Jan 21 2010
Big Placebo says Medicine never cures anything
Kudos to Lindsay Beyerstein of Majikthise for coining a new appellation “Big Placebo.” Big Placebo is the alternative health counterpart to Big Pharma. Both are special interest groups designed to promote their products, whether they are worthy of promotion or not. There is one big difference between them: Big Pharma makes products that usually work (though not always, and sometimes not safely). Big Placebo hawks books and products that never work.
Big Placebo is unsatisfied with the $40 billion it takes in every year on treatments that don’t even work. They’re aiming for a much larger piece of the healthcare pie and to do so they are criticizing modern medicine.
To hear Big Placebo tell it, virtually all illness can be prevented and anyone who gets sick deserves it because of poor lifestyle choices. If only that were so. Unfortunately, most illness and disease is caused by factors beyond people’s control, including infectious agents, genetic defects and inherited predispositions.
Another axiom in the Big Placebo armamentarium is the notion that contemporary American Medicine cures nothing and merely “manages” diseases. According to “Dr.” John Neustadt (naturopathic doctor) writing in the Huffington Post:
The current system teaches disease management and symptom suppression, which is insufficient to meet our healthcare needs. A reformed system needs a new paradigm that stresses health promotion and treatments that attempt to correct the underlying causes of disease.
Dr. Andrew Weill, of Weil Lifestyles LLC, licensing Weil Nutritional Supplements (vitamins and supplements), Dr. Andrew Weil for Origins (skin-care products), Pet Promise (premium pet food), Dr. Andrew Weil for Tea (premium teas), Lucini Italia Organics(organic extra virgin olive oil and whole, peeled tomatoes), Weil by Nature’s Path (organic cereals and nutrition bars), Weil for Vital Choice, Weil Baby™ (baby feeding systems), Weil by Vita Foods, and Orthaheel™, claims:
By no stretch of the imagination does mainstream American “health care” move us closer to this vision of robust, resilient health. It is a fiscally unsustainable, technology-centric, symptom-focused disease-management system.
To hear them tell it, American medicine cures nothing. It simply manages disease and suppresses symptoms. It is a measure of the astounding success of the American medical system that anyone could seriously contemplate such nonsense. American medicine cures so much disease, involving so many people, so reliably and so often that everyone takes it for granted.
Evidently American Medicine doesn’t cure anything except … tuberculosis, pneumonia, bacterial meningitis, gonorrhea, any bacterial illness you care to name. American medicine routinely cures previously deadly conditions like appendicitis, ectopic pregnancies and obstetric hemorrhage. Better yet, it can completely prevent many viral and bacterial scourges through vaccination. It’s not a coincidence that American lifespan has increased from 48 years to 77.7 years in slightly more than a century. Much of what routinely killed Americans is now routinely cured.
In fact, cure is so routine that these illnesses rarely enter American consciousness. No one worries about dying from tertiary syphilis, diphtheria or rheumatic heart disease. Those diseases are routinely prevented or cured in their early stages.
And “disease management” is hardly a deficiency, either. Some diseases cannot yet be cured. Until the day that a cure is discovered, we manage those diseases. Juvenile (type I) diabetes was uniformly fatal until the discovery of insulin. Insulin doesn’t cure diabetics; it merely allows them to live an addition 50 years or more. Instead of dying in childhood, type I diabetics routinely live to have and enjoy grandchildren. Such “disease management” is worthy of praise, not the contempt that Big Placebo attempts to heap on it.
Can we do better? Of course we can, particularly in the areas of chronic diseases caused by smoking and alcohol abuse. However, that’s a far cry from claiming that American Medicine doesn’t cure disease. That cynical and disingenuous claim should be understood for what it is, Big Placebo’s attempt to line its own pockets. Alternative health purveyors and practitioners are charlatans and quacks … and dishonest.
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240 Responses to “Big Placebo says Medicine never cures anything”
Sadly, not only do some of them think modern medicine does nothing, in fact they think it actually does more harm. And yet they don’t see themselves as becoming complacent and taking things for granted, they are renegades and mavericks who are challenging the current medical system. Because of course, today’s doctors do nothing to try to further advance medicince by challenging the system. They’re just sheep doing what big pharma tells them.
Sadly, not only do some of them think modern medicine does nothing, in fact they think it actually does more harm. And yet they don’t see themselves as becoming complacent and taking things for granted, they are renegades and mavericks who are challenging the current medical system. Because of course, today’s doctors do nothing to try to further advance medicince by challenging the system. They’re just sheep doing what big pharma tells them.
In the mind of the general public it seems very easy to conflate the system of delivering medicine (with all of its failings and real-world challenges) with the actual discipline of medicne as a scientific human endeavor. I think that the healtch care debates our American friends are having now may only add to the problem.
If only Atlas could shrug and not kill thousands (if not millions) of people. That would seem to be the only way to shut these people up.
And these are the folks who want to integrate a complementary and alternative sloppy wet French kiss with real medicine — on the house. Your house.
I’m pretty sure modern medicine does promote health and treatments to address the underlying cause for disease. Don’t I see news reports and hear my doctor telling me to exercise more, eat less, and not smoke, so as to reduce my chances for stroke, heart attack, and type II diabetes? Big Placebo should be harassing the American public for not listening to their doctors, and for waiting for a pill or surgery to cure illnesses that could have been prevented.
“Evidently American Medicine doesn’t cure anything except … tuberculosis, pneumonia, bacterial meningitis, gonorrhea, any bacterial illness you care to name. American medicine routinely cures previously deadly conditions like appendicitis, ectopic pregnancies and obstetric hemorrhage.”
Ah, but Dr. Amy, in the fabulous world of Big Placebo (I personally prefer Big Herba) these diseases don’t exist because a special combination of 27 herbs and spices (first discovered by Colonel Sanders in the 1950s) taken daily prevents most diseases instead of simply managing them as so-called “modern” medicine does. And on the rare occasion that one finds oneself coughing up blood or suffering burning sensations during urination, 3 drops of tincture of newt diluted in Lake Erie will set things right.
Now see? All those years you spent in medical school were wasted. You should have been something useful like an E-Lit major.
Don’t get me started on the medical school aspect. That is, alternative medical schooling. With our newfound knowledge regarding sham acupuncture, you could teach the real thing in about an hour, saving much human misery and dollars. As it stands, you could almost get your Airline Transport Pilot License in the same amount of time as the quack, and get paid to fly passengers for less income than an acupuncturist, but at least you’d have your dignity, and a skill that is utterly unforgiving of stupidity.
“To hear Big Placebo tell it, virtually all illness can be prevented and anyone who gets sick deserves it because of poor lifestyle choices. If only that were so. Unfortunately, most illness and disease is caused by factors beyond people’s control, including infectious agents, genetic defects and inherited predispositions.”
Of course we can’t prevent all illness by having a healthy lifestyle! I doubt that anyone makes such an absolute claim. On the other hand, you’re saying that most illness today is unrelated to lifestyle, and that just doesn’t seem right. We know, for example, that the obesity epidemic has resulted in a type 2 diabetes epidemic, which contributes directly to heart disease (and various other diseases). That is just one example of a serious and very common disease that has a strong link to lifestyle.
Of course genetics and luck are involved in any disease, but for modern Americans, lifestyle is often an extremely important factor. Cancer is probably also related to lifestyle, sometimes, since it can be related to obesity.
Some of the most common diseases of middle-aged and older Americans are lifestyle-related. And this is very well known and easy to verify. There have been enough studies showing this fact, so that it is hard to understand why you deny it.
No, an unnatural and unhealthy lifestyle is not the cause of all diseases. Of course not! Things are not so absolute and simple. But unhealthy lifestyles are extremely common today, since physical activity is not a necessary part of everyday life for most of us, and since processed food is easily available and cheap.
A healthy lifestyle requires conscious decisions now days, and the average American doesn’t have the time or inclination to think much about it. And MDs like yourself, who assure your patients their chronic conditions are all because of genetics, etc., just make things even worse.
And I forgot to mention smoking! Don’t tell me that doesn’t contribute to cancer!!
What else can moderate medicine do? Forgive me please for belaboring the point. Even this long reply only illustrates a fraction of advances due to science based medicine.
Vaccination
Tens of thousands of people now avoid smallpox annually because it was eradicated by vaccination. In America we avoid tens of thousands of polio cases, diphtheria cases, pertussis cases and 100s of thousands of measles cases. We have vaccines that treat or prevent rabies, typhoid, cholera, plague, tetanus, pertussis, influenza, varicella, rotavirus, mumps, rubella, hepatitis A. and B., Haemophilus, cervical cancer, pneumococcus, meningococcus, parainfluenza, respiratory syncytial virus, and more. This has resulted in a dramatic decline in morbidity and mortality.
Nutrition
The mortality during childbirth is 100 times lower than it was 100 years ago. Much of this change is due to vitamin D supplementation of dairy products preventing pelvic deformity due to rickets. There has been a dramatic diminution in birth defects due to folate supplementation of bread. Food fortification has nearly eliminated major nutritional deficiency diseases such as rickets, goiter, and pellagra.
Surgery and Anesthesia
Surgical anesthesia and antiseptic surgery allows life-saving and life improving treatment. Hip fractures remain a common injury in the elderly although there has been some success with osteoporosis treatment and prevention. A hip fracture treated in traction resulted in an approximately 80% death rate within the first three months, now 10 or 20% within one year with modern surgical care. Appendicitis without surgery was a near certain death sentence. Many traumatic injuries or serious illnesses such as cancer are now survivable. Heart bypass machines and valve replacement surgery prolongs of the lives of thousands. Ruptured aortic aneurysm is cured by surgical graft replacement of the damaged artery. Some brain aneurysms can be treated before rupture preventing brain damage and death. Heart bypass or angioplasty can limit the extent of heart muscle death after heart attack and diminish the likelihood of future injury the pain. Severe crippling arthritis can now be treated with joint replacement that has a high success rate, literally allowing the lame to walk again. Amputated digits, arms, legs, and feet have been successfully reattached with techniques that are now routine, and also used to repair serious nerve and artery injuries preventing substantial disability and suffering.
Antibiotics
Infections that are now curable routinely led to death, disability, and great suffering before the antibiotic era.
Immune System Diseases
The survival rate from autoimmune disease has dramatically improved, and the morbidity diminished due to disease modifying medications. Protease inhibitors prolonged the survival of AIDS patients.
Cancer
Many cancers can be treated with chemotherapy resulting in long remission or prolonged survival, especially when combined with modern surgical techniques when indicated. Surgical removal of a single metastatic cancer mass has resulted in the prolonged survival in some diseases.
Blood Clotting
The early use of thrombolytic agents has prevented permanent heart damage and heart attack and permanent brain damage in the stroke. Cases of fatal pulmonary embolism and embolic stroke have been reduced with prophylactic use of anticoagulation, and the treatment of phlebitis. Hemophilia is survivable and treatable.
Genetics
Genetics screening and knowledge has allowed families to avoid some of the risks of passing on genetically based diseases to their offspring. PKU, now usually detected at birth with mandatory screening tests, is cured with a special diet
Fractures
Surgical fracture treatment has improved diminishing the burden of suffering, posttraumatic arthritis, deformity, and disability. Fracture nonunion (lack of healing) and, which can lead to pain, deformity, and disability, can now be successfully treated with surgical techniques including bone grafting, transplant, bone transport, and improved surgical hardware. People at risk for fracture can sometimes be identified and treated with effective medications that reduce there risk for future fractures, avoiding the associated morbidity and mortality.
Transplant
Patients with otherwise fatal conditions have survived many years after transplant of heart, liver, lung, kidney, or bone marrow.
Poison
Narcotic, Valium, and other overdoses can be treated with specific antagonist drugs that save lives. There are antitoxins that can be used to treat those envenomed by poisonous animals and insects.
Mental Illness
Much of the profound suffering and disability due to severe mental illness can be ameliorated with medication and modern psychiatric treatment.
Public-health and medical research
The importance of clean water, preventing diseases such as cholera and typhoid, water fluoridation, the role of scurvy prevention with diet, the importance of hand washing, the role of smoking in lung cancer, treatment of hypertension, advances of family planning, and a myriad of other advances that now improve and save 100s of thousands of lives are the result of science based medicine.
Steven Zeitzew
Orthopaedic surgeon, Los Angeles, California
- This document has been prepared with voice recognition software. Please excuse unusual errors. -
“And MDs like yourself, who assure your patients their chronic conditions are all because of genetics, etc., just make things even worse.”
Lizkat, this is a huge mischaracterization of what Dr. Tuteur said.
Her words:
“Unfortunately, most illness and disease is caused by factors beyond people’s control, including infectious agents, genetic defects and inherited predispositions.”
She very clearly says most, not all disease.
Doctors routinely recommend lifestyle changes (within the patient’s physical limits) to people with heart disease, obesity, diabetes, etc. That is part of the standard of care for these patients. Have you not seen the massive campaigns against smoking? We know smoking is a poor lifestyle choice. Hence, why doctors encourage their patients to quit.
You single out the most visible diseases. You’re right that obesity is an epidemic right now and a large part of that is due to lifestyle (excessive calories, poor exercise, etc.). However, there are literally thousands of diseases known to medicine and the great majority of them have little to do with lifestlye choices, as Dr. Tuteur points out. I encourage you to try to list off more of your so-called “lifestyle diseases” and I will respond with a list of every infectious disease (numbering in the 1000’s alone), autoimmune disease, neurological disease, psychiatric disease, and so on. I’m pretty sure I will win.
I prefer “Biq Quacka”
For push-back on health-insurance coverage of unproven, unscientific “treatments” see the Homeopathy 10^23 campaign in the UK “Homeopathy: There’s Nothing In It.
“On the other hand, you’re saying that most illness today is unrelated to lifestyle”
I’m saying that most illness today is what’s left after modern medicine has treated, cured or prevented the diseases that were responsible for the vast majority of deaths of children and adults.
The fact that chronic diseases of the elderly are now the leading causes of death is a sign of the tremendous success of modern medicine, not a sign of its inadequacy.
@ lizditz
i think you fall short on a few points here.
“Of course genetics and luck are involved in any disease, but for modern Americans, lifestyle is often an extremely important fasd as actor. Cancer is probably also related to lifestyle, sometimes, since it can be related to obesity.”
True – However…if you lump everything “lifestyle” into a group – all things related to smoking, obesity, sunbathing…extreme sports…you name it – you might have a list of 100 (maybe 500?) conditions and ancillary conditions as a factor there of.
There are (anyone care to provide an estimate?) literally THOUSANDS of things that can go wrong with you, many of which sbm can address, cure, manage, ameliorate or suppress. I think HH is correct in her use of “most.” You could start counting here:
http://en.wikipedia.org/wiki/Lists_of_diseases
“And MDs like yourself, who assure your patients their chronic conditions are all because of genetics, etc., just make things even worse.”
Do you, HH, recommend that patients make no lifestyle changes in the event such changes could have a positive impact? And, further, assert that all of your patients suffer some genetic condition? Come on! That is patently absurd generalization.
I am not coming to HH’s rescue (I’m sure she’ll address these points if they sufficiently arouse her arguing muscles) but rather, pointing out where you have used a broad brush to paint a necessarily complicated portrait of health and wellness (and of the Drs. who participate). I suspect that it might be fueled by your own displeasure at seeing lazy americans pop pills and contribute to skyrocketing health care by failing to be proactive in their own health outcomes.
whoops, Dr. T wrote this post…not HH. sub where necessary
“The fact that chronic diseases of the elderly are now the leading causes of death is a sign of the tremendous success of modern medicine, not a sign of its inadequacy.”
I think this is partly true, but partly a myth. Infant and child mortality have decreased dramatically. In nature, a high percentage of offspring do not survive. It is nature’s efficient, but cruel, method of keeping species healthy overall. So yes, modern medicine has dramatically increased our lifespans, largely because babies and young children seldom die, while in the past they very often died.
But the average person who survives childhood does not come down with a lot of diseases that are unrelated to lifestyle, and which require medical attention. Yes, of course, some do, but very large numbers do not.
I am not bashing modern medicine — it does save people who would have died from serious injuries, or from bacterial infections, and it does prevent certain viral infections.
But it is misleading to say that we are only surviving to middle age only thanks to medical interventions. Yes, many of us would have died in childhood. But most adults do not depend on modern medicine to keep them alive.
Unless they have one of the very common chronic diseases that are caused by our the very unhealthy lifestyle of the average American.
Let’s say you went to a society that did not practice the unhealthy modern lifestyle. If you decreased infant and child mortality in that society, do you think you would see an enormous increase in chronic disease in the middle-aged?
I really do not think so. But that seems to be what you are claiming.
The on that always really gets me is the accusation that “Western medicine” doesn’t treat the cause of diseases — it just treats the symptoms. Given how many diseases have a symptom unrelated to the cause which gets treated, this seems an absurd thing to say. It’s as if they want us to believe people who go into an ER with a gangrenous leg will be treated with pain killers, not antibiotics. Doctors do treat symptoms; it’s so you can function while waiting for the condition to improve. I take phenazopyridine when I have a urinary tract infection. Doesn’t cure it. Great symptom relief until the ciprofloxacin my doctor prescribed does its job.
It gets especially funny, though, when the argument is made by a homeopath, and I have seen that more than once before. “You don’t treat the cause, you treat the symptom,” says the homeopath, right before going off an preparing a remedy explicitly designed to treat the patient’s symptoms with no regard to the cause.
“There are (anyone care to provide an estimate?) literally THOUSANDS of things that can go wrong with you,”
Most of us, in my estimation anyway, have never been cured of a life-threatening disease. Most of the non-lifestyle diseases are relatively rare. And there are only a relatively small number of serious diseases that smb is able to cure reliably.
How many of us are always rushing to the doctor to be cured of one of those thousands of diseases?
Most of us, in my estimation anyway, have never been cured of a life-threatening disease.
Maybe because you didn’t get one in the first place?
speaking of “big placebo”, i came upon this a few months ago on medicalnewstoday.com, Pain Related Placebo Effect Detected in Spinal Cord. “Direct Evidence for Spinal Cord Involvement in Placebo Analgesia” Science, 2009, Vol. 326 no. 5951 p. 404
Researchers in Germany(University Medical Center Hamburg) found that when they treated volunteers with a placebo that they believed to be a painkiller, scans (fMRI) showed reduced signs of pain-related activity in their(dorsal horn) spinal cords. The author concluded, “these results provide direct evidence for spinal inhibition as one mechanism of placebo analgesia and highlight that psychological factors can act on the earliest stages of pain processing in the CNS”.
I would also love to know if one of LizKat’s assertions is true or not, because I’ve read it many places. The increase in lifespan is due most significantly to less children and infants dying, (from age 48 to 70 something I believe), and not from people being saved at age 30 (or pick an age past 18). That if a person survived childhood, they were very likely to make it to 50+, and that even hundreds of years ago people routinely lived into their 70s. And that it was primarily vaccinations, germ theory, nutrition, indoor plumbing, sanitation, antibiotics that leads to this decrease in child mortality.
Theories about the chronic diseases we know have would be interesting too, since we know vaccinations didn’t cause them. I have no idea if it’s really mostly genetic, “out of our control” factors or not.
Zoe237,
In addition to infant mortality, ancient and primitive people were likely to die from violence or accidents. Traumatic injuries were often fatal, without modern surgery or antibiotics. So if you combine infant mortality with traumatic injuries, that may account for a great deal of the difference in lifespan. We often assume that in previous eras, people were dying from old age in their 30s, but that is not true. And if they were fortunate enough to survive into middle age, they might have been healthier than we are, since they had no soft drinks and they had to walk a lot.
And yes, I have also read that the great modern advances in health were mostly due to improved nutrition, sanitation, surgical technology, antibiotics and vaccines. It was even stated here at this blog (I don’t remember the exact post though).
# lizkaton 21 Jan 2010 at 2:30 pm
“There are (anyone care to provide an estimate?) literally THOUSANDS of things that can go wrong with you,”
Most of us, in my estimation anyway, have never been cured of a life-threatening disease.”
Well. I’ve had pneumonia once. Like a lot of people I have asthma. Had strep throat twice and another serious throat infection once as a child. My daughter had pneumonia once, had to have a finger reattached once (I know not generally life threatening, unless it became infected) I am hypothyroid, which generally isn’t fatal, short term, but is very common and not fun when untreated. My close friend just recovered from thyroid cancer (not really uncommon). My mom had a serious allergic reaction to shellfish and beestings, epipen probably saved her life. I know three people who have had serious bacterial staph infections that would have resulted in death if left untreated. Five people treated for serious heart disease that would have been fatal. Various children treated for congenital heart conditions. (international adoption group) and since my son was born with severe cleft lip and palate that would have made infant starvation a serious risk, I’ll include him in the group of people I know who’s life probably has been saved by sbm.
Oh sorry, three people in serious accidents that would have been fatal without ER, hospital care.
I’m not a medical person either, these are just friends and family.
When you say most of us can you give me a percentage?
@ lizkat (lizditz as well?)
“Most of us, in my estimation anyway, have never been cured of a life-threatening disease. Most of the non-lifestyle diseases are relatively rare. And there are only a relatively small number of serious diseases that smb is able to cure reliably.
How many of us are always rushing to the doctor to be cured of one of those thousands of diseases?”
so now its about frequency of particular disease occurence? not exactly sure how that proves your point that lifestyle changes prevent some inordinately large number of diseases and MDs contribute to this problem by denoting all diseases as genetic…
Likewise, to play on micheleinnmich’s point, my closest people have encountered: occurlar melanoma, cysts, ashma, type 1 diabetes, broken leg, rib, arm, wrist, collar bone, SVT, car accidents, athritis, bee stings, various lascerations…all of which were undoubtedly addressed by sbm. your “most” could use some qualification.
Excellent post! This is a topic that really gets my blood boiling. I can’t stand it when I hear someone say our medical system only treats symptoms, and then talks about how they love their chiropractor, who they have to go to for the rest of their life. If the chiropractor actually cured the “root cause”, why can’t you stop going after a while?
@a – “Big Placebo should be harassing the American public for not listening to their doctors, and for waiting for a pill or surgery to cure illnesses that could have been prevented.”
That’s the thing. Big Placebo is the one who is selling the pill that will save everyone. People don’t get the answer they want from their doctor, and they find someone who sells them false hope instead. I never understood why these people think that taking some unregulated concoction is more “natural” than taking real medicine.
btw, has anybody seen this.
Future doctors support integrated therapies
http://latimesblogs.latimes.com/booster_shots/2010/01/alternative-medicine-doctors.html
I think the title is a bit misleading, because (thankfully) the students are saying that they need more scientific evidence. But still.
micheleinmichigan,
” three people in serious accidents that would have been fatal without ER, hospital care.”
I said that modern medicine can save people with traumatic injuries.
“Five people treated for serious heart disease that would have been fatal.”
Very often, heart disease that requires surgery is lifestyle-related. No, not always, but often.
“My close friend just recovered from thyroid cancer”
Cancer is not one of modern medicine’s triumphs. There are differing opinions, but many believe the attempt to cure cancer has been largely a failure.
“My daughter had pneumonia”
And I specifically said that children were very likely to die before modern medicine. That was the point.
“my son was born with severe cleft lip and palate that would have made infant starvation a serious risk”
Another childhood example.
So at least half of your examples were irrelevant to my comment. And I doubt the average adult has quite so many serious health problems as you, that are not lifestyle related. Actually, asthma sometimes is lifestyle related.
And, as I said, I am not bashing modern medicine. That was not my point.
“A healthy lifestyle requires conscious decisions now days, and the average American doesn’t have the time or inclination to think much about it. And MDs like yourself, who assure your patients their chronic conditions are all because of genetics, etc., just make things even worse.”
Yet MDs have been in the forefront of supporting healthy lifestyles–stopping smoking, limiting alcohol intake, losing weight, healthful diet, exercise. I don’t know of any lifestyle modification that has been established to improve health or lifespan that is not energetically promoted by MDs.
It is Big Placebo that is most guilty of promoting the notion that one can offset the risk of an unhealthy lifestyle by taking vitamins or herbs, eating “organic” foods, and avoiding “unnatural” chemicals. I knew a great guy who thought that he didn’t have to worry about his smoking, because he exercised, and smoked only natural tobacco, without all of those pesticides and synthetic additives of commercial cigarettes. Dead now, of lung cancer.
“But the average person who survives childhood does not come down with a lot of diseases that are unrelated to lifestyle, and which require medical attention.”
That’s flat out false.
In 2006, a total of 2,426,264 resident deaths were registered in the United States (Deaths: Final Data for 2006).
Life expectancy at birth was 77.7 years.
The 15 leading causes of death in 2006 were:
1. Heart disease 26%
2. Cancer 23.1%
3. Stroke 5.7%
4. Chronic lower respiratory diseases 5.1%
5. Accidents 5.0%
6. Diabetes mellitus 3.0%
7. Alzheimer’s disease 3.0%
8. Influenza and pneumonia 2.3%
9. Kidney disease 1.9%
10. Septicemia 1.4%
11. Suicide 1.4%
12. Chronic liver disease and cirrhosis 1.1%
13. Hypertension and hypertensive renal disease 1.0%
14. Parkinson’s disease 0.8%
15. Homicide 0.8%
Other 18.5%
So almost 40% of patients died of disease that have no lifestyle component. (I am assuming that everyone who died from stroke, chronic respiratory disease and chronic liver disease died from lifestyle factors although the percentage in reality is not 100%)
Now let’s look at the diseases that do have a lifestyle component:
There were 559,558 deaths from cancer, but most were from cancers that are not associated with lifestyle choices. Approximately 31% of cancer deaths were due to cancers associated with smoking, which represents 7.1% of total deaths.
There were 631,636 deaths from heart disease. Approximately 67% died from heart problems that may be associated with smoking. That represents 17.4% of total deaths.
So by my informal back of the envelope calculations, more than 63% of deaths annually are due to diseases that are not related to lifestyle.
Heart disease and cancer have by far the largest percentages and both are likely to be influenced by lifestyle. Cancer is sometimes related to obesity, so smoking is not the only lifestyle factor that can lead to cancer. Heart disease, as I said, is related to type 2 diabetes as well as to smoking.
“Most of us, in my estimation anyway, have never been cured of a life-threatening disease.”
Really? Ask around. Find out how many people you know have never received an antibiotic for a lung infection (bacterial lung infections were once a common cause of death among otherwise healthy adults). Find out how many have never required antibiotic treatment for an infected cut. And of course, that doesn’t even begin to take into account those who would have died of tetanus–once a lifelong risk of almost any injury, but for their vaccination.
lizkat – “Most of us, in my estimation anyway, have never been cured of a life-threatening disease. Most of the non-lifestyle diseases are relatively rare. And there are only a relatively small number of serious diseases that smb is able to cure reliably.”
there was a time when you would know at least one person that died from polio. Do to modern medicine, it’s almost eliminated.
Very few people die of measles or chicken pox, thanks to modern medicine. In fact there are a whole long list of things you probably wont’even get anymore, thanks to modern medicine.
There are a variety of internal issue that would kill people, but no longer due, thanks to modern medicine.
pneumonia doesn’t kill as many people as it used to.
Bones are set properly thanks to modern medicine.
Infections don’t kill nearly as many people thanks to modern medicine.
Statistically YOU are alive due to modern medicine.
You are provably wrong. Go troll elseware.
Often related to lifestyle, through type 2 diabetes, related to obesity:
1. Heart disease 26%
2. Cancer 23.1%
3. Stroke 5.7%
9. Kidney disease 1.9%
13. Hypertension and hypertensive renal disease 1.0%
Often related to alcohol overuse:
12. Chronic liver disease and cirrhosis 1.1%
Not diseases:
5. Accidents 5.0%
11. Suicide 1.4%
15. Homicide 0.8%
Lifestyle related, if type 2:
6. Diabetes mellitus 3.0%
These should be separated:
8. Influenza and pneumonia 2.3%
Pneumonia is often secondary to other problems, which may be lifestyle related.
So this is all that’s left. And we don’t know to what extent they may be related to environmental factors:
7. Alzheimer’s disease 3.0%
10. Septicemia 1.4%
14. Parkinson’s disease 0.8%
Geekoid,
I very carefully stated the benefits of modern medicine. It is possible for something to have benefits and yet not be wonderful in all respects.
Steve:”Cancer
Many cancers can be treated with chemotherapy resulting in long remission or prolonged survival, especially when combined with modern surgical techniques when indicated.”
Did you mean to support some highly misleading alt.med rhetoric with this warped characterization of mainstream cancer treatment?
Of the 50% plus of all invasive cancers that are now permanently cured, the vast majority are cured by surgery. Radiotherapy is the next most common curative agent.
A small but important group of cancers can be cured by chemotherapy alone, or by combinations of the above, or with the aid of other adjuvants such as immunotherapy or hormonal interventions.
Even in the palliation of cancer chemotherapy has a less dominant role than many think.
Chemotherapy was already a soft enough target for quack cancer propaganda. Nearly everyone will know of someone who received it but who still died of their cancer.
“Often related to lifestyle, through type 2 diabetes, related to obesity:
1. Heart disease 26%
2. Cancer 23.1%
3. Stroke 5.7%
9. Kidney disease 1.9%
13. Hypertension and hypertensive renal disease 1.0%”
Yes, but as I just explained above, only a subset of those deaths are related to lifestyle factors.
It is axiomatic among purveyors of “alternative” health that most disease and death is attributable to lifestyle choices. Not only is that claim factually false, it is symptomatic of the wishful thinking that characterizes “alternative” health. At it’s heart “alternative” health is about pretending that good health is entirely within your control, that people who follow the guidelines are guaranteed to be healthy and that people who are sick brought it on themselves.
It would be very nice if that were true, but it’s not.
[...] Big Placebo says Medicine never cures anything by Amy Tuteur. I quick, easy-to-read criticism of alternative medicine. I’ve always been [...]
lizkat
I am interested in recapturing your point, if you don’t mind sharing. I think you tread on some valid points, but have basically lost what you are asserting.
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# lizkaton 21 Jan 2010 at 4:38 pm
“I very carefully stated the benefits of modern medicine. It is possible for something to have benefits and yet not be wonderful in all respects.”
Oy, let me introduce you to my husband.
and I would agree, in modern medicine there is room for improvement. But I like to focus on specific issues that could generate reform ideas rather than broad generalizations.
Some medical schools in Australia where I’m from, have teaching sessions on “integrative medicine” ie integration of mainstream and alternative medicine. Most of the medical students and junior doctors I teach think alternative medicine has some basis. Of course they can’t quote any actual papers and say things like “well I tried acupuncture and it helped” or “my sisters best friend swears by homeopathy and it seems to have helped her”.
Note that alternative medicine is big on anything that is nebulous or benigh, it is not so hot on things that are less so ie bone fractures, leukemia, heart attacks, etc.
For a bit of fun see the brilliant UK sketch on You Tube: That Mitchell and Web Look: Homeopathic A&E. Surely the best spoof on alternative medicine ever!
lizkat my whole family all lived pretty healthily. All reasonably slim and fit. My father had 2 heart attacks but died of stomach cancer, all his 11 other siblings died of heart attacks or cancer, my grandparents on both sides both died of cancer (bowel), my mother had a stroke a while ago, age 77.
Honestly it is offensive of you to suggest that these bung genetics are all due simply to lifestyle choices.
I live healthily, eat reasonably well, am active and reasonably fit. I find it very unlikely that I will die of anything else other than heart attack or cancer.
Also, you may not be aware that slim, fit & currently HEALTHY PEOPLE DIE TOO at some stage.
“Most of us, in my estimation anyway, have never been cured of a life-threatening disease”
My sister had the measles. A good friend of mine ovarian cancer. My mother-in-law had a heart attack and a stent put in. I had a rotavirus infection while an infant and spent a week in the hospital. My daughter had a group B strep infection in utero… to save her I had to undergo an emergency c-section and she was born 3 months premature. Surfactant works wonders.
Thank you modern medicine.
Somewhere in all of this give and take, the basic idea of this article may have been lost: “Western” (science based) medicine=effective. Cam=ineffective (as far as current evidence shows). Do any of the commenters here really dispute this?
Enkidu,
I explained that I was talking about non-lifestyle related diseases, and that I was not talking about childhood diseases. Most of your examples are irrelevant to what I was saying.
[“alternative” health is about pretending that good health is entirely within your control, that people who follow the guidelines are guaranteed to be healthy and that people who are sick brought it on themselves.]
I am not an “alternative” health advocate. I am a skeptic. I was trying to show that some of what you are saying is misleading. Hardly anyone believes that good health is entirely under our control. But saying almost the opposite — that lifestyle is not an extremely important factor now days is not at all accurate. Lifestyle-related diseases are extremely common, and it is not just because people are living longer thanks to modern medicine.
LIfestyle factors are extremely important. You try to make it sound like we are fortunate to live long enough to get these chronic diseases that we have no control over. That is just not true.
Even with an ideal lifestyle people will still get old and die. But they probably won’t start getting type 2 diabetes and artery disease in their 40s, or even younger.
“I am interested in recapturing your point, if you don’t mind sharing. I think you tread on some valid points, but have basically lost what you are asserting.”
Dr. Tuteur said that most disease is unrelated to lifestyle, and is caused by genetic factors and other things outside the patient’s control. That is simply not true. We have epidemics of serious diseases now that are very much related to lifestyle. There are even teenagers who are starting to get type 2 diabetes and artery disease — she really thinks this is mostly because of genetics??
“There are even teenagers who are starting to get type 2 diabetes and artery disease — she really thinks this is mostly because of genetics??”
This is really a red herring. Dr T’s post is not about whether people’s “lifestyle” does or does not affect their health.
It is about Big Placebo’s claim that modern medicine is not effective, and that CAM, in contrast, is effective.
Rather than continuing to claim that unhealthy lifestyle is evidence of the ineffectiveness of modern medicine, you should be instead be prepared to show how Big Placebo does (or would do) better.
Not theoretically, mind you, but in reality. Not enough to simply assert that if-people-change-their-lifestyles-they-will-be-healthier. How, specifically, would Big Placebo achieve this change, where current methods do not? Which specific homeopathic tincture in fact reduces laziness, gluttony, and addictive cravings? And which sage advice or naturopathic concoction makes unfit, overweight smokers want to take that tincture in the first place?
And, where is the evidence that they do (or would do) it better in fact than the current regime of doctors’ health advice, advertising campaigns, employer and insurance incentives etc?
We are all in agreement that lifestyle is important. No one has said otherwise. Doctors routinely recommend that their patients eat right and exercise. There is no way of enforcing this. If people want to eat poorly and smoke, then that is their right.
We know type II diabetes is linked to obesity and we know obesity is on the rise. There is no denying this. The genetics of a population have not changed in 20 years, yet their diet and activity levels have. What else can you point to as a life-style disease other than this (and other obesity related diseases)? You are not pointing out anything that science based medicine doesn’t already know.
I think, from a public health perspective, that we should have a strong campaign against obesity, like the aggressive anti-smoking ads of the last 20 years. New York City has already fired the first salvo and hopefully other cities/countries will follow suit. Of course, it is also a much more sensitive issue. This is not just criticizing a bad lifestyle choice, but condeming the way a person looks.
“There are (anyone care to provide an estimate?) literally THOUSANDS of things that can go wrong with you,”
Most of us, in my estimation anyway, have never been cured of a life-threatening disease.”
Non life style diseases that people I know survived:
Breast Cancer
Meningitis (although the people I knew lost their hearing as children)
strep throat
asthma
pneumonia
bronchitis
polio
kidney infections (required IV antibiotics)
diabetes – type 1 and Gestational diabetes
Non Hodgkin’s Lymphoma
measles
scarlet fever
strep throat
recurrent ear infections
heart disease (in this case it is genetic and not lifestyle related)
prostate cancer
tetanus
rabies
In fact if I stop to think about it I know more people who have survived non lifestyle disease than they have disease caused by their lifestyle.
[...] Alternative Medicine industry Big Placebo. I cannot help but be amused by this. Today they take on the claim that modern medicine (aka “Big Pharma”) does not cure anything, but “merely” manages [...]
“If only that were so. Unfortunately, most illness and disease is caused by factors beyond people’s control, including infectious agents, genetic defects and inherited predispositions.”
“It is axiomatic among purveyors of “alternative” health that most disease and death is attributable to lifestyle choices. Not only is that claim factually false, it is symptomatic of the wishful thinking that characterizes “alternative” health. At it’s heart “alternative” health is about pretending that good health is entirely within your control, that people who follow the guidelines are guaranteed to be healthy and that people who are sick brought it on themselves.”
Okay, so I haven’t a clue what percentage is lifestyle related, and what is beyond our control. I do doubt that “most illness and disease” is beyond our control, as quoted above, once you dramatically reduce vaccine and antibiotic preventable disease. However, I am completely annoyed by my recent forced switch as of Jan. 1 to an HMO who “cares” about my lifestyle factors. Anyway, just wanted to note that this has been discussed before (probably several places):
http://www.sciencebasedmedicine.org/?p=2625#more-2625
“Dr. Val: We have to recognize that 75% of our healthcare dollars are spent on the treatment and management of chronic disease, and that those diseases are 80% preventable with diet and lifestyle interventions. Of course, the other 20% are NOT preventable. There will always be people who are injured at random – perhaps by gene mutations (such as cancer), genetic diseases (like Cystic Fibrosis), or even car accidents (spinal cord injuries). “
[...] original post here: Science-Based Medicine » Big Placebo says Medicine never cures … Share and [...]
One of the biggest cons of Big Placebo is passing off their vitamin pills as “nutrition” and the hucksters of them as “nutritionists”. If you eat a good variety of foods, including plenty of different vegetables, you’ll get all the vitamins you need. The body excretes the rest. I suspect that this is true even for the US’s Big Agriculture vegetables, but fortunately I live where I don’t have to put that to the test.
[...] more from the original source: Science-Based Medicine » Big Placebo says Medicine never cures … Share and [...]
A related great article about the challenges of getting out the message from the evidence / science based side of the house!
Pseudoscience in the Ascendency”
For me this is the winning line;
“I’m allergic to willful ignorance, but I’m in desperate need of an open exchange of ideas. I never won a debate using make-believe facts, but neither did I ever win one by calling my opponent stupid.”
[Dr T’s post is not about whether people’s “lifestyle” does or does not affect their health.
It is about Big Placebo’s claim that modern medicine is not effective, and that CAM, in contrast, is effective.]
I am not someone who would try to advocate alternative medicine. I don’t use it myself and I don’t promote it. The point of my comments was to show that Dr. T. had made some misleading and inaccurate statements. I do not think anyone, even if they are a CAM advocate or practitioner, would ever claim that all disease results from lifestyle. And I do not think anyone would claim that modern medicine is worthless. Modern medicine has many extremely valuable treatments and technologies. How many of us would like to have a tooth pulled without anesthesia, for example? All of us, mainstream or not, are in favor for anesthesia, antibiotics, vaccines and surgery, when used appropriately.
So Dr. T. misrepresented her opponents’ claims and is debating a straw man.
She also stated that most disease is unrelated to lifestyle and results from factors outside patients’ control. But we know that is probably completely untrue. We don’t know what percentage of heart disease, kidney disease, liver disease and cancer are lifestyle related, but we can estimate that it’s pretty high. We know that the modern lifestyle, on average, is unhealthy.
She stated that the main reason people are dying of heart disease, cancer, etc., is because modern medicine has cured so many other diseases, and people have to die from something. That is untrue or greatly exaggerated.
The entire post comes across like propaganda, without much concern for accuracy. I am not defending alternative medicine; I am defending accuracy.
Amy,
Do you have a link/reference for Lindsay Beyerstein’s “Big Placebo” comment.
I tried your link and it took me to her most current blog and it took me to her most current post.
I checked back through the last few weeks and her “medicine” posts and didn’t find it.
Thanks.
‘I never won a debate using make-believe facts, but neither did I ever win one by calling my opponent stupid.”
Very true.
Yes I think this makes a sane and fair-minded statement: http://www.bioworld.com/servlet/com.accumedia.web.Dispatcher?next=bioWorldHeadlines_article&forceid=53348
“How many of us would like to have a tooth pulled without anesthesia, for example? ”
Had a root canal done without it. Didn’t like it one bit. Would not recommend it.
“We know that the modern lifestyle, on average, is unhealthy.”
We do? Unhealthy compared to what? Borneo?
“Unhealthy compared to what? Borneo?”
I should have said, more specifically, the modern American lifestyle, where everyone goes from bed to car to office desk, back to car, to couch, to bed. Other modern cultures probably are better. But it is known that type 2 diabetes and heart disease, for example, are rare in more traditional cultures.
Sure there are over-crowded, unsanitary, miserably poor, traditional cultures, and I am not referring to them.
Our knowledge of how pre-modern people lived is of course very limited. Yes, infant mortality was high (nature’s not very nice way of keeping species healthy). And people often died from traumatic injuries, since they had no antibiotics or surgery.
lizkat
ok, i think i got you, but i think this might be where the discrepancy comes in:
“She also stated that most disease is unrelated to lifestyle and results from factors outside patients’ control. But we know that is probably completely untrue. ”
most diseases (all diseases) or most disease (all occurence of disease)?
sure, there are way more type II diabetics than there are lepors. however, there are way more diseases (overall) that are more effectively addressed with sbm than with lifestyle. obviously, two different things.
“So Dr. T. misrepresented her opponents’ claims and is debating a straw man.”
obviously you haven’t trounced around the alt med spheres every much, here are some great quacks to check out. try and find where they fail to advocate a cure all or natural trick…no matter the cause. likewise, try and find a shred of evidence to support their claims or even reasonable temper as to the effectiveness of their own treatments.
http://www.blaylockreport.com/
http://www.mercola.com/
to them EVERY maladay is lifestyle and every cure is cheap, plentiful and “natural.”
“obviously you haven’t trounced around the alt med spheres every much, here are some great quacks to check out.”
Yes there are quacks everywhere you look. But an intelligent discussion should not even bother with them. People go to wacky extremes and we all know that, and we ignore them. It’s misleading to set them up as typical.
“sure, there are way more type II diabetics than there are lepors. however, there are way more diseases (overall) that are more effectively addressed with sbm than with lifestyle. obviously, two different things.”
Yes there are a large number of ailments that are very rare and maybe some of them can be cured with antibiotics or surgery. But the most common disabling and killing diseases today are lifestyle-related. And if alternative medicine practitioners are emphasizing lifestyle over drugs and surgery for these diseases, then they are to some extent correct.
“But the most common disabling and killing diseases today are lifestyle-related.”
Are you sure? Please define your terms. A soldier has one lifestyle and ends up with disabilities, a pro athlete also frequently ends up with disabilities. A truck driver has a more sedentary lifestyle, a single mother’s lifestyle depends on the work she does or doesn’t do. Do you have an ideal “lifestyle” here? What’s the life expectancy of these people compared to say someone living the “natural” paleolithic lifestyle in the jungles of Borneo?
Are you saying SBM hasn’t played a role in improving their lives? Isn’t SBM part of the modern lifestyle?
Not everyone in the world has the upper middle class lifestyle that gives him or her ample rest, exercise, and ability to follow a healthy diet.
“And if alternative medicine practitioners are emphasizing lifestyle over drugs and surgery for these diseases, then they are to some extent correct.”
That is such a crock. Your going to take someone with unstable angina and tell them not to take medications, have a stent placed, or CABG done and tell them to change their lifestyle instead? As has been pointed out multiple times, therapeutic lifestyle changes for prevention are and always have been a part of SBM.
@lizkat
“Dr. Tuteur said that most disease is unrelated to lifestyle, and is caused by genetic factors and other things outside the patient’s control. That is simply not true. We have epidemics of serious diseases now that are very much related to lifestyle. There are even teenagers who are starting to get type 2 diabetes and artery disease — she really thinks this is mostly because of genetics??”
This is a bogus argument. Just because “We have epidemics of serious diseases now that are very much related to lifestyle” does NOT mean that lifestyle is not the cause of most disease.
“The point of my comments was to show that Dr. T. had made some misleading and inaccurate statements. I do not think anyone, even if they are a CAM advocate or practitioner, would ever claim that all disease results from lifestyle.”
But you are doing the same sort of thing. You claim her statements are untrue (implying that most disease is NOT unrelated to lifestyle), but provide nothing more than a very general observation as proof.
“She also stated that most disease is unrelated to lifestyle and results from factors outside patients’ control. But we know that is probably completely untrue. ”
Oh, give me a break… “we know that is probably completely untrue?” In that case, you/we don’t know anything. If something is only probably true, then it’s also possibly false, including your denial that most disease results from factors outside the patients’ control.
“We don’t know what percentage of heart disease, kidney disease, liver disease and cancer are lifestyle related, but we can estimate that it’s pretty high. We know that the modern lifestyle, on average, is unhealthy.”
You claim we don’t know the percentages, then go on to use those “estimates” as proof. More bogusity.
“She stated that the main reason people are dying of heart disease, cancer, etc., is because modern medicine has cured so many other diseases, and people have to die from something. That is untrue or greatly exaggerated.”
Well, is it true, or untrue? The alternative to “untrue *or*” is true. You seem to be suggesting that a claim is exaggerating the truth. Does that mean it’s, like, very very very very true?
All you’ve done is claim that lots of people suffer conditions due an unhealthy lifestyle, which I think is generally understood and agreed. But that’s a far, far cry from proof that most disease is caused by lifestyle (or the alternative, that the claim that most disease is unrelated to lifestyle is false.)
[Well, is it true, or untrue? The alternative to “untrue *or*” is true.]
You may feel a need for clear and certain answers Ken, but you won’t always find them in medical science.
That’s right. Only sCAM has clear and certain answers. With SBM you get answers of a certain probability of being correct.
“That’s right. Only sCAM has clear and certain answers. With SBM you get answers of a certain probability of being correct.”
You don’t get clear and certain answers with either, and that was my point. Diseases result from lifestyle, and from factors outside our control. Exactly what percentage is lifestyle or not varies and depends on many factors. The original post said it’s mostly NOT lifestyle, and that is an overly general and overly certain, and inaccurate, statement.
lizkat,
There are no clear answers. SBM admits it up front. Regarding your lifestyle fixation. I am not sure about that either. As I said before, you have to define your terms. Everyone has a certain lifestyle. I think disease result from life, period.
weing,
Yes everyone has their own lifestyle. But there is a general tendency as societies become westernized. There is less need for walking as people start to drive their cars everywhere. There is less need for physical labor, because of all the labor-saving machinery. Food is more likely to be processed and refined, and to contain substances our bodies did not evolve with. White sugar and flour are known to be especially damaging.
I think we all know all of this very well. I think most MDs know this very well, and see the results in many of their patients. Most of the people I know do not get regular exercise. It’s hard to find the time when they are so busy driving around, working, and watching TV.
And it’s harder to eat food that is natural and didn’t have all its nutrition removed by processing, because it takes more time. It’s easier to get some processed junk food.
This is not true of everyone, but we are not talking about absolutes. We are talking about statistical tendencies. That should be obvious.
You seem to resist the idea that lifestyle is a big problem currently. I don’t know why you resist it, since mainstream medicine is very much in agreement that we have a health crisis, and it is largely because of lifestyle.
“This is not true of everyone, but we are not talking about absolutes. We are talking about statistical tendencies. That should be obvious.”
Take a look at cultures that eat “natural” foods have more “natural” lifestyles as hunters and gatherers and tell me what statistical tendencies you detect.
“You seem to resist the idea that lifestyle is a big problem currently.”
I don’t believe in panaceas. Do I think overeating is a problem? Yes. Do I think we have a health crisis on our hands? That’s another story. SBM has come a long way. Just because we still have problems doesn’t mean it’s a crisis. We still have a long way to go.
But most adults do not depend on modern medicine to keep them alive.
But I would bet that most use modern medicine at least once a year to keep them more healthy.
I am blessed with good health. But a slightly long colon. So I take Buscopan from time to time when the spasms get too painful. Tonsilectomy was also a god-send when I needed it.
My wife is blessed with good health. And hayfever. Summer can be miserable for her without the drugs.
Medicine is far more than keeping people alive. Even healthy people benefit.
In any case, the original statement is misleading. My wife is not in any way being kept alive by modern medicine now. But her experience of child-birth made us very happy we live in modern times.
we have a health crisis
No we don’t. Most people are healthy in a way that previous times could only have dreamed of. We live longer, and live better.
Sure, not all of us are at our peak of potential health.
You seem to be the society equivalent of the “worried well”.
[...] Mark Crisplin over at Science-Based Medicine flips it around and offers a satirical retort of a non-reward of $10,000 [...]
“Take a look at cultures that eat “natural” foods have more “natural” lifestyles as hunters and gatherers and tell me what statistical tendencies you detect.”
Yes that argument is always used, and I think I have already responded to it. Primitive people do not have antibiotics or surgery so they are likely to die from traumatic injuries resulting from violence or accidents. Since many members of a tribe are involved in dangerous activities such as hunting and warfare, these injuries may be common.
I also mentioned that high rates of infant mortality — nature’s not so nice way of keeping a species healthy — skewed the average lifespan for non-modern people. If the average lifespan was 30, or example, that does NOT mean people were decrepit at 30. They may have been extremely healthy, compared to us, but got in the way of an arrow.
All that has nothing to do with general health. We know very little about the general health of prehistoric or primitive people.
“We live longer, and live better.”
We live longer, mostly because of decreased infant mortality, improved sanitation, antibiotics and surgery. Whether or not we live “better” in all respects is a subjective opinion. The people I know with type 2 diabetes, arthritis or dementia are not living so wonderfully, in my opinion. Many of their troubles were caused by lifestyle factors.
“arthritis or dementia are not living so wonderfully, in my opinion. Many of their troubles were caused by lifestyle factors.”
Lizkat,
You are basically proving my point for me. The claim that “most disease” is caused by lifestyle factors is fabricated. I’ve already showed you that it is factually false, and you’ve simply ignored the proof.
Now you are making up new absurd claims. Where is the evidence that arthritis or dementia are caused by lifestyle?
It is far more comforting to pretend that you can control your own health by living a “healthy lifestyle” but that’s merely pretending. Most people die of factors that have nothing to do with lifestyle; in many cases, it’s simply bad luck, and no amount of wishful thinking can protect your from that.
Lizkat,
You state that “We live longer, mostly because of decreased infant mortality, improved sanitation, antibiotics and surgery.”
Three of those four causes are directly the result of modern medicine. Only improved sanitation is partly a lifestyle choice. Even that is largely a result of government projects to build city-wide clean water supply and enclosed sewer systems which were largely the result of scientific studies in the 19th century. Personal improved sanitation such as hand washing is a random factor. Compliance depends a lot on our knowledge of the scientific basis of sanitation or the lack thereof as an influence on our health.
“Whether or not we live “better” in all respects is a subjective opinion”
Unfortunately, science and science based medicine can not as yet tell us anything useful about our subjective opinions. If your opinion is different from mine, we can only agree to disagree.
Perhaps, like Citizen Kane, we were all happier when we were little kids playing with our sleds in the snow. I still have fond memories of those days.
But, to cite an anecdote as a counter illustration, I also remember my grandfather. For most of his life, he suffered from rheumatoid arthritis (which as my sister the doctor points out is different from plain old osteoarthritis). In the mid 1950’s he was confined to bed for over a year. Then, with the help of modern medicine, he was able to get out of bed and go back to work. (I think it was steroids. At least I know it wasn’t because he took more vitamin pills or stopped smoking.) He was also able to go fishing, buy a boat, and teach his kids and grandkids to water ski.
I believe that I have objective, not just subjective, evidence that he lived better as a result of modern medicine.
I specifically gave credit, repeatedly, for the improvements that resulted from modern medicine. However, it is also very well known that the modern lifestyle, which includes automobiles, Coca-Cola and TV, can be extremely damaging to health.
“The claim that “most disease” is caused by lifestyle factors is fabricated. I’ve already showed you that it is factually false, and you’ve simply ignored the proof.”
You showed that “most” diseases are not caused by lifestyle, but you’re just being tricky. I showed how your list was misleading, and that some of the most common diseases today are lifestyle-related.
I still prefer Big sCAM to Big Placebo – it’s more to the point and Big Placebo sounds very benign. It’s not like the placebo effect (or the role belief plays in modulating subject experience) is a bad thing when understood and used ethically, nor is it woo. In certain areas of medicine where the placebo effect is most noticeable – like mental health and chronic pain treatment, which are both very much about subjective experience and often best approached in a multidisciplinary fashion that considers both mind and body – harnessing the placebo effect can be very useful (it’s entirely unnecessary to lie to patients to do this). The placebo effect is part of SBM and not woo (even if much woo harnesses the placebo effect), forsaking or attributing it to CAM is forsaking important knowledge about health, cognition and biology that is actually part of SBM. It’s not like Big sCAM does research into the placebo effect, it’s SBM that does this!
“I showed how your list was misleading, and that some of the most common diseases today are lifestyle-related”
“Lifestyle-related” is a weasel word. Scientists refer to a disease as “lifestyle related” if lifestyle has any statistically significant effect, no matter how small, on the risk of a disease. Yet you seem to take this as an excuse to claim that all cases of that disease are a consequence of lifestyle choices. You have to consider how strong the relationship is. For example let’s suppose that “bad” lifestyle choices results in a relative risk of 1.99 compared to people who make “good” lifestyle choices. Now this is a big effect, nearly a doubling of the risk of the disease. Very few lifestyle choices have been actually found to produce such a large increase in the risk of any disease. Yet a risk ratio of 1.99 would still mean that most of that disease is not due to lifestyle choice.
recently, while in Bioethics class, one of the students was presenting a powerpoint on acupuncture. at the end of his presentation he said something very similar to what John Neustadt said. the student said that conventional medicine doesn’t directly treat diseases, and that “western medicine” only deals with pain. i tried to explain to my fellow pupil that it was the other way around. i find that kids take for granted the marvels of modern science and focus on the diseases that haven’t been cured yet. all was not lost, later i presented my presentation on homeopathy and revealed it to be one of the biggest scams of our time. afterward, most of my peers where convinced that modern medicine isn’t evil, and that people should be careful when accepting an alternative medication. I apologize for any spelling or grammar mistakes, i have dyslexia.
“Yet you seem to take this as an excuse to claim that all cases of that disease are a consequence of lifestyle choices.”
I repeatedly said some, not all. I repeatedly said we should not speak about this in terms of absolutes. But it is very well known that certain diseases very rarely occur in non-western, traditional types of cultures. It is also very well known, and there is plenty of scientific evidence, that physical inactivity and processed food contribute greatly to some of the most common, and most deadly, diseases. It is also extremely well known that cigarettes contribute greatly to cancer and heart disease.
There is nothing controversial in what I am saying.
There was an article in the paper yesterday that radon was the second leading cause of lung cancer. Any truth to that?
While I am not convinced that most diseases are unrelated to lifestyle (at least in the U.S.), I’m enjoying the debate.
Zoe237,
The EPA radon website says there are about 20,000 lung cancer deaths each year due to radon exposure. Practically all of that is in enclosed areas like homes, especially in basements. Those are places where the radon gas, which is chemically inert although it is radioactive, can build up to dangerous levels.
http://www.epa.gov/radon/index.html
According to the NCI website:
“Estimated new cases and deaths from lung cancer (non-small cell and small cell combined) in the United States in 2009:
New cases: 219,440
Deaths: 159,390
”
So, radon related lung cancer deaths are about 12.5% of the total.
The American Cancer Society estimates that 85-90% of all lung cancer deaths are due to tobacco smoking.
http://www.cancer.org/docroot/CRI/content/CRI_2_4_2x_What_Are_the_Risk_Factors_for_Small_Cell_Lung_Cancer.asp?sitearea
So, tobacco and radon are clearly the two biggest factors.
Other, less common risk factors include airborne asbestos fibers and exposure to uranium, beryllium, arsenic and other metals.
lizkat: it is very well known that certain diseases very rarely occur in non-western, traditional types of cultures
and I’m guessing you’re including cancers of various types? But many cancers don’t appear until relatively late in life; the reason they are rare in the cultures you mention may have little to do with lifestyle & everything to do with the fact that people simply die before the cancer develops to the point where it’s noticed.
“It is also very well known, and there is plenty of scientific evidence, that physical inactivity and processed food contribute greatly to some of the most common, and most deadly, diseases. It is also extremely well known that cigarettes contribute greatly to cancer and heart disease.”
I’d like to agree with you but find it difficult. What is your evidence for processed foods contributing to the most common and most deadly diseases? I was under the impression it was the overconsumption of food that was the problem. Feel free to correct me.
“I showed how your list was misleading”
No, you didn’t. You just chose to ignore the fact that more than 2/3 of cancer deaths and 1/3 of heart disease deaths are due to factors other than lifestyle.
“What is your evidence for processed foods contributing to the most common and most deadly diseases? I was under the impression it was the overconsumption of food that was the problem. Feel free to correct me.”
Type 2 diabetes is, to some extent, caused by physical inactivity and by consumption of refined carbohydrates. (Of course there is a genetic component, as there is with any disease.) Simply eating too much is probably not the main cause of obesity. It would be hard to become obese by eating too much unprocessed food. Of course it might be possible. But it is pretty well known that white sugar and white flour are major culprits in obesity and type 2 diabetes.
I don’t think all MDs would agree, but some believe that refined carbohydrates can lead to carbohydrate addiction. For example, you drink a Coke and your blood sugar shoots up, which causes a spike in insulin, which eventually makes you crash. This leads to a craving for more sugar.
The cycle of carbohydrate addiction is thought, by some, to lead to hypoglycemia, which can progress to insulin resistance and hyperglycemia (diabetes).
Type 2 diabetes is a major cause of artery disease, and other disabling and life-threatening illnesses.
A person who is physically active and eats unprocessed natural food could be obese, I guess, but it’s probably rare.
[...] via Science-Based Medicine » Big Placebo says Medicine never cures anything. [...]
I don’t buy that at all. Diabetes was described in ancient Rome and China. They were eating refined carbohydrates?
Weing is right. Diabetes was commonly recognized in the ancient world as sweet urine disease, dating back to ancient Egypt. We don’t have incidence figures. The prevalence of the disease was low, because there was no treatment and patients died quickly.
I’m not buying it that lifestyle plays only a minor role in disease. If you want to talk about ancient civilizations, what were their eating habits and activity levels? How about drinking lots of alcohol, feasting frequently, and having all of your household chores done by servants? Was the prevalence of diabetes lower or higher in certain levels of society? I think there are many questions to be asked an no way of finding answers from those times.
Governments all over the world are spending tons of money on health programmes to influence citizens’ lifestyles to help lower risk of diseases, feel healthier, and live better for longer. Have they planned their health initiatives based on bad science?
“If you want to talk about ancient civilizations, what were their eating habits and activity levels? How about drinking lots of alcohol, feasting frequently, and having all of your household chores done by servants? Was the prevalence of diabetes lower or higher in certain levels of society? I think there are many questions to be asked an no way of finding answers from those times.”
You mean societies in which the average expectancy was 35 years?
“You mean societies in which the average expectancy was 35 years?”
You didn’t bother to read what I explained, repeatedly, about the distribution being skewed by infant mortality. And that people often died from traumatic injuries. And I also said we don’t know much about health and lifestyle in ancient civilizations.
But if you want evidence about the damaging effects of the typical modern lifestyle, it is not hard to find scientific evidence.
“Diabetes was described in ancient Rome and China. They were eating refined carbohydrates?”
Type 1 diabetes has completely different causes than type 2, for one thing, and you don’t know which type they were describing. Type 2 diabetes is currently an epidemic in America. Everyone knows this, or should know it. And you do not see that in societies that do not have a similar lifestyle.
You are assuming it was all Type 1. Is that a safe assumption?
@lizkat, StatlerWladorf, et al
“It would be hard to become obese by eating too much unprocessed food. Of course it might be possible.”
Rubens painted at the dawn of the 17th century and is celebrated for his depictions of plump women. Paintings of Henry VIII and many others whose lives antedated modern food processing show ample girth. In the 17th and 18th centuries plus sizes suggested financial wealth. It was the poor who were thin.
It isn’t that it is difficult becoming obese eating unprocessed food just that it is has, historically speaking, been expensive.
Also:
“But it is pretty well known that white sugar and white flour are major culprits in obesity and type 2 diabetes.”
I’m not going to quibble about white sugar though I question whether replacing it with raw sugar would make any difference. But you’re going to have to show some proof that white flour is linked to type 2 diabetes.
“Rubens painted at the dawn of the 17th century and is celebrated for his depictions of plump women. Paintings of Henry VIII and many others whose lives antedated modern food processing show ample girth. In the 17th and 18th centuries plus sizes suggested financial wealth. It was the poor who were thin.”
Rich people didn’t have to walk.
“You are assuming it was all Type 1. Is that a safe assumption?”
I said we don’t know which type it was. If it was both types, we don’t know how common each was. It is a fact that type 2 diabetes is now an epidemic in the US, and is a major cause of some of the most common serious health problems. I really don’t know why you are trying so hard to argue against that fact.
“You are assuming it was all Type 1. Is that a safe assumption?”
I said we don’t know which type it was. If it was both types, we don’t know how common each was. It is a fact that type 2 diabetes is now an epidemic in the US, and is a major cause of some of the most common serious health problems. I really don’t know why you are trying to argue against that fact.
I am not arguing that diabetes is not an epidemic. You made the claim that processed food is the cause of this modern epidemic. Please back up that claim unless you’ve changed your mind.
“Rich people didn’t have to walk.”
Would you kindly explain how that relates to the point about refined sugar and flour? People got fat before the advent of highly processed foods. No one is arguing that lifestyle doesn’t matter; it does. I am simply questioning how large a role is played by processed foods in causing diabetes.
From the CDC press release on Nov. 19, 2009,
“Obesity is one of several factors linked to type 2 diabetes. Where people live, how much money they earn, their culture and their family history also play a role. An unhealthy diet, lack of physical activity, and socioeconomic factors contribute to both obesity and type 2 diabetes as well as to complications of diabetes. Some population groups also are at higher risk, including a number of racial and ethnic minorities.”
http://www.cdc.gov/media/pressrel/2009/r091119c.htm
Looking at the CDC stats there seems to be a trend of increasing obesity levels and increasing diabetes diagnosis levels from the 1980’s until now.
I’m pretty sure that eating processed foods and refined white sugars and flours can be considered “an unhealthy diet” considering how the body metabolizes those and how they typically are part of high calorie food items which contribute to obesity if eaten in large quantities (as a lot of junk food is, let’s face it). Sedentary lifestyles also contribute to obesity, obviously. It is a fact that we have far more video-game playing fast-food eating overweight young people today than we did in the 1970’s and 1980’s, and that can’t be good for health!
windriven, do you have stats on the incidence of type 1 and 2 diabetes across the US population in say the 1700’s to 1900’s? How about the obesity levels during that time period?
Don’t forget about the “epidemic” of type II diabetes arising in children and teenagers now. Is this really genetic? Dr. Tuteur’s absolutist (or near) assertions that lifestyle isn’t a major cause of disease sounds kind of like her last assertion that “toxins” like lead don’t cause disease either.
Lizkat, you might want to present some backup for your own opinions. “It is well known that” and “well understood” and “everybody knows” aren’t really good arguments. Still, Dr. Tuteur first made the statement that most disease is caused by genetic factors outside our control, so the burden of proof is on her.
Be nice to see a debate between Dr. Tuteur and Dr. Jones on this (see my last post with link).
“You made the claim that processed food is the cause of this modern epidemic. Please back up that claim unless you’ve changed your mind.”
I said that processed food AND physical inactivity is the cause. Yes, they had obesity in earlier times, but it was not as common. There was high calorie food, for the rich, and the rich didn’t have to walk or do physical labor.
Zoe237,
Most of what I am saying is extremely well known and it is extremely easy to find studies that back it up. This is so well known that it is somewhat shocking to see that some MDs are completely unaware.
It seems the fuss over white flour is over the alloxan it contains, which supposedly kills off beta cells in the pancreas thus reducing production of insulin. Seems this may be the case in small animals, but not humans? I don’t know enough about this at the moment.
Windriven, the problem with refined flours is that most of the nutrients and fiber is stripped away, so you feel less full when eating simple carbs. That makes it easier to eat MORE when it’s processed. Try the difference between eating a sandwich on whole wheat bread versus wonder bread- I definitely feel more full with the former. Also, when I eat a piece of white bread (and I love white bread, but try to limit it), I can literally feel it melt it in mouth and taste the sweetness as the simple carbs break down into sugars. After all, carbohydrates are merely complex sugars.
This was intentionally done by the food industry- people prefer the taste of simple, refined carbs because they’re sweeter.
http://www.mayoclinic.com/health/whole-grains/NU00204
So you are saying that if we overeat unprocessed foods and are inactive we won’t get diabetes but if we eat a little processed food and are inactive we will?
lizkat:
You objected to Dr Tuteur making too strong claims; this seems to me to be too strong a claim to make without good evidence behind it. You say white sugar and flour are known to be especially damaging. That implies a claim that they are *intrinsically* harmful, rather than merely problematic insofar as they make it easier to overeat. I’d like to know what you base that on.
Zoe237: of course the food industry intentionally makes food sweet. They’ll make whatever sells well, and that’s determined by what we buy. It’s a vicious circle, and I don’t think either side has the moral high ground, or deserves full (or even majority) blame. After all, the food industry is a subset of us; they eat this stuff too. They make it not only because you and I like it, but because they do too. (There is reasonable justification for the stereotype of the fat chef, after all. Most people go into the biz because they really love food.)
“They’ll make whatever sells well, and that’s determined by what we buy. It’s a vicious circle, and I don’t think either side has the moral high ground, or deserves full (or even majority) blame.”
Oh, I agree. That’s why I avoided making any value statements.
The question we are debating here is one of degree. What percentage is caused by lifestyle and what by genetics? The truth is probably somewhere in the middle of the two extremes.
“Most of what I am saying is extremely well known and it is extremely easy to find studies that back it up. This is so well known that it is somewhat shocking to see that some MDs are completely unaware.”
In other words, you have no scientific evidence.
Please do some research and get back to us on:
Incidence of type 2 diabetes by age
Mortality rate of type 2 diabetes
Number of deaths annually attributed to type 2 diabetes
Proportion of total annual deaths attributed to type 2 diabetes.
Until you know those things, you really don’t know if your claims are true or false, yet you are asserting them anyway.
“What percentage is caused by lifestyle and what by genetics?”
In addition, we are discussing whether the prevalence of various chronic illnesses is rising or whether as the population ages, chronic diseases associated with aging are more common.
My claim it that the rise of chronic diseases associated with old age is only to be expected as life expectancy rises. Moreover, as acute illnesses are treated and cured, the proportion of people dying of chronic diseases associated with age would be expected to rise.
Consider Alzheimer’s disease as one example. Alzheimer’s is a disease of the elderly. As a population ages, the prevalence of Alzheimer’s disease can be expected to rise even thought the incidence of Alzherimer’s stays the same. Therefore, increasing deaths from Alzheimer’s is an inevitable consequence of the success of medicine in treating and curing various diseases.
White flour and white sugar both have a high glycemic index. In other words, they are converted into blood sugar quickly, which over-stimulates the production of insulin.
“In other words, you have no scientific evidence.”
No, I said there is plenty of evidence.
“My claim it that the rise of chronic diseases associated with old age is only to be expected as life expectancy rises. ”
Yes, you claimed that, and you do not have any good evidence to support it.
lizkat, no one disputes that white flour has a relatively high GI. But that does not demonstrate causation. Do you have relevant citations indicating causation?
lizkat,
Show us.
lizkat –
mm” three people in serious accidents that would have been fatal without ER, hospital care.”
l”I said that modern medicine can save people with traumatic injuries. – ”
Cherry picking – you said “”But the average person who survives childhood does not come down with a lot of diseases that are unrelated to lifestyle, and which require medical attention. Yes, of course, some do, but very large numbers do not.”
mm“Five people treated for serious heart disease that would have been fatal.”
l”Very often, heart disease that requires surgery is lifestyle-related. No, not always, but often.”
Sorry, I should have specified five people treated for congenital heart disease. My FIL hole in heart, A friend hole in heart, three children with different congenital heart defects – but I forgot, you cherry picked childhood disease out.
Would you care to share the data or research that says “heart disease that requires surgery is lifestyle-related. No, not always, but often.” ?
mm“My close friend just recovered from thyroid cancer”
l”Cancer is not one of modern medicine’s triumphs. There are differing opinions, but many believe the attempt to cure cancer has been largely a failure.”
Well, I said thyroid cancer, which has an extremely high survival rate with treatment. But if you’d like to call that a failure. —okay.
l”So at least half of your examples were irrelevant to my comment.”
– Oh dear. Did I give you the impression that being relevant to all of your comments was my top priority?
l”And I doubt the average adult has quite so many serious health problems as you, that are not lifestyle related. Actually, asthma sometimes is lifestyle related.”
Well, actually I’m reasonably healthy, but I’ve got some autoimmune issues. They run in the family, so they wouldn’t interest you. My asthma did start when I was working in a location that had a leaky roof and black mold. I’m not sure if I’d call that a lifestyle choice.
“And, as I said, I am not bashing modern medicine. That was not my point.”
Actually you are not bashing modern medicine, you are cherry picking it’s successes and weaknesses to make your point. Which appears to be that some unspecified percentage of people which you consider to be “most” suffer from illnesses that they could be prevented (you believe) by a more healthy lifestyle. And that you are highly offended that Dr. T does not agree with you.
You haven’t specified what you expect modern doctors to do regarding that. I have never gone to a GP that doesn’t give pointers on healthy lifestyles when relevant. What else are they supposed to do? Start jogging clubs? Move in with you and monitor your grocery shopping? Put ‘unhealthy lifestyle participants’ in a sanitarium?
Your points would make more sense if this were a public policy debate, but Dr. T’s point was that modern medicine does cure many ills more reliably than CAM. The fact is science based medicine has made most of the connections about “healthy lifestyle” that you are putting forward.
I for one, get tired of the slightly superior lectures on lifestyle choices being to blame for various diseases. I find they do very little to find solutions.
You really have to be careful when you talk about the benefits of lifestyle changes without the risks. Take a jogger. In some parts of the country they can get mauled by a mountain lion while jogging, raped, mugged, hit by a car, twist an ankle or break a bone. Would you call these lifestyle related?
“And that you are highly offended that Dr. T does not agree with you.”
I can’t imagine where you got that idea. It doesn’t offend me that Dr. T is very wrong about the important of lifestyle in the current health crisis.
“I for one, get tired of the slightly superior lectures on lifestyle choices being to blame for various diseases. I find they do very little to find solutions.”
This has nothing to do with superiority. It is a fact that lifestyle is a major contributing factor to some very serious and disabling illnesses. When MDs fail to emphasize lifestyle to their patients, then their patients assume that lifestyle must not be very important.
“lizkat,
Show us.”
You obviously have internet access. I searched in Google and found many thousands of pages, also found many abstracts in PubMed.
“You haven’t specified what you expect modern doctors to do regarding that.”
The trend seems to be charging more in health insurance for people who are obese or making insurance rates dependent on lifestyle choices. We’ve already done that with smoking. Should we with obesity as well? ( I believe the answer is no, but my new health insurance disagrees). Is processed foods/salt/fast food/whatever going to be the new tobacco?
Modern medicine/ sanitation certainly has saved people to the degree that we now have to worry about these chronic diseases. But that doesn’t tell us what percentage of chronic diseases are lifestyle related versus genetic. If somebody is going to say “most” I’d say that means 90% of chronic diseases are caused by factors outside our control. I don’t buy that (which is what I believe that Dr. Tuteur is saying). But I don’t buy that most of them are caused by lifestyle factors either.
I’ve seen a lot of theory but not sources for any claims, by either side (other than the top 15 causes of death, which doesn’t tell us anything about the factors behind those deaths.) Forgive me if I don’t believe claims without evidence, even if it’s “common knowledge” or because somebody has an MD after their name.
Oh, and when somebody uses life expectancy 100 years ago as proof of their position, my eyebrows raise. False causation anyone? A lot has changed since 1910, not just medicine. For either side.
lizkat,
You are the one making the claim. The burden of proof is upon you to back up your claim. Sorry. You do the work. Years ago I tried, and gave up.
“Modern medicine/ sanitation certainly has saved people to the degree that we now have to worry about these chronic diseases. ”
When life expectancy was 35 years, people who survived childhood and did not die from injuries were not getting diabetes 2 in their 40s. These chronic diseases are not something that just happens from normal aging, in general.
So just show us, already.
I refuse to try to guess which search terms and strategies you used or which articles you found. Whenever someone says “Google it,” I know she’s probably B.S.’ing me. At the very least, it is not up to us to prove your point for you.
This whole either/or debate is a bit silly and simplistic (not to mention that it seems to totally ignore science!). It’s like the nature vs nurture debate – sure some people still cling to it because they’re caught up in an ideological position but almost everyone who’s actually interested in SBM and working on research recognizes complexity and that it’s usually nature AND nurture. Hasn’t anyone here heard of epigenetics?
http://en.wikipedia.org/wiki/Epigenetics
http://www.epidna.com/
Contemporary research into cancer seems to recognize both a genetic and an environmental component to most cancers. Type 2 diabetes may have a genetic component but it’s certainly also environmental otherwise changing habits wouldn’t influence it. Once again ideology blindfolds science and creates confirmation biases that blind those who are emotionally engaged in a simplistic belief because they’re more interested in arguing how “right” they are than actually curious as to how things work. Really, being able to say “I don’t know” is essential to SBM and science in general. And trying to counter one ideological position with another simply reinforces the opposing ideology rather than protecting or serving SBM (mainly because it’s not actually practicing or respecting SBM).
FWIW, this was Dr. Val Jones’ source when she mentioned that 80% of chronic diseases are “caused by diet and lifestyle factors.” There’s a powerpoint there with more sources. No idea if credible or not. There’s also a WHO report on said topic somewhere.
http://www.fightchronicdisease.org/issues/about.cfm
http://www.sciencebasedmedicine.org/?p=2625#more-2625
Just a side statement. I think sometimes people confuse a factor in a condition with a cause.
The other day my MIL, who is a nurse and should know better, told me that a lack of folic acid caused cleft lip and palate and that was why they had more cleft lip and palate in Asia (due to poor diet? I guess she was saying).
When I looked it up, I found that the study showed that mother’s who took folic acid supplements had about a twenty (22) percent decrease in delivering a child with isolated cleft lip and palate. http://www.medicalnewstoday.com/articles/61799.php (I was going to say google it, god forbid:). A twenty percent decrease is good, but it is not “low folic acid causes CLCP”
Different racial populations (regardless of their current residence), Native Americans, Asian, European and African have different incidence of cleft lip and palate, because of the genetic component.
IMO people tend to exaggerate the role of controllable risk factors in their minds. So I am now very cautious of anyone claiming that any controllable risk factor is “the cause” of something. This is not to say some aren’t. I just like to see numbers.
But I guess I’m kinda with FiFi in coming to the conclusion that it is a bit of a pointless debate. Or it would be if I weren’t procrastinating a pile of paperwork.
Google search terms: diabetes type 2 prevention research evidence
http://diabetes-diagnosis.suite101.com/article.cfm/type_2_diabetes_prevention_research
People who are physically active and maintain a normal body mass index are at a decreased risk of type 2 diabetes, according to The Medical Research Council (MRC) study.
“An increased risk for developing type 2 diabetes is associated with overweight and obesity; abdominal obesity; physical inactivity.”
http://en.wikipedia.org/wiki/Diabetes_mellitus#Type_2_diabetes
“A number of lifestyle factors are known to be important to the development of type 2 diabtetes. In one study, those who had high levels of physical activity, a healthy diet, did not smoke, and consumed alcohol in moderation had an 82% lower rate of diabetes. ”
http://www.library.nhs.uk/diabetes/ViewResource.aspx?resID=251169
“Just over 100 years ago, Type 2 diabetes was a rare disease. Less than 25 years ago, it was rare in developing countries. In a relatively short time span in human history we are observing a dramatic change in the incidence of Type 2 diabetes in most populations across the world. Although it is recognised that there are genetic factors that are predispose to diabetes, it is clear that what has changed to account for the rapid increase in the risk for diabetes is the change in the environment. ”
“A number of dietary factors have been shown to increase risk for diabetes. Diet with low fibre content, low unsaturated:saturated fat ratio, high in trans-fat and with a high glycaemic load are all associated with an increase in risk for Type 2 diabetes. ”
“Physical activity is another key factor that determines risk for diabetes. The relative risk of women who take vigorous exercise at least once a week is 0.67 compared to those women who do no exercise at all.”
http://emedicine.medscape.com/article/117853-overview
“Type 2 diabetes mellitus is less common in non-Western countries where the diet contains fewer calories and caloric expenditure on a daily basis is higher. However, as people in these countries adopt Western lifestyles, weight gain and type 2 diabetes mellitus are becoming virtually epidemic.”
“While type 2 diabetes mellitus traditionally has been thought to affect individuals older than 40 years, it is being recognized increasingly in younger persons, particularly in highly susceptible racial and ethnic groups and the obese. ”
“Superimposition of caloric excess (typically, high intake and low expenditure) on a susceptible genotype appears to cause type 2 diabetes mellitus. A large, population-based, prospective study has shown that an energy-dense diet may be a risk factor for the development of diabetes that is independent of baseline obesity.”
lizkat
Pot, meet kettle. You continue to provide only assertions.
I am aware that sucrose is rapidly converted to glucose, and that high levels of glucose stimulate the production of insulin. (That is how the system works.) But that was not your claim. Your claim was that white sugar and flour (presumably you mean “white flour”, though I could be mis-parsing your sentence) are especially bad. But people can use table sugar for decades without developing diabetes (one or two), and in any case, I’m not aware of a link between refined sugar or floud consumption and the other diseases you mentioned as being lifestyle related (asthma, heart disease, etc), so I’m not sure how that supports your overall point.
As far as whether or not this is a useful debate — I don’t know, but I don’t think anyone here has taken the position that ALL disease is due to factors beyond anyone’s control. In other words, I think most of us here are in the “it’s a bit of both” camp. Me, I’m inclined to guess that more of it is not in our control than is. But the rate of chronic illnesses in my family may be a factor in that belief; of the ones I know, the majority of cases were not due to lifestyle factors. (There are a few exceptions; my grandma’s recurrent melanoma, for instance, is probably connected to her love of sunbathing as a teen and young adult.)
That said, it is worth mentioning that lifestyle changes can affect the course of a disease, for better or for worse, regardless of how one came by it. I’ve made a lot of lifestyle changes to deal with my GERD. But people without GERD don’t need to make the same changes; my lifestyle did not cause my GERD (I was very likely born with it), though my lifestyle certainly does affect the course of it. Hubby can get away with eating right before bed. I can’t. Some may take this as evidence the whole condition can be cured with lifestyle changes (I wish!) or that if one merely lives right, one will not suffer acid reflux, but that is not the case. Mostly, you can just adjust your risk factors, which means that while lifestyle can help, it isn’t the whole answer.
The whole lifestyle vs genetics/chance debate does remind me of one question that I’ve always had. Maybe one of the more knowledgeable folks could help me. (They didn’t cover this much in art school)
When they talk about “the cost of” a disease, say diabetes, on the news, they refer to some number that I’m assuming some statistician has come up with that is the cost to treat that disease + missed time, etc. Does that figure include some sort of offset from the typical cost of health care, etc til death? or is it just the actual cost of that illness, not taking into account that that person will eventually get sick and die?
Maybe that’s a silly question, but I’ve always wondered.
“I don’t think anyone here has taken the position that ALL disease is due to factors beyond anyone’s control.”
The original post said that MOST disease is beyond anyone’s control. The message seems to be that improving your lifestyle won’t make much of a difference. However, it is easy to find research that says otherwise. I posted a list of examples that took only minutes to find, but it’s “awaiting moderation” for some reason.
There are several WHO links enumerating the primary chronic disease risk factors. Here are just a few. These links highlight that a large percentage of these risk factors are preventable.
http://www.who.int/dietphysicalactivity/publications/facts/riskfactors/en/index.html
“Chronic diseases are largely preventable diseases.” (page 5 of text) and “Diet has been known for many years to play a key role as a risk factor for chronic diseases.” (page 6 of text) http://whqlibdoc.who.int/trs/WHO_trs_916.pdf
The book “Preventing Chronic Disease, a Vital Investment” by the World Health Organization (see on google books) states (pp. 48-49) “The causes of the main chronic disease epidemics are well established and well known. The most important modifiable risk factors are: unhealthy diet and excessive energy intake; physical inactivity; tobacco use.” And “Many more risk factors for chronic diseases have been identified, but they account for a smaller proportion of chronic disease.” A discussion of harmful alcohol use ensues.
lizkat, my apologies, then, for belaboring the point about evidence. Posts with lots of links go automatically into moderation, since it’s the best way to stop search-engine optimization spammers. (There are seriously people paid to browse the web looking for blogs and forums to post links to certain websites, so as to improve their Google ranking. They’re easy to spot, because they contribute nothing else and are usually only marginally on topic if at all. But it takes a human to spot them reliably, so a growing number of blogs are doing the same thing as this one has.) I’ll be interested in looking at hte links when they come out of moderation.
I think our disagreement isn’t a big as it seems. I agree that lifestyle can affect the course of many diseases; I just don’t think we can confidently say it is responsible for a majority of them. You can have one person who does everything right and dies of a heart attack at 24, and another person who smokes, eats bacon and Twinkies with every meal, and washes it all down with beer but lives to 90. So we know lifestyle is a factor, but it can’t be *the* factor, or those cases wouldn’t exist.
So can we meet in the middle at all?
Note: I don’t think Dr Tuteur intended to imply that lifestyle changes are useless, and I didn’t come away with that message when I read her post. I instead read it as a counterpoint to the frequent alt-med claim that if you just live right, you will never get sick. I think you and I can both agree that such a claim would be untrue, but if you aren’t reading it within that context (of counterpoint to frequent alt med claims), it may come across more strongly than intended.
“You can have one person who does everything right and dies of a heart attack at 24, and another person who smokes, eats bacon and Twinkies with every meal, and washes it all down with beer but lives to 90. ”
We are talking about statistical probabilities. You can always find odd exceptions.
“a counterpoint to the frequent alt-med claim that if you just live right, you will never get sick.”
We all know life is not that simple.
” most illness and disease is caused by factors beyond people’s control, including infectious agents, genetic defects and inherited predispositions.”
That was her statement. If there are alt med practitioners claiming all disease is caused by lifestyle, then they are obviously wrong. But if they say that the most common serious diseases now days are partly or largely caused by lifestyle, then they would probably be correct.
Dr. Tuteur is claiming that we do not have much control at all over our health, and instead it mostly depends on the medical profession.
It’s easy to find cases where people were saved or helped by medical professionals. But it is also easy to find examples where lifestyle is the most important factor. And there is plenty of scientific evidence to confirm that.
So anyone here who denies the importance of lifestyle is very much out of touch with recent research.
From the 2003 WHO technical report “Diet, Nutrition and the Prevention of Chronic Diseases” cited above:
“Nutrition is coming to the fore as a major modifiable determinant of chronic disease, with scientific evidence increasingly supporting the view that alterations in diet have strong effects, both positive and negative, on health throughout life.”
“The latest scientific evidence on the nature and strength of the links between diet and chronic diseases is examined and discussed in detail in the following sections of this report….These include obesity, diabetes, cardiovascular diseases, cancer, osteoporosis and dental diseases.”
“It is clear that the earlier labelling of chronic diseases as ‘‘diseases of affluence’’ is increasingly a misnomer, as they emerge both in poorer countries and in the poorer population groups in richer countries. This shift in the pattern of disease is taking place at an accelerating rate; furthermore, it is occurring at a faster rate in developing countries than it did in the industrialized regions of the world half a century ago. This rapid rate of change, together with the increasing burden of disease, is creating a major public health threat which demands immediate and effective action. It has been projected that, by 2020, chronic diseases will account for almost three-quarters of all deaths worldwide, and that 71% of deaths due to ischaemic heart disease (IHD), 75% of deaths due to stroke, and 70% of deaths due to diabetes will occur in developing countries.”
Zoe237,
You make some good points, but you weren’t quite correct when you said that :
“Dr. Tuteur first made the statement that most disease is caused by genetic factors outside our control”
Actually, what she said was:
“Unfortunately, most illness and disease is caused by factors beyond people’s control, including infectious agents, genetic defects and inherited predispositions.”
So, genetic defects and inherited predispositions (which are genetic if not necessarily defects) are some of the factors, as well as infectious agents, that Dr. Tuteur asserted cause most illness and disease.
That’s not quite the same as saying that most disease is caused by genetic factors, since it also includes infectious agents in the cause set.
Most times most is not necessarily a majority.
“Dr. Tuteur first made the statement that most disease is caused by genetic factors outside our control”
Actually, what she said was:
“Unfortunately, most illness and disease is caused by factors beyond people’s control, including infectious agents, genetic defects and inherited predispositions.”
So, genetic defects and inherited predispositions (which are genetic if not necessarily defects) are some of the factors, as well as infectious agents, that Dr. Tuteur asserted cause most illness and disease.”
Yes, I wish I could edit. Mostly, I just stopped putting the infectious agents part in there after I’d typed that sentence several times. Dr. Tuteur subtly shifted the debate (rightly imo, in response to the comments) when she listed the top 15 causes of death in the U.S. The only one, at least clearly, that is related to infectious agents is the flu and pneumonia and septicemia. There were also homicide, car accidents, etc.
So the ones we’re left to debate are 1. Heart disease 26%
2. Cancer 23.1%
3. Stroke 5.7%
4. Chronic lower respiratory diseases 5.1%
6. Diabetes mellitus 3.0%
7. Alzheimer’s disease 3.0%
9. Kidney disease 1.9%
12. Chronic liver disease and cirrhosis 1.1%
13. Hypertension and hypertensive renal disease 1.0%
If I take just her quote from the original post, and you include the entire world’s population, I’m guessing that infectious agents diseases (particularly malaria and rotavirus) kills FAR more people than any obesity/ diet/tobacco/alcohol lifestyle related disease. So I couldn’t quibble with her there.
Whether chronic western world diseases however are lifestyle related, I am still unsure of. Neither side has presented much evidence.
I think we all recommend therapeutic lifestyle changes for our patients and for ourselves. The science behind these recommendations is mostly based on epidemiological studies. I know of no convincing evidence for processed foods causing diabetes. The “everybody knows” attitude has always been a red flag for me. Things are not as simple as we would like. I still don’t think I buy the explanations for the obesity survival paradox. That’s just me.
A brief statistical comparison of obesity, diabetes and influenza
For numbers on obesity, I went to a recent report in JAMA:
http://jama.ama-assn.org/cgi/content/full/2009.2014
which stated “The prevalence of obesity increased in the United States between 1976-1980 and 1988-1994 and again between 1988-1994 and 1999-2000.”
And:
In 2007-2008, the age-adjusted prevalence of obesity was 33.8% overall, 32.2 among men, and 35.5% among women. … The increases in the prevalence of obesity previously observed do not appear to be continuing at the same rate over the past 10 years, particularly for women and possibly for men.”
For obesity and diabetes, I checked the CDC January press release:
http://www.cdc.gov/media/pressrel/2009/r091119c.htm
which stated that “The proportion of U.S. adults who are obese was 26.1 percent in 2008, according to BRFSS data. CDC estimates that nearly 8 percent of the population, or about 24 million people, have diabetes. Of these, 5.7 million are undiagnosed.”
And, the January 15 CDC estimates of H1N1 cases stated that
“CDC estimates that between 39 million and 80 million cases of 2009 H1N1 occurred between April and December 12, 2009. The mid-level in this range is about 55 million people infected with 2009 H1N1.”
So, if we use the slightly higher JAMA number, about 100 million people in the U.S. are obese. This is a huge number, certainly a major risk factor for other diseases such as diabetes, and roughly comparable to the prevalence of smoking about 40 years ago. However, we have enormously reduced the prevalence of smoking through public relations and legal measures and expect to reduce it more, so there is some hope to do so as well for obesity.
In fact, the JAMA report noted that “increases…do not appear to be continuing at the same rate”.
Also, keep in mind that while obesity is a risk factor for other diseases, I don’t think it is yet classified as a disease in and of itself.
Thus, last year 100 million people in the U.S. were obese, 24 million had diabetes (type unspecified) and 55 million had the H1N1 form of influenza.
Even so, most people in the U.S. are not obese, most obese people do not have diabetes (at least not yet). And, although diabetes is partly caused by lifestyle factors and a lot of people have diabetes, a lot more people had influenza (a germ-caused disease) last year than had diabetes.
I have another post coming. We’ll see which shows up first.
Unfortunately, a lot of this discussion has devolved into the question of whether disease x or condition y or risk factor z is best described by the term some or many or a lot or most or mostly or almost all or all.
Unless we define those terms carefully and precisely, all such a discussion is likely to get us is an apparent case of facial argyria.
At least lizkat gave some useful references on the connection between lifestyle choices like diet and exercise and diabetes. But, I noticed that her last reference states that:
“The genetics of type 2 diabetes are complex and not completely understood, but presumably this disease is related to multiple genes (with the exception of maturity-onset diabetes of the young [MODY]). Evidence supports inherited components for pancreatic beta-cell failure and insulin resistance. Considerable debate exists regarding the primary defect in type 2 diabetes mellitus.”
So, even though making at least 4 or 5 of the right lifestyle choices can substantially lower your chance of getting type 2 diabetes, there is still a genetic factor.
No one disputes that those lifestyle changes are beneficial and desirable.
But, it’s not a strict either-or situation and trying to argue it into one is pointless.
Zoe said “I’m guessing that infectious agents diseases (particularly malaria and rotavirus) kills FAR more people than any obesity/ diet/tobacco/alcohol lifestyle related disease.”
I would have guessed the same, but I was more than surprised to learn from the book “Preventing Chronic Disease, a Vital Investment” by the World Health Organization that in five out of the six regions of WHO, deaths caused by chronic diseases dominate the mortality statistics and that worldwide the total number of people dying from chronic diseases is double that of all infectious diseases (including HIV/AIDS, tuberculosis and malaria), maternal and perinatal conditions, and nutritional deficiencies combined. Mortality percentages for the total number of deaths worldwide in 2005 are given as follows: communicable disease, maternal and prenatal conditions and nutritional deficiencies 30%; chronic disease 61% and injuries 9%.
The only region where infectious disease deaths outnumber chronic disease deaths is Africa, (albeit at a much smaller margin than I expected) while in all other regions chronic disease mortality is at least twice that of infectious disease mortality.
The WHO projected these (rounded) numbers for various causes of mortality worldwide in 2005:
Cardiovascular diseases 17.5 million
Cancer 7.6 million
Chronic respiratory disease 4.1 million
HIV/AIDS 2.8 million
Tuberculosis 1.6 million
Diabetes 1.1 million
Malaria 900,000
That should read “perinatal” not “prenatal”.
“The WHO projected these (rounded) numbers for various causes of mortality worldwide in 2005″
The WHO’s numbers are produced by mathematical modeling and those numbers are highly dependent on the assumptions of the models.
This is a critical issue. One of the sources of distrust of the medical profession is ever changing recommendations. One day hormone replacement therapy is not only great, but is virtually mandated; several years down the road it is found to cause increases in breast cancer. One day, vitamin X is recommended to prevent heart disease; several years down the road it is found to be useless.
As Dr. Novella recently pointed out (http://www.sciencebasedmedicine.org/?p=3367), the data on salt intake is weak, yet public health organizations are spinning elaborate recommendations and even mandates that are entirely based on this weak science.
Consider the “obesity” epidemic. For more than a decade, it has been well known among those who read the scientific papers that overweight people live longer than those with an “ideal” BMI. You would never had known that to read newspapers and magazines, let alone expert commissions making recommendations for “ideal” weight.
In many areas, including the WHO report you quoted, the “experts” are out far ahead of the science, and that is not a good thing.
I was practicing when the recommendations for routine estrogen replacement therapy in menopause became the standard of care. I had read the papers. I was unimpressed with the scientific basis for the recommendations (as were many other physicians) and frankly surprised that such a widespread intervention was being introduced with very little long term study.
But the “conventional” wisdom was that ERT prevented chronic diseases associated with aging and that “preventive” care is always justified. That turned out to be wrong. Had we waited for definitive evidence, we would never have instituted routine ERT in the first place.
Not only were some people harmed by the recommendation, but public trust in medical recommendations was severely damaged by the fiasco.
In my judgment, the public health recommendations on diet and chronic disease are way out ahead of the science and we are setting ourselves up for being embarrassed yet again.
Public health authorities should not issue blanket recommendations (and certainly not mandates) unless the science is virtually iron clad. Acting otherwise risks ever more damage to the trust that the public reposes in medicine and public health.
“The people I know with type 2 diabetes, arthritis or dementia are not living so wonderfully, in my opinion. Many of their troubles were caused by lifestyle factors.”
Maybe theirs were. But have you done any research on how much arthritis risk is determined by genetics?
You might be surprised.
I agree that preventative public health policies should not be mandated based upon weak evidence. However, the burden and associated risks of complying with particular public health mandates must be weighed against the potential benefits. Salt v. ERT is an apples to oranges comparison.
Altering diet by reducing salt intake is a relatively minor adjustment, most likely risk free, as compared with the intervention of ERT. If reducing salt intake also helps reduce weight via reduction in salty “junk” foods, there’s an added benefit for obese individuals. There is a significant difference between a preventative action that requires reduction of a dietary component which is more than adequately consumed, and a preventative action that requires pharmaceutical/hormonal intervention. If only more physicians were as cautious about ERT as Dr. Novella is about salt. Kudos to Amy for not jumping on the ERT bandwagon.
Regarding Amy’s comment about the benefits of being overweight, there is a substantial difference between “overweight” and “obese”.
“Altering diet by reducing salt intake is a relatively minor adjustment, most likely risk free, as compared with the intervention of ERT.”
But I think they share some important similarities. First, they reflect a rush to implement recommendations based on initial scientific investigations without waiting for long term results, which are ultimately the only results that count.
Second, they reflect a belief that “preventive” care has no risks only benefits. In the case of ERT, it is easy to imagine the risks associated with a treatment. But there can be risks associated with dietary restrictions or other preventive measures.
Third, damaging the public trust is an important risk. Quacks and charlatans exploit the increased cynicism engendered by recommendations that turn out to be wrong to raise suspicion of all medical treatments, therapeutic as well as preventive.
This is the paradox of medicine. The better it works, the more opportunity naysayers have to claim it’s either unnecessary or false, and the more plausible those claims are to the public, because comparatively few of them have ever experienced the debilitating and lethal diseases that medicine has prevented them (and everyone they know) from having.
“the data on salt intake is weak”
And that’s why I have never recommended the low salt diet.
“Consider the “obesity” epidemic. For more than a decade, it has been well known among those who read the scientific papers that overweight people live longer than those with an “ideal” BMI.”
Any research I read on that subject was correlational and uncontrolled. On average, it is better to be moderately overweight (not obese) than thin. But the comparison should control for age and health status. If you include people who are emaciated because of disease or depression, then the results will not be meaningful.
There is plenty of evidence showing links between obesity and the major diseases I had mentioned.
“the “conventional” wisdom was that ERT prevented chronic diseases associated with aging and that “preventive” care is always justified.”
ERT really should NOT be considered a preventative health measure. I have never recommended it or used it.
“the public health recommendations on diet and chronic disease are way out ahead of the science”
No it is not, as my links should have shown. There is abundant evidence on the benefits of physical exercise, and the dangers of prolonged inactivity.
“I’m guessing that infectious agents diseases (particularly malaria and rotavirus) kills FAR more people than any obesity/ diet/tobacco/alcohol lifestyle related disease.”
I explained very carefully that I was talking about modern western societies.
“So, even though making at least 4 or 5 of the right lifestyle choices can substantially lower your chance of getting type 2 diabetes, there is still a genetic factor.”
Yes there is always a genetic factor in anything, and I did mention that. But type 2 diabetes is an epidemic in the US because of lifestyle. Not because our genetics have changed, and not because modern medicine is keeping us alive for so long. Yes, the risk of type 2 diabetes increases with age (maybe because lifestyle factors build up over time). However, type 2 diabetes is also increased dramatically in younger age groups.
“No one disputes that those lifestyle changes are beneficial and desirable.”
Yes they do. According to the original post, we have little control over our health. According to the post we should ignore the research, and the common sense, which tells us that extreme and prolonged physical inactivity is something our bodies did not evolve to deal with. We also did not evolve with highly processed and unnatural food.
According to Amy Tuteur, we can not do much to prevent deadly diseases like type 2 diabetes, heart disease and stroke. She thinks Americans are getting these diseases mainly because we live longer, and they inevitably occur with age.
Yes it’s true that age weakens the body and it becomes increasingly vulnerable. But how you care for your body over the decades will make an enormous difference in how well it withstands the effects of age.
It isn’t simply the passing of time, it is also what the body experiences during that time. Someone who smoked for 10 years is much less likely to get lung cancer than someone who smoked for 40 years.
So the idea that chronic diseases result from age is partly an illusion.
Yes, my complaint is that you seem to think that “some” is meaningful with respect to your claim that most disease is lifestyle-related. Let me repeat my point, since you didn’t seem to get it:
You have to consider how strong the relationship is.
To get to “most,” you need an increase in risk in excess of a factor of two. Smoking aside (and it is the medical profession that has been in the forefront of demonstrating smoking risks and promoting smoking reduction), there simply is not much evidence for lifestyle risks of that magnitude for common diseases.
Amy I agree wholeheartedly with your caution regarding 1) the rush to implement public health recommendations based on initial scientific investigations without waiting for long term results; 2) the belief that “preventive” care has no risks only benefits and 3) damage to public trust via premature recommendations
I only wish these principles were applied judiciously to all areas of preventive medicine. For example, what about the practice of implementing new vaccination policies without waiting for long term results (what are the long term effects of Gardasil, for example?). What about the harm caused by something as seemingly harmless as cancer screening? And one need not be a charlatan or quack to become slightly cynical about all the H1N1 hype. Regarding your point number 2, I believe that preventative interventions should bear a very high burden of proof of safety.
I just can’t muster up the same degree of concern over moderate dietary recommendations to reduce salt and sugar intake as for preventive medical interventions like pharmaceuticals and vaccines and the potential cascade effect of cancer screening, nor do I think the same degree of scrutiny is warranted. Forgive me for being a little incredulous that the sbm community that so warmly embraces every new vaccine is so concerned and cautious about moderate dietary recommendations.
Amy I agree wholeheartedly with your caution regarding the following 1) the rush to implement public health recommendations based on initial scientific investigations without waiting for long term results; 2) the belief that “preventive” care has no risks only benefits and 3) damage to public trust via premature recommendations.
I only wish these principles were applied judiciously to all areas of preventive medicine. For example, what about the practice of implementing new vaccination policies without waiting for long term results (what are the long term effects of Gardasil, for example?). What about the harmful effects of something as seemingly harmless as cancer screening? And one need not be a charlatan or quack to become slightly cynical about all the H1N1 hype. Regarding your point number 2, I believe that preventative interventions should bear a very high burden of proof of safety.
I just can’t muster up the same degree of concern over moderate dietary recommendations to reduce salt and sugar intake as for preventive medical interventions like pharmaceuticals and vaccines and the potential cascade effect of cancer screening, nor do I think the same degree of scrutiny is warranted. Forgive me for being a little incredulous that the sbm community that so warmly embraces every new vaccine is so concerned and cautious about moderate dietary recommendations.
“We also did not evolve with highly processed and unnatural food.”
We didn’t evolve with cooked food either. Is it possible that the idea that chronic diseases result from lifestyle is partly an illusion?
“We didn’t evolve with cooked food either.”
Anything we did not evolve with could be a possible source of stress on the body. There are people who avoid cooked food. I have no idea if that makes any sense, or if there is any research on the subject. But a general rule of thumb could be that anything that is very far from what our bodies evolved with just might be harmful.
“Is it possible that the idea that chronic diseases result from lifestyle is partly an illusion?”
Certainly it could be partly an illusion. Not many things are always and absolutely true.
But the evidence we have so far strongly suggests that a great deal of serious disease, in modern western societies, is related to the unnatural typical lifestyle.
Alternative medicine practitioners tend to believe this, but that is no reason for mainstream practitioners to deny and ignore the evidence.
If your patients are led to believe that most disease, even in modern western societies, results from genetics, infections, and other factors outside their control, they might not take their lifestyle habits seriously. It’s much easier to avoid exercise, especially after avoiding it for decades.
If a physician sincerely believes that lifestyle matters, his/her patients will get the message, and maybe they will take the advice. But if you only half believe it, your patients will sense that it doesn’t matter all that much.
Actually, there is some evidence that other hominids may have cooked their food as well, though they may have been using the “firebearer” method (find a natural fire, light some flammable material off of it, transport it, feed it, tend it over months, use it to light cookfires….) rather than making their own fire. So we may have indeed evolved eating cooked food, though clearly we do retain the ability to eat raw food.
It’s difficult to date the origin of processed foods. Flour and cheese both predate recorded history, as do fermented products and various types of jerky. It is possible that they go back far enough that they have indeed influenced our evolution.
weing – “We didn’t evolve with cooked food either. Is it possible that the idea that chronic diseases result from lifestyle is partly an illusion?”
Maybe we did. There is some thought that human evolution has speed up with population increase.
http://www.scientificamerican.com/article.cfm?id=culture-speeds-up-human-evolution
BTW, while the main reason people like white flour today is flavor (and probably also familiarity), that wasn’t why it was invented. It was invented to deal with shelf life issues. Whole wheat spoils because of fatty acids in the germ. This takes months, but when you have to ship stuff by steamer before you can even think about selling it, it can become an issue. So in the 19th Century, somebody hit upon the idea of removing the germ. White flour is all endosperm. It is much lower in nutrients, so modern flour has to be fortified.
For all its nutritional deficits, white flour did make possible an explosion of new baked goods. What most Americans would call “cake” is not possible with whole-wheat flour. And while that’s not exactly a ringing health-food endorsement, I think it’s cool.
What’s up? I posted a comment over an hour ago, and at least five people have posted after me. My comment contains no links.
“But the evidence we have so far strongly suggests that a great deal of serious disease, in modern western societies, is related to the unnatural typical lifestyle.”
This is where you lose me. I do not think the evidence is as strong as you think it is. What is the natural lifestyle that you espouse? Even wearing clothes is unnatural.
“What is the natural lifestyle that you espouse? Even wearing clothes is unnatural.”
You seem to think in absolutes weing. I keep saying we seldom know the absolute truth about anything, not in medicine anyway. Our species has always interfered with nature in one way or another. The other animals accept their lot and don’t try to improve things very much. We, on the other hand, have been messing with nature since we first appeared.
So it’s natural for human beings to be unnatural, but very often we suffer consequences. I am in no way saying we should stick to what’s natural — I personally don’t want to go around naked.
But we do need to consider what substances and practices may be harmful because of their unnaturalness. We know that introducing soft drinks, cars, TV, etc., into traditional societies results in increased rates of obesity, type 2 diabetes, heart disease, etc.
If you’re so skeptical, why not try a little experiment? Stop exercising and start living on junk food for a while, and see how it goes.
At 11:49 I responded to Amy’s comment of 9:41 am. My comment (with zero links) was held in “moderation” for over two hours and was finally just posted retroactively as of the actual submission time, effectively burying it in the stream of subsequent comments. This practice impedes the flow of discourse. Seven other comments, more lengthy and with links, posted after mine. I am curious to know what required lengthy moderation? Any tips for avoiding that in the future?
“Anything we did not evolve with could be a possible source of stress on the body. There are people who avoid cooked food. I have no idea if that makes any sense, or if there is any research on the subject. But a general rule of thumb could be that anything that is very far from what our bodies evolved with just might be harmful.”
That’s a very serious misunderstanding of evolutionary biology. Moreover, it is obviously spectacularly wrong. We evolved along side the bacteria and viruses that sicken and kill us, not to mention the wild animals that ate us as well as climatic conditions that lead us to freeze to death or die of heat stroke.
Evolution does not lead to perfection. It selects for individuals best able to compete in the current environment. And as the environment changes, the relative value of various adaptations changes, too. In an environment in which malaria is prevalent, the sickle cell gene is advantageous. In the current environment, it has only risks and no benefits. That is not an argument letting malaria run rampant simply because that recapitulates nature.
To quote Hobbes, life in the state of nature was “solitary, poore, nasty, brutish and short. It is only by modifying our environment that we have escaped the short lifespans imposed upon us by nature.
It is foolish to imagine that life in nature is ideal and modern lifestyles have introduced dangers. The truth is exactly opposite.
“That’s a very serious misunderstanding of evolutionary biology. Moreover, it is obviously spectacularly wrong.”
You completely misunderstood my statement. I did not say, or imply, that everything we evolved with is good for us. I am sure you had some idea of what I meant. Substances that are manufactured and not found in nature may have unexpected results when ingested, especially over long periods. And unnatural behaviors, such as seldom moving the voluntary muscles,.may have adverse effects on the body.
We evolved to breath certain kinds of gases, and to ingest certain kinds of substances. I don’t know how you turned that simple idea around into something bizarre.
[To quote Hobbes, life in the state of nature was “solitary, poore, nasty, brutish and short.]
Just because Hobbes said it doesn’t make it true. First of all, our species has always been social, not solitary. And whether or not it was poor and nasty varied tremendously depending on the environment.
“Substances that are manufactured and not found in nature may have unexpected results when ingested, especially over long periods.”
Or they may have beneficial results that far exceeds anything found in nature.
The latest bio-anthropological data indicates that worldwide human populations in nature never exceeded 100,000 and at times dropped as low as 10,000. Now world population is 6 billion. The idea that life in the state of nature was wonderful and that modernity has made people sicker is laughable.
I watch TV only when I exercise. I eat a variety of junk foods but only limited amounts.
“The idea that life in the state of nature was wonderful and that modernity has made people sicker is laughable.”
No one is saying that life in the state of nature was wonderful. But the fact that human population has exploded is not necessarily a sign that modern life is so wonderful either. We have created a lot of sickness and a lot of filth. I am not an environmentalist, but it’s hard to not notice any of the destruction we have caused.
[“Substances that are manufactured and not found in nature may have unexpected results when ingested, especially over long periods.”
Or they may have beneficial results that far exceeds anything found in nature.]
No, there is usually a downside to any of the new medications, especially if taken for too long. I don’t think I want to debate you over this, except to say that most mainstream MDs are not nearly as radical as you. Most would admit that drugs have side effects and that prevention is usually preferable.
And yes I am aware that there are people, such as type 1 diabetics, who survive only because of modern medicine. That is not what the controversy is about.
You have obviously convinced yourself that humanity has done nothing but good for the world, and that we should never bother to stop and think about anything we’re doing. You obviously have nothing but contempt for nature and don’t think we can learn anything from it.
I know I can’t reason with people who have radical views. It should have been obvious that I never said pre-modern societies were all wonderful, or that everything in nature is pure perfection.
“I watch TV only when I exercise. I eat a variety of junk foods but only limited amounts.”
Me too. I don’t think it pays to be a fanatic.
“But the fact that human population has exploded is not necessarily a sign that modern life is so wonderful either.”
But it is a sign that modern medicine (and technology) has been spectacularly successful and that evolution does not lead to health or reproductive success.
The fact that chronic diseases associated with old age are increasing is a sign of the SUCCESS of modern medicine, not its deficiencies. This is precisely what we would expect if our efforts to reduce deaths in children and adults are accomplishing their aims.
“No, there is usually a downside to any of the new medications”
No more or less than anything else. There are risks associated with wearing clothes (catching fire, allergies), risks associated with living in houses (they could fall down or burn down), risks associated with exercise (you can get run over while jogging).
There are risks associated with everything. The important point is that the risks (and death rate) associated with life in the state of nature is astronomically higher than the risks (and death rate) of life in technologically advanced societies. And the increase in chronic diseases proves that the risks in nature are greater than the risks in highly advanced societies. You have to live long enough to get those diseases, something that rarely happened until relatively recently.
lizkat and weing your typing is excellent for people who are simultaneously exercising.
michelinmichigan,
I exercise my fingers when I type. Also when I play Halo ODST. Not too much though. The wife says it makes me too pugnacious.
“The fact that chronic diseases associated with old age are increasing is a sign of the SUCCESS of modern medicine, not its deficiencies.”
You choose to look at it that way. You choose to ignore the fact that large numbers of middle-aged people, even young people, are getting these “old age” diseases. You choose to ignore the evidence that an unnatural lifestyle can be very damaging.
“You have to live long enough to get those diseases, something that rarely happened until relatively recently.”
You prefer to believe that, and you ignored all my comments about the skewed life span statistics. Yes we have disabled infant mortality, but in the process we helped create a horrendous population explosion, which has contributed to misery in the poor nations.
And haven’t you heard of the modern day traditional societies where many people live to be very old, and healthy? How can you be so sure that all pre-moderns lived short miserable lives?
I am all for modern medicine and technology, but that doesn’t prevent me from having respect for nature, or from seeing that we have created many serious problems. In some ways we are happier and healthier now, and in some ways we are sadder and sicker.
Almost everything in life involves trade-offs and almost nothing is certain. You prefer to see only one side of the story.
And you still can’t explain how you can deny the importance of lifestyle. You insist that type 2 diabetes, heart disease, cancer, etc., just happen to anyone who escapes early death.
I hate to think of you telling your pregnant patients to go ahead and smoke cigarettes, since lifestyle doesn’t matter.
“The fact that chronic diseases associated with old age are increasing is a sign of the SUCCESS of modern medicine, not its deficiencies.”
You choose to look at it that way. You choose to ignore the fact that large numbers of middle-aged people, even young people, are getting these “old age” diseases. You choose to ignore the evidence that an unnatural lifestyle can be very damaging.
“You have to live long enough to get those diseases, something that rarely happened until relatively recently.”
You prefer to believe that, and you ignored all my comments about the skewed life span statistics. Yes we have disabled infant mortality, but in the process we helped create a horrendous population explosion, which has contributed to misery in the poor nations.
And haven’t you heard of the modern day traditional societies where many people live to be very old, and healthy? How can you be so sure that all pre-moderns lived short miserable lives?
I am all for modern medicine and technology, but that doesn’t prevent me from having respect for nature, or from seeing that we have created many serious problems. In some ways we are happier and healthier now, and in some ways we are sadder and sicker.
Almost everything in life involves trade-offs and almost nothing is certain. You prefer to see only one side of the story.
And you still can’t explain how you can deny the importance of lifestyle. You insist that type 2 diabetes, heart disease, cancer, etc., just happen to anyone who escapes early death.
“You choose to ignore the evidence that an unnatural lifestyle can be very damaging.”
Compared to what? Life expectancy is higher than it’s ever been. It has shot up by nearly 30 years since 1900 alone. If modern lifestyles were so dangerous, the life expectancy would decrease.
“you ignored all my comments about the skewed life span statistics.”
Your comments don’t mean a thing. You MUST provide scientific evidence for your claims.
“Compared to what? Life expectancy is higher than it’s ever been. It has shot up by nearly 30 years since 1900 alone. If modern lifestyles were so dangerous, the life expectancy would decrease.”
Certain factors caused average life span to increase, such as antibiotics, improved sanitation and certain kinds of surgery. At the same time other factors, such as decreased need for walking or physical labor, and increased availability of processed food, have been detrimental to health.
So things can get better in some ways and worse in other ways at the same time. You seem to think it has to be all one way or the other.
You could look at some of the articles I linked (I could easily have found thousands more). It’s hard to believe anyone completely denies the importance of lifestyle.
And you seem to have no interest in quality of life. As long as people are alive, it doesn’t matter to you if they are sick and miserable and in need of constant medical attention.
If you ignore nutrition and exercise, you might still make it to old age. But you will be more likely to suffer mentally and physically.
I find it very hard to believe you live on junk food and never exercise, ignoring all the sensible advice that everyone knows all about. But I guess if you really believe what you’re saying, then you must.
“lizkat and weing your typing is excellent for people who are simultaneously exercising”
Why thank you. It does take a lot of practice.
[“you ignored all my comments about the skewed life span statistics.”
Your comments don’t mean a thing. You MUST provide scientific evidence for your claims.]
So you don’t believe that reduced infant mortality was the main reason for increasing life span? Or you believe it but you have a policy at this blog that references are required for all statements? Sort of like writing a graduate thesis?
But if you want to verify my statement about life span you can simply ask the other sbm bloggers. The same information has been posted here.
lizkat,
I need to ask, what do you define as “natural” and “unnatural”?
You’ve used those two words consistently throughout this thread but by not providing any context for what they actually mean makes much of your argument, irrelevant.
I mean, sitting on a rock all day eating wild almonds seems like a pretty “natural” thing to do. Running on an electrical contraption for an hour without actually going anywhere, while watching a blinking box of lights, seems absurdly “unnatural”. And yet, most people would probably describe the latter as the better lifestyle choice.
#
# weingon 26 Jan 2010 at 5:42 pm
“I exercise my fingers when I type. Also when I play Halo ODST. Not too much though. The wife says it makes me too pugnacious.”
I used to exercise my liver, but the price of wine strained by pocketbook, so I took up exercising my self restraint. When that fails I exercise my sense of humor (which is very weak.)
Pugnacious? Do you tell your wife you love it when she is erudite?
# lizkaton 26 Jan 2010 at 7:48 pm
Why thank you. It does take a lot of practice.
Yes, I tried river dancing, but the spell check couldn’t keep up.
Lol weing.
“To quote Hobbes, life in the state of nature was “solitary, poore, nasty, brutish and short. It is only by modifying our environment that we have escaped the short lifespans imposed upon us by nature. ”
Very interesting outlook on life, science/technology versus nature. As if it’s an either/or proposition.
“The saddest aspect of life right now is that science gathers knowledge faster than society gathers wisdom” -Isaac Asimov
I do wonder if type 2 diabetes isn’t related so much to diet, why diet can help control it.
You both are way oversimplifying.
http://en.wikipedia.org/wiki/Life_expectancy
“A pre-20th century individual who lived past the teenage years could expect to live to an age comparable to the life expectancy of today.”
“You both are way oversimplifying.”
No I am not. I am very careful to not make absolute and simplistic statements. My goal has been to correct the absolute and simplistic statements of the blogger.
“I do wonder if type 2 diabetes isn’t related so much to diet, why diet can help control it.”
Everyone knows that type 2 diabetes is related to nutrition and exercise. It seems that the only person in the world who doesn’t know it is the one who wrote this post.
And furthermore I provided links to articles. Nothing makes any difference when someone has their preferred beliefs and is not open to evidence.
lizkat, please refrain from statements like “I hate to think of you telling your pregnant patients to go ahead and smoke cigarettes, since lifestyle doesn’t matter.”
and “you seem to have no interest in quality of life. As long as people are alive, it doesn’t matter to you if they are sick and miserable and in need of constant medical attention.”
You are unfairly maligning Dr. Tuteur and not responding to what she actually said.
We would like to maintain a polite forum for discussion, and your comments would be much better received if you presented evidence to support your claims. Then others can review that evidence and present their own. That could lead to a constructive discussion. Exaggerations, sarcasm, and ad hominem attacks are not constructive.
lizcat – ““you ignored all my comments about the skewed life span statistics.”
If you want to exclude childhood mortality you need to look at life expectancy (for a given age). These chart show the percentiles of people surviving at any given age in 1900, 1949/1951 and 2004. http://www.cdc.gov/nchs/fastats/lifexpec.htm – download the pdf linked from “U.S. Life Tables, 2004, table 11″
From the pdf
“The survival curve for 1900-1902 shows a rapid decline in survival in the first few years of life and a relatively steady decline thereafter. In contrast, the survival curve for 2004 is nearly flat until about age 50 after which the decline in survival becomes more rapid. Improvements in survival between 1900 and 1949-1951 occurred at all ages, although the largest improvements were among the younger population. Between 1949-1951 and 2004, improvements occurred primarily for the older population.”
The chart in the pdf is more clear. It shows that a 18 year old could indeed expect to live longer (on average) in 2004 than a 18 year old in 1900.
I will not take on the quality of life issue. In Daniel Gilbert’s book Stumbling on Happiness, he suggests that when surveyed most people judge a given disabled person as being much less happy than that person actually is.
“Yes we have disabled infant mortality, but in the process we helped create a horrendous population explosion, which has contributed to misery in the poor nations.”
I have never seen any research or statistic that says a lower infant mortality rate has led to a population explosion in poor nations or any nations. You are not citing any research. I goggled it and did not find any such research.
People can tell when you are just making things up you know. This is not Fox News.
lizkaton 26 Jan 2010 at 8:48 pm
http://en.wikipedia.org/wiki/Life_expectancy
“A pre-20th century individual who lived past the teenage years could expect to live to an age comparable to the life expectancy of today.”
Yes that page also says
“This article may require cleanup to meet Wikipedia’s quality standards. Please improve this article if you can. (June 2009)”
That is “wikipedia’s” quality standards.
Other interesting viewpoints (aging is facinating!):
(this one talks a lot about inflammation, heart disease in ancient Egyptians, and a *possible* evolutionary tradeoff between reproductive success and longevity).
“Indeed, the causes of death at old age in developed and developing countries are similar, indicating that in the second half of human life, death from cardiovascular disease is taking the lead, under both affluent and adverse environmental conditions (Bonow et al, 2002). Under adverse conditions, relatively few will reach old age to suffer from cardiovascular disease, but it becomes epidemic in developing countries as soon as death from infection and malnutrition disappears and life expectancy rapidly increases.”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1298970/
(states that the infant mortality decrease as responsible for increase in life expectancy is true, but only prior to 1950).
Broken Limits to Life ExpectancyScience 10 May 2002:
Vol. 296. no. 5570, pp. 1029 – 1031
DOI: 10.1126/science.1069675
(states the importance of nutrition in public health achievements, as well as the decrease in stroke and coronary heart disease because of risk factor modification):
Ten Great Public Health Achievements — United States, 1900-1999
http://cdc.gov/mmwr/preview/mmwrhtml/00056796.htm
” Yes we have disabled infant mortality, but in the process we helped create a horrendous population explosion, which has contributed to misery in the poor nations.”
Please elaborate on this. The “natural” lifestyle calls for reproducing as much as possible doesn’t it? What does the “natural” lifestyle call for in eating? Eat as much as possible, as there may not be any food for the next few days or weeks. How about resting? Conserve your energy, so when the predator comes around you’ll have a better chance of getting away. What? No predators around? The way I see it, it is our “natural” inclinations that are the problem and responsible for the misery. The scientific progress made in medicine, food production, etc are the tools that have enabled these problems to be even possible. You seem to be a luddite, pining for the halcyon days of yore that exist only in your imagination. Ask any old person, they’ll tell you. Old age sucks. Even if you took care of yourself your whole life it’s no longer a picnic. Your natural lifestyle will not stave off old age. Research into the mechanisms of aging might. See you on the ski slopes when I’m a hundred.
Oops, forgot a link for the second one.
http://www.sciencemag.org/cgi/content/full/296/5570/1029?ijkey=otI/7cJky6kA6&keytype=ref&siteid=sci
@weing-
“Ask any old person, they’ll tell you. Old age sucks.”
Ask any old person, they’ll tell you. Death sucks more (worse?).
@windriven-
They also say “Don’t get old.” They won’t tell me how? The only way I know how to do that is to die young.
I just wanted to mention that medicine is a practical practice. To try to second guess what a doctor should say to a patient based on what “most people” need to hear is inappropriate.
When a pregnant patient with a history of bipolar is in the hospital for their second drug overdose in a month. It’s probably not an appropriate time to suggest they quite smoking.
When a patient who is obese is seeing a GP with complaints of joints that are painful, swell and fever. It may be far more appropriate for that physician to take the appointment time addressing the complaint and save the weight issue for a time when they have the complaint under control.
Yes, it is good for a doctor to give well timed lifestyle advice to a patient who has risk factors or is aggravating their condition with that lifestyle, but is not the physicians job to treat each patient like they are treating the whole American population. That patient is an individual with a unique medical history, inherited risk factors and personality.
Also I have to point out that when Dr T. said “Unfortunately, most illness and disease is caused by factors beyond people’s control, including infectious agents, genetic defects and inherited predispositions.” That in no way suggests that in the case of people who do have lifestyle factors (whether they are most or not) that they should not be advised on their lifestyle.
I think most people could agree on the statement “Most people maintain a healthy thyroid hormone level without intervention” Does that suggest that you should ignore a thyroid hormone deficit in an individual?
I would understand Lizcat’s complaint if Dr. T’s title had been “America’s Doctor Overemphasis Lifestyle when Treating Patients”
But it was not. It was “Big Placebo says Medicine never cures anything”. The point being that medicine does in fact cure a great deal of things.
“You seem to be a luddite, pining for the halcyon days of yore that exist only in your imagination. ”
Not at all. You decided to take my moderate statements to an absolute extreme. I have simply pointed out that the current state of things is not so marvelous and some like to think.
If I notice that there are problems now, does that mean I believe there was an ideal time in the past. Not at all!
As I keep saying, things are seldom all one way or the other. There is good and bad now, there was good and bad at most other times.
[lizkat, please refrain from statements like “I hate to think of you telling your pregnant patients to go ahead and smoke cigarettes, since lifestyle doesn’t matter.”]
The claim was that lifestyle doesn’t matter, and that is what I have been disagreeing with. Common sense alone should be enough, but I provided links to evidence. Dr. Tuteur still does not agree that lifestyle is important, and I think that is unfortunate for her patients.
Even if an MD doesn’t explicitly tell their patients that lifestyle doesn’t matter very much, patients can get that message in subtle ways.
[They also say “Don’t get old.” They won’t tell me how? The only way I know how to do that is to die young.]
Yeah, that was the advice I always got from my grandmother. So I started smoking. But I was still alive at 30, so I quit.
“Your natural lifestyle will not stave off old age.”
You’re mistaking me for someone who said, or thought, things I didn’t say or think. I am not a health nut or nature fanatic. I am not anti-science or anti-medicine. When I see someone being fanatical, I try to point out their logical and scientific errors. But then I am sometimes mistaken for a fanatic in the opposite direction.
I do not have a natural lifestyle. I wear clothes, I drive a car. I even own a TV. Once in a while I drink diet coke. And I love certain kinds of ice cream.
I have a very moderate lifestyle. I don’t exhaust myself with too much exercise and I don’t torture myself by eating only raw twigs.
But at age 62, I don’t have any of those “inevitable” chronic diseases or aches and pains. Even though family history includes lots of artery disease, I don’t have it.
lizkat,
Man you are old.
lizkat said, “The claim was that lifestyle doesn’t matter”
Really? I don’t remember reading any such claim. Again, you are responding to an exaggeration of what Dr. Tuteur wrote, rather than to her exact words. You took her moderate statements to an absolute extreme.
Then you respond to claims that you are a luddite by answering “Not at all. You decided to take my moderate statements to an absolute extreme.”
Oh, the irony! How does it feel to be on the other end?
“most illness and disease is caused by factors beyond people’s control”
Most patients would interpret that to mean their nutrition and exercise habits won’t affect their health very much. If you are going to be sick or healthy mostly because of factors you don’t control, then there would not be much reason to change your habits.
That statement was wrong and misleading, and it definitely implies that lifestyle doesn’t matter.
The opposite opinion — that health depends entirely on lifestyle, would also be wrong. As I said.
“It’s not a coincidence that American lifespan has increased from 48 years to 77.7 years in slightly more than a century. Much of what routinely killed Americans is now routinely cured.”
And I pointed out how misleading that kind of statement is. It implies that it was common for adults to die at around age 48, but that is not true. Only infants and children had a high chance of dying from infectious diseases.
The main victory of modern medicine has been disabling infant mortality, and that is why average lifespan data is misleading.
It is not true that pre-modern people died before their bodies had a chance to wear out and develop heart disease, cancer, diabetes, etc. It is not true that they would have developed these diseases if they happened to live longer.
At least there is no evidence to support that claim, and there is evidence against. Which I provided.
Dr. Tuteur’s central claim was that Americans (and other similar nationalities) get these deadly chronic diseases mainly because modern medicine allows us to live long enough for our bodies to wear out.
I strongly disagree with that claim. It is often repeated, but still wrong.
Yes it’s true that if we all died at 48 there would be much less cancer, heart disease, etc. But that is not the reason pre-moderns, or non-moderns, didn’t get those diseases. And the evidence supports what I am saying.
Yes they died from things that are curable today. But it is unscientific to assume that, as the drug ad says, “as they were building their lives, cholesterol was building in their arteries.”
okay, the strangest part of this conversation is ,
[They also say “Don’t get old.” They won’t tell me how? The only way I know how to do that is to die young.]
lizkat “Yeah, that was the advice I always got from my grandmother. So I started smoking. But I was still alive at 30, so I quit.”
If I take it into my head to take my grandmother’s rhetorical advice to not get old, I certainly I don’t start smoking. There are much more direct ways to die before 30.
I mean, when someone tells you to build a house do you start saving Popsicle sticks?
“The opposite opinion — that health depends entirely on lifestyle, would also be wrong. ”
The opposite opinion would be that health depends mostly on lifestyle.
“Dr. Tuteur’s central claim was that Americans (and other similar nationalities) get these deadly chronic diseases mainly because modern medicine allows us to live long enough for our bodies to wear out.
I strongly disagree with that claim. It is often repeated, but still wrong.”
Where is your proof? Are we supposed to take you at your word that the claim is wrong?
From what I’ve read, even mummies had evidence of coronary calcification. The iceman also had evidence of carotid atherosclerosis. We know those diseases existed then, we just don’t have data on their prevalence in those times.
lizkat – are you aware that a blog is not written for “most people”? It is written for the writer and the readers, usually people who have an interest in the blog topic.
Even then “most people” could misinterpret a quote when taken out of context.
Even taken out of context, I do not read the statement your way. But then I did read the WHOLE post before reading or posting comments. Did you?
But since we are talking about most people. Who here (insane people who are still reading these comments) interpreted Dr. T’s. statement to mean.
“You can do damn well whatever you want with your life, eat only McDonalds, smoke a pack a day. It will not adversely effect your health.”
Raise your hand.
Notice my hand is not raised.
“we just don’t have data on their prevalence in those times.”
But we know that they dramatically increase when traditional societies are westernized. This has happened with Native American tribes, for example. Don’t believe me — I know you won’t — there is plenty of evidence.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1783583/
“The metabolic syndrome seems to be an emerging epidemic that affects roughly one out of five persons in Western industrialized countries. Similar to other chronic diseases, the metabolic syndrome is a complex, lifestyle-dependent illness. Its solution is not difficult to achieve: eat less, exercise more. These solutions must become part of everyday life and be woven into our social life to be effective. Health care professionals need to help people to understand the potential benefits that may result from the introduction of dietary patterns and exercise, and support them in adopting and adhering to these behavioral patterns. Actually, society as a whole needs to acquire a profound consciousness of the relevance for health of lifestyle factors such as nutrition and activity.”
Dr. Tuteur could easily call Lizkatz’s arguments a strawman or describe the ways she counseled her patients about lifestyle and how those changes could influence their health, as the other bloggers on here would. 200 posts ago, she could have said, I absolutely believe lifestyle contributes to disease and if you reread my post, I never said otherwise, thus making your argument a strawman. ONE sentence could have saved us at least 50 comments.
Yet she doesn’t, and I can only assume that she knows that ambiguity/controversy draws comments. Or she really does not believe that lifestyle (other than alcohol and tobacco) or environmental toxins can affect disease rates, I don’t know. She rarely clarifies and never makes caveats, something standard in intelligent discourse. I mean, at least be clear in your opinions rather than leaving the audience guessing.
As I mentioned, however, I have no problem with her original statement, simply because she used “most” rather than “all” diseases. It’s the common use of absolutes that bothers me.
“But at age 62, I don’t have any of those “inevitable” chronic diseases or aches and pains. Even though family history includes lots of artery disease, I don’t have it.”
Lizkat has just illustrated the seductive appeal of Big Placebo and its claims. It offers magical thinking: if other people are sick, it must be because they did something wrong, and if I do everything right, I won’t get sick.
Lizkat, I’m glad that you are well, but sorry that you don’t appreciate your good fortune. You’re lucky, pure and simple; that’s all. Tomorrow you could be diagnosed with breast cancer or drop dead from an undetected brain aneurysm or develop the first symptoms of Parkinson’s disease, and, you know what? There’s nothing you can do to prevent it.
If any of those things happen to you, and I hope they do not, you will at least gain some sympathy for your fellow human beings who are suffering from serious medical problems through no fault of their own. And perhaps you would appreciate the claims of Big Placebo for what they are: pandering to the worried well to make money from their gullibility.
“You’re lucky, pure and simple; that’s all.”
So you have stated your opinion, in absolute terms, once again. Good health is entirely because of luck, and nothing we do can help us stay healthy.
You have steadfastly refused to admit that lifestyle is a factor. You have refused to acknowledge any of the evidence I linked.
So you have stated your opinion, in absolute terms, once again. Good health is entirely because of luck, and nothing we do can help us stay healthy.
You have steadfastly refused to admit that lifestyle is a factor. You have refused to acknowledge any of the evidence I linked.
” Or she really does not believe that lifestyle (other than alcohol and tobacco) or environmental toxins can affect disease rates, I don’t know. ”
She has not made a single statement that acknowledges the possible contribution of lifestyle factors to some of the most common serious diseases of industrialized societies today. Just because alternative medicine emphasizes lifestyle and prevention, Dr. Tuteur feels obligated to take the opposite position. Even though it is at odds with logic and evidence.
And anything that is illogical and unscientific bothers me, and that is why I tried to correct some of her statements. There is a tendency to have a worshipful attitude towards modern medicine and to give it too much credit.
Yes modern medicine has accomplished a lot, but there are also areas where it has failed. And one of its failures, in my opinion, is neglecting to educate patients about lifestyle. Yes, now you mention nutrition and exercise (well some of you anyway) to your patients.
But Dr. Tuteur has not once, in any of her comments, acknowledged that people do have some control over their own health. No, we would all have dropped dead at age 48 if not for modern medicine.
“Yes modern medicine has accomplished a lot, but there are also areas where it has failed. And one of its failures, in my opinion, is neglecting to educate patients about lifestyle. Yes, now you mention nutrition and exercise (well some of you anyway) to your patients.”
Switch your doctor. I have not had a doctor in my adult life (27 years) that did not have a medical history questionnaire that asked about smoking, alcohol consumption, exercise, drug use, sexual activity, seat belt use and weighted you in at the office. Diet advice is available, they have a nutritionist in the network (at all the different practices I’ve visited).
The local hospitals have diet and nutrition workshops, they have exercise, posture and flexibility workshops. They also have support groups for many of the more common chronic illnesses. I will say that I have not received a lot of unsolicited diet advice from my doctors, but then my blood pressure is low, my cholesterol is good, my weight is steady and I don’t have any diabetics in my family. Occasionally we talk about how to work more exercise into my day. But, if she tried to “educate me” about the importance of exercise, I’d be offended. Because I do not live in a cave, so I have heard about it, since kindergarten.
“And anything that is illogical and unscientific bothers me”
To me, your comments have read as some the most illogical and unscientific ones I’ve seen in a while (outside of the circumcision debate.) Either you lack self awareness or your comments are not communicating your true views.
(Or I am deluded, which is always a possibility. I mean I am insane enough to keep returning to the computer to read this thread, when it is clearly frustrating and futile.)
[But, if she tried to “educate me” about the importance of exercise, I’d be offended. Because I do not live in a cave, so I have heard about it, since kindergarten.]
Right. We have all heard that exercise can help prevent some of the most common serious diseases. Wasn’t that my point? Wasn’t Amy Tuteur objecting to the claim that we do have some control over our health? No one has been able to show any evidence that she is right.
The only reason I am not sick is that I’m “lucky, pure and simple.” Not because I make sure to avoid the inactivity habit that almost everyone I know tends to fall into.
“Wasn’t Amy Tuteur objecting to the claim that we do have some control over our health?”
No, that was you deliberately mischaracterizing what I wrote.
At no point did I suggest, nor would I suggest, that there is nothing to do to lower the risk of various diseases related to lifestyle. For example, I never said, nor would I ever say, that it makes no sense to stop smoking, since obviously not smoking REDUCES the risk of developing lung cancer.
But, and this is the critical point, not smoking does not PREVENT getting lung cancer. Approximately 10% of patients who develop lung cancer have never smoked. Moreover, it doesn’t even prevent getting sick, since there are many other illnesses that can occur that have absolutely nothing to do with smoking.
Simply put, while exercising and refraining from smoking, drinking alcohol in excess, and eating to excess can REDUCE the risk of various chronic illness, that does NOT mean that you will not develop one of those chronic illness, and it certainly does not mean that you will not get sick and even die from your illness. The majority of deaths in this country each year are the result of diseases and conditions that have nothing to do with lifestyle.
Finally, the rise of chronic diseases as a cause of death is a sign of SUCCESS in modern medicine. Quite reasonably and appropriately, we addressed the greatest effort to treating, curing and preventing illnesses that WERE responsible for the majority of deaths. When you do that, the result is that chronic illnesses associated with aging rise to the fore as a cause of death.
“while exercising and refraining from smoking, drinking alcohol in excess, and eating to excess can REDUCE the risk of various chronic illness, that does NOT mean that you will not develop one of those chronic illness, ”
Maybe it’s just your strange terminology that has me confused. If a lifestyle change can greatly REDUCE the risk of certain diseases, then that means, to me, that it largely PREVENTS that disease.
“the rise of chronic diseases as a cause of death is a sign of SUCCESS in modern medicine. ”
This is just your opinion, or your preferred way of seeing things. It is not possible to argue against an emotional preference. The reality is that you cannot back that up with clear evidence.
But this debate is not making any progress. You told me the reason I am not sick is pure and simple luck. Then you say lifestyle can reduce the risk of certain diseases.
So this whole thing is going in crazy circles and I have lost interest. And so has everyone else I am sure.
Dr. Amy, I agree with the essence of your argument about the successes of modern medicine, but so far I’m not satisfied that this:
is a supportable claim. Noting that the #1 cause of death in the US is heart disease, for example, do we know what percentage of deaths due to heart disease are attributable, even in part, to high cholesterol, or smoking, or other lifestyle choices? Moving down the list to #2, cancer–same question. How many of those cancer deaths are from lung cancer (and yes, your point that nonsmokers can also develop lung cancer is well taken, but this is, I believe, the exception rather than the rule).
I am not trying to tweak you, here. I am honestly interested in the factual basis of your claim. As both of these diseases are famously heterogeneous, it seems ridiculous to me to say that most cases are caused by lifestyle, but it doesn’t seem any less ridiculous to claim that they have *nothing* to do with lifestyle.
“Noting that the #1 cause of death in the US is heart disease, for example, do we know what percentage of deaths due to heart disease are attributable, even in part, to high cholesterol, or smoking, or other lifestyle choices? Moving down the list to #2, cancer–same question. How many of those cancer deaths are from lung cancer (and yes, your point that nonsmokers can also develop lung cancer is well taken, but this is, I believe, the exception rather than the rule).”
I wrote about that issue up thread.
Looking at the top 15 causes of death, almost 40% of patients died of disease that have no lifestyle component. (I am assuming that everyone who died from stroke, chronic respiratory disease and chronic liver disease died from lifestyle factors although the percentage in reality is not 100%)
Now let’s look at the diseases that do have a lifestyle component:
There were 559,558 deaths from cancer, but most were from cancers that are not associated with lifestyle choices. Approximately 31% of cancer deaths were due to cancers associated with smoking, which represents 7.1% of total deaths.
There were 631,636 deaths from heart disease. Approximately 67% died from heart problems that may be associated with smoking. That represents 17.4% of total deaths.
So by my informal back of the envelope calculations, more than 63% of deaths annually are due to diseases that are not related to lifestyle.
“If a lifestyle change can greatly REDUCE the risk of certain diseases, then that means, to me, that it largely PREVENTS that disease.”
You are confused.
If a behavior prevents a disease, it means that the disease WOULD have occurred BUT FOR the behavior. We cannot claim that not smoking prevents dying from lung cancer, because we cannot claim that the patient would died from lung cancer but didn’t only because he didn’t smoke.
Indeed, some people develop lung cancer without ever having smoked and many people who smoke do not develop lung cancer.
And we certainly cannot claim that not smoking largely prevents cancer since 69% of cancers are not related to smoking.
“Yes modern medicine has accomplished a lot, but there are also areas where it has failed. And one of its failures, in my opinion, is neglecting to educate patients about lifestyle. ”
The use of the word “patients”, implies that you believe that doctors should be responsible for lifestyle advice on a one-on-one basis.
Have you considered that this is the most costly and ineffective way of imparting lifestyle information? Lifestyles are entrenched long before most people have any formative contact with the medical profession, through experiences in the home and with peers.
This is why CAM is also speaking through its hat when it suggests that it can help with the problem of generally poor lifestyles in developed countries. All CAM offers is equally expensive pampering of its own adherents, who probably already have superior lifestyles. It potentially aggravates the public health problem by offering panacea for the consequences of poor lifestyles, against most of the evidence.
The real problem is compliance, anyway. By adulthood most people already know the major lifestyle causes of poor health, and it is pointless obsessing about details of diet if you are going to smoke and never exercise.
I don’t know what the answer is, but to the extent that it lies with poor public education, schools, the public media, and trying to deal with poor parenting would seem to be the best places to start.
Did you know that a 600ml bottle of Coke contains about 13 teaspoonfuls of sugar? That is something that EVERYONE should know in these days when many seem averse to drinking plain water when thirsty.
“Did you know that a 600ml bottle of Coke contains about 13 teaspoonfuls of sugar? That is something that EVERYONE should know in these days when many seem averse to drinking plain water when thirsty.”
HeHe, I read this awhile ago. 1 teaspoon of sugar is about 10 calories. I felt particularly shame faced because I used to make fun of a friend for putting 3 tsp of sugar in his tea (are you going to have any tea with your sugar). I never actually did it with a coke in my hand, but…
“I don’t know what the answer is, but to the extent that it lies with poor public education, schools, the public media, and trying to deal with poor parenting would seem to be the best places to start.”
Oh well, when it comes to parenting, feeding kids is kind of an art. By that I mean, you work really hard, all the critiques think you s&*k, some days it makes you want to drink too much vodka and drive into a telephone pole and you don’t get any appreciation until after you’re dead.
As to parent education, actually our daycare/preschool was quite helpful to me in this regard. Ours used to send home healthy simple lunch ideas (they didn’t provide lunch) and nutrition facts. They also had mostly healthy food at their parties, which was a nice opportunity to see that kids do in fact eat vegetables when they are in a group. They would sit down with the kids during lunch and encourage them to take at least one bite of all of their foods.
Sorry, I digress.
micheleinmichigan,
You may have a problem there. A teaspoon of sugar is about 4.2gm. Each gm is about 4 calories. So, a teaspoon would be a little over 16 calories. But I digest.
Research seems to be showing a link between inflammation, immune response and chronic diseases. We’re still at the early stages of understanding many aspects of how nutrition and exercise influence health so I’m not proposing any absolutist perspective here or promoting an ideological position regarding dietary or activity choices – just pointing out that this is a very fertile area of research within medical science at the moment and we still have a lot to learn. Sometimes it’s important to say “we don’t know” rather than grasp at false certainty to make ourselves feel more knowledgeable than we really are (as unsettling as some of us find uncertainty). Plus this ties in nicely with both the the debate in this thread and Dr Novella’s post regarding evolution in medicine. (I posted it in this thread so as not to infect the other thread with this debate! A bit of debate/thread hygiene seemed to be called for!)
This is an interesting article about a study on the immune system, inflammation and eating…which illustrates why it’s worthwhile to keep an open mind about the influence of “lifestyle” – meaning diet and exercise – on our health and the development of a variety of diseases.
http://www.sciencedaily.com/releases/2010/01/100120131153.htm
“FOXO and the antimicrobial peptide genes which it switches on occur in almost all groups of animals. That is why the researchers believe that the direct link between the food supply and the immunological defence probably developed during the early stage of evolution of metazoan organisms.
The research of the Bonn biologists could also be clinically relevant. For a number of common diseases such as type II diabetes or obesity (adiposity) are the result of an increased intake of calories. Furthermore, such diseases are accompanied by increased inflammation of the barrier tissue, a disturbed immune system and an overall reduced life span. ‘Our results present new starting points for understanding of these diseases,’ Professor Joachim Schultze from the LIMES Institute, who also is involved in the research project, says.
The scientists at LIMES will concentrate next on the relationship between calorie intake and life span. Examinations of nematodes, fruit flies and mice have shown that a reduced calorie intake can increase life span. Professor Hoch says: ‘We now want to find out whether this is due to an foxo-dependent improvement of the barrier functions of the natural immune system.”
weing – yes, I must have messed up the gram/tsp conversion. thanks!
“Research seems to be showing a link between inflammation, immune response and chronic diseases. We’re still at the early stages of understanding many aspects of how nutrition and exercise influence health so I’m not proposing any absolutist perspective”
My perspective is not absolutist. I am merely pointing out that the unnatural modern lifestyle may greatly increase the common chronic diseases. I had heard about the connection between chronic inflammation and metabolic syndrome, type 2 diabetes, heart disease, cancer, etc. There may be something about certain types of obesity, for example, that contributes to chronic inflammation.
I still don’t know what the “natural” lifestyle is. For example is eating fruits, nuts, vegetables, and cereals natural? These have all been domesticated by man and bear little resemblance to their natural, wild forms. Is it natural to be using the internet? Is it unnatural to treat people so that more of them live long enough to develop chronic diseases?
Dr. Tuteur,
I apologize for missing that point upthread. I admit that I have not read all 200+ comments. Perhaps the reiteration of these data will be helpful to more than just me. As a latecomer to the discussion, it appears as though some other commenters may have missed this explanation as well. Such oversight could well explain otherwise mystifying allegations such as
I have great admiration for your patience. Keep up the thought provoking posts!
[I still don’t know what the “natural” lifestyle is.]
Natural vs. unnatural is relative. Using modern technology is not natural, but that doesn’t make it bad. Doing things in a relatively more natural way is not necessarily good. But we should acknowledge that our bodies evolved over millions of years and they are adapted for ingesting certain kinds of substances. A plant that has been domesticated is still more or less a natural plant. But a substance that has been manufactured and processed, such as trans-fats, we may want to label as “unnatural.”
Because trans-fats do not occur in natural food, our bodies are not adapted to ingest them. Maybe if we ate trans-fats for a couple million years we would be able to tolerate them. I have no idea. But we do know that now they give our bodies a lot of trouble.
So we have to apply some common sense when deciding what is or isn’t natural, and when naturalness is important. A poison mushroom may be natural, but that doesn’t mean it’s good for you.
We have all heard that whole grains are better than processed grains. Why do you think that would be true?
And why, if you had to guess, do you think regular physical exercise might be better than prolonged inactivity?
If we apply a little common sense we can find ways to compromise between the modern life we have become used to, and our bodies which evolved very gradually in a very different environment.
There is no simple formula saying “natural is good, unnatural is bad.” And there are no simple rules telling us what is or is not natural.
So we are on our own, but fortunately we have our brains to guide us through the maze. And yes we can still get sick in spite of all our effort. But if you refuse to acknowledge your body’s nature, getting sick becomes more likely.
And it isn’t a simple question of sick vs. healthy. There is a whole range. We can be better than just not sick, we can be extra healthy. The average out of shape middle-aged American probably doesn’t remember what it’s like to feel good.
lizkat – I don’t think you’re being absolutist, though I do think you’re being painted as one and responded to as if you are taking an absolutist position rather unfairly. The problem when people determine their position as being primarily against something (rather than curious about the reality) is that they tend to see everyone as friend or foe. And anyone who questions their position – even if they’re not actually taking an oppositional stance – is painted as the enemy (and in this case assumed to be a promoter of alt-med fallacies). It becomes about black and white thinking rather than full spectrum analysis.
The problem when discussing “lifestyle” is that we’re still only at the early stages of truly understanding the role of various nutrients on health, eating patterns, exercise and so on. There’s more and more research being done, particularly in countries with public healthcare systems since there’s actually a profit/cost motivation in keeping the population healthy and preventative medicine. It’s not the kind of research that’s often funded by commercial interests (with longevity research being one exception for obvious reasons, this is just as driven by Boomer fear of aging and mortality as a lot of woo is). There’s generally no profit to be made by pharmaceutical companies and there’s more profit to be made by alt-med companies if they don’t do research because the research may well discount their grandiose claims (though alt-med companies do sometimes do cargo-cult versions of research…all ritual and no content). Though alt-med companies do often distort and misrepresent real research that’s done (as do the PR departments of universities at times).
The “natural vs unnatural” thing is pretty silly since everything that exists is actually nature – even if something is synthesized, it’s still made from chemicals and exists within the real world. Technology is hardly unnatural, it’s made by humans. Sure there are things that harm ecosystems and don’t belong in rivers, that don’t naturally occur without human intervention but human intervention is natural. Whether something is healthy for humans (or the ecosystem) or not is an entirely different question than whether something is natural. My fundamental questions tend to be whether something is healthy or not, not whether it’s natural or not.
If the last 100 years of science have taught us anything, it’s the limitations of our own knowledge and our ability to predict consequences. That doesn’t mean we haven’t learned all kinds of wonderful and interesting things about ourselves and the world, nor does it mean that the scientific method is flawed, what it means is that as individuals and a species we need to be vigilant for our own biases and arrogance. For instance, antibiotics are an amazing and life saving discovery. However, indiscriminate use that was once assumed to by a good (or at least okay) thing is now recognized as being the source of superbugs that are a bad thing. Doctors didn’t set out to create superbugs, it’s just that science couldn’t predict the consequences of overuse and it took time and experience for us to be able to see the consequences of our actions.
We’re still only starting to unravel the mysteries around genes, epigenetics and the influence of environment on the expression of disease. Most experts in these fields seem to consider it not a matter of nature vs nurture (to borrow from psychology) but rather a matter of nature AND nurture (hence the development epigenetics as a field of research and interest in how evolution applies to biology vis a vis medicine). There’s some pretty interesting stuff being both theorized and proven (even our grandparents diets have an influence on our health, for instance).
Anyone making grand claims one way or the other – that it’s exclusively genes or exclusively environment – is overstepping the bounds of evidence and taking an ideological position that few people who actually work in these fields would adopt. Anyone sincerely interested in the science around nutrition, exercise and epigenetics would be aware of this and not adopt an either or position themselves. (Even if they find alt-med types claiming to be experts in “lifestyle” annoying.) If anything, science and medicine need to vociferously reclaim this ground from both alt-med and commercial interests so people can make informed choices about their everyday health. Incidentally, I think it’s perfectly valid to decide to “live fast and die young” or trade off some longevity for pleasure. That kind of thing is a personal choice and as long as you’re not taking someone else down with you, have at it! (And, yes, I recognize that’s an ideological position regarding personal freedom
“Because trans-fats do not occur in natural food, our bodies are not adapted to ingest them”
That’s actually not true. CLA is a naturally occurring trans fat.
I basically agree with most of what you said there Fifi. I am always trying to remind people that we humans don’t know nearly as much as we think we know. Life is an interesting learning process and there aren’t any experts with all the big answers. Some people can’t face that and they seem to need an absolute faith in something, whether it’s a religion or an ideology, or mainstream medicine, or alt medicine, or whatever.
“That’s actually not true. CLA is a naturally occurring trans fat.”
Weing, I am sure you know what I meant. Most of the trans-fat they use in processed food is very bad for us. I am glad they made it illegal, at least in some states.
lizkat and weing – Heh, a lot of this research is being done in Canada (and funded by dairy councils and the beef industry). There’s a distinct difference between the kinds of transfats lizkat is talking about iTFAs (industrial transfats) and the kind you’re bringing up weing (which would be the “natural” kind found in dairy and beef).
http://www.canada.com/edmontonjournal/news/story.html?id=d71af069-92d6-4ff6-aba4-57836267c3ba
Once again, what this really shows us is how nutritional science is still very much in its infancy and we still have a great deal to learn about nutrition and biology.
lizkat – “I am always trying to remind people that we humans don’t know nearly as much as we think we know. Life is an interesting learning process and there aren’t any experts with all the big answers. Some people can’t face that and they seem to need an absolute faith in something, whether it’s a religion or an ideology, or mainstream medicine, or alt medicine, or whatever.”
Very true. However, we do know a whole lot of things and the pace of new understanding of ourselves and the world really has been pretty phenomenal and exciting. Particularly as science has unshackled itself from cultural/religious prejudices and ideological biases. Though the invention of new technologies so we can see things differently is just as important (the invention of the MRI for instance, which has radically altered scientific understanding of the brain and mind…it’s turned our understandings about neurobiology on their head, so to speak
We only need to go back 30 years to find a whole slew of biases based upon religion and ideology – or just plain lack of understanding – that were authoritatively believed to be scientific fact that have now been overturned by science. That’s the beautiful thing about science and what makes it so different than religion or any other ideology, it can prove its own orthodoxies or understandings to be wrong. That, of course, doesn’t mean it doesn’t give us the best evidence we’ve got at this time to navigate reality and the world.
Amy, how did you get your MD again? Man, this is the stupidest article I’ve ever read.
Placebo is the standard in which we prove significance in outcome.
Doesn’t it strike anyone ironic that the article is saying placebo is synonymous with ineffectual, all the while pharmaceutical labs across the world are spending billions to edge out placebo in trial after trial with only limited success? The authors point isn’t lost, it just took considerable energy to get past the opening statement without dismissing the entire article outright for mortally wounded logic.
Good point, nfat. I just ran across this article in Wired which makes it seem as if big pharma is running scared from big placebo….
http://www.wired.com/medtech/drugs/magazine/17-09/ff_placebo_effect?currentPage=2