[dcolgan]

In one of my favorite books, Antifragile, Nassim Taleb argues that health is largely subtractive - if you want to be healthy, remove unnatural things from your body (sugar, medicines, sitting too much, etc), and only undergo surgery, go to the hospital, or take medicine in very serious cases where the harm of not doing something outweighs the potential complications. Especially since hearing more about more about how the American health system is not exactly incentivized to always look out for the best interest of the patient, I'm inclined to agree with him.

[criley2]

>if you want to be healthy, remove unnatural things from your body (sugar, medicines, sitting too much, etc),

?? What is "natural"? How do you define "natural"? Is there a single point in human evolution that you call "done" and emulating that discrete point is natural, and anything before or after is 'unnatural'?

I always struggle to understand "natural" woo because it is, at its core, an undefined and meaningless word with absolutely no scientific or medical relevance.

>and only undergo surgery, go to the hospital, or take medicine in very serious cases where the harm of not doing something outweighs the potential complications.

So, basic modern medicine? If your general doctor is recommending unnecessary medications or not doing cost/benefit for you, then medicine isn't broken, your doctor is.

>Especially since hearing more about more about how the American health system is not exactly incentivized to always look out for the best interest of the patient, I'm inclined to agree with him.

Why on earth would you conflate the profit motives of healthcare middlemen to imply that the science behind medicine isn't credible?

This is a shockingly ignorant statement openly peddling ludditeism and implicitly denouncing science in favor of the pitiful naturalism fallacy.

Really surprised to see such irrationalism on this forum.

[tracker1]

> Why on earth would you conflate the profit motives of healthcare middlemen to imply that the science behind medicine isn't credible?

Because marketing often distorts the results or outright lies. It's not necessarily the science that is the problem, but the marketing and approach in pharmaceutical sales that will push this. This has been, on occasion, reflected in terms of studies, efficacy and results in terms of manipulation of data.

Personally, I feel that compulsory licensing models as part of a dual-sourcing (at least two manufacturers for any drug) would help resolve or reduce a lot of the issues surrounding this. As well as reverting to some prior legal and cultural issues in terms of how marketing of prescription medications is done. TV/Youtube/Dr.Office advertising has gotten pretty horrible, and does very little to actually help people.

[scrollbar]

I will reflect your outrage back to you now:

Why on earth would you NOT assume that institutionalized greed affects the results of medical science?

Who is funding the science? What are their financial motives? Who conducts the research? What are their financial motives? Are incentives aligned to produce quality medical research with the patient's best interests in mind, or the bottom lines of medical companies (pharma, medtech, even hospitals, etc.)?

I'm shocked and surprised at your shock and surprise. I don't think your arguments are irrational. I simply think they are naïve.

[criley2]

>Why on earth would you NOT assume that institutionalized greed affects the results of medical science?

Because I studied medical science and research for many years, have family in the medical field, and write medical software for a living.

Or rather, I understand very clearly how greed and the capitalist motivation affects health care, as it's literally my life. But with a realistic understanding comes the end of emotional histrionics and petty exaggeration.

AKA: I'm basically informed on this subject, unlike most of the commenters here.

>Who is funding the science? What are their financial motives? Who conducts the research? What are their financial motives? Are incentives aligned to produce quality medical research with the patient's best interests in mind, or the bottom lines of medical companies (pharma, medtech, even hospitals, etc.)?

What is GLP?

What is GMP?

What is a NME?

How many NME's does the FDA approve per year?

>I'm shocked and surprised at your shock and surprise. I don't think your arguments are irrational. I simply think they are naïve.

I'm not shocked or surprised at your response, it's a classic case of Dunning Kruger where you are so ignorant regarding medical science, the intense science based regulation of the FDA, and the business of creating drugs, biologics, devices etc, that you are inherently incapable of evaluating your or mine competency here. If you think I am naive, that is a real testament to the depth of your ignorance on this subject.

Back in university, we used this book to teach people the absolute and most basic fundamentals of this industry https://www.amazon.com/Drugs-Discovery-Approval-Rick-Ng/dp/0...

If you'd like me to answer your questions honestly, I'd be more than happy to take some time to source and answer your question from the perspective of someone who has studied this subject academically and participates in it professionally. But the book linked will discuss I believe every one of your ethical concerns.

[scrollbar]

I'm sure you're well read and educated. I won't ever be as knowledgeable on the subject as you.

I have the benefit, though, of not having my entire livelihood and career dependent on my faith in the systemic health of mainstream medicine.

Maybe you're right. Honestly based on the tone of your initial comment, I have written off your impartiality, and so have little desire to learn from you. I'm sure you feel the same towards me. So here's to coming to a stalemate while putting other people down on the Internet. Maybe that's the important learning point, for me.

[MrFantastic]

Then you should be familiar with how generations were lied to and told that Fat caused heart disease and low-fat/high carb was the best way to eat.

Research funded by the Sugar Industry.

[criley2]

>Then you should be familiar with how generations were lied to and told that Fat caused heart disease and low-fat/high carb was the best way to eat.

I'm familiar enough with the FDA to know the difference of the Office of Food and Vet and the Office of Med Product and Tobacco.

Why don't you go research what CDER is, and try to determine whether or not diet guidance has anything at all to do with CDER and the actual topic of this thread.

"Research funded by the Sugar Industry."

Outrage porn funded for free, peddled by you.

[shriphani]

Irrationalism? Err no.

Taleb expounds on his definition of the natural - anything that man has done for 100s of years without observing downside.

There is reasonable cause to believe that people are very interventionist in a lot of cases where all that is needed is letting the system sort itself out. Diabetes medication for instance (again - not in all cases): https://www.youtube.com/watch?v=da1vvigy5tQ

A lot of openness to low quality scientific work done in a lot of domains and our eagerness to think that anything with numbers slapped on it is better has given us wonderful gifts like high-fructose corn syrup, trans-fat, thalidomide (all within the last century).

The Taleb metric is just that a lot of systems don't respond in a linear fashion to random input. High levels of consumption of a substance only materialize with a delay of a few decades in horrible ways and the negative result can undo all the positives over the duration of the use of said substance. Thus is it important to err on the side of those things that have been (i) well tested over centuries and (ii) strong evidence doesn't exist that said substance is actually dangerous (tobacco for instance).

[dekhn]

Note that thalidomide is still used as a medicine; it is a very effective drug when other drugs don't work. The issue was that it was given to pregnant women, when it was known that it shouldn't have been.

[shriphani]

I think it was only a stereoisomer that caused trouble.

[dekhn]

not exactly, the story is really complicated.

[dcolgan]

I think some nuance here is needed. My understanding of "natural" primarily comes from an understanding of evolutionary history. If humans have been doing something for millions of years, it is likely to be more "natural" and therefore not cause harm compared to recently invented things. But it is not a black and white thing, but rather a spectrum.

Some examples: Trans fats were invented because they thought saturated fat, which was consumed by humans for a long time, were not healthy, and this new thing was supposed to be better. Then it was found to cause all kinds of problems and are now banned in many places. Here I think it was pretty cut and dry.

An anecdote I've found others corroborate: I used to have foot pain. Some people suggested orthotic insoles, but I also found the barefoot shoe proponents saying that shoes without any padding at all (more "natural") work better. Five years later I never have any foot pain. The Vivobarefoot or Vibram Fivefingers shoes are definitely not something that was around a million years ago, but the principle is the same.

In healthcare, an example in the book is how many people are prescribed statin drugs if their cholesterol is too high, even if there is no other visibly problematic symptoms. Taleb would argue the far better solution is to improve the person's diet, or just wait and see if something happens, than to start taking a drug that isn't.

The author once strained his back lifting weights. The doctor suggested an expensive and invasive surgery. Instead he just rested for a while and the problem went away. On the other hand, my mom recently had neck surgery to replace several vertebrae. She'd been in pain for years and nothing could fix it. So in this case I think Taleb would agree that the risk of a dangerous surgery might be worth it in that case.

An extreme example from the book: in the early 20th century children were given doses of radiation to treat acne. We obviously look at this and scoff, but it is the same idea.

> Why on earth would you conflate the profit motives of healthcare middlemen to imply that the science behind medicine isn't credible?

I'm looking at the profit motives to see where I should be cautious. I feel like this very site is where I've read many articles about how scientific studies had bias because of funding from the companies invested in a certain answer. From what I can see, if you follow the money, you can explain a great deal of the behavior of large institutions.

So I'm not at all advocating ludditeism or against science. Rather I'm against scientism (I think the word he uses in the book) - the belief that science has all the answers and that newer things are inherently better than older things just because they are. They may in fact be better, but not always. Sometimes atheists I meet are just as close-minded as the religious.

[hnhg]

So you're saying, if an anecdote fits your theory, it's proof, and forget searching too hard for anything that runs contrary to your beliefs?

I think science works a bit better than this, and I put my faith in that.

[dcolgan]

A good hypothesis can be used to make predictions. I'm just saying with my foot issues that the heuristic of "subtractive medicine is better than additive medicine" was able to predict that removing padding from my shoes would make my problem go away. And it did. That does not prove anything but it worked here.

[hnhg]

Say that the padding had worked, you might have rationalised it to to be that it's unnatural to walk on hard surfaces ("our ancestors never walked on concrete").

There are also probably many instances in your life where this hasn't worked, but you've cherry picked the example that does.

It's very likely that your body healed itself regardless of the padding. You might have just needed time. You've figured that it's removing the padding but it might not be a factor. It's why studies need decent sample sizes to make strong conclusions.

[dcolgan]

That's fair enough, but also why I looked for other people who had similar experiences. I'm definitely not always right, that is true. I am not a doctor, lawyer, or accountant.

[njarboe]

I'm pretty sure the early hydrogenated oils were created (Crisco, 1911) because they had similar and in some cases superior properties to animal fats and butter, but were cheaper and had a longer shelf life. The idea they were healthier came later.

[adrr]

Infant mortality and life expectancy are improving with modern medicine and diet. Most of our problems today stem from the over consumption of food and lack of physical activity. Cancer rates are at an all time low even though media makes it seem like everything(non caloric sweeteners, plastics, herbicides) around us causes cancer.

https://www.cdc.gov/cancer/dcpc/data/race.htm

[mmstick]

Except that the US, a major proponent of modern medicine, ranks very poorly compared to other nations in the infant mortality charts -- especially against countries that prefer natural non-western medicine, and life expectancy is clearly linked to financial status -- those that can afford health care. IE: where I used to live in Arkansas, the average life expectancy is 67, whereas in a rich state like Virginia, it's 87. What's the difference? Ability to afford health care.

[adrr]

Everything is correlated to obesity. Arkansas has the highest obesity rate in the nation. When you look into our infant mortality rate it is linked in preterm births. Preterm birth is highly linked to obesity and is trending up.

http://sm.stanford.edu/archive/stanmed/2013fall/article2.htm...

[raverbashing]

Sugar is natural (though HFCS is not)

The first cartoon tells everything I think about this: http://www.newyorker.com/cartoons/bob-mankoff/cave-cuisine

[dcolgan]

I would argue that yes, sugar is natural, but the degree that people tend to eat sugar these days is unnatural. I'd argue that is the root problem. And to respond to the first image of the comic, that nobody lives past 30, some things I've read suggest that was more due to infant mortality skewing the average, deaths from war, and deaths from what today would be preventable diseases. If an ancient person avoided those three things, they lived quite a long time, and didn't get cancer or heart disease.

I have no exact sources for those last few assertions, it's just what I remember reading (I think also in the Antifragile book).

[narrowrail]

While sugar (a really generic term usually referring to sucrose) is natural, it occurs in the highly fibrous stalks of sugar cane. Most sugars naturally occur within fiber, while modern food practices extract and/or refine leaving the fiber behind.

[EGreg]

My grandfather used to tell me about a Chinese king who paid his doctors only when he was well, not the other way around.

I used to really dislike private insurance companies but after teaching about Charles Babbage using math for "Comparative View of the Various Institutions for the Assurance of Lives" I realized something:

Insurance companies are the most aligned with your wellness financially. They want as many healthy people to pay in as possible.

And thus a government health insurance system with universal coverage would be even more financially aligned with increasing health.

I think one of the greatest things you can do as a startup is to improve health for people, through diet and exercise apps and preventative checkups etc. and the insurance companies will PAY YOU to do it!

[fictioncircle]

> Insurance companies are the most aligned with your wellness financially. They want as many healthy people to pay in as possible.

That is only true if they are forced to accept people blindly and without screening.

Otherwise, they simply create a screening process centered around removing unhealthy people and preventing unhealthy people from enrolling.

[theseatoms]

If an insurance company can "remove" you when you become unhealthy, then they weren't providing insurance in the first place.

[dzdt]

What do you think happens when insurance is provided through your employer and you develop a health problem that interferes with your ability to do that job?

[openasocket]

In that case, assuming you are fired from your work, you can get a continuation of your insurance under COBRA. See https://en.wikipedia.org/wiki/Consolidated_Omnibus_Budget_Re...

The short answer is you can get a continuation of your same health plan for a certain period of time, but you have to pay more because your employer isn't subsidizing your premiums. Generally this extension lasts for 18 months, though if you qualify for disability it can go for 29 months. And you do have to pay the full price for the plan because your employer is no longer providing it for you, though you may get government assistance.

Also relevant is the Family and Medical Leave Act. Also, if you're unable to do your job due to a medical issue you may qualify for https://en.wikipedia.org/wiki/Social_Security_Disability_Ins... , along with Medicare. And there's regular disability insurance: https://en.wikipedia.org/wiki/Disability_insurance

[DougWebb]

I've gone through this; you should be aware that COBRA is a retroactive continuation of your coverage, from the day you leave your job, but it's not actually continuous. It can take weeks for the paperwork to go through, and during that time you effectively have no coverage. I found this out because I was scheduled for a surgery the week after leaving my job, and while checking in the hospital told me they couldn't verify my insurance. I was delayed about an hour while trying to convince them that I'd applied for (and paid for) COBRA already, and that I was, or would be, covered for the surgery that day. Eventually the department head allowed me to be checked in, but I'd gotten lucky.

[fictioncircle]

Probably worth keeping in mind that many SSDI requests are denied and the process can take 18 months.

So pretty much everyone needs an 18 months of savings + COBRA costs. Even then its quite likely not enough unfortunately.

[theseatoms]

You likely lose your job and your healthcare insurance, at least after some period of time, I'm assuming. (Fortunately I can't speak from experience.)

So you did not, in fact, have insurance against a very bad situation. All the more reason to eliminate employer-based health insurance tax incentives. I don't buy anything else through my employer. Why should I be insuring against my future medical bills through them?

It obscures my effective insurance premia (via a lower salary), on top of the already obscured price of healthcare, since most insurance policies cover so many incidental, non-catastrophic medical costs.

[EGreg]

Single Payer. Medicare for all.

[fictioncircle]

> If an insurance company can "remove" you when you become unhealthy, then they weren't providing insurance in the first place.

Yup, hence Obamacare with mandatory enrollment and the removal of all the tools they used to it. Then people complain about prices going up. :/

[DougWebb]

Therein lies the difference of opinion between the Democratic and Republican points of view on US healthcare. Democrats want a system where insurance companies have to cover everyone regardless of their health, and (most) Republicans want (or have voted for) a system where the unhealthy are off in one pool with insurance they can't afford, while the healthy are in another pool with insurance that's cheap but doesn't cover any actual healthcare.

[taeric]

While I love that and the related books, I think this is somewhat silly. At a base level where you are depriving your body of everything, food is medicinal in nature. Without it, you die.

Now, I get that being cognizant of what you add to your body seems beneficial. And, to a large extent, adding extra burden to your liver and other organs is not a good idea. However, to think that you should avoid all medicine unless acutely sick seems disingenuous. And to modify that for allowing chronically sick people opens a wide door to a ton of chronic states.

[openasocket]

> only undergo surgery, go to the hospital, or take medicine in very serious cases where the harm of not doing something outweighs the potential complications

Is there anyone, in the world, advocating for getting surgery or taking medicine when the harm of not doing so is less than the potential complications? I'm pretty sure if a doctor did that it would be malpractice.

[Fnoord]

> if you want to be healthy, remove unnatural things from your body (sugar, medicines, sitting too much, etc)

You should not stop using medicine without discussing this with your MD. I said medicine; you should do the same with drugs. Some drugs should not be quit cold turkey. To name one, alcohol.

Furthermore, the reason you should try to not use too many medicine, is because medicine (and drugs, and herbs) have side effects. So you (and your MD) need to think critical if the good outweighs the bad, and this should be reflected throughout the lifetime of the usage of the medicine. Because before you know it, you end up using medicine B, C, and D all because of side effects related to medicine A.

As for 'unnatural', criley2 touched upon that subject; how do you define that? Is synthetic counterpart always worse than natural counterpart? I find such advice downright dangerous. Following that logic, St John's Wort is always better than a synthetic anti depressant. St John's Wort has its place (if standardised!), but it has a lot of contra indications. It doesn't work well with a LOT of other medicines and drugs. For example, it is dangerous if used together with an SSRI or with MDMA. Yet, if people follow the advice by this writer, they'd prefer to resort to a herb like this (perhaps not even standardised) because "its natural".

I knew people who ate raw meat regularly, and had to be administered to hospital because of food poisoning. Yet refused, because the hospital wasn't 'raw food' enough. Don't tell me this "it has to be natural" bullshit. It stems from a fear of the unknown, technology or science. It claims to argue that only Earth and nature are good. I'm not buying that (I'm not buying the 'natural is bad' either though). What is good or bad for you has to stand on its own merit. Drawing the line between 'natural' and 'unnatural' (whatever that indeed might be) is a silly oversimplification. Don't buy into it! People who use it are trying to grab your money out of your pocket to make a run for it.

[narrowrail]

What is the difference between medicine and drugs?

It seems highly relevant since there seems to be some quibbling about using the word natural and that it has no meaning (I agree, but another comment mentioned exactly what Taleb meant by natural).

[Theodores]

I could not agree with you more! Today is my last day clutching a frothy latte, ever! I gave up on chocolate recently due to Cadbury's being bought by Kraft and since then I have moved to the equally sugary fruits for my treats.

So now I am going to eat what I eat when I am not well - fruit, salads, fruit and more salads. No beige foods and not necessarily cooked meals. So no chips either.

I also happen to be vegetarian so I really just want to fine tune what I eat rather than go on a diet, which rarely works for people who do such things.

I also think there is something cool about being 'powered by fruit, nuts and vegetables' with only a bicycle for transport.

I am not convinced about any medicines, particularly pain killers, I will save those and the antibiotics until I get past 8 on the A+E pain scale.

https://www.fastcompany.com/3050319/how-giving-up-refined-su...

[hfourm]

Further, try to take only what medicine you need, maybe just a Sudafed instead of a SUDAFED DM X + PAIN

[dkural]

vaccines, antibiotics etc. are pretty big improvements upon the natural order. Brings the famous New Yorker cartoon about cavemen observing their life spans to mind.