatever standard you are setting, but it is objectively false to say it isn't there.
My standard is "doing it for everything, rather than for one thing"; and more importantly, not acting upon data about chronic disease progression, if it isn't a time-series.
In science, you don't call one datapoint "data." You call it an anecdote. Outside of emergency medicine/urgent care, medical practice should be the same.
I honestly can't imagine how you believe breast cancer is diagnosed and treated, but it's clearly inaccurate. So is the cute phrase about "in science".
You didn't understand what I said. Breast cancer screening is the "one thing" I referred to that we're doing right. But who cares if we're doing one thing right? We're doing screening for literally every other cancer wrong. And not getting any less wrong over time.
We — the medical profession in general — are aware of the proven effectiveness of time-series analysis of regular mammograms as a screening technique. However, we have failed utterly to spread this "obvious" knowledge out from the specialty that understands it and has proven its effectiveness, to literally anywhere else. We've been doing regular mammograms for decades now, but that hasn't sparked (wide) adoption of regular scans + time-series-based screening for any other cancer.
There is a certain moral culpability in that. A certain negligence of duty / not seeing the forest for the trees in what it means to be saving lives. (I hypothesize that doctors in at least some specialties, could save more lives over the course of their career by dropping their practice and instead turning into advocates for wide adoption of periodic-scans + time-series-analysis-based screens. Somewhat like would have been true of a doctor in the 1800s quitting doctoring to instead become an advocate for hand-washing before surgery.)
You're right, I had absolutely no idea that you thought we were doing breast cancer screening right. And I don't know if you're now failing to communicate your awareness of regular screening for prostate and cervical cancer, or skin cancer in higher risk locations, or if that doesn't count somehow, or what. I also don't know if you have any evidence for the existence of these other tests that we could be doing on everyone and the risk-benefit profile that shows we should be doing them, or if you're assuming such tests and evidence exists, or complaining that we haven't invented the tests that must be theoretically possible.
It can be hard to predict how aggressive a tumor will be. It isn't uncommon for people to obtain cancers that they "die with" instead of "die of". In those cases, treatment can be worse for the patient than the cancer. But since you don't know which it'll be, people get the treatment and sometimes wind up worse off than they otherwise would have.
And as the GP post cites, the scans themselves can cause health problems down the road. Performing them on massive scale will increase the occurrences of those side effects.
Knowing that there is something weird in your body sets off a cascade of medical care that easily escalates to surgery, anesthesia, medication to manage complications, side effects of that medication, time in the hospital being at risk for infection, etc. These things absolutely can kill you, or at least put you through hell. When there was actually nothing wrong with you in the first place. That is why the medical establishment is so conservative about it.
Isn't the danger of knowing there's something weird there caused by the rarity of knowing anything at all?
I'd imagine that if there was consistent, good information available, we'd figure out how and when to act on it. The real issue is the massive cost of performing any given scanning procedure to everyone alive.
The question is not even what doctors think warrants a follow up. The question is what a malpractice attorney could construe as warranting a follow up, if it turns out later to have been real.
Once a scan exists, doctors are essentially forced to act on it. If an algorithm for deciding which scan results to pay attention to were so solid that it would hold up in court, that might make more scanning reasonable on the margin? I dunno though.
I think modern medical ethics demands a physical treatment for literally everything and anything that's discovered, including quite a few that either aren't physically dangerous (e.g. atypical brains) or are inevitable (a 90+ year old with a laundry list of conditions). And, as other comments have pointed out, a panicked surgical response to a mammogram isn't based on time series data.
I totally understand and agree with trusting that medical professionals "know better", but I also would not conflate current practices with absolute perfection. It's clearly not a perfect profession or practice.
You don't have to conflate current practice with perfection. You just have to bother learning what the current practice is and why - and "it's just so rare to know anything" is not the correct answer. Just to start with basics: yes, actually mammograms are analyzed using time series data of a patients previous scans!
Full body scans, as they currently exist, are not recommended for routine-usage. These scans use large amounts of radiation. This can increase your risk of cancer. If you have more tests, your risk increases.
Further, they are costly, and often times insurance does not reimburse or cover it. They can cost anywhere from $500-1000.
Unless you find a way to make this viable for the general population and lower the radiation exposure, this will never become viable for use.
I'm a physician that uses ultrasound every shift, and I'm pretty darn good at it. I've even used one of the specific devices you linked to.
Virtually every physician I know is foaming at the mouth to learn more ultrasound and to apply it to new indications and with new approaches. Inappropriate use of ultrasound for harebrained indications (for which we have far superior alternatives) is on of my pet peeves.
I am not a cancer doc, but I am drawing a blank as to what solid tumors you could possibly be referring to for which ultrasound is the preferred screening or diagnostic technique, or what kind of conspiracy you're vaguely implying that prevents its use. IME, virtually everyone is (over?) eager to use ultrasound for every condition under the sun, and I am sincerely perplexed as to what experiences have led you to form your opinion on this matter.
POCUS is used commonly in my experience and there are large amounts of curriculum devoted to it. We haven't had affordable access to POCUS for decades so I don't see how doctors have refused to learn it for decades.
Probably not. Costs have come down immensely, most HN users could afford a butterfly if they wanted to play around with it.
Ultrasound has limited penetration for deeper tissues so you aren't going to see lung cancer with it (especially behind ribs), and overweight patients don't image as well, again because of limitations in imaging depth. Regardless of uptake it's not going to solve all our diagnostic challenges.
It also takes skill to know what you are seeing and to know how to find what you're looking for. Anyone could learn, but it's a time investment and physicians have limited time as is.
Still, it is becoming more popular and soon it won't be uncommon for your primary care doc to pull out the probe and see if your gallbladder is inflammed or if that abscess is going to be amenable to in office drainage.
"Doctors have for decades refused to learn to use this technology"
In Sweden this is actually standard practice. It's used for patients who have syndromes that guarantee them to get cancer several times over in their lifetime. IIRC some get an MRI every 6 months. The reason it's not done to a wider population.. well you can't justify the cost in a state funded healthcare system. The health benefit just isn't justifiable when MRIs are so scarce and expensive to run.
> Virtually all deaths from solid cancers are preventable with routine scans to find tumors before they metastasize.
Fantastic. I take it from those links this would be detectable with a full body MRI? I already wanted an excuse to start getting those regularly.
> Compare the experience of getting an x-ray from a dentist to getting one from a doctor. Or getting an ultrasound from an OB to getting one from any other doctor.
Can you expand on this? It sounds like you're implying something (I might agree with), but am not sure.
> Fantastic. I take it from those links this would be detectable with a full body MRI? I already wanted an excuse to start getting those regularly.
There is a lot of research on the topic but it doesn’t agree with the OP’s thesis. Full body scans can be purchased if you have the funds, but you are far more likely to get false positives than to actually catch a cancer this way. The ensuing medical costs and possibly even unnecessary surgeries are statistically likely to cause you more detriment than any benefit you might receive. This is counterintuitive to many, but the truth is that it’s not actually easy to spot nascent pre-symptomatic cancers from full body scans without incurring a massive number of false positives along the way. Something like 1 in 8 people will end up getting flagged for “warning signs of potential cancer” during these scans that turns out to be nothing upon further investigation. Few people continue to get the tests for this reason.
If you're looking for a hobby, it's 2022 and you can buy better-than-a-potato ultrasound gear on eBay for less than $1000. Also, cheap ECG amplifiers are quite available these days.
I think the difference is that ultrasound/imaging is routine annual from dentist and monthly or whatever from OB during pregnancy, but otherwise requires a specialist referral for a specific injury or complaint.
It's also the case that a pregnancy is a hugely obvious invisible but major health situation, and teeth are expected to rot frequently.
There is a fair amount of scientific study that has linked diet to some cancers. Those same diet attributes that can make one obese also lead to higher rates of cancer.
Wait, so I've been avoiding McDonalds all this time for no reason? I literally lost a GF because I decided to skip eating one afternoon when the only place close to us was McDonalds!
My paternal grandmother got dementia and eventually died. My oldest uncle got dementia and eventually died. My father (the middle one) has dementia now. Now my youngest uncle is afraid that he only has a few good years left.
My fortunate paternal grandfather just had a heart-related incident and died quickly at a much younger ager than his wife.
I follow a good lifestyle to the degree that I do only because I want a good quality of life in my middle years and a bit beyond that. I am not interested in subsisting on carrots, cauliflower and exercise bands so that I can become a fit 75 year old with dementia.
Hopefully I’ll be lucky and die in early old age or I’ll get cancer. Dementia can fuck off.
I think it should be postponable. If everyone wasn't obese and didn't smoke or drink guess what... we would still get cancer or die of heart disease or dementia. At least this goes for the US and much of Europe.
True. What prevents cancer death is wingsuit basejumping and faster motorbikes. And war I guess, but that makes cancer death look attractive (and when you're working too close to the radar or DU ammunition is part of the equation, it can very well cause cancer death on top of all the "prevention")
It is preferable to die of "old age" (including heart disease or dementia) at 90 than from cancer at 35. Yes, eventually everyone dies, but some early deaths are preventable, it seems to be half of cancer deaths, some car crashes, suicides etc. This means we can and should do something about it.
Living with one case in the extended family, we are still glad she is alive and able to recognize most of us and have a discussion, but probably this is a very subjective matter and your experiences may be different.
My grandmother died at 99 with dementia. It didn't last too long, thankfully--it came only in the last few months.
I'm so thankful even just for the last couple of years she got to spend with us. She was my neighbor, so we got to spend a lot of time together, and we had always been close.
There was in fact a bit of pain seeing her at the end, but I don't remember her that way, and I wouldn't change any of it.
It's definitely preferable to RISK dementia. It's not like it's a guarantee at some certain age.
A lot of the joy in my life would have been diminished if she hadn't lived so long.
(Virtually) no-one dies of lifestyle-related cancers at 35. I still wouldn't want to die of cancer or heart disease at 60-80 (my grandmother was very unhealthy, had her first heart attack before 65, and died at 72), but I think dementia is a scarier prospect (my great grandmother died at 96 but had dementia for at least a decade before that).
Not always, if you’ve been close to someone who lived into their 90s and were barely there for a decade due to mental decline you wouldn’t necessarily think it was the best way to go. Rotting in a nursing home confused and suffering for a couple of decades isn’t luxury.
You are completely right. In the few cases of dementia I know, people lived just a few weeks after they completely lost memory and awareness, not long term.
Thats unusual, if I'm understanding your description right. Severe dementia (requiring 24 hour care/supervision) lasts a couple of years on average. Even moderate dementia, the level at which people can live in memory care units but have trouble communicating and understanding their surroundings, can last ten years.
What the hell? A slow decline for years is not uncommon at all. At first you know that you are going to forget yourself and be completely helpless, and then you spend years in that state.
My brother in laws sister was recently diagnosed with cancer. Before she was diagnosed, she quit her job with benefits to stay home and take care of her father with advanced Parkinson’s. Her cancer is treatable and has a high probability of being curable, but she doesn’t have and can’t get insurance and doesn’t qualify for government help. Her choice is death or go into such incredible debt that she will never have hope to pay it off. She is 29. She has chosen death.
>Her choice is death or go into such incredible debt that she will never have hope to pay it off. She is 29. She has chosen death.
What about going into debt to get healthy and just flipping her debtors the bird? Or bankruptcy? Or waiting for hyperinflation to render her debts moot? Or moving to another country where those debts are effectively meaningless?
This is in the US? Has she worked with hospital staff, social workers, and lawyers (and maybe even federal/state representatives/officials) on all the possible ways to swing this? (Examples: maybe there's some way to get into ACA marketplace insurance soon, or to get onto Medicaid, or to do asset protection?)
Stress, and being in the mode of taking care of someone with advanced illness, might have her feeling down, and approaching and thinking about this differently than she would normally.
The obsession that you can live longer by doing this healthy trick is not really helpful. Ultimately you are going to die of cancer if you avoid any other cause of death (and even that is impossible).
What's annoying me is the survivor bias. How do you know that people wouldn't have died earlier if they didn't do what supposedly caused the death over decades? Let alone that you cannot actually pinpoint what caused the cancer (but guess of course).
I think you shouldn't smoke and you probably should avoid alcohol or only consume in considerate amounts and don't eat like it's your last meal over and over, but you can't just say don't drink, smoke and overeat (or even don't eat this, but that) and pretend that it is better.
The obsession that you can live longer by doing this healthy trick is not really helpful.
It's not simply a matter of 'avoiding cancer' but more 'avoiding a slow, painful death due to cancer'. It's not even a matter of "you have to die of something!" Most forms of cancer are not a nice way to die. If you can avoid getting it so that you die of something else, especially something really nasty like lung cancer, you definitely want to give that a go.
I'm old enough to have seen friends and relatives die of cancer and I really don't want to go that way. Seeing the affect on those people, and even more on their families who had to watch them fade away, was $^&%ing horrible.
What I really want is more approachable Euthanasia. I’m not afraid of dying, it will happen to all of us, but I dont want for me or my relatives a months of pain when everyone knows it will only lead to death.
> Okay then, nothing you can do I guess. You're hereby absolved from behaving responsibly towards your own body. Is that better?
>> I think you shouldn't smoke and you probably should avoid alcohol or only consume in considerate amounts and don't eat like it's your last meal over and over, but you can't just say don't drink, smoke and overeat (or even don't eat this, but that) and pretend that it is better.
I addressed it already, but let me add this: Just be sensible and do what is best for you (in terms of health). There is no single way for everyone to do it right.
We know that processed red meat definitely causes cancer. We also know that it doesn't cause very much cancer. Our message isn't "stop eating processed red meat", it's "if you have a family history of colon cancer; if you know you have a genetic predisposition to colon cancer; if colon cancer is something you're worried about, then you may wish to reduce the amount of processed red meat that you eat".
Well, you could use your reasoning to justify drinking and smoking. Why did you stop there? People live to old age despite doing those things. And how can you actually be sure that it's the drinking/smoking that killed you? People get lung cancer and cardiac events without doing either.
The truth of the matter is that all we can do is try to stack the deck in our favor. A major part of life is deciding which trade-offs matter to you.
> The truth of the matter is that all we can do is try to stack the deck in our favor. A major part of life is deciding which trade-offs matter to you.
Which is, what I said. And the trade-off can even be smoking or drinking alcohol, even if this does not seem right (to you or me). Paracelsus applies.
Anyone know what the curve for alcohol looks like?
I know no amount of alcohol is "safe", and a lot of alc is very bad, but in between, what does it look like? Is it a cliff after more than 2 drinks a week? 10? Does it matter if it's beer or whiskey?
Even the lowest of those seems like an astronomical amount to me. I'm not sure I have 14 drinks per year. If increasing my drinking by 52x would on-average lose 6 months of life, seems like I probably shouldn't worry.
I don't know, and that is very hard to measure definitively due to confounding variables. In the nuclear industry we have a similarly hard question for ionizing radiation dose. Since the 50s we just use a dumb linear no threshold curve, assuming every little bit hurts.
Anyone know of promising cancer startups? Was listening to a podcast that mentioned pancreatic cancer mortality rates and it's basically a death sentence (stage 1 85%+, later 95%+)
I don't drink or smoke but would love to avoid cancers. Wife was working at a great one but it basically shutdown cause clinical trials are so expensive.
We need more advanced clinical trial /organ-body simulations.
That's what we as Computer Scientists can do... if we could have a sufficiently good virtual representation of the human body (at least enough parts of it)the cost and time of human trials would be reduced so much... it would be revolutionary.
When speaking about cancers attributable to lifestyle, why does it have to be deaths? Why not incidences of cancer? Not all incidences of cancer lead to death.
When a death is prevented, that can be at any stage, from avoiding the lifestyle choice like smoking and drinking, to the doctors spotting the cancer early and intervening in time.
So if we are talking about cancer deaths preventable through lifestyle changes, that is just mixing in too many variable. Some incidences of cancer attributed to lifestyle may have been prevented from becoming deaths due to medical intervention, which clouds the numbers.
The other direction is rather more interesting in my opinion: No matter what you do, you can only reduce your chance of getting cancer by 50% compared to the average population.
50% of a tiny number is a tiny number. If the absolute risk of dying from any cancer is small, decreasing that risk by 50% isn't that much of an improvement overall.
The argument that "more knowledge is better, always" is just not viable. Not when you look at all the people driving alone in their car, or walking alone on the street with a mask on.
There are, as any doctor will tell you, large numbers of people who will see their doc for any questionable data and demand treatment. Preferably a pill they can take once a day. They are not willing to be reassured and will happily go to a different doctor who gives them what they want.
the Canadian Centre on Substance Abuse and Addiction just released a new report[1] on Low-Risk Alcohol Drinking Guidelines.
> Among healthy individuals, there is a continuum of risk for alcohol-related harms whereby the risk is:
> • Negligible to low for individuals who consume two standard drinks or less per week;
> • Moderate for those who consume between three and six standard drinks per week; and
> • Increasingly high for those who consume more than six standard drinks per week.
standard drink is the equivalent of a bottle of beer (12 oz., 341 ml, 5% alcohol) read more on the old report [2]
I know I will watch my beer intake more closely now.
"In 2019, half of all male deaths from cancer, and more than one-third in women, were due to preventable risk factors including tobacco and alcohol use, unhealthy diets, unsafe sex and..."
How does unsafe sex cause cancer? What is unsafe sex in this context?
Probably cancer from HPV virus, which (at least in Sweden) is vaccinated against in 10 (11? 12?) year-olds, before their sexual debut. HPV is so transmissible and so common that on average, if you have had 2-3 partners, you can kind of count on having HPV.
... and what I've learned from this is that half of cancer deaths have absolutely nothing to do with smoking, alcohol or obesity. Damned if you do, damned if you don't.
"Alcohol in moderation" is far less than most think. Depending on study, closer to 3 drinks per week or 4 oz of red wine daily. How many people do you know who drink, but only 1/2 a beer a day?
Wifi/Routers,Mobile phones & masts......
All cause a lack of oxygen...silent weapons for quiet wars....Covid was cover for their upgraded network with even less safety done than the last gen..
You all know it...we all grew up learning the same tech..your just scared shitless by the implications of it!!..
Covid should have woken you all up...instead your playing with the devil for a last round---god speed!
There are all kinds of carcinogenic compounds we know are avoidable but people are exposed to nonetheless. The article points out several examples.
Some cancers are more likely to occur based on gender and more predictable gene expressions, but these aren’t mutually exclusive. You can be more likely to get cancer without doing anything special while still vulnerable to an increased risk of cancer through exposure to carcinogens (like alcohol, smoke, processed meats, etc).
> Data show that smoking, drinking alcohol and obesity are the biggest contributors to cancer worldwide.
> Nearly 50% of cancer deaths worldwide are caused by preventable risk factors, such as smoking and drinking alcohol, according to the largest study of the link between cancer burden and risk factors
Interested to see what your response is to the article once you finish reading it :-)
Life causes cancer. :) The symptom is cancer, the problem statement is a fix is needed for the human immune system to be more targeted and aggressive in purging cancer from the body, as well as more robust cellular repair mechanisms.
The human body can take enormous amounts of environmental abuse, but there’s clearly room for improvement.
"Approximately 39.5% of men and women will be diagnosed with cancer at some point during their lifetimes (based on 2015–2017 data)."[1]
Many lives will experience cancer, but not the majority. So it seems to be more complex that immune inadequacy (unless 60% of immune systems are working really well, which would be noteworthy). It seems like a reasonable hypothesis that environment is playing a larger role than individual genetic variations. So encouraging people (or even scaring them) to not smoke, not drink, eat better and exercise more seems like a reasonable approach - it won't cure cancer, but it could reduce rates?
Improvements should be designed to balance self preservation with self destruction. Immunotherapy, gene therapy, and CRISPR are still in their infancy.
I read somewhere (I don't remember the source, but it was some medicine journal) that 4% of smokers are genetically more inclined to die from lung cancer; while lung cancer is correlated with the number of cigarettes (intensity and length of time), these people will have lung cancer even with a very low number of cigarettes.
I know a few anecdotal cases where entire families of smokers died from lung cancer, while their partners, also smokers, had no problem, but I don't put much weight on that. Also I heard that smoking can cause other cancers like colon cancer in specific genetic conditions, but I don't know more details.
I like to blindly attribute these things to bodily chemistry. Anything you put in your body now will affect everything from now on in your material world :)
Fitter, happier, more productive
Comfortable (Not drinking too much)
Regular exercise at the gym (Three days a week)
Getting on better with your associate employee contemporaries
At ease
Eating well (No more microwave dinners and saturated fats)
A patient, better driver
A safer car (Baby smiling in back seat)
Sleeping well (No bad dreams)
No paranoia
Careful to all animals (Never washing spiders down the plughole)
Keep in contact with old friends (Enjoy a drink now and then)
Will frequently check credit at (Moral) bank (hole in wall)
The solution to obesity is simple.
People want tasty food .
It is possible to make it with healthy ingredients.
But market is flooded with white flour,sugar,wheat and milk products.
It takes effort to prepare it yourself.
Lustig claims there was a catastrophic shift from fats to sugars due to blaming fats for obesity. Supposedly fructose doesn't trigger the satiation signals that fats do however.
Fructose also has different glycemic profile - it doesn't trigger the same big spike is blood sugar that glucose does. It has to be metabolized by the liver first, which is the rate-limiting step. Although, too much can lead to a cirrhosis-like condition called non-alcoholic fatty liver disease [1]. Sugar is bad, even fructose.
With that in mind, there's no such thing as a minimum required daily intake of carbohydrates.
Yeah, fats definitely have issues, but, they come with rate limiters - satiation triggers. Heart of his argument is that fructose triggers nothing, so you keep chugging it, and with almost identical stress to liver as alcohol, which also has a limiter for most people (you pass out :) )
Satiation is more complicated then that. You can eat pure fat or pure sugar and neither option will make you feel full. Both will also cause malnutrition in you, no matter how much of them you consume.
The solution isn't simple, because the problem is that we have bodies that are evolutionarily designed for a world of extreme calorie scarcity that are living in a world of extreme calorie abundance.
Our deep genetic firmware hasn't been programmed to deal with this kind of extremely unnatural corner case, and we're collectively breaking because of it.
We just take 3 meals a day for granted without asking where this movement really came out of. Hint: agriculture/produce won't do well if people only eat 1 meal a day.
Eating one/two meals a day is something that nobody talks about as much as this other food conscious movements like gluten, carbs, now keto. All of this seems driven at pushing demand towards certain sector.
It's a sort of arms race. Unprepared plain raw organic produce is delicious, if you haven't been eating prepared food covered in salt and other seasoning for years. Once you start adulterating your food with flavor crystals, you require that stuff just to move the needle.
A flavor tolerance develops, similar to drug tolerance.
> Unprepared plain raw organic produce is delicious
Yeah, although I doubt it was as delicious before modern farming. Or even if it was, we didn't have most of it.
But an animal roasted over a fire is equally as delicious; just ask an Alone contestant. One woman ate the gut contents of a rabbit and said it was one of the best things she'd ever eaten.
I don't think so, I think it's more that we grew to live in a "feast famine" environment, but suddenly we are now in an environment with infinite food. It goes against our instincts to not eat food that is there. Instead we have to hope we have the willpower to overcome it with our rational thought processes. Most people, if they are not busy with other things, will want to eat. "Thankfully" we have capitalism and so people are busy and pushed to be even busier. I think without that, if we really had time to sit and relax without those mental pressures of progression, we would be much fatter.
It is just one of the ways that human material conditions has quickly changed way faster than the human animal has managed to evolve for it, and so it is unsuited for such environments. I think we might eventually have a technological solution (everyone on appetite suppressants)
While eating healthier things would probably help to an extent, nothing's stopping people from just eating more of those healthier foods and still becoming obese. Healthy or not, food is calories and a surplus of those calories will lead to weight gain.
Technically correct but practically beside the point. That's not how humans work.
What stops people from just eating more of those healthier foods is that they make you feel full more quickly and longer with the same amount of calories.
I agree that they make you feel full more quickly and for longer but a good amount of obese people don't overeat because they're hungry, they overeat because it's their way of dealing with problems. It's an unhealthy coping mechanism like alcohol and drug abuse and should be treated as such.
Don't get me wrong, I'm all for having higher food standards and healthier foods, I just don't think it'll help with obesity as much as you'd think.
I would be surprised if any of the large people in my life were overeating healthy foods like oats, chickpeas, bananas, lentils. Usually those were the things missing from their diet.
Frankly, it seems like low satiating, high dense foods are the only foods up to the task of making someone obese. e.g. The ease of drinking a liter of Coke vs eating that same amount of calories in beans.
I would be interested to see the food diary of someone who claims to overeat healthy food. I think it would illuminate our mass confusion about "healthy food". The healthy foods I think of are the kinds you can eat ad libitum without much consequence.
It’s not simple. Tasty food that has a considerable amount of water in it which can be produced and distributed on an industrial scale cheaply… is not an easy problem.
Really we just need to evolve so that these high energy density foods aren’t such a problem.
I don't think that's simple. People want tasty food with the least effort involved. This is a genetic programming. buffalo:bear::mcdonalds:healthy_cooking
It takes effort to make money to buy things we don’t prepare. Everything takes effort; it’s the trade off that needs evaluation. “Takes effort” is a given.
It's funny how cr is still billions / year, but there has been this natural clinic that has cured thousands of people.. .from 1970.
was it something like gerrison miracle etc..
of course big pharma does not like "free" medicine
Following on the discussion yesterday about "science is political and that's bad" (and posters saying "no, it's not"):
Nature Magazine has soiled itself irrevocably with its political stances. Now when you read anything like this, you have to ask, "was this written because of some new scientific information, or was it just in furtherance of their agenda?"
