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240 thoughts on “Big Placebo says Medicine never cures anything

  1. lizkat says:

    [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.

  2. lizkat says:

    “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.

  3. weing says:

    lizkat,

    Man you are old.

  4. Harriet Hall says:

    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?

  5. lizkat says:

    “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.”

  6. micheleinmichigan says:

    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?

  7. weing says:

    “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.

  8. micheleinmichigan says:

    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.

  9. lizkat says:

    “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.

  10. lizkat says:

    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.”

  11. Zoe237 says:

    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.

  12. “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.

  13. lizkat says:

    “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.

  14. lizkat says:

    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.

  15. lizkat says:

    ” 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.

  16. micheleinmichigan says:

    “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.)

  17. lizkat says:

    [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.

  18. “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.

  19. lizkat says:

    “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.

  20. Danio says:

    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:

    The majority of deaths in this country each year are the result of diseases and conditions that have nothing to do with lifestyle.

    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.

  21. “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.

  22. “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.

  23. pmoran says:

    “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.

  24. micheleinmichigan says:

    “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.

  25. weing says:

    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.

  26. Fifi says:

    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.”

  27. micheleinmichigan says:

    weing – yes, I must have messed up the gram/tsp conversion. thanks!

  28. lizkat says:

    “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.

  29. weing says:

    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?

  30. Danio says:

    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

    [Dr. Tuteur] 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.

    I have great admiration for your patience. Keep up the thought provoking posts!

  31. lizkat says:

    [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.

  32. Fifi says:

    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 :-)

  33. weing says:

    “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.

  34. lizkat says:

    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.

  35. lizkat says:

    “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.

  36. Fifi says:

    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.

  37. Fifi says:

    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.

  38. emcsun says:

    Amy, how did you get your MD again? Man, this is the stupidest article I’ve ever read.

  39. nfat says:

    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.

  40. wales says:

    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

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