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240 thoughts on “Big Placebo says Medicine never cures anything

  1. lizkat says:

    “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.

  2. lizkat says:

    “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.

  3. weing says:

    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.

  4. windriven says:

    “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.

  5. StatlerWaldorf says:

    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!

  6. StatlerWaldorf says:

    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?

  7. Zoe237 says:

    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).

  8. lizkat says:

    “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.

  9. lizkat says:

    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.

  10. StatlerWaldorf says:

    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.

  11. Zoe237 says:

    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

  12. weing says:

    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?

  13. Calli Arcale says:

    lizkat:

    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.

    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.)

  14. Zoe237 says:

    “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.

  15. “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.

  16. “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.

  17. lizkat says:

    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.

  18. lizkat says:

    “In other words, you have no scientific evidence.”

    No, I said there is plenty of evidence.

  19. lizkat says:

    “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.

  20. windriven says:

    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?

  21. weing says:

    lizkat,
    Show us.

  22. micheleinmichigan says:

    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.

  23. weing says:

    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?

  24. lizkat says:

    “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.

  25. lizkat says:

    “lizkat,
    Show us.”

    You obviously have internet access. I searched in Google and found many thousands of pages, also found many abstracts in PubMed.

  26. Zoe237 says:

    “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.

  27. weing says:

    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.

  28. lizkat says:

    “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.

  29. David Gorski says:

    You obviously have internet access. I searched in Google and found many thousands of pages, also found many abstracts in PubMed.

    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.

  30. Fifi says:

    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).

  31. Zoe237 says:

    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

  32. micheleinmichigan says:

    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.

  33. lizkat says:

    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.”

  34. Calli Arcale says:

    lizkat

    “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.

    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.

  35. micheleinmichigan says:

    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.

  36. lizkat says:

    “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.

  37. wales says:

    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.

  38. Calli Arcale says:

    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.

  39. lizkat says:

    “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.

  40. wales says:

    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.”

  41. squirrelelite says:

    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.

  42. Zoe237 says:

    “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.

  43. weing says:

    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.

  44. squirrelelite says:

    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.

  45. squirrelelite says:

    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.

  46. wales says:

    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

  47. wales says:

    That should read “perinatal” not “prenatal”.

  48. “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.

  49. Yvi says:

    “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.

  50. wales says:

    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”.

  51. “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.

  52. yeahsurewhatever says:

    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.

    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.

  53. lizkat says:

    “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.

  54. lizkat says:

    “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.

  55. lizkat says:

    “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.

  56. trrll says:

    I repeatedly said some, not all.

    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.

  57. wales says:

    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.

  58. wales says:

    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.

  59. weing says:

    “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?

  60. lizkat says:

    “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.

  61. Calli Arcale says:

    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.

  62. micheleinmichigan says:

    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

  63. Calli Arcale says:

    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. ;-)

  64. wales says:

    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.

  65. weing says:

    “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.

  66. lizkat says:

    “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.

  67. wales says:

    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?

  68. “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.

  69. lizkat says:

    “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.

  70. lizkat says:

    [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.

  71. “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.

  72. weing says:

    I watch TV only when I exercise. I eat a variety of junk foods but only limited amounts.

  73. lizkat says:

    “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.

  74. lizkat says:

    “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.

  75. “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.

  76. micheleinmichigan says:

    lizkat and weing your typing is excellent for people who are simultaneously exercising. :)

  77. weing says:

    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.

  78. lizkat says:

    “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.

  79. lizkat says:

    “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.

  80. “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.

  81. lizkat says:

    “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.

  82. lizkat says:

    “lizkat and weing your typing is excellent for people who are simultaneously exercising”

    Why thank you. It does take a lot of practice.

  83. lizkat says:

    [“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.

  84. JRB says:

    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.

  85. micheleinmichigan says:

    #
    # 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.

  86. Zoe237 says:

    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.

  87. lizkat says:

    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.”

  88. lizkat says:

    “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.

  89. lizkat says:

    “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.

  90. Harriet Hall says:

    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.

  91. micheleinmichigan says:

    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.

  92. micheleinmichigan says:

    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.

  93. Zoe237 says:

    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

  94. weing says:

    ” 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.

  95. windriven says:

    @weing-

    “Ask any old person, they’ll tell you. Old age sucks.”

    Ask any old person, they’ll tell you. Death sucks more (worse?).

  96. weing says:

    @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.

  97. micheleinmichigan says:

    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.

  98. lizkat says:

    “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.

  99. lizkat says:

    [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.

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