Curiously, however, for a system apparently stultified by the dead hand of government, Australia’s health system far outperforms the free market-based US healthcare system, which spends nearly twice as much per capita as Australia to deliver far worse outcomes — including Americans dying five years younger than us.
The shocking truth: Australia has a world-leading health system — because of governments
Overall, we now have the fourth-highest life expectancy in the world.
This is contrary to the narrative that pervades the media about our health system — one in which our “frontline” health workers heroically battle to overcome government neglect and inadequate spending, while the population is beset by various “epidemics” — obesity, alcohol, illicit drugs.
In fact, Australian longevity is so remarkable that in August The Economist published a piece simply titled “Why do Australians live so long?”
It's not a very free market when there is such a large power differential between the buyer and the seller. You can't exactly shop around for the ambulance or the hospital when you need it, nor can you realistically circumvent the artificially constrained supply [1] of doctors to get cheaper healthcare (unless you live next to the border).
When the alternative is a one-sided market like this, government becomes rather more appealing.
The US healthcare system is deeply flawed but only a small fraction of spending goes to emergency care involving ambulance transportation. The vast majority of healthcare spending is for elective services and patients do have time to shop around. Self-insured employers have been cutting costs by pushing employees to high-deductible health plans with HSAs, which gives plan members a financial incentive to find cheaper options. Of course there are still challenges around getting meaningful price estimates from providers despite recent federal regulations on this topic.
In fact it's almost impossible to get a price estimate up front in many cases. A procedure may involve multiple codes which may or may not be covered by your insurance, and the only way to find out if they are covered is to have the procedure and then check the bill. Frequently you won't even get the codes up front. If you call they can't even say if a particular procedure will be covered or not, the call centers are just not set up to do that. There is incredible complexity as the procedure may or may not be covered depending on patient, provider, plan, how much they've spent this year, region, if the doctor's front office made a clerical error at any point, if the insurance company made a clerical error, if the claim is processed on a Wednesday vs. a Friday, etc... If you have a procedure done twice the coverage may be totally different on the second time, with some parts covered that were previously not covered and vice versa.
Thankfully you can often get denials reversed after the fact by calling and complaining, but that takes an hour and is another roll of the dice. The only people who like the US system are wall street people who own stock in the companies.
> the patient does not pay for insurance their employer does
Not really true, as the employer could otherwise pay that money to the employee who would then shop for his own insurance. So the employee pays, but doesn't have a choice.
Because they compete with other employers? If an employee costs X, it doesn't matter to the employer if X is all cash to the employee or split with the insurance provider.
The entire reason health insurance got so mixed up with employment was as a workaround to WW-II era wage freezes. Employers couldn't pay more salary, so they offered other benefits including insurance to attract and retain employees. Now we're stuck with that.
The free market aspect is the insurance marketplace.
If you’re poor, you’re fucked. If you’re old you’re ok. If you work for the government or certain companies, you have access to world class care. Everyone else is on a spectrum from high quality PPO to the shittiest Cigna plan.
There is nothing free about the health insurance market. It is regulated to hell to the point where a common complaint of actuaries I know is that they are not allowed to price your health risk.
It's usually not the same amount. The Affordable Care Act (Obamacare) explicitly allows health plans to set premiums based on age and smoking status. However, this might not capture the full risk differential for some members.
There's a deeper philosophical question here about how we should spread risks and costs across society. Like should some plan members pay more because they have a history of cancer, or because they engage in risky activities like flying light airplanes?
Ironically, two of his three factors are still able to be priced in: age and smoking status. Weight, gender, and many other risk factors are not, though.
> ^ When the grossly overweight 60yo smoker pays the same amount as a health-conscious 30yo, we have a problem.
It depends on what your goals are. The reasoning behind why the ACA ("Obamacare") is the way it is:
> Suppose you want to make health coverage available to everyone, including people with pre-existing conditions. Most of the health economists I know would love to see single-payer — Medicare for all. Realistically, however, that’s too heavy a lift for the time being.
> For one thing, the insurance industry would not take kindly to being eliminated, and has a lot of clout. Also, a switch to single-payer would require a large tax increase. Most people would gain more from the elimination of insurance premiums than they would lose from the tax hike, but that would be a hard case to make in an election campaign.
> Beyond that, most Americans under 65 are covered by their employers, and are reasonably happy with that coverage. They would understandably be nervous about any proposal to replace that coverage with something else, no matter how truthfully you assured them that the replacement would be better.
> So the Affordable Care Act went for incrementalism — the so-called three-legged stool.
> It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.
> So insurance regulation has to be accompanied by the individual mandate, a requirement that people sign up for insurance, even if they’re currently healthy. And the insurance must meet minimum standards: Buying a cheap policy that barely covers anything is functionally the same as not buying insurance at all.
> But what if people can’t afford insurance? The third leg of the stool is subsidies that limit the cost for those with lower incomes. For those with the lowest incomes, the subsidy is 100 percent, and takes the form of an expansion of Medicaid.
The goal of the ACA in the US was getting closer to universal coverage, and that means 'subsidizing' bad behaviour to a certain extant.
Certainly smokers and such should practice more (so-called) 'personal responsibility', but there are a lot of situation where the pre-existing condition is not smoking or other lifestyle choice, but something genetic / congenital. So unless we want to get into (social) Darwinism and leave those folks on the sidelines, the lifestyle folks can end up coming along for the ride when society decides to protect other non-lifestyle pre-existing people.
The problem with your outlook is you can’t follow through unless you’re a sociopath. Are you willing watch your parent/child/friend/spouse reap the consequences of their “lifestyle choices” and suffer and/or die? I have watched that happen - i guarantee you that you wouldn’t.
Last year, my wife died from a recurrence of metastatic melanoma. By your standard, that suffering was her “fault”, because she failed to use sunscreen as a teenager. If insurance was rated like general liability insurance, she would have been dropped 8 years ago when the original cancerous lesion was removed. Fuck that noise.
I would have bankrupted the entire family to fight for the 60% survival rate in a few months, and she would have suffered even more without adequate care at the end.
We have Medicare “socialism” because social security was allowing the elderly to support themselves and live longer. Many were neglected and dying in inhumane ways, or saddling families with the burden of being a full time caretaker. It’s gross that we live in a society drowning in riches, but we take a principled stance to avoid taxation for rich people, at an incalculable human cost.
Maybe but I'm more concerned about a) easily demonstrable and measurable risks not being addressed and b) separating people from the consequences of their own choices.
Ignoring risk and consequences doesn't make them go away.
On the subject of (b), shouldn't tobacco companies be paying the risk premium for their customers? Why does the buck stop at the individual consumers and not those making money from their misery?
To put it into more technical, economic terms: why should the individual tobacco consumer bear the full cost of their externalities while the tobacco company does not?
> shouldn't tobacco companies be paying the risk premium for their customers
How would that even work? Any such tax would be priced in into the price of the product. It doesn’t really matter if the government is collecting it directly or through the tobacco companies.
Or if we wanted tobacco companies to pay for all the damage they did retroactively they would just go bankrupt, since they don’t have even remotely enough cash/assets to cover it.
The tobacco company (also composed of people) is well aware of the health consequence of smoking to its customers yet freely chooses to continues to sell tobacco products. Where's the difference?
Actually it's much worse than that. The tobacco company is not just selling tobacco products, it's marketing them and actively encouraging their use!
What about the 60 year old with autoimmune issues? That have expensive drugs but it wasn’t “their actions” that led to this?
The entire system only works if healthy 30 year olds are putting in somewhat similarly (it will be cheaper regardless). Insurance is based on the idea of spreading risk. Without it insurance cannot function.
Even the insurance side isn't really a free market. I've only ever gotten like two choices of insurance provider at any job I've had. More than two plans, but very limited provider choices. You can't get a job offer and then during onboarding say, "sorry, this insurer is unreliable, can we use this other provider instead?"
It is incredibly frustrating to have only one option for insurance provider, and then discover that a solid majority of the health care providers in your area don't take that insurance because they have such a bad reputation.
Then you get into the wonderful world of getting receipts for every procedure and manually submitting them, only for them to be rejected so you have to call and tell them to provide the service they promised you. The insurance isn't even cheap! My monthly deduction would be close to the same price as an Obamacare plan, and that doesn't include the employer contribution. Healthcare is such a racket.
There's also a lot of regulation and lots of subsidies (the US has similar per capita public spending to Canada - old people on Medicare are not cheap). If something is so heavily regulated and subsidised that the private sector is only there to outsmart the government to line their pockets, it's inferior to even a public system.
You’re still significantly limited by your insurance carrier’s network and also the consolidation of the healthcare industry. I used to live in a city of 1 million that had essentially two hospital networks that bought everything. You could not find a specialist not associated with those two companies. Pre-natal, allergy, cardiac, two choices. When my seventy year old doctor who ran a practice out of his house retired he sold the practice to one of the two.
It’s not shopping for a tv. You can’t choose not to buy. It’s often time sensitive even if by appointment. Pricing is incredibly complex as are the details of the product. Your average person does not have the information necessary to navigate the market.
That "medical professional" has literally 90 seconds to review your case and say yes/no. They've never met you. They don't know your doctor. All they have are some notes on the case, a billing code, and a quota to reach every day. They get bonuses based on how much money they save the insurance company.
All of that cost savings makes US healthcare cost double what it does anywhere else in the world.
I think you're a little confused about causality. All healthcare systems, including fully socialized ones, perform similar types of case review to ration care and hold down costs. US healthcare costs might be high now but would be even higher if the payers (including the Medicare / Medicaid government payers) paid every claim that came in without denying those that fail to mean plan coverage rules.
If we want to hold down costs then we'll have to put a greater focus on preventative care, stop expensive treatments for terminal patients, impose price controls on providers, and stop subsidizing drug development for the rest of the world. None of those measures are politically popular.
Yes, exactly. Since demand for healthcare services is essentially unlimited, creating artificial shortages is one way to ration care and hold down public spending. The US government already creates healthcare shortages in other ways, such as constraining the number of residency slots to limit Medicare spending. (I don't support this, but it is somewhat effective from a fiscal policy perspective.)
Legally speaking the insurance company isn't overruling medical professionals. They're simply refusing to pay. Patients still have the option of paying for treatments out of pocket. (I do understand that for poor patients this is a distinction without a difference, I'm just clarifying the legal issue.)
Some states have recently passed laws which limit the authority of health plans to conduct medical reviews or deny payment for services that providers deem medically necessary. This will reduce hassles and expenses for some patients, but it will also accelerate the inflation of insurance premiums paid by everyone else.
other than normal doctor’s office visits, i have no idea what i’m going to pay when i get a small procedure done.
a basic heart ultrasound cost me over $1k while my vasectomy cost me a $60 copay. i was expecting those prices to be flipped.
and don’t get me started on labs. i’ve gotten bills for basic screens years later for thousands of dollars.
you can’t shop around if you don’t know what you’ll pay until months after it happens. if you call the insurance company beforehand you wait on a static filled line with a call center in india, and even with the CPT code they can’t give you a straight answer.
They don't know. Nobody does until the bill is processed. There are a thousand factors that might affect your coverage. This is the nightmare I'm living through right now. Even if you have the code and doctor and patient the help desk at the insurance company can't say for sure if they will cover it or not. That comes down to the discretion of the claims adjuster. You won't know if something is going to cost $100 or $10,000 until after it is done.
The provider or the insurance company? The provider can give you the cash price, but that's a made up number with no relation to reality. The Insurance company can give you what the standard discount would be on that procedure, but they can't say if they'll cover it, give only that discount, give nothing, or anything in between.
if you ask the provider you will eventually get burned. they can only give you the cash price as a backstop.
if you ask the insurance company you’ll never get an answer. providers are usually more helpful about what “should be covered”, but that’s not guaranteed.
seems like prior authorization is the only way to really make sure charges are covered but takes forever. but even then, if your insurance covers $x and they bill $y, you might get a balance bill in the mail.
point is, the market is heavily skewed against the consumer.
Even so, when was the last time someone needed cancer treatment but said "ooh, that's pricey, nah, I'd rather buy a new car instead".
This is my main argument against private healthcare: there's no real choice involved. Without even getting into what a free market is and perfect information etc, the main advantage of a capitalist society is you get to choose what you like. Nobody chooses healthcare (at least, not the super expensive part).
A large portion of healthcare could be free market. Insurance should be for unlikely events not every single thing deemed "medical". My home and auto insurance don't cover regular costs for maintenance. Why must health insurance cover a checkup with the doctor?
To me that is the funny thing today if you look at markets Chinese markets under it's communist system are actually freer than US. China is not interested any 1 company getting a monopoly and becoming more powerful than the government so they promote finance multiple companies resulting in a truer capitalist market than the US.
> Chinese markets under it's communist system are actually freer than US
Right up until the moment that the CCP decides to purge your entire sector, sure. I don't know if it counts as "free" if the government stands ready to nuke the sandbox they so generously let you play in.
You would expect market cap of the largest players to decline if the market becomes more competitive... which was China's primary goal with their recent crackdown.
They proactively forced interconnectivity and limited the ability for companies to make "walled-garden peudo-monopolies", as we have in the US with Apple and Google.
If the same happens here (through act of congress, or legal outcomes), you can expect their market caps to decline as well. A decline in market cap doesn't speak at all to whether it's beneficial to the industry or consumers
> They proactively forced interconnectivity and limited the ability for companies to make "walled-garden peudo-monopolies", as we have in the US with Apple and Google.
WeChat is the inspiration for the idea of the "everything app" that so many US companies want to create but have always failed to. Has it somehow been newly limited in its ability to control an absurd percentage of all Chinese internet-connected activity?
"China is planning to introduce a new mobile payment regulation aimed at reducing the market share of Tencent Holdings' WeChat app, similar to efforts made by the National Payments Corporation of India to curb Google Pay and Phone's growing dominance in the market"
China's methods are more authoritarian than are viable in the west. But the general premise of a competitive market being better for society than dominance by a small number of firms is supported well by history
> China is not interested any 1 company getting a monopoly and becoming more powerful than the government
Those are 2 different things.
Monopoly doesn't mean "more powerful than the government". I'm not sure what that means, since the CCP disappears or coerces anyone who might threaten the supremacy of the CCP (or Pooh Bear) in any way.
Capitalism results in a single winner, for many industries. CCP prefers kingmaking in various industries, because it's easier for the government to control a few players than a multitude. This isn't what "fair market" means, in context. It's modern communism. State owned companies that are directed by government, rather than direct investment or day to day management. China learned from Russia's failures, I would say. I would also concede it's less regulated, under a political lens.
Not really. Chinese SOEs comprise around 60% of market capitalization and around 23% of GDP, far higher than USA or other developed economies.
While they do have a competitive market, the government very much does pick and choose winners and loosers here like Huawei, resulting in consolidation into a few large conglomerates like every other country. Their (software) tech scene certainly dosen't like more particularly "capitalist" than Big Tech, nor is the Fed pumping subsidies to Tesla like BYD, if anything they're sidelining Elon Musk.
Always when I read this I think they are comparing too very different societies where healthcare is just one factor. Americans are so much less healthy than Australians due to lack of exercise, poor diets, stress, no holidays, guns and crime. Its a miracle that if the US health is nearly as good as Australians it shows how great the US healthcare system really is.
Part of the Australian national, state, and local health care system is policy to encourage healthy life styles and to discourage, limit, or ban food additives, tobacco, etc.
Back in the 1970s the AU Government was running campaigns such as Life. Be In It: https://www.youtube.com/watch?v=GNjEge3Awl8 (many short segments airing with commercials on TV).
Planning requirements typically require open spaces, walking paths, sporting facilities, etc.
A "healthcare system" needs to be more than simply "immediate care for the injured, sick, and|or dying".
> Part of the Australian national, state, and local health care system is policy to encourage healthy life styles and to discourage, limit, or ban food additives, tobacco, etc.
, realise that mental health services also had poor inclusion at times and that "gambling" is being implied to fall under mental health services (and hence not addressed).
On a more serious note, gambling in Australia has some serious industry influence that's preventing it being properly addressed - see: (for example) Media Watch -s2024e31- Monday 2024-09-09 They're Addicted
This honestly feels like the kind of thing where 20 years from now we'll be more aware of the side effects and people will shake heads about how stupid "we" were today.
If this is going to be an exception, it'd be truly interesting.
There are already a bunch of studies showing that the ozempic causes massive muscle loss and lessens bone density. And before anyone remarks "just do resistance training", I doubt the people that take the easy solution will do it in conjunction.
Do they cause it in excess of normal weight loss in the same time period? I'm asking because regular weight loss that's quick will have both of these effects too.
Correct me if I'm wrong but Ozempic doesn't cause you to lose weight, instead it controls your appetite. It's not something like DNP, right?
'Normal weight loss' here refers to eating the same amount of calories without taking Ozempic. You should lose weight at the same speed as with Ozempic, because it's the calories that matter when it comes to fat loss.
Weight loss always comes with some muscle loss and bone density loss, because the structure now supports less weight than before, and our bodies dislike to maintain muscle apparatus beyond what is necessary.
Unless Ozempic causes significantly more muscle loss than other ways of losing weight, that news isn't really news.
I cannot possibly even imagine how this could be the case, considering just how deadly and miserable obesity is. I don't see how we can hypothetically "solve" obesity and then go back to an obese population because the drug makes you nauseous or something. And that's not even considering the, what I can only assume to be, trillions of dollars of healthcare cost savings over time.
>Its a miracle that if the US health is nearly as good as Australians it shows how great the US healthcare system really is.
Or its a ticking time bomb: 39.6% of Americans are Obese(BMI 30 or higher). Fast forward 15 years and this will probably collapse the country. It certainly will be the No 1 issue in the country bar none. Ozempic may actually give the country a chance of some sort of future.
"Free market" is one of the best examples of a technical term people use with complete confidence despite not knowing what it really means. Furthermore, even if you do know what it means you probably remember it as something you learnt on day 1 of economics class before learning all the reasons they never really exist and what governments try to do about that.
I’ve studied economics for years and I’m still of the opinion that the only government intervention to the market should be breaking monopolies and cartels. I’m waiting for a piece of literature that would convince me otherwise, maybe you could provide one?
I can't, but I'm curious how you think problems like externalities would sort themselves out. Also what about natural monopolies like utilities and infrastructure that can't really be broken up?
I think humans are excellent survivors. I don’t lose sleep over externalities because of that alone. What I mean by that is that once people realise their daily lives are being affected by a negative externality, they start making decisions that alleviate that hardship.
I do recognise though that it’s an unsolved problem, and will lead to some form of regulation as our understanding is lacking.
I think only harmful monopolies should be broken up by force, since they’re a legitimate market force. I’m conceding some ground on that because I’m not prepared to claim that monopolies aren’t always harmless.
Australians (and other outsiders) use that term when talking about aspects of the US because that is the Hollywood picture of how the US functions.
That is the lie that is sold, and people outside have no way to know it’s not true. Even today there are hundreds of millions of Americans who say they live in a free market and that it’s the best thing ever.
> Australians .. use that term when talking about aspects of the US because
Australians have a weird sense of humour - it's clear from here that most aspects of US economics are decidedly not free markets but so many US citizens never shut up about "free markets" and have such a bicameral Capitalist v. Communist view of the world that it makes sense to just deadpan nod along.
Maybe reread https://news.ycombinator.com/item?id=41856242 and ask yourself if the article really thinks the US health system is a proper Adam Smith free market .. or just a "US free market" with extra heavy air quotes.
Is the US health system free market? The government provides healthcare via Medicare and Medicaid for seniors, the people for whom life expectancy and healthcare quality have the highest correlation.
It’s a mixed bag, but the funding source doesn’t necessarily make it a controlled market, to the degree that Medicare and Medicaid pay non-government providers and allow competition (which again, is mixed). Medicare and Medicaid coverage make up one third of the US population. The other two thirds are on group/employer insurance, private insurance, or no insurance at all.
For non-seniors, the medical insurance system certainly sometimes doesn’t feel like a free market from the consumer perspective, but the insurance companies are private for-profit institutions, and the medical providers are too, so it may well fit the definition.
> the people for whom life expectancy and healthcare quality have the highest correlation.
What do you mean by this? Fatalities among the young will have a much larger impact on lowering nationwide life expectancy than fatalities among the elderly.
The quote is from a Crikey reporter, I (an Australian) wouldn't agree that the US health system is classic free market .. but it appears to have more regulatory capture by vested commercial non government profit orientated interests than by social policy best outcome for the masses civil authorities.
( Describing various systems in various countries as either communist of free market capitalist is pretty simplistic, it's not much as a linear spectrum either )
I'd also argue that the foundation for a high life expectancy doesn't start with good health care for seniors .. unless the metric is "life support via artificial means" .. life expectancy is grounded in healthy living and excerise from an early age well maintained with good health programs.
Next to the USA, Australia provides some of the highest earning opportunities for medical specialists thanks to its very well-developed private sector. A doctor might clock AU$300/400k for a 0.5FTE role at a public hospital, and then bring in another AU$500/600k+ from their private practice (and that's a very low figure for a lot of specialities). As a result, Australia can attract and retain extremely high-quality doctors with the public sector essentially riding the back of the earning potential provided by the private sector. Interestingly, I think the reason you don't often see full private specialists is that due to lack of market forces applying to public healthcare, the public system crowds out the private system on complex/innovative care -- so as a specialist you need to retain a public presence to get access to the high-profile work that you use to support your private billings.
AFAIK Australian healthcare system is mixed public private with a heavy lean on private. The healthcare market is open to market forces as the government works through subsidies. Plus I think many of the hospitals are religiously run institutions which helps protect from private equity influence.
The US has massive government regulation and dysfunctional state intervention in healthcare if not directly then vicariously with rules around Medicare. The US government helps make the dysfunction that private equity later exploits.
So I’m not sure that it would be correct to use Aus and the US as examples of the either end of the private / public continuum.
I would use UK or France as an example of a public system and Singapore as a light touch private, and perhaps India or Turkey as a laissez-faire system.
The UK and France systems appear to be degrading and do not appear long term affordable and I think they will soon be adopting Canadian style Maid systems to cut cost.
Germany is a weird one because it seems like half the doctors there are homeopaths and the Germans love their insurance but I’m not sure if they get value for it.
Personally I’d prefer the Australian or Singaporean style systems but I’d classify those as mostly private.
Australia absolutely has a hybrid health care industry with layers; health, medical, surgery, pharmacy and mostly outcomes based regulation rather than much assistance to maximise financial profits.
The current system grew out of a more fully public system under a many years past Whitlam government, people like the universal health for all aspects and wanted additional private services in the mix. It's evolved from there, with government oversight directed towards keeping things accessable and fair.
The US appears to have "massive government regulation and dysfunctional state intervention" as the end result of a lot of fingers in the pie bending regulation toward "middlecare" providers that don't apply splints or save lives, just diddle about with insurance schemes. (Admittedly that's just an impression from afar).
> The US government helps make the dysfunction that private equity later exploits.
My feeling is the US government is largely an arm of private interests in many matters.
Health Care in Australia embraces public policy such as Food Regulation to ban and limit additives, parks and sports grounds to encourage exercise, limiting access to tobacco, and some interesting national level drug acquisition deals to keep pharmacy costs low.
These cause a flow on of less per capita input into the medical side; lower heart disease, less smoking related issues, etc.
I don't disagree that there is a lot that Australia does right and the US would be better off with an Australian style system complete with a universal healthcare. Australia could have gone the NHS route but did pivot to the mixed system under Howard. Additionally it does appear to me that the National Disability Insurance Scheme is absolutely rife with fraud - I'm not even sure who'd you'd blame for that as it seems intentionally set up for such an outcome to undermine the very idea. So I'm not sure how well the Australian system will last even if it has lasted well up until now. Of course being Australia they'd combine NDIS with Robo-Debt and mistakenly hound a bunch of poor people to death.
I'm assuming the rational behind drawing the distinction between the US and Aus systems is to somehow inform what the US should do, I don't think giving an already corrupted government system more power will help. It's very hard to uncorrupt things and because of that reason I think the US would benefit from a more laissez-faire system.
Additionally Australia has many advantages that the US does not and the US could not emulate Australia even if they wanted to. I don't know how long that'll last either - mathematically I would assume a country could not get rich and stay rich repeatedly selling houses to each other but it does seem to have lasted a very long time. I assume at some point the Aus government will run out of ways to prop up the housing market. The combination of negative gearing and all sorts of first home buyer grants is just insane.
I had private health insurance in Germany. It was quite expensive and had a very high deductible — so pretty bad incentives around routine health care, I never made a claim in 13 years.
The upside was that if you needed, say, a brain transplant for ten million Euros, as long as it was medically necessary they would pay for it.
Now I have a policy elsewhere that is cheaper, still covers me when I go to Europe, and has a much better copay structure while being 100% private. Downside is I can’t afford that brain transplant, but I’ll probably be OK for everything else.
But if a procedure is medically necessary in Germany, public insurance pays for it too (and if they deny, you can, often successfully, appeal or sue them). The biggest difference is that you’ll get an appointment much faster due to the quota system for public insurance patients, and that private insurance can cover more things that aren’t strictly necessary.
>But if a procedure is medically necessary in Germany, public insurance pays for it too (and if they deny, you can, often successfully, appeal or sue them
When you're very sick you hardly have time, money and energy do deal with a lawsuits so that you can get the care you desperately need. By the time you win your lawsuit you could be dead or your condition worse from the stress.
The crazy thing is that I originally signed up for private because it was cheaper than public… at the beginning anyway. I much prefer the Austrian model, in which — I believe anyway — everyone has to pay for public, but then you can get extra private on top if you like.
I was an employee so this didn’t apply to me, but for my freelancer friends it seemed very unfair that they had to use private.
"less likely to die from drug overdoses. Older age groups are also less likely to die from chronic diseases such as circulatory problems and heart disease. Cancer mortality rates are lower in Australia than they are in all other Anglophone countries, except among American men aged over 65. And Australians are also less likely to die in road accidents than other countries"
So what does this have anything to do with healthcare system ( govt or free market) .
The issue with most of these is that they have better health outcomes overall but when it comes down to the uncommon cancer your mom has, she will have a much higher chance of survival in the US. The difference is a lot of poor folk without adequate healthcare die of relatively straightforward conditions like diabetes while if you do have healthcare you end up getting the state of the art though it might bankrupt you.
There's nothing in the Australian health care system that precludes people with uncommon conditions seeking specialist treatments either in Australia or abroad.
> she will have a much higher chance of survival in the US.
Without a deep dive it looks ballpark the same, to be honest.
AU Cancer Survival Rates:
The 5-year survival for cancer in 1991–1995 was 55% and by 2016–2020, the rate had increased to 71%. Even with decreasing mortality rates and increasing survival, the number of deaths from cancer has been increasing.
Five-year survival rates have also been increasing for an even longer period of time. The overall cancer survival rate was 49 percent in the mid-1970s. It currently sits at 68 percent
We/Australia has a massive focus on early detection of skin cancer due to our overly sunny weather. It's possibly that we detect more cancer and treat it earlier thus the better outcomes?
> when it comes down to the uncommon cancer your mom has, she will have a much higher chance of survival in the US.
A few years back my Mum in Australia was diagnosed with stage 4 lung cancer, given 12 months to live.
For just shy of 3 years she had radiation, chemo, trial drugs worth nearly a million a pop all in a brand new cancer Center. Because she lived a couple of hours away she got free transport to and from and free hotel. Not pay and claim it back, fully free.
She was on an enormous cocktail of drugs that dad would get at the pharmacy that raised a lot of eyebrows for the strength of the opiates among other things.
For three years they never paid a cent. They never paid a cent of health insurance, never had private cover, never had a deductible. That would all be the same if they had never worked or took a decade off to pursue some hobby.
Trust me when I say it was stressful and emotional enough without adding money or paperwork or insurance into the equation
The comparison to my friends in the US who couldn’t get a separated shoulder fixed because it was “out of network” or had to move hospitals the day after a C section because the insurance didn’t want to pay anymore is downright disgusting.
For real people living their lives the two systems are vastly different.
Obesity's definitely a factor, but other developed countries haven't seen the same level of stagnation despite their own skyrocketing obesity rates. For that matter, Americans also smoke less compared to most of Europe.
There's likely at least one other major factor, and I would assume that it's some variation of "inability to access high-quality care for financial reasons" given how much of a wealth disparity there is in various healthcare outcomes.
Older age groups are also less likely to die from chronic diseases such as circulatory problems and heart disease. Cancer mortality rates are lower in Australia than they are in all other Anglophone countries
So you get less cancer because you have 'access high quality healthcare' ? how does that work?
wealth disparity there is in various healthcare outcomes.
Wealthy have access to good food. have less stress and engage in mental and physical recreation more and ofcourse regular screenings.
Why would it depend just on one factor like hospital access?
Plausibly you can get less cancer by encouraging people to stop smoking, drink less, be less exposured to known carcinogens (either by awareness or regulation). A good healthcare system can also mean you catch cancers early or treat them earlier.
less likely to die from drug overdoses. Older age groups are also less likely to die from chronic diseases such as circulatory problems and heart disease. Cancer mortality rates are lower in Australia than they are in all other Anglophone countries, except among American men aged over 65. And Australians are also less likely to die in road accidents than other countries
So why are they getting less chronic diseases despite being equally obese.
yep exactly. 'healthcare' should be called 'disease care' . Most ppl are too far gone to recover from their illness by the time they go to the doctor.
All the medicines they prescribe are merely to manage symptoms. I have GERD and reflux. I was given PPI after many many tests. How does taking PPI extend my lifespan. Whatever has gone wrong with my body is still there.
How is this not obvious to ppl making this absurd correlation between hospital care and lifespan.
Medicine doesn't have shit of new breed of diseases and disorders ppl are dying from. Doctors don't have answers to any of modern illnesses so how does it matter if access to a useless person is govt funded or 'free market'.
> I have GERD and reflux. I was given PPI after many many tests. How does taking PPI extend my lifespan. Whatever has gone wrong with my body is still there.
It can potentially extend your life by reducing your probability of developing esophageal cancers, improve your quality of life in the meantime, and there are other complications from untreated GERD I can't recall but would negatively impact your life.
They are only approved for short term use because of myriad of side effects ( including things like life threatening colon inflammation, kidney disease ect)
The people have never specifically asked for anything, because we're not a direct democracy and we don't have federal referenda. What does that matter?
Bernard is well across many aspects of US, UK, and AU political views, government systems, media etc. with his own particular views as we all have.
In context he's writing for an Australian audience about a conservative Australian trope that the Australian health system is weighed down with government meddling and would do better with, for example, a "US free market" approach.
I think we all appreciate that's an illusion, a myth spun for children.
I think it’s extremely important to see that it is neither a myth nor an illusion spun for children.
It is a carefully constructed plan that will ensure rich people get a whole lot richer and poorer people get worse care. It’s not an accident or nice story. It’s class warfare
Depends on what you mean by health care. Medicare is insurance, not care, and while insurance is part of the system, Medicare often pays private healthcare providers for service. Medicare only insures ~14% of the US, less than one sixth and is only available for people 65 and older. For those reasons, your example maybe doesn’t demonstrate what you imply.
The healthcare system in the US is far, far from a free market. Most people would describe it as a crony capitalist market. There's a lack of transparency, lack of competition, and lobbyists of established players have too much say in the lawmaking process.
I assume you are referring to a larger amount of people living in poverty in the US?
Could this also (partially) be explained by the cost of healthcare? Something like a downwards spiral where average people end up poor either due to direct costs of healthcare or neglecting their own healthcare due to cost?
- greater usage of surgeries and prescriptions, leading to greater exposure to medical malpractice (the 3rd leading cause of death in the US.)
- higher birthrate. more pregnancies.
- less cultural tolerance of abortion. Greater willingness to take on risky pregnancies
- single parent homes (people with less family support)
- ethnicities which are more susceptible to certain disease and lifestyle risks
- greater exposure to crime in impoverished areas
- more life time spent traveling in cars
- more restricted access to health insurance (as you said only accessing healthcare in dire emergency)
The US is a different world than most countries which tend to be geographically tight and culturally homogenous. It's very difficult to make comparisons, not to mention differences in data collection and reporting ethics.
The CDC doesn’t record medical malpractice as a category for cause of death or injury. It’s grouped under “accidents” in their statistics (their official 3rd ranked category).
> The CDC’s published mortality statistics, however, count only the “underlying cause of death,” defined as the condition that led a person to seek treatment.
Because of this political choice the information comes from 3rd parties digging into the accidents category.
> The US is a different world than most countries which tend to be geographically tight and culturally homogenous
So, if this was the issue, you'd probably expect outcomes to be better in less diverse, physically smaller US states. Looking at, say, life expectancy by state (https://commons.wikimedia.org/wiki/File:Life_expectancy_map_...) doesn't seem to bear this out, really; on your theory you'd probably expect, say, West Virgina to be handily beating California or Texas.
Also, of course, _Australia_, which started the thread, could hardly be called either geographically tight or culturally homogenous. Australia is roughly the size of the contiguous United States.
Indeed. On the spectrum of health risks Australia is more like the US than France, but it’s far away. The most similar country is possibly Russia or Brazil.
Demographics (I assume you mean race?) can't be the reason. West Virgina is IIRC almost exclusively white and has a lower live expectancy than North Korea.
Our organization (the American Federation for Aging Research) is hosting a webinar with Jay Olshansky (author of the paper) and Andrew Scott, a leading economist in longevity to discuss Jay's results on 10/22.
The gist is that this isn't quite as cut and dry as it may seem.
We also paid to make the Nature Aging paper open access.
> We also paid to make the Nature Aging paper open access.
That’s awesome! Did you make a deal with the authors to pay for the fee during publication or is this something anyone can do by approaching the journal itself?
Thanks! I wasn't directly involved in that discussion, but I imagine anyone can do it. It is a requirement for some grants and for some research funders.
Edit: if you need to know I would just ask the editor if it's an option
> We also paid to make the Nature Aging paper open access.
Why not just use a preprint server like Medrxiv?
Arxiv is now the default place to publish papers in physics -- and, with that established, it seems to me that it would be for the best if more institutions, researchers, and organizations in biology, medicine, chemistry, and other areas also use preprint servers.
Just let it sink a second, they speak about how many baby born after 2000 will reach 100 years old, how we are reaching the absolute limit of human survival.
75% overweight... Everyone know fat people don't live long. I bet all the studies done in the 90's that predicted we would easily be able to reach 100 years old didn't take that into account.
Both are also largely meaningless because they're based on BMI, which is literally just mass/height^2. No measure of percent body fat, no measure of any other aspect of health, just mass by the square of height.
If you're comparing the BMI of two countries with very similar gene pools it's not a bad point of comparison (though the raw number still doesn't tell you much without more context about build types), but when you're comparing Australia to the US the gene pools of the non-European minority groups are sufficiently different to make BMI pretty worthless as a point of comparison for public health.
Yeah, it's not height itself that's the problem, it's body shape. As just one example: some people have long torsos and short legs, others long legs and short torsos. Those two groups will have wildly different BMI curves even at similar health levels.
BMI is a very crude measure. It is only useful in the extreme, and not particularly relevant for an individual. If you have a BMI of 40 you should think about losing weight, but exactly nobody need a composite number to know they are that fat. Similarly, you might have a normal BMI but an LDL of 300 or a strange lump on your thyroid. These things are vastly more important than your BMI
To be fair BMI is based on Belgians from the 1850s with all the implications it has. Modern people are much taller (+15 cm for males) and eat a lot more protein.
So the line between normal and overweight is somewhat blurry. e.g. someone who is 6'3" and weighs 200 pounds is overweight. Which might or might not be the case (but you certainly don’t need to a body builder or invest a lot of time to maintain at least reasonably healthy 18-20% body fat ratio).
>To be fair BMI is based on Belgians from the 1850s with all the implications it has.
It's a pretty straightforward formula, and even though the cutoffs might be arbitrary, there's undoubtedly a u shaped mortality curve centered somewhere around 20-25. At a population level I don't think any of that is a relevant factor. No one thinks that your risk of death hinges on crossing an arbitrary line, but being fatter definitely isn't good for your health.
But the question here is whether you can compare the BMI curves of two countries and come to any conclusions, and the answer is pretty solidly "no".
Bone density, muscle mass, torso height relative to leg height—none of these things are factored into BMI and all of these vary wildly depending on genes.
Being born with worse attributes doesn't mean those attributes are out of the equation. A lot of people die much younger than they should just by poor luck, with little or no control on their end.
If you happen to have higher bone density and higher muscle mass just because you have higher testosterone, you're still better off. Sometimes people just get the short end of the stick. That doesn't necessarily mean BMI doesn't work.
I've even met smokers, smokers! Who have better cardiovascular health than me and are skinnier. Which really fucking sucks for me.
Veins have a 2D cross section where body’s are 3D. That’s one reason why using height ^2 not height ^3 may better correlate with health.
Similarly, cancer risks may scale with the amount of tissue or the surface area for things like skin / colon cancer but it’s hard to see how being taller is beneficial.
I'm thinking that ozempic and zepbound will have something to say about this. When ozempic becomes available as a generic (2032) it's going to be available for $10 a dose and a huge amount of people will be taking it.
Ozempic's mechanism of action is not "ramp up your metabolism" or "make you absorb fewer calories from food." It's "make the desire to eat less intense, making it easier to remain on a diet plan." That diet plan could be, "eat exactly the same things but less of them," but it will often be, "cut out unhealthy snacks" or whatever.
>It's "make the desire to eat less intense, making it easier to remain on a diet plan." That diet plan could be, "eat exactly the same things but less of them," but it will often be, "cut out unhealthy snacks" or whatever.
If people can't be convinced to eat carrots over chips, what makes you think they're going to suddenly eat carrots over chips after eating medication that makes them want to eat less?
I'm not sure how making someone less hungry magically makes them want to eat carrots over chips. Is the reason why they're eating chips because they're so hungry and so pressed for time that they're reaching for the highest calorie food? Or do they eat whatever's the most delicious? If it's the latter, I doubt being less hungry is going to make them choose healthier options over more delicious ones.
People aren't idiots. They know what foods are healthy.
A lot of people struggle with intense cravings for foods that they know to be unhealthy. These cravings stack up against their willpower and sometimes overcome that willpower and they eat in ways that they know are unhealthy.
If the cravings are less intense, willpower wins more often, cravings win less often.
I think that you will indeed see that some people on ozempic eat much the same mix of foods as before, but less so. But others will in fact change their dietary mix. And I'm pretty sure that the empirical evidence supports me on this.
Oh I can answer this one. I've never liked chips but was still ~230lb before Ozempic. I tried various diets, but the willpower to maintain one was pretty overwhelming if anything else was going on in my life. I tried eating carrots to get full. And let me tell you, it feels very strange to eat half a pound of carrots, feel your stomach be full, almost painfully full, and still be just as hungry. Same with salads. I would still feel hungry, even though the stomach is full. Even though I liked the taste of the carrots or the salad. It felt like I hadn't actually eaten, and that I was still hungry for an actual meal. With Ozempic? I can just eat a salad, feel good about it, and feel satiated for hours. It just works?
From my friends who are on ozempic, yes it has literally done just that. Along with the fact because they are driven to eat less they, in general are less snacky (and thus eat less chips) and tend to avoid greasy/fried foods because combined with the medicine it leaves them feeling worse afterwards than eating a similar "healthier meal".
Yes N=2, small sample sizes, but I could also see how being less snacky makes one less likely to eat chips. (Why I almost pathologically don't keep easy to eat food in my pantry, granted this can also backfire too).
People prefer the chips because their brains are broken and they have a fixation on tasty foods. It clogs their thoughts processes - basically, they have an addiction.
If you don't care much for food then you don't mind eating the carrots and you don't mind losing the chips. If your entire life is food, then you do mind.
Entirely possible they do - but those effects would probably manifest in some fashion earlier than actual death. We'll have at least 7 years to see if we can spot them. But, even if they do exist, they will probably be small (given we haven't found them so far), and the positive effect on life expectancy via weight loss is huge.
i.e. the benefits of the weight loss almost certainly outweigh any side effects that are likely to manifest.
People have been taking them for decades for other reasons, so if they had side effects reducing max life expectancy worse than being overweight surely we'd know by now.
A study by researchers from the University of British Columbia (Canada) shows a link between drugs intended for diabetics and severe gastrointestinal diseases: pancreatitis, intestinal obstruction, biliary pathologies and gastroparesis.
Only fools would convince themselves a drug has no sideeffect.
The worst is that these drugs were created for legitimate use but are now being abused by what I would call lazy fat who can't get their finger out of their arse and start eating healthy.
When there is a natural, effective and no side effects alternative, why go the medication way.
When I was at university, I made a game of spending as little as possible on food. 50p/day. Didn't realise until someone here refused to believe me, that my diet then was about 1100 kcal/day during term time. Didn't feel bad at all.
A few years after graduation, for unrelated reasons, I was on antidepressants. I massively over-ate, became obese, gained stretch marks that will likely remain for life.
There was no voice in my head telling me I was even over-eating, there was no awareness of what I was doing to myself even when I felt the weird tingle in my belly that in retrospect was the tearing flesh that has the outward sign of a stretch mark — I ate without thought.
There is no "natural, effective" solution, because our natural instincts are at odds with our unnatural world.
So the solution is to take a hormone so we can still eat all the junk food we massively produce?
Ozempic is exactly the type of drug Unilevel/Nestlé would create if they were tasked with reducing obesity. I wonder if they'll include a free 7 day dose of it with Mars bars.
That's pretty much the exact opposite of what you seem to think it does, and is exactly the kind of thing that will hurt Nestlé's junk food line. (Though probably not their bottled tap water line).
Seriously — the US and Europe have not been in a remotely "natural" condition since over a century before I was born. Even the air we breathe is significantly different from its natural condition.
I wish people with your worldview could try some drug enhancing appetite for like a month. See how easy it is to get their fingers out of their arse and keep eating healthy when their body is craving food all day long.
Would you also tell people suffering from depression to just cheer the fuck up instead of going the medication way?
We don’t know if MMR doesn’t but we still give kids[0] the vaccine in infancy. The vaccine is too young (<60 y old). So I suppose ask yourself what proof you need and why.
0: most kids, I just got the disease instead and the vax later
We do know MMRV causes more seizures in kids than MMR and countries (like Canada) still choose to administer the vaccine with riskier outcomes due to costs and the fact parents don’t like to come back for more shots.
Honest puzzlement: how is it possible to be so underinformed when google, duckduckgo and wikipedia are right there? Are they blocked some places where hacker news isn't?
You live in a world where willful stupidity is far from rare. Yes, I know that we should assume incompetence before malevolence, but that was an earlier era. A mixture of the two is the new norm.
Ozempic et al are nothing like amphetamines. They definitely have side-effects but we have far, far more evidence that the benefits are outweighed than we did for stimulants in the 80s.
Every decade or two I hear this about some wonder drug only for them to turn out just as bad as what they were replacing. The opioid epidemic being the latest one.
Do you pay more attention to those and ignore the actual success stories?
The opioids thing is hardly comparable. Everybody clearly knew the risks (for the past 100+ years) and chose to ignore them. This is an almost entirely new type of drugs.
Do you pay attention to the people who win at Russian roulette more than those who lose?
OxyContin was marketed to be the safe alternative to all opioids that came before it, impossible to become addicted to and extremely difficult to overdose from. This was a lie.
> Do you pay attention to the people who win at Russian roulette more than those who lose?
Well.. no since you cant really win anything. With pharmaceuticals on the other I hand I think 1 Oxycontin/etc. like “situation” would be a reasonable price to pay for let’s say 4 major successes.
You were talking about decades. Surely you noticed the advancements in treating cancer, HIV and a multitude of other conditions since the 90s?
> This was a lie.
Sure. But it’s on the same level as saying that filtered cigarettes don’t cause cancer. If a doctor actually believes that he’s just too dumb to be a doctor… (although I assume most safety claims were relative to other opioids and not in absolute terms?)
Are there any signs that the situation with Semaglutides is that similar? Yes they are new and not well understood drugs (well not really but sort of..) and it’s not inconceivable that their longterm cost might end up outweighing the benefits but I don’t really see any signs of an actual conspiracy yet.
studies estimate that moderate obesity takes about 2-3 years of life expectancy (defined as having a BMI of 30-35), only people with severe obesity (BMI of 40-45+) lose on average 6-13 years, comparable to smoking.
Given that severe obesity is still uncommon even in the rich world it only has a small impact on life expectancy overall.
This is what people also don't realize. When these sorts of people get old they become immobile as they lose what precious little of actual muscle mass they had and unsupported joints start failing left and right. Sure your life expectancy might only be 2-3 years shy. What about your health span? That's what most people are actually interested in extending when they talk about living longer.
Yeah, this is why I lift everyday and I plan too until I can no longer do it. Lifting is also good for mobility if done correctly. Especially deep squats.
Hunched over old people do not have the muscle mass to help keep them upright, I guess amongst other things.
- strengthening muscles around joints allowing for more controlled movement.
- increasing flexibility: Dynamic movements in weightlifting, like squats, lunges, and overhead presses, can stretch and strengthen muscles simultaneously, improving flexibility over time.
- improving joint health because loading the joints with resistance can increase the production of synovial fluid, which helps lubricate joints and promote better movement.
- promoting balance and coordination because exercises often challenge stability and coordination, which can help improve motor control and range of motion in everyday movements.
Why do people on HN think the US is special about (quantity of) driving? All wealthy non-microstate nations are driving nations. And, they drive a lot. That includes Australia.
Having lived in Europe, Australia, worked in US and Japan, I guess I have pretty unique experience with this.
Americans walk the least out of all, followed by Australians. When I visit the the US for work. People sometimes stop and asked me if I'm ok because I'm carrying my groceries home from the store. People would say: "What are you doing? do you need help?" lol
Virtually nowhere is designed for walking outside of say New York, parts of San Fran etc.
Being slightly overweight is associated with longer lifespan. Really look it up, the longest lifespan is slightly overweight and top of normal bmi. Lifespan gets down when you move toward obese, somewhere in the middle of overweight segment.
The worst life expectations are in underweight category.
You should be suspicious of definitions where the average is abnormal. If 75% of people are over weight, maybe the definition of overweight is wrong.
These definitions are arbitrary anyway. In india they define a bmi of 25 as obese. The same indian after moving to America is not obese until a bmi of 30.
Meanwhile, the average height is also going up, which also correlates with lower life expectancy.
Cardiologists already had to back off their blood pressure guidelines when they defined the average middle aged man as hypertensive in the past.
Well, the average wasn't abnormal, and now it is, without the definition changing. That's telling us something. We're becoming fatter. That doesn't make being fatter "normal". It makes it average, but that's not the same thing. Historically, we know this is abnormal.
Maybe the past was underweight. Life expectancy is up compared to the past along with bmi.
Also in Asia, average bmi is 23, and average bra size is B. In the usa, average bmi is 29, average bra size is DD. Probably same thing applies for men in relation to bench press and deadlift numbers.
I remember a paper that said optimal weight to reduce mortality is just below overweight. slightly overweight people were living as long as "normal" weight people and being very low "healthy" weight really wasn't that great.
I don't know what they based "normal" bmi weight on, but it's not by setting the middle of the range to max longevity.
That’s a bizarre hill to die on, I see all kinds of larger people survive into their 90s when I was living near and volunteering at a nursing home as a teenager
I see all kinds of larger people survive into their 90s
So dangerous to extrapolate from anecdotal observation like this. If I see old people smoking, doesn't mean smoking is safe. It just means it doesn't kill at 100% effectiveness.
It's actually a 100% death rate as all smokers sure. Jokes aside, your statement doesn't have meaning. Many deaths are not attributable to a single cause. However, it's been studies endlessly and is well accepted that smoking increases all-cause mortality.
That’s the funny thing: at homes and nursing homes all around America you will find WW2 veterans. One could conclude that WW2 wasn’t dangerous from that, I suppose.
> The decline in the United States is driven by increasing numbers of deaths because of conditions such as diabetes and heart disease in people aged roughly 40 to 60.
People are asking if we should be surprised by the headline but are missing this. As suggested in the article by the researchers, there is something dragging down the average since the 2010s. Not even hitting the general expectation of ~75 years. We don’t have solid answers yet, only theories.
So yes, generally while going up against the process of aging is going to create barriers (eg can we get to 130 years old), we are also failing to raise the baseline which is the bigger issue that people might not grasp when it comes to “life expectancy rates”.
That's not what I meant. A solid answer as to why those conditions are happening, not the fact that they are happening at all.
We have research on what can affect heart health, like what things might be linked to it, such as smoking and alcohol. We also know genetics plays a huge role.
So we don't actually have solid answers, actionable answers as to the rise of heart health issues. Look at this analysis[1] regarding how dietary guidelines specifically for fats (saturated, trans) have very little substantial evidence supporting it. Yet this gets repeated by the average person, that fats are the ultimate evil you must avoid. In another study[2] we find that reducing your fat intake still resulted in the same rates of mortality as those who ate more. This is also why more in the space are shifting away from these sort of claims ("only eat x amount of saturated fat per day") and more to general food composition (eg who cares if a fish has saturated fats, eat the fish with vegetables).
It's quite challenging to figure out, everyone has their theories. All I'm saying is we don't actually have the answers yet.
Perhaps there are many causes of heart disease and diabetes. It is likely that actionable information would require a case-by-case assessment. That is exactly what doctors do, so getting people time with doctors seems pretty useful.
Regarding other factors, American culture is fairly similar to Canadian culture. However Canadians have free healthcare, meaning more Canadians see doctors than Americans. So I wonder if they have lower levels of obesity, heart disease and diabetes, and if their lifespans have also been decreasing.
I don't like this use of "free". It is paid for by taxes. That is no where near free. It is extremely hard in a highly advanced economy to provide quality healthcare at less than 10% of GDP. That is a huge number for any wealthy country.
The general view of US healthcare is that not much of the money paid toward better health outcomes reaches the target.
A quote from another comment here is:
Australia’s health system far outperforms the .. US healthcare system, which spends nearly twice as much per capita as Australia to deliver far worse outcomes — including Americans dying five years younger than us.
> Yet this gets repeated by the average person, that fats are the ultimate evil you must avoid.
I've been hearing this complaint (that the guidelines claim fat are the worst) for way too long, when in (my) reality, all the guidelines I've seen in the last 25 years has put more emphasis on carbs than on fats (i.e. too many carbs is evil).
I know "low fat" diets were the craze a long time ago. And sure, advertisers still like to slap "low/no fat" labels. But I believe the actual recommendation has been to lower carbs since around the 90's.
To be fair the framing of “carbs are evil” is also lazy. The root cause of most cardiovascular disease and type 2 diabetes is obesity due to excess calories of any sort (although once you’re diabetic or prediabetic carbs are a HUGE problem no matter what).
The modern lifestyle is incredibly sedentary and every civilisation is built on staple foods that can feed hours of manual labour (with modern snacks thrown on top).
Calling a major food group evil is just a good scapegoat because it’s much more palatable than telling people that they don’t move enough and eat too much food.
One thing I think that we can be very specific about: Diets high in saturated fat surely increase your chances for cardiovascular disease.
Also, I agree with your general sentiment: Framing carbs are evil is lazy. First, calories matter. Second, if your calories are general under control, most people need fewer calories as they age. Many choose to restrict carbs to maintain weight.
All of this shit is stupid. Research has pretty conclusively shown at this point that a high proportion of calories coming from saturated fat specifically will raise LDL cholesterol levels, in people who have neither genetic predisposition toward low or high LDL. If you have one of those, it won't make a difference either way.
Whether that leads to actual heart disease is iffier, but not terribly controversial among cardiologists as far as I can tell. It's only doubted on the Internet where everyone wants to be a galaxy brain with some answer the doctors don't want you to know.
But nobody ever demonized fat in general, and demonizing carbs is just as stupid. Eating enormous amounts of carbs is fine as long as you actually use them. My daily calories right now are around 3,900 with carbs at 650 grams a day, a fair amount being syrups I eat early in the morning while running. If you listened to the Internet, you'd believe I was diabetic already, yet basically every remotely serious endurance athlete eats like this and is fine. Glucose that is continuously and immediately shuttled into muscle cells to power mitochondria and provide energy for movement does no harm whatsoever. It's roughly the entire point of animal metabolism. Glucose that sits around in your blood forever because you're sitting around staring at a screen for 16 hours a day while stuffing your face is what causes problems because of all the oxidizing effects of glucose when it isn't taken apart quickly and turned into ATP.
My BMI is 21.6 for what it's worth. As far as I can tell, the whole "mystery" behind why no diets work is because no diet can magically make people eat less when they spend the overwhelming majority of their time not moving and hunger decouples from energy expenditure. If you're sufficiently active as a lifelong athlete, every diet works. I ate super sized McFlurries, entire boxes of Entenmann's donuts, and Little Debbie's treats as a teenager as staples of my diet. As an adult, I've tried paleo, zone, mediterranean. Right now, I pretty much just eat the standard American food pyramid. None of these has managed to magically poison my brain or destroy my metabolism because metabolic function can be trained just like any other bodily function and it is trained by doing regular athletic activity with a high energy demand. Just like your muscles atrophy if you never do any resistance training, your metabolism atrophies if you never do any aerobic exercise.
I can't claim to know the secret to weight loss but I know how to never get fat in the first place. On every team I was ever on from middle school to college to my time in the Army, whether that be cross country, track, volleyball, basketball, tennis, or general outdoor adventurism and long-haul hiking with a weighted pack, the overweight rate was never 0 but it sure as shit wasn't 70%. And we were all eating the same "poisons" and manufactured foods from evil Nestle that the rest of you were eating.
Portion Sizes and the No/Low Fat craze from the 90s mentioned in another post are related.
This is all my THEORY, a speculation that I would like someone to study or to find a study about.
Theory / speculation:
Humans evolved with natural sugars, fats, proteins/meats; primitive cooking, probably some grains (more recently). That's what our bodies know how to process, to react to.
All the fake sugars, modified foods that lack the components our bodies use to regulate internal processes; highly processed foods which also lack those components we need to feel satiated and to produce the messengers to digest correctly: those are likely the causes of obesity (not feeling full, so more eating) and bodies behaving poorly.
'Food Deserts' and corporations that are geared around selling large portions of tasty but unsatisfying food, or only offering huge sizes rather than also offering adults a tasty portion that's not intended for take home leftovers also contribute.
Also: my main vice for this topic. Can I _please_ have lightly caffeinated + carbonated water that isn't outrageously expensive?
Are they insane, though? How many hours average man should work to pay for average monthly dose of the average quality insulin? May be even more affordable than in other countries.
According to ceicdata, annual household income per capita in USA is 10.6 times more than in Mexico. Even with prices 10 times higher it is slightly more affordable in USA.
I don’t think the average man should have to work any hours to pay for an average monthly dose of average quality anything that they require to stay alive. Perhaps I’m insane.
I don't believe being able to work is an ethical prerequisite to survival. I don't believe being willing to work is an ethical prerequisite to survival.
The government can work to provide the medication that its citizens require to stay alive. Under such a system, those who are able and willing to work can, via taxes or other contributions, provide medications that some citizens require to stay alive. Many such systems seem to cost less overall than the system currently existing in the United States, so the average man who will work will have to work fewer hours to pay for an average dose of average quality anything required to stay alive.
Alternatively or in tandem, the pharmaceutical companies can sell such medications at cost, with rebates and coupons for no/low-income patients, while still making plenty of profit on reasonably priced pharmaceuticals that patients do not technically require to survive.
People also require food and water (and arguably shelter and clothing). Should those also be provided by society in average doses and at average quality?
That does not seem likely to result in a stable and productive society, particularly when many working people would have below average housing in order that government beneficiaries could have average housing provided to them.
As I said, I don't believe being able to work is an ethical prerequisite to survival. I don't believe being willing to work is an ethical prerequisite to survival.
Yes, I believe people should have food and water sufficient for survival regardless of their ability to work.
In the system, as proposed, it seems like some will choose to work and pay taxes in order that someone who is able but unwilling to work can have better housing and food than they do.
That doesn’t seem like it will have broadly popular support.
> it seems like some will choose to work and pay taxes in order that someone who is able but unwilling to work can have better housing and food than they do
This is certainly possible because it already happens now with the current setup.
Huh? Statins are a medication type in which increases in life expectancy are extremely hard to point to all. I think they're almost a "poster child" for medications that correct a problem to an extent but whose overall benefit is quite dubious.
(and given that these medications were highly prescribed before any long term studies were finish - creating considerable incentive for people to find benefit - I'd personally wager they are overall harmful but that's me guessing - the main point is they definitely aren't boost-life-expectancy-by-years drugs but probably aren't reduce-life-expectancy-by-years drugs either, given the studies)
Every few years, the lobby inserts op-eds insisting that statins are of such indisputable benefit and zero side effects that they should go into the water supply. I understand this from the companies themselves, but I have no idea which studies are convincing normal people that this is sane.
There is no lobbying like the lobbying for massively selling classes of drugs of dubious effect.
I think the distinction there is between immediate cause and root cause. Heart disease and diabetes (or complications thereof) is the immediate cause of death, but what is causing an increase in those diseases is theory at this point.
Is it not clearly obesity? Why everyone is obese is perhaps unclear (although portion sizes, ultra processed foods, screen time and sedentary lives, etc, all seem to likely play a clear role), but I’d be surprised if the level of obesity that exists didn’t cause more heart disease and diabetes.
Yes. Why is everyone tiptoeing around this? The obesity rate has increased by something like 50% since the turn of the century. It is a major risk factor for all the causes of death being discussed here. Sure there are probably many factors but this is clearly a big one.
Go here https://www.cdc.gov/bmi/adult-calculator/index.html and enter your height and weight. If you fall above the healthy category, you are part of the obesity rate and are what most research points to when it comes to increased cardiovascular risk. Also for asians the numbers are slightly lower.
I find that when I point this out, people often get mad. They feel they aren't obese. But the research doesn't support them, if you are anywhere outside of the "healthy" categorization you are at the same risk (that we know of so far) as "clinically obese" people.
Still remember my first time ever setting afoot in USA, Newark airport coming from Norway, in 1999, going to a tech conference.
I saw more grossly obese people at that airport in the first ten minutes than I had back home in probably the previous year. It really stood out to me.
It must be your general dietary makeup and lifestyle. All that corn syrup. Also, I don't see any reason why it would have gotten better since then.
Just calling a spade a spade from an outsider's perspective..
> must be your general dietary makeup and lifestyle. All that corn syrup
It’s not just America [1].
Norway’s obesity rate runs at roughly half America’s [2]. But the trend across the world is increasing rates of overweightness, obesity and--most worryingly--child obesity.
It's been a minute since then, I've been in Australia for the past two decades as well - and yup, the trend is bad almost everywhere.
Having read (well, listened to) Attia's excellent OUTLIVE, I've reversed my own (slowly turned bad) trajectory by switching my diet to the basics - all home made meals, making my own breads, lots of milk and eggs, meats (not in excess), exclusively extra virgin oil and pure butter in my cooking (zero blends/veg oil etc), and not buying any (sugar) snacks - combined with exercise. Oh and no alcohol for the past few years either - sacrifices had to be made. :-)
Luckily my own kids are showing zero signs of obesity, they are very healthy.
People hate fat people. Everywhere I look, everyone is obsessing with diets and weight. People go to unhealthy extremes to try to loose weight, then predictably fail and cycle.
Disordered eating is a norm and being ashamed is a norm.
I find obesity a weird problem societally because literature to get people to stop being obese on a population level just kind of sucks. All we know is stuff that doesn't really work. Shaming fat people, pointing out their fatness, or other public pressure doesn't do anything. Strict diets like keto or OMAD don't work on a population level (individuals can get great results but I'm talking enough to statistically move the needle as a population). Ozempic and other injectables seem like the best widespread treatment, but that doesn't tell us any causes.
We're not making movement on this because we're not calling it what it is -- an addiction.
We dance around it and call it 'obesity' but the real medical cause of obesity is an addiction to unhealthy food.
This is compounded by the fact that it is completely legal for people to make their food more addictive and therefore unhealthy and advertise it to addicted people with underhanded marketing techniques that take advantage of their addiction.
Until we recognize this as an addiction issue that is compounded by dealers being able to operate with impunity we won't make any headway -- short of technological advancements like Ozempic that allow people to side step their addiction.
To the best of my knowledge, there's actually no diet that has been proven to yield long-term weight loss. (There are of course individual success cases.)
> Shaming fat people, pointing out their fatness, or other public pressure doesn't do anything.
Says who? Are you implying that true societal shame is still being enforced right now, without hundreds of refuges in the form of safe spaces and social justice advocacy groups? I'm pretty sure that such shame worked pretty well in the past, and still does in countries like Japan.
In the end, you'll just have to realize that the root issue you're facing is decadence, and that's there's no fighting it.
We've tried a few decades of fat positively and just pretending that being fat isn't a personal failure, and just a symptom of society.
Fat positivity? It's not really a popular position, and is in fact regarded as a loathesome movement.
You think every fat kid, especially those bullied, don't want to be thin?
You think shaming is going to work? That's an uphill battle, especially against the human body and the urges it generate, the causes we do not fully understand.
Normal healthy humans are supposed to be able to self regulate their weight at a healthy level. I have seen at least one friend who has an atrocious diet, poor eating habit, and yet remain rail thin.
If shaming did work, then it would have been implemented widely and obesity is solved. But it's not. We don't have anything that works as well as ozempic.
I am all for taking responsibility, but we ought to be cognizant about the current limitations of our tools and flexible at how we would solve problems, rather than sticking to dogma or trying the same thing over and over again and expecting different results.
For example, I found a psychological trick that enables me to work long hours. Tricks for eventually getting rid of bad food addiction(sadly, I am at it again).
You may simply not be aware of the extent of the movement. The fat acceptance movement has attempted to recast the issue not as a health issue, but as a civil rights issue, where criticizing fatness is violating the civil rights of fat people. There is a National Association to Advance Fat Acceptance (NAAFA).
Online there's tons of content encouraging fat gain - for example Tiktok women celebrating "BBW" as a sexy thing and the r/PlusSize subreddit, where members encourage each other to remain "big and beautiful" and post anti-science content claiming that being fat is healthy. I saw for example a post by a 20-something woman who was morbidly obese and had had a blood clot in her leg but everyone was still insisting she was a "healthy" type of fat person, herself included.
Of course you will find very few doctors who will endorse this movement or its ideas. And the vast majority of us understand that obesity is unhealthy. But the fat acceptance movement has almost certainly played some role in making people believe that obesity is less dangerous than the research shows.
I won't be shy about my view here, obesity is a terrible disease and if you have it you must take steps to cure it. If you don't your quality of life will be lower in dozens of ways and you will die younger, probably not in a comfortable way. (Not to mention that its economic cost is enormous... a principal way that you can reduce health care costs personally, is to not be fat.)
First and foremost we must renew society's understanding that this is a disease, acceptance is not an option, and it must be prevented, treated and cured.
> If shaming did work, then it would have been implemented widely and obesity is solved. But it's not. We don't have anything that works as well as ozempic.
What kind of reasoning is this? This is only true if you believe good policies always get implemented. You'll notice other countries like Japan don't require every man and child to be drugged to stop eating food, and they have a much stronger sense of shame for being an undue burden on society.
Is it not the case that as BMI increases the risk increases? My BMI is not healthy - and I don’t deny that makes me subject to increased risk - but I would still think morbidly obese is far worse than obese which is worse than overweight, in terms of risk of diabetes, cardiovascular disease, etc.
Not strictly. Over the past few decades I've occasionally but regularly seen evidence that "overweight but not obese" (BMI 25-30) might actually be healthier than a normal weight (BMI 18.5-25). In those studies obese did have a worse outcome than both.
IIRC mostly they had to do with seasonal sicknesses like the flu, the theory being that your body can burn the extra fat during periods you aren't able to eat well.
I mostly get mad not because obesity isn't a problem, but because BMI is a bad way to measure it. It may work in the general, but it can give bad information in specific cases.
I'm a good example of how it fails. I have long arms and legs which causes my BMI to be fairly low. However, my body fat is fairly high. I need to lose fat but were I to rely solely on BMI I'd think I'm fine.
What I'd want instead of BMI is body fat percentage. I think that gives a much better measure of health problems.
> I find that when I point this out, people often get mad. They feel they aren't obese. But the research doesn't support them, if you are anywhere outside of the "healthy" categorization you are at the same risk (that we know of so far) as "clinically obese" people.
Depends. All cause mortality is notoriously lower for "overweight" people than "normal weight" people.
Really smells like one of those “some alcohol is healthier than none” things where there’s a subset of the otherwise-healthiest group that’s in the otherwise-healthiest group because they’re very sick.
A big 30-year Danish study that seems to be one of the main ones referenced for this purpose sure appears to be doing exactly what I worried it was: measuring the predictive power of BMI for mortality, not the healthiest weight for someone to maintain, which are different things. I see nothing in the abstract & methods about correcting for sick people tending to lose weight, and the healthiest BMI creeping up over time as mean population BMI increased, plus the U-shaped mortality curve, really do look like what you’d expect to see if they’re not accounting for that.
The evidence that being overweight is healthier is a bit dubious, but the evidence that having a "normal" BMI is healthier than "overweight" is nonexistent.
In anyone afaik. The healthiest weight is to be slightly overweight. The worst results are for underweight people and for obese people. The curve makes nosedive in its ends.
> I find that when I point this out, people often get mad. They feel they aren't obese. But the research doesn't support them, if you are anywhere outside of the "healthy" categorization you are at the same risk (that we know of so far) as "clinically obese" people.
"Overweight" is longer-lived than "Normal," and "Grade I Obesity" isn't significantly less longer lived than "Normal." So what you're pointing out is misinformation, which is why people are annoyed by it. There is a case that "Normal" includes more sick and dying people because sick people often lose weight, but the difference still can't be as stark as reddit knowledge makes it out to be.
Conclusions and relevance: Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.
Yeah if I try to handwave obesity impact on diabetes and cardiovascular diseases to the average cardiologist, they are going to tear me a new one within minutes.
I don't know why is this even a question. Do people really think being overweight is a net positive?
You gotta go higher in BMI for those to kick in. Basically, where you are within normal and slightly overweight bounds is mostly an aesthetic concern with slight lifespan advantage for slightly overweight people.
When you move toward obese or into underweight category, health problems kick in.
I am on track to lose about 40lbs in 2024 and I suspect the main variable is really as simple as we have mastered the art of making really incredible tasting food.
It is so pervasive though it is hard to tell until you go on a really boring and restrictive diet. It is just hard to not gain weight on average when the food tastes this good with such incredible variety.
That is even if you buy something at the store. With our "foodie" culture, restaurants are an entire other level of choice and taste on top of that.
1) Taste is very overrated, IMO. Too much gratification in our society.
2) SALTY is a taste. Once you remove salt and give it a few weeks, you will start finding about tastes you didn't know existed.
3) Once you cook your own food from scratch using quality and healthy ingredients , what you find tasty can change. It has in my case.
I don’t think the taste itself is an issue, it’s the availability. If I have to cook a delicious steak every time I want to eat I’m not going to randomly snack all day since it’s quite a process. My food consumption will remain at a reasonable amount. Whereas if I just pull out a bag of $chips from the pantry I could eat the whole bag without feeling sated.
I hope this isn't a throwaway account(!). This is a good post. Can you share what/why it is working for you? The best stories always share small experiments that people tried where they learned what didn't work.
Kind of. The tricky thing here is that most people have a rigid view of "obesity" in their minds as it's easier to shift blame to, but the only thing research has shown is that abnormal BMI leads to increased cardiovascular issues. Which includes slightly overweight people.
Higher levels of body fat (which is almost always the cause of a high BMI unless you are an active athlete) is pretty directly tied to inflammation and pre-diabetic insulin resistance. This subsequently results in the liver producing more triglycerides and lipoproteins that clog the circulatory system and the inflammation itself promotes hypertension. All of this together results in more heart attacks and strokes. There's a pretty clear mechanistic link between obesity and cardiovascular disease.
That doesn't mean obese people are "to blame" for any medical complications they might suffer from obesity. It also doesn't mean that obesity is a death sentence; people's bodies function differently and we've all heard stories of pack a day smokers that lived into their 90s. But there is absolutely a connection between the two.
All those things you mention are almost certainly contributors. Another one for you to investigate if you'd like to get pissed off: endocrine-disrupting chemicals. They are everywhere and many of them are strongly tied to metabolic disorders including obesity.
Eating yourself to a point where it hurts your knees to walk, or you get winded going up a flight of stairs, is not the kind of hedonism Epicurus had in mind.
I'm actually a little surprised at the framing here. I didn't realize anyone thought we could overcome aging. I thought the goal was to live longer, but not to completely overcome aging. That sounds somewhat foreign to me. Is that a commonly reasonable goal for folks?
That is to say, I'm not clear that "beating aging" is what is required for "long life." Is that definitionally required and I'm just being dense?
I'm assuming this is a tiered discussion? In that nobody thinks we should freeze aging at baby stages for someone. Such that we would still want some aging, but would then try and fix a point where all aging can be stopped?
> That is to say, I'm not clear that "beating aging" is what is required for "long life."
Ageing is not a perfectly understood process, so what it would mean to overcome aging wasn’t clear, and there was some hope decades ago that maximum human lifespans would just keep going up indefinitely as medicine slowly eliminated the various causes of death.
But now this research concludes what has been suspected for a while - that even under perfect conditions the average human lifespan isn’t going to hit 100. Even if you eat and exercise well and have the best medical treatment, and avoid all the other things that might kill you, ageing will get you.
The medical term for this is “mortality compression”, the idea that as we remove all the ways people die early, the ages of death for everyone end up being squashed up against a limit.
It will take significant breakthroughs in technology (probably some combination of gene therapy, cancer treatments and nanotechnology) to actually stop, or reverse aging.
I think this somewhat makes sense. Just going on the discussion, I was missing that this is using "aging" as shorthand for "the degenerate effects of aging." I'm assuming the growth effects of aging would be more "maturing" or some such.
I still think calling this "defeating aging" is an odd framing. But it makes sense in the standard context here.
It's the bit of life where you can dress yourself and control your bowels that most people would like to extend. I think nobody gets into longevity research hoping they'll be able to dodder around a nursing home with a walker for 25 years instead of 15.
But you could do that by extending the bit of your life where you can do those things. Not necessarily turning off aging?
As I said down thread, this could just be a potato/potahto thing? If this is just definitionally beating getting frail, then that makes sense. But I don't know that I could pin down an age that I would want to freeze progress at. Nor do I think I expected that there would be a general age to freeze aging at. Let me keep my strength longer, but I expect I will be/look/appear older and older the older I get.
Now, granted, I'd be delighted if I have the same strength my 90 year old grandfather in law did. In his 70s, I'm pretty sure the only thing I could beat him at was a race. Lifting things or doing manual work outside, and he was far beyond what I was in my 30s.
> but I expect I will be/look/appear older and older the older I get.
I have a suspicion that something is being miscommunicated between you and many others here. (I admit that I might be wrong. But hear me out.)
It sounds like you are thinking about the visual signs of aging. Like wrinkling of the face, or salt-and-pepper hair. That kind of thing. And sure, there is a lot of vain people who would like to stop that from happening.
But in general the aging people want to defeat is not the wrinkled face. It is things like our immune system demonstrably going to crap as we turn older. Or losing muscle mass. Or becoming senile. Or our bones becoming more fragile.
For young people the flue is basically an inconvenience (by and large). But as we age things like seasonal flue becomes huge issues. People's immune system used to work for decades without a hitch, and then suddenly it decides to crap out. Why?
I can also put it into a more mathematical framework. If maybe that helps? Imagine plotting the probability of a human dying in their x'th year assuming that they have survived before x-1 years. If you plot this now you would see a sort of bath-tub like curve. There is some chance a newborn dies in their first few years of life due to birth defects. Because of that the first few years have a higher probability of death. Then the plot plateaus, and the probability remains basically constant low number for multiple decades. People can still die due to violence, or accidents, or random health issues, but the chance of that doesn't really change much from year to year. And as you approach the other "side" of the bath-tub you see that the probability starts climbing again. And this climb is quite rapid. By the time you are 100ish (plus minus a few years) you have fairly good chances of dying in any given year. And then around 105ish you have about even chances of dying or staying alive in each year. And then we don't have anyone who ever lived to 130.
On this kind of plot if we were to defeat aging what you would see is that the plateau remains constant. That is the chances of a 35 year old dying in the next year where the same as the 135 year old dying in the next year.
Right, this is what I meant with the potato/potahto thing. To me, wrinkled face, graying hair, more hair, etc. are all things that are part of aging.
Which is why I balk at the framing of "defeating aging." We want to defeat the decline that comes with advanced age. But this doesn't necessarily mean we have to freeze the clock at some age, as it were. May be that that is the way it happens.
I think it is just a difference in how you view it? I'd expect ancient person to be noticeably ancient. Not necessarily frail, but just as an old tree has signs of aging that younger trees don't necessarily have. Not that they stopped aging entirely.
So, if you limit aging to "getting frail," I am fully there. But there are other things that happen as you age.
I honestly thought the whole point was beating aging. Whether that's longer life or cancer or whatever. The point is to stay 20-40 forever, from what I can tell.
But, by the time you hit 20-40, you have already done a ton of aging?
Fair that I don't expect to be as strong in my 60s as I am now. Or when I hit 70+. If I get that far. Light weight training is plenty to get to be in good physical shape, though? Get to where you can do 10-30 pushups and run a continuous mile, and you are probably doing fine?
But this gets to my question, essentially? Is "aging for the elderly" different than "aging for the middle aged?"
So, what does it mean to "beat aging in a medical sense?" If it is just definitionally to not have any of the bad effects of aging, then sure. Of course I would want that. What are the names for the good things that are generally along for the ride with aging?
Going back to my earlier quip, if you could turn off aging for babies/toddlers, how would that be a good thing?
This may somewhat surprise you, but I would ask the same for people in the 30s. 40s even, at this point. Freezing someone at that age doesn't sound appealing to me. At all.
So the heart of my question is why do we view "defeating aging" as the same as "living longer?" Or is this something where the target age that people would want to be generally coalesces on a common number?
"Aging" in the context of "defeating aging" refers to the phenomena of declining metabolism and deteriorating genetic data.
Wrinkling skin, graying hair, loss of muscle mass and bone density, loss of mental acuity, decline of libido, late-life diseases (eg: cancer, Alzheimer's, type-2 diabetes), and so on.
It's scientifically proven that our bodies spend enormous amounts of energy up into our 20s when we reach sexual maturity and then glide through on momentum through our 30s into our 40s when we are raising our children.
Once we're in our late 40s to early 50s we're done spawning new life and our bodies throw in the towel, starting the slow but inevitable deterioration culminating in death.
It's that whole physical process that we as a species want to overcome, we want to defy being just machines for spawning more machines. Life is fucking evil.
Growing wiser from more and more life experiences is also part of aging, but it's not what we refer to when we say "defeat aging".
This makes sense, though I still find the framing odd. I don't mind that I look older now that I'm, you know, older. Defeating aging feels like it would be to find a way to be forever young. Extending life doesn't feel like it would need that.
Obviously, we need some way to not completely lose genetic data and such. If there is a "throwing in the towel" moment, as it were, find a way to prevent that. But living forever doesn't equal forever young, to me. Mayhap I'm just too old for that to have meaning anymore? :D
I always wondered why I personally know almost nobody who has managed to exceed average age. With the only exception of my previous landlady, she became 95. In my family, the average age is roughly 60, with three siblings on my fathers side dying before 50. Both my grandpas died around 50. My best friend died with 18. Many of the fellow blind people I know died below 50. And I am from a relatively rich country, with classical western standards. It is almost as if I was thrown into a local minimum while the simulation was set up. I would understand if the phenomenon was largely limited to my family, call it genes then. But it doesn't end there. I guess the personal statistics becomes only meaningful after your own death and beyond. But really, looking at how many people had to pass away early, I am beginning to get spooked.
> I would understand if the phenomenon was largely limited to my family, call it genes then
Perhaps there are other shared variables besides genes? For one thing, blindness is associated with higher mortality [1]. And even within a country, life expectancy can vary dramatically by region, city, and even neighborhood. Or perhaps the people you know happen to be more likely to share certain occupations, mindsets, levels of physical activity, or diets?
I wonder how much impact there will be on average life expectancy uncovering that a lot of the super-long-lived population examples have been pension fraud.
Probably not much because you can find long-lived populations that don't follow the administrative boundaries of pensions.
King County in Washington State, which contains the Seattle metro area, has a life expectancy of 86.3 years. This is higher than any country in the world. If you move one county south (Pierce), it is 75.7 years, slightly worse than the US average currently. Not surprisingly, there are many obvious factors that may contribute to this e.g. the obesity rate in Pierce County is 50% higher and the obesity rate in King County is roughly half the US obesity rate. The Seattle metro is a relatively walkable city and people do, Pierce County is not. As a matter of demographics, King County is significantly more Asian than Pierce County. And so on.
Both counties are geographically large and contain many municipalities. It is difficult to come up with a theory where pension fraud in King County is so high relative to Pierce County that it explains a >10 year difference in life expectancy.
There is quite a lot of disagreement but I think you are correct. My source appears to be bad AI generated content; I did not dig in too much.
The underlying source of 86.3 matches San Juan county from other sources. Seattle metro areas are a bit over 83, and King County is somewhere between 81-82 from sources that seem more primary.
For every pension fraud that went on that long and took such an obvious risk with continuing to a notable age, I imagine there were hundreds or thousands of shorter frauds.
In this case, the “shorter frauds” involve dying near the reported date of death? By your definition, the postulated (unreported) deviation is statistically insignificant.
i don't think that's generally true. quality of life at old age could be increasing due to several factors. for example: decrease of hard labor and better protections for laborers, doctors telling their elderly patients to go to the gym and train their strength and people generally being more health conscious.
The youth are drinking less, and great non-alcoholic substitutes are becoming available for a wide variety of beverages. I hope these trends make a difference long term.
I’ve had to make very few compromises to still enjoy life while staying alcohol free - I can even have a decent bottle of wine, or a rum and Coke should I be in the mood for one.
What little life expectancy they gain by drinking less - and not stopping completely - is completely overshadowed by their high-sugar, high-sodium, meat-heavy diet.
What the fuck do you guys think GLP-1 inhibitors do? Why even bother posting if you don't understand the most surface level of what I'm saying.
> drinking habits
GLP-1 inhibitors have also been shown to reduce drinking and smoking. It's essentially an anti-addiction drug.
It's very easy to sit on a throne when you don't have a food addiction. For those who do, it's not as simple as "durrr eat better". Come on guys we have to start putting that meat sack between our ears to use.
We've been trying, and ONLY been trying, the "discipline" approach for the entirety of the obesity epidemic. And it is not working. Point blank, this is not an effective method of treating obesity or diabetes.
If that's your suggestion, it's obvious you don't actually know what's going on. Which is fine, but then perhaps silence would do you some good. Less embarrassment that way.
Talking about the number of people who live over 100 along with the average life expectancy seems to be mixing two unrelated things.
To show that we are hitting a limit on our ability to extend lifetime, we really should look at having reached 95, how many people reach 105 or something like that.
To say that the average life expectancy is dropping and therefore we have reached our limit on their ability to extend the lifetimes ignores the fact that much of the reason for a stage life expectancy drop in my country is lifelong maltreatment, often self-inflicted--death-oriented decisions on drugs, nutrition, and activity.
Anyone know of a good source like Our World in Data for tracking life expectancy across countries?
Our world in data hasn't updated life expectancy past 2021.
I've half wondered if it's because the article is optimistic but life expectancy has stalled since 2020. Coild also be the underlying data hit a snag. Would love to see an update
There is a limit to how far you can postpone death without actually reprogramming the DNA. We have likely plateaued it. We are not going to have people living to 200 by just doing more of what we are doing, with greater fervor.
Isn´t this also an issue with World War's 1 and 2? They both dented life expectancy fairly significantly, and that cohort is now aging out of the figures. If the rate of increase is being measured, then that would presumably play a small part?
The way life expectancy is usually calculated, it shouldn't have an effect. It is calculated is by looking at the mortality rate for each age group, which gives a probability of death for each age, and by simulating people growing up in such conditions, and then taking the average age of death.
By doing so, historical events outside of the study period don't have a major effect. In this study, they deliberately avoided the covid pandemic as it would have caused a significant drop in life expectancy that is not representative of a general trend. Of course, the future is not taken into account either. Despite what the name may suggest, life expectancy is like a snapshot of the studied period (1990-2019 here), not a prediction.
> overall, the study found that children born since 2010 have a relatively small chance of living to 100 (5.1% chance for women and 1.8% chance for men). The most likely cohort to see a full century are women in Hong Kong, with a 12.8% chance.
I do not understand how some of the conclusions about reaching the limitations of reducing aging or reached given this simple data. not to mention a direct quote that is very inspirational in the article itself
"if we cannot imagine it today, does not mean it is not possible"
Overall, the study found that children born since 2010 have a relatively small chance of living to 100 (5.1% chance for women and 1.8% chance for men). The most likely cohort to see a full century are women in Hong Kong, with a 12.8% chance.
How do you quantify the chance of a teenager living to 100?
It's assumed that the odds of dying at a given age are frozen. So if someone is currently 15, their odds of making it to 100 are their odds of surviving 16 times their odds of surviving 17 times their odds of surviving 18, and so forth. If you're in the US, as of 2021, for all ages over 11 your life expectancy decreases by less than 1 year per year, and if you've attained the ripe old age of 119, your life expectancy is only one month shorter than that of someone 2 years younger than you.
Many demographic trends like fertility rate are treated the same way. While it is not a very accurate prediction for how long a current young person will actually live, it's a consistent metric that doesn't rely on a particular model of future events. It's good for discussions like this where we're more interested in how the value is changing than the actual value itself.
Either they use some prediction model (accuracy of which is comparable to any 100-years-ahead predictions) or they keep hostage time travelers from 2120s.
>”It tells you that something pretty negative is happening among some subgroups of the population to drag the average down, because the wealthier, more highly educated subgroups are actually doing better,” Olshansky says.”
It is expensive to live a healthy lifestyle in the US.
The actual story here is that it's slowing down because the lower tail is growing, not because the upper tail is compressing as we hit some kind of upper limit of human longevity. That is: more people are actually dying younger, which has been gradually offsetting other people living longer.
That’s the exact opposite conclusion of this paper.
“Our analysis also revealed that resistance to improvements in life expectancy increased while lifespan inequality declined and mortality compression occurred.”
I wonder if "life expectancy" is really such a useful metric, since it aggregates so many different things together. It's kind of like measuring "aggregate years of human life lived".
It's still useful because it provides some information. Specifically, a change in life expectancy, or a change in the rate of change in life expectancy (as here) means something. We just don't necessarily know what that something is without further study.
It leads to a lot of misunderstandings. For example, lower life expectancy throughout history is far more attributable to higher infant mortality than to adults dying young. But people think everybody died at 45.
If not forever, but if 200-ish becomes a norm, it would be super awesome. Now, it is like, “Awesome, I know this, I know that. I need to learn that.” “Hold on, time to die.”
I assure you many aspects of a society where 200 years old becomes a normal life expectancy would be a hellscape and not "awesome." We already currently have a massive societal and economic problem with aging populations as things currently are.
The problems are due to what aging involves and the lack of young people inverting the population pyramid; getting us to 200 at all means solving every age-related biological problem, while also meaning we have longer to start a family and have kids to stabilise that population pyramid.
Lol ok so imagine your dream scenario is everyone, magically and with equality, is able to live and reproduce to absurdly long time frames - that’s also a hellscape in so many easily imaginable ways. you’ll start to see jobs requiring 100+ years experience or with the right genetic modifications to make you insurable enough to invest a 60 year career into. Since this is all science fiction, we can imagine all sorts of things as we understand this is fiction. My only real point is this isn’t a utopian future. we can’t deal with the amount of humans we already have at the ages they live to. I don’t see what solving aging does to solve any of these problems.
> you’ll start to see jobs requiring 100+ years experience
Do you currently see jobs demanding 50+ years experience?
Even if we ignore the fact that most jobs won't require any more experience to do than they take now just because we live longer, longer periods of time won't seem as costly to us either. Right now 100+ years of experience is absurd because the only way they could ever have that much experienced is if they worked from the day they were born until the day they died, and even then they would need to live an exceptionally long life. If we lived to 200, you could start your career in your 30s, get those 100 years experience, and still have 70 years - an entire current lifetime - to reap the rewards afterwards.
Being more realistic, there is some finite amount of money you need to put away to live indefinitely off interest at any given level of comfort. Right now reaching that threshold in the 50ish healthy adult years we have is a difficult but achievable goal for most people. But with more time you can reach that threshold on a less aggressive trajectory and enjoy retirement for substantially longer (all while being healthier to boot).
As a thought experiment, if you want to imagine how you would feel about your doubled lifespan, consider your current lifespan doubled from some previous threshold. Would you prefer to live only 35 years on average with 50 being advanced old age? Sure there might be some benefits, perhaps some jobs might lessen their experience requirements, but would this be overall a more pleasant world with higher quality of life? We did not choose a 75-100 year lifespan to optimize human happiness, it is just the number we happened to wind up at as a result of a process that did not consider human happiness at all.
Everything is, before it gets invented. 200 years ago, radio, cars, skyscrapers, anaesthesia, transplants, space travel, plastics, and bioprinting were all scifi. Aluminium was almost exactly 200 years ago.
Voice-to-voice translation and cheap synthetic gem quality diamonds were too, even when I was a kid.
I'm not saying any of this will be easy — from what I've heard, it's sufficiently hard that one would need to do a PhD in the subject just to really understand how hard and I've not done that — but you are made of atoms, and the atoms in your body can be rearranged into a younger form.
That the only mechanism to do so today is called "cannibalism" is an (enormous and repugnant!)
implementation detail, even though it's also an existence-proof of the possibility of such a re-arrangement.
Do you know what's not science fiction? People are already experimenting with genetically modifying themselves, because of things as simple as "they don't enjoy lactose intolerance".
> I don’t see what solving aging does to solve any of these problems.
Then you don't understand the actual problems.
Most of the costs we have today from an aging population are that old people are physically weak, get sick a lot, have many expensive complications, and 30 years ago they collectively didn't have enough kids for the next generation to be able to afford to look after them so well.
When you write:
> we can’t deal with the amount of humans we already have at the ages they live to
That's because (1) it's their kids (us) doing the "dealing with", and they didn't have so many; and (2) our natural aging process is awful.
Anti-aging's biggest promise is that it makes age-related degeneration much easier to manage.
(And all that's assuming "you’ll start to see jobs requiring 100+ years experience" isn't obviated by AI).
Societies change, and also plainly ours does not work that way as we don't have a high proportion of jobs requiring even 10 years' experience despite most of us spending ~47 years in the workforce.
Come on wouldn't it be great fun with a dozen diseases, broken hip bone, shitting in diapers (if one can afford) people celebrating their 177th birthday. Seems people would sacrifice their first born if such dream life is guaranteed.
Physical exercise is the most potent life extension intervention we have. So it's very unlikely we'll get anyone to 200 if they're stuck in bed with a broken hip.
The macroeconomic implications of that large a fraction of the population being above working age or such a large fraction of one's life not being working years are not exactly great.
Apart from the fact that "working age" doesn't mean the same thing in a world that has anti-aging interventions?
Our economic system is incompatible with the next 200 years irregardless of what specifically gets invented.
At 5%/year, that's a factor (not percentage) of 17292 growth; in energy terms that's not quite boiling the oceans, but it is making the poles the only barely livable zone.
In any sense besides energy, this kind of growth implies automation that makes the meaning of work radically different than today. Human or superhuman AI would be an example of that, but the successful creation of that has other complications that we can currently only guess at with less awareness than the Victorians had of climate change or biodiversity loss.
It seems reasonable to expect it to grow even at a diminished rate until everyone enjoys equivalent access to health care, nutrition, occupational safety etc but that is subject to the political environment, priorities of the electorate and the capacity of the economy. Without pandemic, famine, war or natural disaster a decline in life expectancy is generally the result of public policy for a rich democracy and not an inevitability.
I think we need to distinguish between longevity and health though. Lots of people live with chronic disease and giving them more quality of life counts for more than longer life IMO.
If someone said “my son has stopped wetting the bed”, would you reply “did you expect them to wet the bed forever”? What if someone said “my leg no longer hurts”, would you reply “did you expect it to hurt forever”? How about “my bag of candy is almost empty”, would you reply “did you expect it to be full forever”?
The information that something stopped or slowed down is still useful without having to think it was going to go on eternally. It allows you to adjust your plans for the future.
I understand some tech billionaire want to live forever by eating hundreds of pills a day for nutrition, anti-aging, disease control etc. Their life may be "great" for some definition of great.
But do billions of people on earth think that their life will become great in another 50 years even if it is rather miserable right now? I just live under rock to not know the desires of modern human.
I wonder how Ozempic will change this? I really do expect we will all be on this soon and maybe we can resume the increase in lifespan that has been stalled by obesity, lack of exercise, and processed food.
When antibiotics were first invented some people thought we'd be taking them daily as a vitamin. Turns out that's not such a good idea despite them being life saving in some scenarios
The accepted view is a lot like the accepted views to mono-cultures for crops. In that they are bad. The practiced take, though, is quite the opposite? Crops are dominated by mono-cultured fields. And though antibiotics are known not to be used constantly, farms seem to use them at an amazing rate.
I'd love to see a longer exploration of this. Why is it farms seem to be full of practices that we are taught are bad?
I'm curious on the numbers on this. Every time the general topic comes up, avocados and bananas seem to come up and completely spurn the idea. Googling says 80+% of crops are rotated on a regular basis. Though, it is noted that "cover crops" are sub 10% of rotations. Which seem to be required for fruit farms.
At any rate, I'll be reading more on this some. I have real work I should be doing, after all. :D
Assuming you're not on drugs or thinking of killing yourself, you're probably not in the cohort that's dragging the life expectancy stats down.
Life expectancy is a weighted average (no pun intended), and so it's unusually sensitive to outliers. People who die early drag the average down much more than people who live close to the mean life expectancy. The biggest premature killers of Americans are obesity, drugs, car accidents, and suicide. Anything that addresses one of those causes of death has an outsize effect on life expectancy. There are 100M+ obese Americans. There are about 100,000 overdose deaths per year. Obesity, while not as lethal as drugs or suicide, afflicts 1000x as many patients, and so a treatment for it can have a large effect on the numbers.
> The Oxford University research found that moderate obesity, which is now common, reduces life expectancy by about 3 years, and that severe obesity, which is still uncommon, can shorten a person's life by 10 years. This 10 year loss is equal to the effects of lifelong smoking.
> According to the CDC, 9.4% of adults in the United States were severely obese between August 2021 and August 2023. This is higher for women (12.1%) than men (6.7%). The prevalence of severe obesity varies by age group, with the highest rates in adults aged 40–59 (12.0%)
Only 9.4% of people are severely obese. Moderately obese people have only a ~4% shorter life-span than healthy weight individuals - much of which can probably be attributed to other lifestyle issues besides simply being overweight.
This will move the needle, but I doubt as much as you think.
There's a lot more smokers than there are severely obese people.
>There's a lot more smokers than there are severely obese people.
Huh, I was going to argue this, but you're right (in the US). 19.5% of the population smokes, so there's about twice as many smokers as severely obese people.
I was sure it had dropped to 5-10%. I guess I'm in a bubble (of fresh air).
Kind of a tangent but I think a big part of the explanation for declining life expectancy is hiding here in plain sight.
Since everyone knows smoking is bad for a long time now, we’re going to eventually need to categorize stuff like lung-cancer as a death of despair, similar to other deaths caused by alcoholism, opioids, or suicide.
A lot of people who otherwise might quit smoking are probably looking at impossible dreams of home ownership or retirement, and thinking consciously or unconsciously that there is more dignity in a death at 50-60ish than one at 80ish when you’re unemployable and the thin promises of social safety nets have fallen through.
Smoking (or other high risk activities) might be a dirty habit but it’s still more socially acceptable than suicide.
Dying sooner is certainly not why they started.. rather the bleakness of outlook is a (fairly rational) reason why they don’t quit.
If obesity is supposed to be the other main candidate for why life expectancy is down, you can do a similar analysis there. Is life really good enough to prolong or attempt to improve for people that are in at-risk categories? That’s the question people are looking at when they choose to move towards or away from self-care. For someone who makes minimum wage and already has to choose between paying for a date or paying for rent, it makes less sense for them to care much about losing weight, because it makes a bad life longer but won’t help their love life.
This is how practically all population-level analysis of health is just economics in disguise, even without directly looking at costs of medicine/services
I think your hypothesis is correct but your reasoning is wrong. Few people are morbid enough to think "Oh my life sucks so why bother looking after myself". But if you're constantly stressed because you're struggling in life, small indulgences like smoking, alcohol and fast food/sugar are a lot harder to resist as they provide a much needed outlet/release.
It would be really interesting to see a stat that is like… “life expectancy without morbidities that can be avoided with some effort.”
Which, I recognize is a pretty privileged way of putting it—people struggle with weight, mental health, and drugs, and those are real struggles that shouldn’t be ignored. I just also want to see where things are developing on the upper-bound for reasonably plausible lifespans.
I should probably have said the change in life expectancy is a weighted average, weighted by how far you are from the average. If average life expectancy is 80, removing a data point where somebody died at 40 has 8x the effect of removing a data point where somebody died at 75.
(To reproduce exactly the scenario being discussed, you fit a constant-only model to the data using least squares: that gives the average as the best fit. Then, you measure the leverage of each point of interest.)
> Known as GLP-1 agonists, these drugs were originally developed to help control diabetes. But there's increasing evidence that they have other health benefits, beyond controlling weight. They seem to boost heart health, protect the kidneys, improve sleep apnea, and lower the risk of certain obesity-related cancers.
Yeah, I'm still kind of confused by this sentiment. There's a cohort that claims metformin somehow extends life as well. I'm pretty sure if a doctor prescribed me Ozempic that'd be grounds for malpractice.
It does. But not exactly in healthy humans by any sizable amount. Works pretty well for diabetics and prediabetics, and in cases of PCOS. Otherwise the effect is rather small and depends on prevention of diabetes and a few kinds of cancer.
It has a side effect of reducing muscle gains from exercise.
As for life extension by GLP-1 active drugs, it's much more of a guess. Mechanism is relatively similar. Side effects might not be...
Ozempic seems to have a large number of positive effects for virtually everyone. It's a little premature to think everyone will be on it "soon" and there are plenty of people who won't take something even if it's universally beneficial.
Yeah why would I take a pill if I can get the same effect through discipline and hard work? I understand not everyone can do that but if I can it would be absurd for me to take a drug for the rest of my life. Especially when I enjoy the work involved in changing my weight and body composition.
If a doctor tried to push that on me I would fire that doctor.
Well the ozempic helps you do the discipline and hard work. You don't take ozempic, eat everything, and get skinny. No, it makes it easier to diet and exercise.
For some they don't need the "motivation". For others, their mind is constantly under attack and pushed to eat, like an addict. For them it can be very helpful.
Taking a medication with potentially severe side effects (including perhaps some that we haven't found yet) is hardly equivalent to using a machine to wash my clothes.
Because at its core it changes who I am. I had a really bad experience on SSRIs as a teenager, and those were also pitched to me as "low to no side effects."
My washing machine isn't going to make me suicidal if I start or stop using it.
It wont. This is about maximum lifespans. Weight loss might mean more people reach their maximum, but that maximum has proved, to quote the article: “resistant to improvements”.
Why should Americans trust public health or the government after decades of utter failure? Every single measurable data point of health has decreased under the 'experts' watch. Record cancer, obesity, heart disease, mental health disaster, etc. The messaging around the covid vaccines and masking was a disaster.
Same thing is happening in Europe and other developed nations. UK considering giving ozempic to unemployed? How about subsidized or free gym memberships instead? Things are going to get alot worse before getting better. The established intuitions will continue to double down no doubt.
Cutting out sugar and useless carbs, and trying to replace those things with nuts and quality proteins - more nourishing and filling substitutes, can help a bit, I think. Mostly, try to stay away from refined sugar and products containing sugar or corn syrup. And for the love of God, lots more vegetables. Less dairy perhaps?
Get an apartment on at least the third floor, in a building without a lift.
Get a pet dog which needs to be walked several times a day.
Eat lots of chili peppers[0]:
"The analysis included data from more than a half a million people in multiple countries. When compared with people who never or rarely ate chili pepper, those who ate it regularly had lower rates of death due to cardiovascular disease (by 26%), cancer (by 23%), or any cause (by 25%)."
I know people who are incapable of eating lunch or any meal without a large can/bottle of full-strengh coca cola or such, ever single day. Most of whom complain about not being able to lose weight.
The science is pretty clear. Breaking out of old habits is much more challenging.
I think my main point was about reducing all sugar, and reducing the intake of garbage carbs.
"Although nuts are high in fat, it’s mainly healthier unsaturated fat. They contain protein, B vitamins, vitamin E and minerals, including iron, potassium, selenium, magnesium, zinc and copper."[0]
I get your main point. My main point is that unsaturated fats, specifically poly-unsaturated fats, are definitely not better than saturated fats and we shouldn't be telling people to eat more nuts. The evidence linking saturated fat to heart disease has been weak, and organizations like the American Heart Association have promoted this claim while also promoting crap products like Crisco while taking money from Proctor & Gamble.
"The idea that saturated fats cause heart disease, called the diet-heart hypothesis, was introduced in the 1950s, based on weak, associational evidence"[0]
>These studies have two main messages: When you eat saturated fat in moderation (contributing 10% or fewer of your daily calories), it has little effect on cardiovascular disease. When you cut back on saturated fat, replacing it with unsaturated fats or whole grains is good for your heart and arteries, while replacing it with easily digested carbohydrates isn't.
That is not a study. It’s science denying storytelling from Nina Teicholz, a frequently debunked charlatan.
Every time you replace saturated fat with unsaturated fat, health markers improve.
“…the rate of improvement in life expectancy in the decade of 2010–19 had dropped below that seen between 1990 and 2000. People were still living longer, but not by as much.”
“The analysis looked at the period of 1990 to 2019, to avoid the distorting impact of the COVID-19 pandemic.”
At least life expectancy was still growing before COVID.
Now after the introduction of dirty (mass production was not the same quality as the small batches used in leading studies) COVID vaccines, plus the virus itself which caused some trouble to not fully healthy people, we will see a life expectancy decline.
Excess deaths did already rose worldwide.
Meanwhile they want you to get more dirty vaccines..
In our relentless quest for longevity and a richer life experience, one profound consideration emerges: the role of sleep in our daily lives. Sleep, which consumes approximately one-third of our existence, represents a significant barrier to maximizing our time and productivity. If we could find a safe way to eliminate the need for sleep, we would theoretically unlock vast reservoirs of hours previously devoted to rest, transforming them into opportunities for personal and societal advancement.
I have a hard time imagining this will ever become a reality; the need for sleep is fairly deeply hard-coded in how our brains operate, and I believe it's also needed for some more basic cellular functions.
It's not binary I guess (sleep "once a week" is less than "sleep once a day"), but even some incremental improvements seem very far off.
One also has to wonder if it's actually desirable to have less sleep and be "on" with fewer or no breaks.
> If we could find a safe way to eliminate the need for sleep, we would theoretically unlock vast reservoirs of hours previously devoted to rest, transforming them into opportunities for personal and societal advancement.
While in practice, what would happen is that we’d be doing more of the same. Bosses would be demanding more time in the office, people would be spending more time doomscrolling, nothing would change. It’s a pipe dream to think that if we had more time in the day we’d suddenly start using it more respectfully and responsibly.
we currently spend about half our waking hours during the day at work during the week. if we got those 8 hours of sleep back then presumably we would get 4 more hours of non-working awake time.
seems decent to me. I hate sleeping, the problem is i get tired and cant avoid it.
On the plus side, this would solve the housing problem too. Without the nuisance of sleep requirements we would move to the offices and live, ahem, produce there 24/7. Much like cattle.
This is the great future the visionary OP envisions for us.
It doesn't preach so much as it explores. The author strikes me as being more economically literate than Rand or LeGuin, but not as good a writer as the latter.
The real and staggering excellence of the series is the speculation - it's not such hard SF that it explains the mechanisms by which everything happens, and there are real characters who do more than stand as cardboard observers to technology, but it's crunchier than most.
The current thinking is that Alzheimers and dementia are caused by the brain’s waste disposal system malfunctioning and results in an accumulation of proteins in the brain that damages a lot of important functions. This waste disposal only happens during sleep.
Not suggesting anyone try this but some people claim to sleep only two hours a day with this approach:
https://www.sleepfoundation.org/how-sleep-works/polyphasic-s...
"Uberman Sleep Schedule: Six 20-minute naps are spaced evenly throughout the day, totaling two hours of sleep per 24-hour period."
A book on sleep and how important it is to learning and health:
https://en.wikipedia.org/wiki/Why_We_Sleep
"Walker spent four years writing the book, in which he asserts that sleep deprivation is linked to numerous fatal diseases, including dementia. ... The values of sleep and the consequences of sleep deprivation are also brought up in the book. One particular research conducted in the past, where people volunteered themselves to sleep for only six hours in a span of 10 nights, is brought up by Walker. This resulted in the volunteers being "cognitively impaired" along with their brains being heavily damaged, regardless of the three week eight-hour sleep schedule they received later."
I'm all for getting rid of sleep, but given how society is structured I worry that the extra time will just end up being used for longer commutes and more zoom calls. Hardly advancement.
For some reason I would feel disappointed if sleep was a solved issue. I feel as though perhaps I need that daily break from being conscious for my own mental health.
For an interesting side piece:
The shocking truth: Australia has a world-leading health system — because of governmentsSource: https://www.crikey.com.au/2024/10/16/pubic-private-healthcar...
Bypass: https://clearthis.page/?u=https%3A%2F%2Fwww.crikey.com.au%2F...
Other references:The Economist: https://www.economist.com/graphic-detail/2024/08/23/why-do-a...
AU Gov Report: Advances in measuring healthcare productivity https://www.pc.gov.au/research/completed/measuring-healthcar...
> the free market-based US healthcare system
market, maybe, "free" market? I doubt it.
It's not a very free market when there is such a large power differential between the buyer and the seller. You can't exactly shop around for the ambulance or the hospital when you need it, nor can you realistically circumvent the artificially constrained supply [1] of doctors to get cheaper healthcare (unless you live next to the border).
When the alternative is a one-sided market like this, government becomes rather more appealing.
1. https://en.wikipedia.org/wiki/American_Medical_Association#R...
>>the free market-based US healthcare system
>market, maybe, "free" market? I doubt it.
The consumer of healthcare is doubly removed from the price of healthcare. This is the opposite of a free market.
The patient did not pay the doctor, the insurance company does. In most cases the patient does not pay for insurance their employer does.
So the normal pricing forces of a free market are removed.
Then we need to talk about certificate of need laws which restrict the supply...
The US healthcare system is deeply flawed but only a small fraction of spending goes to emergency care involving ambulance transportation. The vast majority of healthcare spending is for elective services and patients do have time to shop around. Self-insured employers have been cutting costs by pushing employees to high-deductible health plans with HSAs, which gives plan members a financial incentive to find cheaper options. Of course there are still challenges around getting meaningful price estimates from providers despite recent federal regulations on this topic.
In fact it's almost impossible to get a price estimate up front in many cases. A procedure may involve multiple codes which may or may not be covered by your insurance, and the only way to find out if they are covered is to have the procedure and then check the bill. Frequently you won't even get the codes up front. If you call they can't even say if a particular procedure will be covered or not, the call centers are just not set up to do that. There is incredible complexity as the procedure may or may not be covered depending on patient, provider, plan, how much they've spent this year, region, if the doctor's front office made a clerical error at any point, if the insurance company made a clerical error, if the claim is processed on a Wednesday vs. a Friday, etc... If you have a procedure done twice the coverage may be totally different on the second time, with some parts covered that were previously not covered and vice versa.
Thankfully you can often get denials reversed after the fact by calling and complaining, but that takes an hour and is another roll of the dice. The only people who like the US system are wall street people who own stock in the companies.
> the patient does not pay for insurance their employer does
Not really true, as the employer could otherwise pay that money to the employee who would then shop for his own insurance. So the employee pays, but doesn't have a choice.
they could but they don't.
and salaries are stagnant. why would they pay extra? at least they're obligated to provide insurance, even if it's terrible and impenetrable
Because they compete with other employers? If an employee costs X, it doesn't matter to the employer if X is all cash to the employee or split with the insurance provider.
The entire reason health insurance got so mixed up with employment was as a workaround to WW-II era wage freezes. Employers couldn't pay more salary, so they offered other benefits including insurance to attract and retain employees. Now we're stuck with that.
The free market aspect is the insurance marketplace.
If you’re poor, you’re fucked. If you’re old you’re ok. If you work for the government or certain companies, you have access to world class care. Everyone else is on a spectrum from high quality PPO to the shittiest Cigna plan.
There is nothing free about the health insurance market. It is regulated to hell to the point where a common complaint of actuaries I know is that they are not allowed to price your health risk.
^ When the grossly overweight 60yo smoker pays the same amount as a health-conscious 30yo, we have a problem.
It's usually not the same amount. The Affordable Care Act (Obamacare) explicitly allows health plans to set premiums based on age and smoking status. However, this might not capture the full risk differential for some members.
https://www.cms.gov/marketplace/private-health-insurance/mar...
There's a deeper philosophical question here about how we should spread risks and costs across society. Like should some plan members pay more because they have a history of cancer, or because they engage in risky activities like flying light airplanes?
Ironically, two of his three factors are still able to be priced in: age and smoking status. Weight, gender, and many other risk factors are not, though.
> ^ When the grossly overweight 60yo smoker pays the same amount as a health-conscious 30yo, we have a problem.
It depends on what your goals are. The reasoning behind why the ACA ("Obamacare") is the way it is:
> Suppose you want to make health coverage available to everyone, including people with pre-existing conditions. Most of the health economists I know would love to see single-payer — Medicare for all. Realistically, however, that’s too heavy a lift for the time being.
> For one thing, the insurance industry would not take kindly to being eliminated, and has a lot of clout. Also, a switch to single-payer would require a large tax increase. Most people would gain more from the elimination of insurance premiums than they would lose from the tax hike, but that would be a hard case to make in an election campaign.
> Beyond that, most Americans under 65 are covered by their employers, and are reasonably happy with that coverage. They would understandably be nervous about any proposal to replace that coverage with something else, no matter how truthfully you assured them that the replacement would be better.
> So the Affordable Care Act went for incrementalism — the so-called three-legged stool.
> It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.
> So insurance regulation has to be accompanied by the individual mandate, a requirement that people sign up for insurance, even if they’re currently healthy. And the insurance must meet minimum standards: Buying a cheap policy that barely covers anything is functionally the same as not buying insurance at all.
> But what if people can’t afford insurance? The third leg of the stool is subsidies that limit the cost for those with lower incomes. For those with the lowest incomes, the subsidy is 100 percent, and takes the form of an expansion of Medicaid.
* https://archive.is/HzS1G / https://www.nytimes.com/2017/07/10/opinion/obamacare-repeal....
* https://thehealthcareblog.com/blog/2023/02/15/all-three-legs...
The goal of the ACA in the US was getting closer to universal coverage, and that means 'subsidizing' bad behaviour to a certain extant.
Certainly smokers and such should practice more (so-called) 'personal responsibility', but there are a lot of situation where the pre-existing condition is not smoking or other lifestyle choice, but something genetic / congenital. So unless we want to get into (social) Darwinism and leave those folks on the sidelines, the lifestyle folks can end up coming along for the ride when society decides to protect other non-lifestyle pre-existing people.
> The goal of the ACA in the US was getting closer to universal coverage, and that means 'subsidizing' bad behaviour to a certain extant.
Yes, therefore separating people's lifestyle choices from the plainly obvious risk and consequences involved.
But if you can socialize your losses (banks) or bad decisions (people) and avoid some of the consequences, I get it.
The problem with your outlook is you can’t follow through unless you’re a sociopath. Are you willing watch your parent/child/friend/spouse reap the consequences of their “lifestyle choices” and suffer and/or die? I have watched that happen - i guarantee you that you wouldn’t.
Last year, my wife died from a recurrence of metastatic melanoma. By your standard, that suffering was her “fault”, because she failed to use sunscreen as a teenager. If insurance was rated like general liability insurance, she would have been dropped 8 years ago when the original cancerous lesion was removed. Fuck that noise.
I would have bankrupted the entire family to fight for the 60% survival rate in a few months, and she would have suffered even more without adequate care at the end.
We have Medicare “socialism” because social security was allowing the elderly to support themselves and live longer. Many were neglected and dying in inhumane ways, or saddling families with the burden of being a full time caretaker. It’s gross that we live in a society drowning in riches, but we take a principled stance to avoid taxation for rich people, at an incalculable human cost.
[flagged]
Maybe but I'm more concerned about a) easily demonstrable and measurable risks not being addressed and b) separating people from the consequences of their own choices.
Ignoring risk and consequences doesn't make them go away.
On the subject of (b), shouldn't tobacco companies be paying the risk premium for their customers? Why does the buck stop at the individual consumers and not those making money from their misery?
To put it into more technical, economic terms: why should the individual tobacco consumer bear the full cost of their externalities while the tobacco company does not?
> shouldn't tobacco companies be paying the risk premium for their customers
How would that even work? Any such tax would be priced in into the price of the product. It doesn’t really matter if the government is collecting it directly or through the tobacco companies.
Or if we wanted tobacco companies to pay for all the damage they did retroactively they would just go bankrupt, since they don’t have even remotely enough cash/assets to cover it.
> why should the individual tobacco consumer bear the full cost of their externalities while the tobacco company does not?
Because people are well aware that smoking is dangerous and can freely choose to smoke or not.
The tobacco company (also composed of people) is well aware of the health consequence of smoking to its customers yet freely chooses to continues to sell tobacco products. Where's the difference?
Actually it's much worse than that. The tobacco company is not just selling tobacco products, it's marketing them and actively encouraging their use!
Definitely disagree with at least the ‘can freely choose to not smoke’ Nicotine is highly addictive much more so than many illegal drugs.
Don't use quotation marks if you're going to rephrase what I said.
What about the 60 year old with autoimmune issues? That have expensive drugs but it wasn’t “their actions” that led to this?
The entire system only works if healthy 30 year olds are putting in somewhat similarly (it will be cheaper regardless). Insurance is based on the idea of spreading risk. Without it insurance cannot function.
But what's the point of a health care system where only those that don't need it can afford it?
The point of insurance is to cover unforeseen costs. Not to foist bills you know you're going to have onto other people.
Yes, those bills should be paid out by the state such as happens in developed countries like Brazil.
Choose two from: Good/fast/free.
Those "civilized" countries universally have very long wait lists that make health outcomes worse.
But the point of healthcare is to help people not die, regardless of if they can pay or not. We have a problem then, because outcomes don't line up.
If anything, healthcare and insurance have almost completely perpendicular incentives. No wonder then we have the world's most inefficient system.
Even the insurance side isn't really a free market. I've only ever gotten like two choices of insurance provider at any job I've had. More than two plans, but very limited provider choices. You can't get a job offer and then during onboarding say, "sorry, this insurer is unreliable, can we use this other provider instead?"
It is incredibly frustrating to have only one option for insurance provider, and then discover that a solid majority of the health care providers in your area don't take that insurance because they have such a bad reputation.
Then you get into the wonderful world of getting receipts for every procedure and manually submitting them, only for them to be rejected so you have to call and tell them to provide the service they promised you. The insurance isn't even cheap! My monthly deduction would be close to the same price as an Obamacare plan, and that doesn't include the employer contribution. Healthcare is such a racket.
There's also a lot of regulation and lots of subsidies (the US has similar per capita public spending to Canada - old people on Medicare are not cheap). If something is so heavily regulated and subsidised that the private sector is only there to outsmart the government to line their pockets, it's inferior to even a public system.
The American health care system is also highly regulated. There’s nothing free about it in any sense if the word.
> You can't exactly shop around
The vast bulk of health care is by appointment, not a dash in the ambulance.
You’re still significantly limited by your insurance carrier’s network and also the consolidation of the healthcare industry. I used to live in a city of 1 million that had essentially two hospital networks that bought everything. You could not find a specialist not associated with those two companies. Pre-natal, allergy, cardiac, two choices. When my seventy year old doctor who ran a practice out of his house retired he sold the practice to one of the two.
It’s not shopping for a tv. You can’t choose not to buy. It’s often time sensitive even if by appointment. Pricing is incredibly complex as are the details of the product. Your average person does not have the information necessary to navigate the market.
Even more fun is when your doctor refers you to a specialist that's in-network, but your insurance comes up with a bunch of reasons to deny it.
How did we collectively decide that it's okay for insurance companies to overrule medical professionals?
AFAIK the overruling is done by a "medical professional" as well, albeit one that's on the insurance company's payroll.
That "medical professional" has literally 90 seconds to review your case and say yes/no. They've never met you. They don't know your doctor. All they have are some notes on the case, a billing code, and a quota to reach every day. They get bonuses based on how much money they save the insurance company.
All of that cost savings makes US healthcare cost double what it does anywhere else in the world.
I think you're a little confused about causality. All healthcare systems, including fully socialized ones, perform similar types of case review to ration care and hold down costs. US healthcare costs might be high now but would be even higher if the payers (including the Medicare / Medicaid government payers) paid every claim that came in without denying those that fail to mean plan coverage rules.
If we want to hold down costs then we'll have to put a greater focus on preventative care, stop expensive treatments for terminal patients, impose price controls on providers, and stop subsidizing drug development for the rest of the world. None of those measures are politically popular.
Price controls always result in shortages.
Yes, exactly. Since demand for healthcare services is essentially unlimited, creating artificial shortages is one way to ration care and hold down public spending. The US government already creates healthcare shortages in other ways, such as constraining the number of residency slots to limit Medicare spending. (I don't support this, but it is somewhat effective from a fiscal policy perspective.)
Legally speaking the insurance company isn't overruling medical professionals. They're simply refusing to pay. Patients still have the option of paying for treatments out of pocket. (I do understand that for poor patients this is a distinction without a difference, I'm just clarifying the legal issue.)
Some states have recently passed laws which limit the authority of health plans to conduct medical reviews or deny payment for services that providers deem medically necessary. This will reduce hassles and expenses for some patients, but it will also accelerate the inflation of insurance premiums paid by everyone else.
other than normal doctor’s office visits, i have no idea what i’m going to pay when i get a small procedure done.
a basic heart ultrasound cost me over $1k while my vasectomy cost me a $60 copay. i was expecting those prices to be flipped.
and don’t get me started on labs. i’ve gotten bills for basic screens years later for thousands of dollars.
you can’t shop around if you don’t know what you’ll pay until months after it happens. if you call the insurance company beforehand you wait on a static filled line with a call center in india, and even with the CPT code they can’t give you a straight answer.
> i have no idea what i’m going to pay when i get a small procedure done.
All you gotta do is ask.
They don't know. Nobody does until the bill is processed. There are a thousand factors that might affect your coverage. This is the nightmare I'm living through right now. Even if you have the code and doctor and patient the help desk at the insurance company can't say for sure if they will cover it or not. That comes down to the discretion of the claims adjuster. You won't know if something is going to cost $100 or $10,000 until after it is done.
> They don't know
It works every time I asked.
The provider or the insurance company? The provider can give you the cash price, but that's a made up number with no relation to reality. The Insurance company can give you what the standard discount would be on that procedure, but they can't say if they'll cover it, give only that discount, give nothing, or anything in between.
The provider. And yes, I negotiate.
The prices you're getting are fake, whether you know it or not. Because you're not the one paying.
This is why it's sometimes cheaper to have no insurance than insurance.
if you ask the provider you will eventually get burned. they can only give you the cash price as a backstop.
if you ask the insurance company you’ll never get an answer. providers are usually more helpful about what “should be covered”, but that’s not guaranteed.
seems like prior authorization is the only way to really make sure charges are covered but takes forever. but even then, if your insurance covers $x and they bill $y, you might get a balance bill in the mail.
point is, the market is heavily skewed against the consumer.
and then wait 3 weeks for them to get back to you, as they contact your insurance and work out what they can get away with billing
Even so, when was the last time someone needed cancer treatment but said "ooh, that's pricey, nah, I'd rather buy a new car instead".
This is my main argument against private healthcare: there's no real choice involved. Without even getting into what a free market is and perfect information etc, the main advantage of a capitalist society is you get to choose what you like. Nobody chooses healthcare (at least, not the super expensive part).
A large portion of healthcare could be free market. Insurance should be for unlikely events not every single thing deemed "medical". My home and auto insurance don't cover regular costs for maintenance. Why must health insurance cover a checkup with the doctor?
> This is my main argument against private healthcare: there's no real choice involved.
Is your argument that there is choice involved in public healthcare? Or simply that it's not even a question?
There are many options for cancer treatment, with different prices, efficacy, misery, etc.
> Nobody chooses healthcare
Yeah, they do. Root canal vs implant vs dentures, for example. Ozempic vs diet+exercise, for another.
Even for non-emergency, the short amount of time before a health issue turn serious means that it's already hard for you to take second opinion.
There is no free market when pain and distress is involved, that is for sure.
When I am psychotic I cannot exactly choose which psychiatric hospital I want to check into and ponder about the price to put it off for another day.
And this is what the free market did to psychiatric hospitals: https://www.wral.com/holly-hill-hospital/21507953/
To me that is the funny thing today if you look at markets Chinese markets under it's communist system are actually freer than US. China is not interested any 1 company getting a monopoly and becoming more powerful than the government so they promote finance multiple companies resulting in a truer capitalist market than the US.
> Chinese markets under it's communist system are actually freer than US
Right up until the moment that the CCP decides to purge your entire sector, sure. I don't know if it counts as "free" if the government stands ready to nuke the sandbox they so generously let you play in.
https://www.reuters.com/technology/beijings-regulatory-crack...
You would expect market cap of the largest players to decline if the market becomes more competitive... which was China's primary goal with their recent crackdown.
They proactively forced interconnectivity and limited the ability for companies to make "walled-garden peudo-monopolies", as we have in the US with Apple and Google.
If the same happens here (through act of congress, or legal outcomes), you can expect their market caps to decline as well. A decline in market cap doesn't speak at all to whether it's beneficial to the industry or consumers
> They proactively forced interconnectivity and limited the ability for companies to make "walled-garden peudo-monopolies", as we have in the US with Apple and Google.
WeChat is the inspiration for the idea of the "everything app" that so many US companies want to create but have always failed to. Has it somehow been newly limited in its ability to control an absurd percentage of all Chinese internet-connected activity?
This was and is part of their goal, yes.
https://asia.nikkei.com/Business/Technology/Beijing-asks-Ten...
"Beijing asks Tencent to lower WeChat's mobile payment market share"
https://www.forbes.com/sites/zennonkapron/2022/11/09/chinas-...
https://www.business-standard.com/world-news/china-may-impos...
"China is planning to introduce a new mobile payment regulation aimed at reducing the market share of Tencent Holdings' WeChat app, similar to efforts made by the National Payments Corporation of India to curb Google Pay and Phone's growing dominance in the market"
China's methods are more authoritarian than are viable in the west. But the general premise of a competitive market being better for society than dominance by a small number of firms is supported well by history
It's so ironic. Market competition is definitely intense over there.
> China is not interested any 1 company getting a monopoly and becoming more powerful than the government
Those are 2 different things.
Monopoly doesn't mean "more powerful than the government". I'm not sure what that means, since the CCP disappears or coerces anyone who might threaten the supremacy of the CCP (or Pooh Bear) in any way.
Capitalism results in a single winner, for many industries. CCP prefers kingmaking in various industries, because it's easier for the government to control a few players than a multitude. This isn't what "fair market" means, in context. It's modern communism. State owned companies that are directed by government, rather than direct investment or day to day management. China learned from Russia's failures, I would say. I would also concede it's less regulated, under a political lens.
Not really. Chinese SOEs comprise around 60% of market capitalization and around 23% of GDP, far higher than USA or other developed economies.
While they do have a competitive market, the government very much does pick and choose winners and loosers here like Huawei, resulting in consolidation into a few large conglomerates like every other country. Their (software) tech scene certainly dosen't like more particularly "capitalist" than Big Tech, nor is the Fed pumping subsidies to Tesla like BYD, if anything they're sidelining Elon Musk.
"free" is newspeak for "rules only apply to the poor, ie.e the lower 99.9%"
Always when I read this I think they are comparing too very different societies where healthcare is just one factor. Americans are so much less healthy than Australians due to lack of exercise, poor diets, stress, no holidays, guns and crime. Its a miracle that if the US health is nearly as good as Australians it shows how great the US healthcare system really is.
Part of the Australian national, state, and local health care system is policy to encourage healthy life styles and to discourage, limit, or ban food additives, tobacco, etc.
Back in the 1970s the AU Government was running campaigns such as Life. Be In It: https://www.youtube.com/watch?v=GNjEge3Awl8 (many short segments airing with commercials on TV).
Planning requirements typically require open spaces, walking paths, sporting facilities, etc.
A "healthcare system" needs to be more than simply "immediate care for the injured, sick, and|or dying".
There's a book or two in the backstory of why neither Dentistry nor Mental Health get the same inclusion in traditional health systems :(
Can you complete the assertion or cite what you were going to cite (if it was half done)?
It's complete as it stands.
see: https://theconversation.com/why-isnt-dental-included-in-medi...
, realise that mental health services also had poor inclusion at times and that "gambling" is being implied to fall under mental health services (and hence not addressed).
On a more serious note, gambling in Australia has some serious industry influence that's preventing it being properly addressed - see: (for example) Media Watch -s2024e31- Monday 2024-09-09 They're Addicted
I bet you it wouldnt make much of a difference.
Unfortunately, obesity rates are rising worldwide, including in Australia.
> Ozempic has entered the chat.
This honestly feels like the kind of thing where 20 years from now we'll be more aware of the side effects and people will shake heads about how stupid "we" were today.
If this is going to be an exception, it'd be truly interesting.
There are already a bunch of studies showing that the ozempic causes massive muscle loss and lessens bone density. And before anyone remarks "just do resistance training", I doubt the people that take the easy solution will do it in conjunction.
Do they cause it in excess of normal weight loss in the same time period? I'm asking because regular weight loss that's quick will have both of these effects too.
> Do they cause it in excess of normal weight loss in the same time period?
I think you mean diet and exercise when you say 'normal'. Its not possible to have that much 'normal weight loss' in the 'same period'.
Correct me if I'm wrong but Ozempic doesn't cause you to lose weight, instead it controls your appetite. It's not something like DNP, right?
'Normal weight loss' here refers to eating the same amount of calories without taking Ozempic. You should lose weight at the same speed as with Ozempic, because it's the calories that matter when it comes to fat loss.
Weight loss always comes with some muscle loss and bone density loss, because the structure now supports less weight than before, and our bodies dislike to maintain muscle apparatus beyond what is necessary.
Unless Ozempic causes significantly more muscle loss than other ways of losing weight, that news isn't really news.
Conversely, this is also why the strongest powerlifters are huge heavy guys. They aren't necessarily healthy. But they are strong.
Ozempic doesn't cause that, losing weight via diet does. Weight Watchers moms get the same thing.
The only people who don't are people who lose weight through resistance training. Which is a small minority - because we have a HUGE diet culture!
I cannot possibly even imagine how this could be the case, considering just how deadly and miserable obesity is. I don't see how we can hypothetically "solve" obesity and then go back to an obese population because the drug makes you nauseous or something. And that's not even considering the, what I can only assume to be, trillions of dollars of healthcare cost savings over time.
Its a transfer of wealth from the fast food conglomerates to Novo Nordisk. They won't take this lying down. Ozempic resistant foods are coming.
>Its a miracle that if the US health is nearly as good as Australians it shows how great the US healthcare system really is.
Or its a ticking time bomb: 39.6% of Americans are Obese(BMI 30 or higher). Fast forward 15 years and this will probably collapse the country. It certainly will be the No 1 issue in the country bar none. Ozempic may actually give the country a chance of some sort of future.
> it shows how great the US healthcare system really is.
You think paying vastly more for much worse outcomes is a good thing??
Boy do I have a GREAT used car for you!
Free market-based US healthcare system? Which US are we talking about?
"Free market" is one of the best examples of a technical term people use with complete confidence despite not knowing what it really means. Furthermore, even if you do know what it means you probably remember it as something you learnt on day 1 of economics class before learning all the reasons they never really exist and what governments try to do about that.
I’ve studied economics for years and I’m still of the opinion that the only government intervention to the market should be breaking monopolies and cartels. I’m waiting for a piece of literature that would convince me otherwise, maybe you could provide one?
I can't, but I'm curious how you think problems like externalities would sort themselves out. Also what about natural monopolies like utilities and infrastructure that can't really be broken up?
I think humans are excellent survivors. I don’t lose sleep over externalities because of that alone. What I mean by that is that once people realise their daily lives are being affected by a negative externality, they start making decisions that alleviate that hardship.
I do recognise though that it’s an unsolved problem, and will lead to some form of regulation as our understanding is lacking.
I think only harmful monopolies should be broken up by force, since they’re a legitimate market force. I’m conceding some ground on that because I’m not prepared to claim that monopolies aren’t always harmless.
Australians (and other outsiders) use that term when talking about aspects of the US because that is the Hollywood picture of how the US functions. That is the lie that is sold, and people outside have no way to know it’s not true. Even today there are hundreds of millions of Americans who say they live in a free market and that it’s the best thing ever.
> Australians .. use that term when talking about aspects of the US because
Australians have a weird sense of humour - it's clear from here that most aspects of US economics are decidedly not free markets but so many US citizens never shut up about "free markets" and have such a bicameral Capitalist v. Communist view of the world that it makes sense to just deadpan nod along.
Maybe reread https://news.ycombinator.com/item?id=41856242 and ask yourself if the article really thinks the US health system is a proper Adam Smith free market .. or just a "US free market" with extra heavy air quotes.
The us system is what a free market approach inevitably degrades into when consumers don't have a real option to say no to a service.
So the free market approach degrades to heavily regulated and government controlled?
No, it degrades into monopolists with a captive audience. Insurance companies are modern day water barons.
Is the US health system free market? The government provides healthcare via Medicare and Medicaid for seniors, the people for whom life expectancy and healthcare quality have the highest correlation.
It’s a mixed bag, but the funding source doesn’t necessarily make it a controlled market, to the degree that Medicare and Medicaid pay non-government providers and allow competition (which again, is mixed). Medicare and Medicaid coverage make up one third of the US population. The other two thirds are on group/employer insurance, private insurance, or no insurance at all.
For non-seniors, the medical insurance system certainly sometimes doesn’t feel like a free market from the consumer perspective, but the insurance companies are private for-profit institutions, and the medical providers are too, so it may well fit the definition.
> the people for whom life expectancy and healthcare quality have the highest correlation.
What do you mean by this? Fatalities among the young will have a much larger impact on lowering nationwide life expectancy than fatalities among the elderly.
The quote is from a Crikey reporter, I (an Australian) wouldn't agree that the US health system is classic free market .. but it appears to have more regulatory capture by vested commercial non government profit orientated interests than by social policy best outcome for the masses civil authorities.
( Describing various systems in various countries as either communist of free market capitalist is pretty simplistic, it's not much as a linear spectrum either )
I'd also argue that the foundation for a high life expectancy doesn't start with good health care for seniors .. unless the metric is "life support via artificial means" .. life expectancy is grounded in healthy living and excerise from an early age well maintained with good health programs.
Next to the USA, Australia provides some of the highest earning opportunities for medical specialists thanks to its very well-developed private sector. A doctor might clock AU$300/400k for a 0.5FTE role at a public hospital, and then bring in another AU$500/600k+ from their private practice (and that's a very low figure for a lot of specialities). As a result, Australia can attract and retain extremely high-quality doctors with the public sector essentially riding the back of the earning potential provided by the private sector. Interestingly, I think the reason you don't often see full private specialists is that due to lack of market forces applying to public healthcare, the public system crowds out the private system on complex/innovative care -- so as a specialist you need to retain a public presence to get access to the high-profile work that you use to support your private billings.
AFAIK Australian healthcare system is mixed public private with a heavy lean on private. The healthcare market is open to market forces as the government works through subsidies. Plus I think many of the hospitals are religiously run institutions which helps protect from private equity influence.
The US has massive government regulation and dysfunctional state intervention in healthcare if not directly then vicariously with rules around Medicare. The US government helps make the dysfunction that private equity later exploits.
So I’m not sure that it would be correct to use Aus and the US as examples of the either end of the private / public continuum.
I would use UK or France as an example of a public system and Singapore as a light touch private, and perhaps India or Turkey as a laissez-faire system.
The UK and France systems appear to be degrading and do not appear long term affordable and I think they will soon be adopting Canadian style Maid systems to cut cost.
Germany is a weird one because it seems like half the doctors there are homeopaths and the Germans love their insurance but I’m not sure if they get value for it.
Personally I’d prefer the Australian or Singaporean style systems but I’d classify those as mostly private.
Australia absolutely has a hybrid health care industry with layers; health, medical, surgery, pharmacy and mostly outcomes based regulation rather than much assistance to maximise financial profits.
The current system grew out of a more fully public system under a many years past Whitlam government, people like the universal health for all aspects and wanted additional private services in the mix. It's evolved from there, with government oversight directed towards keeping things accessable and fair.
The US appears to have "massive government regulation and dysfunctional state intervention" as the end result of a lot of fingers in the pie bending regulation toward "middlecare" providers that don't apply splints or save lives, just diddle about with insurance schemes. (Admittedly that's just an impression from afar).
> The US government helps make the dysfunction that private equity later exploits.
My feeling is the US government is largely an arm of private interests in many matters.
Health Care in Australia embraces public policy such as Food Regulation to ban and limit additives, parks and sports grounds to encourage exercise, limiting access to tobacco, and some interesting national level drug acquisition deals to keep pharmacy costs low.
These cause a flow on of less per capita input into the medical side; lower heart disease, less smoking related issues, etc.
I don't disagree that there is a lot that Australia does right and the US would be better off with an Australian style system complete with a universal healthcare. Australia could have gone the NHS route but did pivot to the mixed system under Howard. Additionally it does appear to me that the National Disability Insurance Scheme is absolutely rife with fraud - I'm not even sure who'd you'd blame for that as it seems intentionally set up for such an outcome to undermine the very idea. So I'm not sure how well the Australian system will last even if it has lasted well up until now. Of course being Australia they'd combine NDIS with Robo-Debt and mistakenly hound a bunch of poor people to death.
I'm assuming the rational behind drawing the distinction between the US and Aus systems is to somehow inform what the US should do, I don't think giving an already corrupted government system more power will help. It's very hard to uncorrupt things and because of that reason I think the US would benefit from a more laissez-faire system.
Additionally Australia has many advantages that the US does not and the US could not emulate Australia even if they wanted to. I don't know how long that'll last either - mathematically I would assume a country could not get rich and stay rich repeatedly selling houses to each other but it does seem to have lasted a very long time. I assume at some point the Aus government will run out of ways to prop up the housing market. The combination of negative gearing and all sorts of first home buyer grants is just insane.
I had private health insurance in Germany. It was quite expensive and had a very high deductible — so pretty bad incentives around routine health care, I never made a claim in 13 years.
The upside was that if you needed, say, a brain transplant for ten million Euros, as long as it was medically necessary they would pay for it.
Now I have a policy elsewhere that is cheaper, still covers me when I go to Europe, and has a much better copay structure while being 100% private. Downside is I can’t afford that brain transplant, but I’ll probably be OK for everything else.
But if a procedure is medically necessary in Germany, public insurance pays for it too (and if they deny, you can, often successfully, appeal or sue them). The biggest difference is that you’ll get an appointment much faster due to the quota system for public insurance patients, and that private insurance can cover more things that aren’t strictly necessary.
>But if a procedure is medically necessary in Germany, public insurance pays for it too (and if they deny, you can, often successfully, appeal or sue them
When you're very sick you hardly have time, money and energy do deal with a lawsuits so that you can get the care you desperately need. By the time you win your lawsuit you could be dead or your condition worse from the stress.
The crazy thing is that I originally signed up for private because it was cheaper than public… at the beginning anyway. I much prefer the Austrian model, in which — I believe anyway — everyone has to pay for public, but then you can get extra private on top if you like.
I was an employee so this didn’t apply to me, but for my freelancer friends it seemed very unfair that they had to use private.
Looks like you conflated two unrelated things ?
The issue with most of these is that they have better health outcomes overall but when it comes down to the uncommon cancer your mom has, she will have a much higher chance of survival in the US. The difference is a lot of poor folk without adequate healthcare die of relatively straightforward conditions like diabetes while if you do have healthcare you end up getting the state of the art though it might bankrupt you.
There's nothing in the Australian health care system that precludes people with uncommon conditions seeking specialist treatments either in Australia or abroad.
> she will have a much higher chance of survival in the US.
Without a deep dive it looks ballpark the same, to be honest.
AU Cancer Survival Rates:
15 Aug 2024 - https://www.aihw.gov.au/reports/cancer/cancer-data-in-austra...US Cancer Survival Rates:
2023: https://www.cancercenter.com/community/blog/2023/01/cancer-s...Interesting, Australia seems to be actually doing better with cancer survival rates. I truly wonder what the downsides are if any.
We/Australia has a massive focus on early detection of skin cancer due to our overly sunny weather. It's possibly that we detect more cancer and treat it earlier thus the better outcomes?
I would love to see those cancer stats without the skin cancer stats.
> when it comes down to the uncommon cancer your mom has, she will have a much higher chance of survival in the US.
A few years back my Mum in Australia was diagnosed with stage 4 lung cancer, given 12 months to live.
For just shy of 3 years she had radiation, chemo, trial drugs worth nearly a million a pop all in a brand new cancer Center. Because she lived a couple of hours away she got free transport to and from and free hotel. Not pay and claim it back, fully free.
She was on an enormous cocktail of drugs that dad would get at the pharmacy that raised a lot of eyebrows for the strength of the opiates among other things.
For three years they never paid a cent. They never paid a cent of health insurance, never had private cover, never had a deductible. That would all be the same if they had never worked or took a decade off to pursue some hobby.
Trust me when I say it was stressful and emotional enough without adding money or paperwork or insurance into the equation
The comparison to my friends in the US who couldn’t get a separated shoulder fixed because it was “out of network” or had to move hospitals the day after a C section because the insurance didn’t want to pay anymore is downright disgusting.
For real people living their lives the two systems are vastly different.
I expect it has more to do with Americans’ high level of obesity and other poor lifestyle factors.
Obesity's definitely a factor, but other developed countries haven't seen the same level of stagnation despite their own skyrocketing obesity rates. For that matter, Americans also smoke less compared to most of Europe.
There's likely at least one other major factor, and I would assume that it's some variation of "inability to access high-quality care for financial reasons" given how much of a wealth disparity there is in various healthcare outcomes.
Why would it depend just on one factor like hospital access?
Cancer mortality is not the same as incidence, you can plausibly have more cancer while still having a lower mortality
Plausibly you can get less cancer by encouraging people to stop smoking, drink less, be less exposured to known carcinogens (either by awareness or regulation). A good healthcare system can also mean you catch cancers early or treat them earlier.
Australians are not exactly a svelte lot either, ranking 10th in the OECD countries for obesity (US is the third), and on par with the UK.
Yeah, Ozzies also drink like fish, at least when I was living there. Good lord, so much boozing.
Maybe the worse outcome related to other factors, e.g. diet or obesity rates.
The figure I see thrown around is America has a 40% rate of obesity.
Australia looks like it's 32%.
European countries look like 20-30%.
I think these rates alone could explain life expetancy regardless of health care system.
yep exactly. 'healthcare' should be called 'disease care' . Most ppl are too far gone to recover from their illness by the time they go to the doctor.
All the medicines they prescribe are merely to manage symptoms. I have GERD and reflux. I was given PPI after many many tests. How does taking PPI extend my lifespan. Whatever has gone wrong with my body is still there.
How is this not obvious to ppl making this absurd correlation between hospital care and lifespan.
Medicine doesn't have shit of new breed of diseases and disorders ppl are dying from. Doctors don't have answers to any of modern illnesses so how does it matter if access to a useless person is govt funded or 'free market'.
> I have GERD and reflux. I was given PPI after many many tests. How does taking PPI extend my lifespan. Whatever has gone wrong with my body is still there.
It can potentially extend your life by reducing your probability of developing esophageal cancers, improve your quality of life in the meantime, and there are other complications from untreated GERD I can't recall but would negatively impact your life.
They are only approved for short term use because of myriad of side effects ( including things like life threatening colon inflammation, kidney disease ect)
> The shocking truth: Australia has a world-leading health system — because of governments
In the US, government is elected by people. You can't blame a gvt for not doing what it hasn't been mandated to do.
Hilarious .. next you'll be saying the two party sink-hole the US electoral system gravitated into is representative of the population at large.
Are you touring with this material, or is it off the cuff standup?
When did the people specifically asked for this kind of system?
The people have never specifically asked for anything, because we're not a direct democracy and we don't have federal referenda. What does that matter?
We get the government we deserve.
The US is hardly a free market health care system.
For example, Medicare.
If you wish you could take that up with Bernard Keane who wrote the piece.
https://www.crikey.com.au/author/bernard-keane/
Bernard is well across many aspects of US, UK, and AU political views, government systems, media etc. with his own particular views as we all have.
In context he's writing for an Australian audience about a conservative Australian trope that the Australian health system is weighed down with government meddling and would do better with, for example, a "US free market" approach.
I think we all appreciate that's an illusion, a myth spun for children.
I think it’s extremely important to see that it is neither a myth nor an illusion spun for children.
It is a carefully constructed plan that will ensure rich people get a whole lot richer and poorer people get worse care. It’s not an accident or nice story. It’s class warfare
Depends on what you mean by health care. Medicare is insurance, not care, and while insurance is part of the system, Medicare often pays private healthcare providers for service. Medicare only insures ~14% of the US, less than one sixth and is only available for people 65 and older. For those reasons, your example maybe doesn’t demonstrate what you imply.
>the free market-based US healthcare system
The healthcare system in the US is far, far from a free market. Most people would describe it as a crony capitalist market. There's a lack of transparency, lack of competition, and lobbyists of established players have too much say in the lawmaking process.
See: https://news.ycombinator.com/item?id=41856242
demographics in the US are very different than Australia, I suspect those in the bottom 1/3rd of US health drag it down significantly.
I assume you are referring to a larger amount of people living in poverty in the US?
Could this also (partially) be explained by the cost of healthcare? Something like a downwards spiral where average people end up poor either due to direct costs of healthcare or neglecting their own healthcare due to cost?
demographic differences of all kinds:
- greater usage of surgeries and prescriptions, leading to greater exposure to medical malpractice (the 3rd leading cause of death in the US.)
- higher birthrate. more pregnancies.
- less cultural tolerance of abortion. Greater willingness to take on risky pregnancies
- single parent homes (people with less family support)
- ethnicities which are more susceptible to certain disease and lifestyle risks
- greater exposure to crime in impoverished areas
- more life time spent traveling in cars
- more restricted access to health insurance (as you said only accessing healthcare in dire emergency)
The US is a different world than most countries which tend to be geographically tight and culturally homogenous. It's very difficult to make comparisons, not to mention differences in data collection and reporting ethics.
> medical malpractice (the 3rd leading cause of death in the US.)
Not to downplay the malpractice problem, but this doesn’t sound remotely plausible. Do you have some sources to back up this claim?
I googled around a bit and it appears to come from some sloppy misuse of statistics in a journal one time, plus internet amplification.
The CDC doesn’t record medical malpractice as a category for cause of death or injury. It’s grouped under “accidents” in their statistics (their official 3rd ranked category).
> The CDC’s published mortality statistics, however, count only the “underlying cause of death,” defined as the condition that led a person to seek treatment.
Because of this political choice the information comes from 3rd parties digging into the accidents category.
https://www.propublica.org/article/study-urges-cdc-to-revise...
> The US is a different world than most countries which tend to be geographically tight and culturally homogenous
So, if this was the issue, you'd probably expect outcomes to be better in less diverse, physically smaller US states. Looking at, say, life expectancy by state (https://commons.wikimedia.org/wiki/File:Life_expectancy_map_...) doesn't seem to bear this out, really; on your theory you'd probably expect, say, West Virgina to be handily beating California or Texas.
Also, of course, _Australia_, which started the thread, could hardly be called either geographically tight or culturally homogenous. Australia is roughly the size of the contiguous United States.
If you ignore massive wealth inequality.
The point about less diverse is that’s it’s easier to operate health programs which match the values of the population.
Not that small ethnic group = healthy.
Those examples are mostly good ones, but:
> The US is a different world than most countries which tend to be geographically tight and culturally homogenous
I am not sure how much you know about Australia, but homogeneity and geographically tight is definitely not how you would describe it.
Indeed. On the spectrum of health risks Australia is more like the US than France, but it’s far away. The most similar country is possibly Russia or Brazil.
Demographics (I assume you mean race?) can't be the reason. West Virgina is IIRC almost exclusively white and has a lower live expectancy than North Korea.
It seems you believe “demographics” is a dog whistle for “which people are white”.
West Virginia is extremely poor.
Our organization (the American Federation for Aging Research) is hosting a webinar with Jay Olshansky (author of the paper) and Andrew Scott, a leading economist in longevity to discuss Jay's results on 10/22.
The gist is that this isn't quite as cut and dry as it may seem.
We also paid to make the Nature Aging paper open access.
Event: https://www.afar.org/events/webinar-lifeexpectancy-1
> We also paid to make the Nature Aging paper open access.
That’s awesome! Did you make a deal with the authors to pay for the fee during publication or is this something anyone can do by approaching the journal itself?
Thanks! I wasn't directly involved in that discussion, but I imagine anyone can do it. It is a requirement for some grants and for some research funders.
Edit: if you need to know I would just ask the editor if it's an option
$12290
>We also paid to make the Nature Aging paper open access.
What a world to live in.
> We also paid to make the Nature Aging paper open access.
Why not just use a preprint server like Medrxiv?
Arxiv is now the default place to publish papers in physics -- and, with that established, it seems to me that it would be for the best if more institutions, researchers, and organizations in biology, medicine, chemistry, and other areas also use preprint servers.
> Can we overcome ageing?
75% American are overweight..
Just let it sink a second, they speak about how many baby born after 2000 will reach 100 years old, how we are reaching the absolute limit of human survival.
75% overweight... Everyone know fat people don't live long. I bet all the studies done in the 90's that predicted we would easily be able to reach 100 years old didn't take that into account.
To be clear, it looks like the health stat term "overweight" means anything greater than "normal", which includes obese.
Quick Google search:
First hit: Source: https://www.abs.gov.au/statistics/health/health-conditions-a....US NIH says: 73.1% are overweight (includes obese). Ref: https://www.niddk.nih.gov/health-information/health-statisti...
Sure, 73.1% > 65.8%, but Australia is still plenty overweight. Both are appalling.
> Both are appalling.
Both are also largely meaningless because they're based on BMI, which is literally just mass/height^2. No measure of percent body fat, no measure of any other aspect of health, just mass by the square of height.
If you're comparing the BMI of two countries with very similar gene pools it's not a bad point of comparison (though the raw number still doesn't tell you much without more context about build types), but when you're comparing Australia to the US the gene pools of the non-European minority groups are sufficiently different to make BMI pretty worthless as a point of comparison for public health.
How do they even pretend that works when some South Asians are shorter and the Danes are so large? Are the Danish just 100% obese?
This says it's <20% there[1][2]
1: https://en.wikipedia.org/wiki/Average_human_height_by_countr...
2: https://academic.oup.com/eurpub/article/33/3/463/7058153
Height is factored in, albeit in a very simple way
Yeah, it's not height itself that's the problem, it's body shape. As just one example: some people have long torsos and short legs, others long legs and short torsos. Those two groups will have wildly different BMI curves even at similar health levels.
BMI is a very crude measure. It is only useful in the extreme, and not particularly relevant for an individual. If you have a BMI of 40 you should think about losing weight, but exactly nobody need a composite number to know they are that fat. Similarly, you might have a normal BMI but an LDL of 300 or a strange lump on your thyroid. These things are vastly more important than your BMI
To be fair BMI is based on Belgians from the 1850s with all the implications it has. Modern people are much taller (+15 cm for males) and eat a lot more protein.
So the line between normal and overweight is somewhat blurry. e.g. someone who is 6'3" and weighs 200 pounds is overweight. Which might or might not be the case (but you certainly don’t need to a body builder or invest a lot of time to maintain at least reasonably healthy 18-20% body fat ratio).
>To be fair BMI is based on Belgians from the 1850s with all the implications it has.
It's a pretty straightforward formula, and even though the cutoffs might be arbitrary, there's undoubtedly a u shaped mortality curve centered somewhere around 20-25. At a population level I don't think any of that is a relevant factor. No one thinks that your risk of death hinges on crossing an arbitrary line, but being fatter definitely isn't good for your health.
But the question here is whether you can compare the BMI curves of two countries and come to any conclusions, and the answer is pretty solidly "no".
Bone density, muscle mass, torso height relative to leg height—none of these things are factored into BMI and all of these vary wildly depending on genes.
> vary wildly depending on genes
Being born with worse attributes doesn't mean those attributes are out of the equation. A lot of people die much younger than they should just by poor luck, with little or no control on their end.
If you happen to have higher bone density and higher muscle mass just because you have higher testosterone, you're still better off. Sometimes people just get the short end of the stick. That doesn't necessarily mean BMI doesn't work.
I've even met smokers, smokers! Who have better cardiovascular health than me and are skinnier. Which really fucking sucks for me.
Veins have a 2D cross section where body’s are 3D. That’s one reason why using height ^2 not height ^3 may better correlate with health.
Similarly, cancer risks may scale with the amount of tissue or the surface area for things like skin / colon cancer but it’s hard to see how being taller is beneficial.
I'm thinking that ozempic and zepbound will have something to say about this. When ozempic becomes available as a generic (2032) it's going to be available for $10 a dose and a huge amount of people will be taking it.
I'm not quite sure this will address the root issues. Obesity is linked with very unhealthy diet. Ozempic isn't going to address that.
It does at least potentially address that.
Ozempic's mechanism of action is not "ramp up your metabolism" or "make you absorb fewer calories from food." It's "make the desire to eat less intense, making it easier to remain on a diet plan." That diet plan could be, "eat exactly the same things but less of them," but it will often be, "cut out unhealthy snacks" or whatever.
>It's "make the desire to eat less intense, making it easier to remain on a diet plan." That diet plan could be, "eat exactly the same things but less of them," but it will often be, "cut out unhealthy snacks" or whatever.
If people can't be convinced to eat carrots over chips, what makes you think they're going to suddenly eat carrots over chips after eating medication that makes them want to eat less?
Because that's literally what Ozempic does.
I'm not sure how making someone less hungry magically makes them want to eat carrots over chips. Is the reason why they're eating chips because they're so hungry and so pressed for time that they're reaching for the highest calorie food? Or do they eat whatever's the most delicious? If it's the latter, I doubt being less hungry is going to make them choose healthier options over more delicious ones.
People aren't idiots. They know what foods are healthy.
A lot of people struggle with intense cravings for foods that they know to be unhealthy. These cravings stack up against their willpower and sometimes overcome that willpower and they eat in ways that they know are unhealthy.
If the cravings are less intense, willpower wins more often, cravings win less often.
I think that you will indeed see that some people on ozempic eat much the same mix of foods as before, but less so. But others will in fact change their dietary mix. And I'm pretty sure that the empirical evidence supports me on this.
Oh I can answer this one. I've never liked chips but was still ~230lb before Ozempic. I tried various diets, but the willpower to maintain one was pretty overwhelming if anything else was going on in my life. I tried eating carrots to get full. And let me tell you, it feels very strange to eat half a pound of carrots, feel your stomach be full, almost painfully full, and still be just as hungry. Same with salads. I would still feel hungry, even though the stomach is full. Even though I liked the taste of the carrots or the salad. It felt like I hadn't actually eaten, and that I was still hungry for an actual meal. With Ozempic? I can just eat a salad, feel good about it, and feel satiated for hours. It just works?
From my friends who are on ozempic, yes it has literally done just that. Along with the fact because they are driven to eat less they, in general are less snacky (and thus eat less chips) and tend to avoid greasy/fried foods because combined with the medicine it leaves them feeling worse afterwards than eating a similar "healthier meal".
Yes N=2, small sample sizes, but I could also see how being less snacky makes one less likely to eat chips. (Why I almost pathologically don't keep easy to eat food in my pantry, granted this can also backfire too).
People prefer the chips because their brains are broken and they have a fixation on tasty foods. It clogs their thoughts processes - basically, they have an addiction.
If you don't care much for food then you don't mind eating the carrots and you don't mind losing the chips. If your entire life is food, then you do mind.
Sometimes the dose (portion) makes the poison.
It reduces your interest in food. If you eat chips, you will do it less often.
I'm not sure what angle you are getting at. There is tons of data that shows that yes, people lose weight on it.
Ozempic directly address an unhealthy diet, particularly a diet of overconsumption. That's actually, like, all it addresses.
How do you know they don’t have side effects that would reduce max life expectancy?
Entirely possible they do - but those effects would probably manifest in some fashion earlier than actual death. We'll have at least 7 years to see if we can spot them. But, even if they do exist, they will probably be small (given we haven't found them so far), and the positive effect on life expectancy via weight loss is huge.
i.e. the benefits of the weight loss almost certainly outweigh any side effects that are likely to manifest.
People have been taking them for decades for other reasons, so if they had side effects reducing max life expectancy worse than being overweight surely we'd know by now.
have they? why are they only gaining prominence now?
Because they have been made available for weight loss.
Viagra's original purpose was for heart conditions, that purpose didn't make the headlines (or spam folders) either.
Almost. Pulmonary hypertension, high blood pressure in the arteries of the lungs. Pretty close to the heart.
Oh? I stand corrected. I thought it was for angina.
Treatment of type 2 diabetes.
We don't, but there's also no particular reason to believe it will unless some evidence for it appears.
Similar to zero-calorie sugar substitutes, "too good to be true" isn't always the case. Sometimes new inventions really are just better.
A study by researchers from the University of British Columbia (Canada) shows a link between drugs intended for diabetics and severe gastrointestinal diseases: pancreatitis, intestinal obstruction, biliary pathologies and gastroparesis.
Only fools would convince themselves a drug has no sideeffect.
The worst is that these drugs were created for legitimate use but are now being abused by what I would call lazy fat who can't get their finger out of their arse and start eating healthy.
When there is a natural, effective and no side effects alternative, why go the medication way.
When I was at university, I made a game of spending as little as possible on food. 50p/day. Didn't realise until someone here refused to believe me, that my diet then was about 1100 kcal/day during term time. Didn't feel bad at all.
A few years after graduation, for unrelated reasons, I was on antidepressants. I massively over-ate, became obese, gained stretch marks that will likely remain for life.
There was no voice in my head telling me I was even over-eating, there was no awareness of what I was doing to myself even when I felt the weird tingle in my belly that in retrospect was the tearing flesh that has the outward sign of a stretch mark — I ate without thought.
There is no "natural, effective" solution, because our natural instincts are at odds with our unnatural world.
So the solution is to take a hormone so we can still eat all the junk food we massively produce?
Ozempic is exactly the type of drug Unilevel/Nestlé would create if they were tasked with reducing obesity. I wonder if they'll include a free 7 day dose of it with Mars bars.
It reduces food intake by lowering appetite.
That's pretty much the exact opposite of what you seem to think it does, and is exactly the kind of thing that will hurt Nestlé's junk food line. (Though probably not their bottled tap water line).
There really is no natural solution if you are taking medication that increases your weight. Kinda disproving your own example there.
Is this "nature" in the room with us right now?
Seriously — the US and Europe have not been in a remotely "natural" condition since over a century before I was born. Even the air we breathe is significantly different from its natural condition.
Why do you think I gave that example?
I wish people with your worldview could try some drug enhancing appetite for like a month. See how easy it is to get their fingers out of their arse and keep eating healthy when their body is craving food all day long.
Would you also tell people suffering from depression to just cheer the fuck up instead of going the medication way?
We don’t know if MMR doesn’t but we still give kids[0] the vaccine in infancy. The vaccine is too young (<60 y old). So I suppose ask yourself what proof you need and why.
0: most kids, I just got the disease instead and the vax later
We do know MMRV causes more seizures in kids than MMR and countries (like Canada) still choose to administer the vaccine with riskier outcomes due to costs and the fact parents don’t like to come back for more shots.
A vaccine is very different than a hormone taken daily.
Wait, doing amphetamines for weight loss is cool again and has no drawbacks of it's own?
I don't think ozempic is amphetamines.
Honest puzzlement: how is it possible to be so underinformed when google, duckduckgo and wikipedia are right there? Are they blocked some places where hacker news isn't?
You live in a world where willful stupidity is far from rare. Yes, I know that we should assume incompetence before malevolence, but that was an earlier era. A mixture of the two is the new norm.
Ozempic isn’t anywhere near the amphetamine class of weight control prescriptions, where are you getting your misinformation from?
Welcome to the 80s part 2. Hope you enjoy the ride.
Ozempic et al are nothing like amphetamines. They definitely have side-effects but we have far, far more evidence that the benefits are outweighed than we did for stimulants in the 80s.
Every decade or two I hear this about some wonder drug only for them to turn out just as bad as what they were replacing. The opioid epidemic being the latest one.
Do you pay more attention to those and ignore the actual success stories?
The opioids thing is hardly comparable. Everybody clearly knew the risks (for the past 100+ years) and chose to ignore them. This is an almost entirely new type of drugs.
Do you pay attention to the people who win at Russian roulette more than those who lose?
OxyContin was marketed to be the safe alternative to all opioids that came before it, impossible to become addicted to and extremely difficult to overdose from. This was a lie.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140023/
> Do you pay attention to the people who win at Russian roulette more than those who lose?
Well.. no since you cant really win anything. With pharmaceuticals on the other I hand I think 1 Oxycontin/etc. like “situation” would be a reasonable price to pay for let’s say 4 major successes.
You were talking about decades. Surely you noticed the advancements in treating cancer, HIV and a multitude of other conditions since the 90s?
> This was a lie.
Sure. But it’s on the same level as saying that filtered cigarettes don’t cause cancer. If a doctor actually believes that he’s just too dumb to be a doctor… (although I assume most safety claims were relative to other opioids and not in absolute terms?)
Are there any signs that the situation with Semaglutides is that similar? Yes they are new and not well understood drugs (well not really but sort of..) and it’s not inconceivable that their longterm cost might end up outweighing the benefits but I don’t really see any signs of an actual conspiracy yet.
> Everyone know fat people don't live long.
studies estimate that moderate obesity takes about 2-3 years of life expectancy (defined as having a BMI of 30-35), only people with severe obesity (BMI of 40-45+) lose on average 6-13 years, comparable to smoking.
Given that severe obesity is still uncommon even in the rich world it only has a small impact on life expectancy overall.
> ...studies estimate that moderate obesity takes about 2-3 years of life expectancy
This is really hard to believe. Moderate obesity has to shave at least 10 years off life expectancy.
A 70 year old man 6' tall with a BMI of ~35 weighs 260 lbs. That is pretty overweight.
Anecdotally, I just don't see many people that overweight or heavier making it into their 80s.
On the contrary. Conditional on living to your 60s, being moderately overweight is positively correlated with lifespan, not negatively.
When you're old, setbacks that cause you to lose your appetite are much more common and much bigger threats to the health of skinny people.
I don't know where you live, but I've met tons of moderately fat people in their 70s and 80s.
Combined with getting in your car and driving absolutely everywhere (most Americans)?
This is what people also don't realize. When these sorts of people get old they become immobile as they lose what precious little of actual muscle mass they had and unsupported joints start failing left and right. Sure your life expectancy might only be 2-3 years shy. What about your health span? That's what most people are actually interested in extending when they talk about living longer.
Yeah, this is why I lift everyday and I plan too until I can no longer do it. Lifting is also good for mobility if done correctly. Especially deep squats.
Hunched over old people do not have the muscle mass to help keep them upright, I guess amongst other things.
Lifting is universally recommended to keep you healthy as you age, that and 30 min of moderate to intense cardio per day.
Lifting does very little for mobility.
> Lifting does very little for mobility.
Weightlifting can improve mobility by:
- strengthening muscles around joints allowing for more controlled movement.
- increasing flexibility: Dynamic movements in weightlifting, like squats, lunges, and overhead presses, can stretch and strengthen muscles simultaneously, improving flexibility over time.
- improving joint health because loading the joints with resistance can increase the production of synovial fluid, which helps lubricate joints and promote better movement.
- promoting balance and coordination because exercises often challenge stability and coordination, which can help improve motor control and range of motion in everyday movements.
My neurosurgeon and my rehabilitation program would both disagree with you.
Why do people on HN think the US is special about (quantity of) driving? All wealthy non-microstate nations are driving nations. And, they drive a lot. That includes Australia.
Bicycle are pretty common in Europe, infrastructures are designed around it and pedestrian since the middle 90's.
Most people still have a car but you wouldn't think about taking the car to go buy bread for instance.
Having lived in Europe, Australia, worked in US and Japan, I guess I have pretty unique experience with this.
Americans walk the least out of all, followed by Australians. When I visit the the US for work. People sometimes stop and asked me if I'm ok because I'm carrying my groceries home from the store. People would say: "What are you doing? do you need help?" lol
Virtually nowhere is designed for walking outside of say New York, parts of San Fran etc.
Being slightly overweight is associated with longer lifespan. Really look it up, the longest lifespan is slightly overweight and top of normal bmi. Lifespan gets down when you move toward obese, somewhere in the middle of overweight segment.
The worst life expectations are in underweight category.
Haha people really don't want to hear your message
It's hard to take seriously the aversion especially Americans seem to have against overweight and obesity
Funny the land of the free is so incredibly intolerant on this one point
You should be suspicious of definitions where the average is abnormal. If 75% of people are over weight, maybe the definition of overweight is wrong.
These definitions are arbitrary anyway. In india they define a bmi of 25 as obese. The same indian after moving to America is not obese until a bmi of 30.
Meanwhile, the average height is also going up, which also correlates with lower life expectancy.
Cardiologists already had to back off their blood pressure guidelines when they defined the average middle aged man as hypertensive in the past.
Well, the average wasn't abnormal, and now it is, without the definition changing. That's telling us something. We're becoming fatter. That doesn't make being fatter "normal". It makes it average, but that's not the same thing. Historically, we know this is abnormal.
Maybe the past was underweight. Life expectancy is up compared to the past along with bmi.
Also in Asia, average bmi is 23, and average bra size is B. In the usa, average bmi is 29, average bra size is DD. Probably same thing applies for men in relation to bench press and deadlift numbers.
There is probably a distinction to be made between
"here is the theoretical limit given adherence to modern recommendations on cardiovascular health, exercise, etc."
and
"you all didn't listen and got fat instead"
I remember a paper that said optimal weight to reduce mortality is just below overweight. slightly overweight people were living as long as "normal" weight people and being very low "healthy" weight really wasn't that great.
I don't know what they based "normal" bmi weight on, but it's not by setting the middle of the range to max longevity.
That’s a bizarre hill to die on, I see all kinds of larger people survive into their 90s when I was living near and volunteering at a nursing home as a teenager
I see all kinds of larger people survive into their 90s
So dangerous to extrapolate from anecdotal observation like this. If I see old people smoking, doesn't mean smoking is safe. It just means it doesn't kill at 100% effectiveness.
> It just means it doesn't kill at 100% effectiveness.
If you wait long enough, everything has a 100% effectiveness.
if you wait long enough, obesity actually becomes a protective factor for serious issues; like Falling & Sarcopenia.
I see “plenty” of life long smokers making it to their 80s and 90s too, that doesn’t mean it didn’t take out 90% of them along the way.
Good example of how people overestimate the impact of these things. Closer to 10% of smokers get lung cancer.
But COPD, Emphysema and cardio vascular issues also affect smokers, it’s not just lung cancer.
Sure.but I don't think it escalates to a 90% death rate
It's actually a 100% death rate as all smokers sure. Jokes aside, your statement doesn't have meaning. Many deaths are not attributable to a single cause. However, it's been studies endlessly and is well accepted that smoking increases all-cause mortality.
Im not arguing against that at all. I was making a point about the magnitude of that impact.
People tend to over-estimate the impact of both smoking and obesity.
That’s the funny thing: at homes and nursing homes all around America you will find WW2 veterans. One could conclude that WW2 wasn’t dangerous from that, I suppose.
You could conclude that WW2 wasnt 100% fatal. Actual death rates was about 1 in 40, ie 2.5%
Depending on your priors, This may be a lot or not
https://en.wikipedia.org/wiki/Survivorship_bias
> The decline in the United States is driven by increasing numbers of deaths because of conditions such as diabetes and heart disease in people aged roughly 40 to 60.
People are asking if we should be surprised by the headline but are missing this. As suggested in the article by the researchers, there is something dragging down the average since the 2010s. Not even hitting the general expectation of ~75 years. We don’t have solid answers yet, only theories.
So yes, generally while going up against the process of aging is going to create barriers (eg can we get to 130 years old), we are also failing to raise the baseline which is the bigger issue that people might not grasp when it comes to “life expectancy rates”.
> We don’t have solid answers yet, only theories.
The exact quote you gave had a pretty solid answer, certainly not just "theories".
That's not what I meant. A solid answer as to why those conditions are happening, not the fact that they are happening at all.
We have research on what can affect heart health, like what things might be linked to it, such as smoking and alcohol. We also know genetics plays a huge role.
So we don't actually have solid answers, actionable answers as to the rise of heart health issues. Look at this analysis[1] regarding how dietary guidelines specifically for fats (saturated, trans) have very little substantial evidence supporting it. Yet this gets repeated by the average person, that fats are the ultimate evil you must avoid. In another study[2] we find that reducing your fat intake still resulted in the same rates of mortality as those who ate more. This is also why more in the space are shifting away from these sort of claims ("only eat x amount of saturated fat per day") and more to general food composition (eg who cares if a fish has saturated fats, eat the fish with vegetables).
It's quite challenging to figure out, everyone has their theories. All I'm saying is we don't actually have the answers yet.
[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9794145/ [2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092457/
Perhaps there are many causes of heart disease and diabetes. It is likely that actionable information would require a case-by-case assessment. That is exactly what doctors do, so getting people time with doctors seems pretty useful.
Regarding other factors, American culture is fairly similar to Canadian culture. However Canadians have free healthcare, meaning more Canadians see doctors than Americans. So I wonder if they have lower levels of obesity, heart disease and diabetes, and if their lifespans have also been decreasing.
Also, Canadians are pretty fat. It looks like 65% are overweight, which includes obese. Ref: https://www.statista.com/statistics/1317268/overweight-obesi...
Fair point, it isn’t “free” of course. But it is accessible to everyone. No copay/deductible/coinsurance bs.
> It is extremely hard in a highly advanced economy to provide quality healthcare at less than 10% of GDP.
In the US we pay 17% of GDP towards healthcare and tons of people still can’t afford it.
The general view of US healthcare is that not much of the money paid toward better health outcomes reaches the target.
A quote from another comment here is:
> Yet this gets repeated by the average person, that fats are the ultimate evil you must avoid.
I've been hearing this complaint (that the guidelines claim fat are the worst) for way too long, when in (my) reality, all the guidelines I've seen in the last 25 years has put more emphasis on carbs than on fats (i.e. too many carbs is evil).
I know "low fat" diets were the craze a long time ago. And sure, advertisers still like to slap "low/no fat" labels. But I believe the actual recommendation has been to lower carbs since around the 90's.
This is ultimately a strawman.
To be fair the framing of “carbs are evil” is also lazy. The root cause of most cardiovascular disease and type 2 diabetes is obesity due to excess calories of any sort (although once you’re diabetic or prediabetic carbs are a HUGE problem no matter what).
The modern lifestyle is incredibly sedentary and every civilisation is built on staple foods that can feed hours of manual labour (with modern snacks thrown on top).
Calling a major food group evil is just a good scapegoat because it’s much more palatable than telling people that they don’t move enough and eat too much food.
One thing I think that we can be very specific about: Diets high in saturated fat surely increase your chances for cardiovascular disease.
Also, I agree with your general sentiment: Framing carbs are evil is lazy. First, calories matter. Second, if your calories are general under control, most people need fewer calories as they age. Many choose to restrict carbs to maintain weight.
All of this shit is stupid. Research has pretty conclusively shown at this point that a high proportion of calories coming from saturated fat specifically will raise LDL cholesterol levels, in people who have neither genetic predisposition toward low or high LDL. If you have one of those, it won't make a difference either way.
Whether that leads to actual heart disease is iffier, but not terribly controversial among cardiologists as far as I can tell. It's only doubted on the Internet where everyone wants to be a galaxy brain with some answer the doctors don't want you to know.
But nobody ever demonized fat in general, and demonizing carbs is just as stupid. Eating enormous amounts of carbs is fine as long as you actually use them. My daily calories right now are around 3,900 with carbs at 650 grams a day, a fair amount being syrups I eat early in the morning while running. If you listened to the Internet, you'd believe I was diabetic already, yet basically every remotely serious endurance athlete eats like this and is fine. Glucose that is continuously and immediately shuttled into muscle cells to power mitochondria and provide energy for movement does no harm whatsoever. It's roughly the entire point of animal metabolism. Glucose that sits around in your blood forever because you're sitting around staring at a screen for 16 hours a day while stuffing your face is what causes problems because of all the oxidizing effects of glucose when it isn't taken apart quickly and turned into ATP.
My BMI is 21.6 for what it's worth. As far as I can tell, the whole "mystery" behind why no diets work is because no diet can magically make people eat less when they spend the overwhelming majority of their time not moving and hunger decouples from energy expenditure. If you're sufficiently active as a lifelong athlete, every diet works. I ate super sized McFlurries, entire boxes of Entenmann's donuts, and Little Debbie's treats as a teenager as staples of my diet. As an adult, I've tried paleo, zone, mediterranean. Right now, I pretty much just eat the standard American food pyramid. None of these has managed to magically poison my brain or destroy my metabolism because metabolic function can be trained just like any other bodily function and it is trained by doing regular athletic activity with a high energy demand. Just like your muscles atrophy if you never do any resistance training, your metabolism atrophies if you never do any aerobic exercise.
I can't claim to know the secret to weight loss but I know how to never get fat in the first place. On every team I was ever on from middle school to college to my time in the Army, whether that be cross country, track, volleyball, basketball, tennis, or general outdoor adventurism and long-haul hiking with a weighted pack, the overweight rate was never 0 but it sure as shit wasn't 70%. And we were all eating the same "poisons" and manufactured foods from evil Nestle that the rest of you were eating.
> That's not what I meant. A solid answer as to why those conditions are happening, not the fact that they are happening at all.
Nestle ? McDonalds ? Burger King ?
Portion sizes. The average plate is larger than it was, say, in the 60's.
Portion Sizes and the No/Low Fat craze from the 90s mentioned in another post are related.
This is all my THEORY, a speculation that I would like someone to study or to find a study about.
Theory / speculation:
Humans evolved with natural sugars, fats, proteins/meats; primitive cooking, probably some grains (more recently). That's what our bodies know how to process, to react to.
All the fake sugars, modified foods that lack the components our bodies use to regulate internal processes; highly processed foods which also lack those components we need to feel satiated and to produce the messengers to digest correctly: those are likely the causes of obesity (not feeling full, so more eating) and bodies behaving poorly.
'Food Deserts' and corporations that are geared around selling large portions of tasty but unsatisfying food, or only offering huge sizes rather than also offering adults a tasty portion that's not intended for take home leftovers also contribute.
Also: my main vice for this topic. Can I _please_ have lightly caffeinated + carbonated water that isn't outrageously expensive?
Caffeine addiction gets cheap when you stop beating around the bush and start just buying the caffeine pills that are like a cent a pop.
Insane prices for insulin?
edit: you really think insulin prices don't have an effect on the lifespans of diabetics?
Are they insane, though? How many hours average man should work to pay for average monthly dose of the average quality insulin? May be even more affordable than in other countries.
Insulin is cheap elsewhere.
> U.S. manufacturer gross prices per 100 international units of insulin were on average 9.71 times those in OECD comparison countries combined.
It is 10 times more expensive in USA.
According to ceicdata, annual household income per capita in USA is 10.6 times more than in Mexico. Even with prices 10 times higher it is slightly more affordable in USA.
Yeah, but my claim was not for Mexico. It was for OECD.
Isn't Mexico a part of OECD?
I don’t think the average man should have to work any hours to pay for an average monthly dose of average quality anything that they require to stay alive. Perhaps I’m insane.
Who then will work to provide these average monthly doses of things they require to stay alive?
I don't believe being able to work is an ethical prerequisite to survival. I don't believe being willing to work is an ethical prerequisite to survival.
The government can work to provide the medication that its citizens require to stay alive. Under such a system, those who are able and willing to work can, via taxes or other contributions, provide medications that some citizens require to stay alive. Many such systems seem to cost less overall than the system currently existing in the United States, so the average man who will work will have to work fewer hours to pay for an average dose of average quality anything required to stay alive.
Alternatively or in tandem, the pharmaceutical companies can sell such medications at cost, with rebates and coupons for no/low-income patients, while still making plenty of profit on reasonably priced pharmaceuticals that patients do not technically require to survive.
https://www.mayoclinicproceedings.org/article/S0025-6196(19)...
https://www.house.mn.gov/Caucus/View/DFL/31433
People also require food and water (and arguably shelter and clothing). Should those also be provided by society in average doses and at average quality?
That does not seem likely to result in a stable and productive society, particularly when many working people would have below average housing in order that government beneficiaries could have average housing provided to them.
As I said, I don't believe being able to work is an ethical prerequisite to survival. I don't believe being willing to work is an ethical prerequisite to survival.
Yes, I believe people should have food and water sufficient for survival regardless of their ability to work.
In the system, as proposed, it seems like some will choose to work and pay taxes in order that someone who is able but unwilling to work can have better housing and food than they do.
That doesn’t seem like it will have broadly popular support.
> it seems like some will choose to work and pay taxes in order that someone who is able but unwilling to work can have better housing and food than they do
This is certainly possible because it already happens now with the current setup.
People putting off healthcare because it costs money?
I recommend studies about stain medication in increasing life expectancy.
We're talking years of increased life expectancy.
Sadly statin is not without its downsides.
We're talking years of increased life expectancy.
Huh? Statins are a medication type in which increases in life expectancy are extremely hard to point to all. I think they're almost a "poster child" for medications that correct a problem to an extent but whose overall benefit is quite dubious.
(and given that these medications were highly prescribed before any long term studies were finish - creating considerable incentive for people to find benefit - I'd personally wager they are overall harmful but that's me guessing - the main point is they definitely aren't boost-life-expectancy-by-years drugs but probably aren't reduce-life-expectancy-by-years drugs either, given the studies)
Link from google: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531501/
Every few years, the lobby inserts op-eds insisting that statins are of such indisputable benefit and zero side effects that they should go into the water supply. I understand this from the companies themselves, but I have no idea which studies are convincing normal people that this is sane.
There is no lobbying like the lobbying for massively selling classes of drugs of dubious effect.
I think the distinction there is between immediate cause and root cause. Heart disease and diabetes (or complications thereof) is the immediate cause of death, but what is causing an increase in those diseases is theory at this point.
Is it not clearly obesity? Why everyone is obese is perhaps unclear (although portion sizes, ultra processed foods, screen time and sedentary lives, etc, all seem to likely play a clear role), but I’d be surprised if the level of obesity that exists didn’t cause more heart disease and diabetes.
Yes. Why is everyone tiptoeing around this? The obesity rate has increased by something like 50% since the turn of the century. It is a major risk factor for all the causes of death being discussed here. Sure there are probably many factors but this is clearly a big one.
Go here https://www.cdc.gov/bmi/adult-calculator/index.html and enter your height and weight. If you fall above the healthy category, you are part of the obesity rate and are what most research points to when it comes to increased cardiovascular risk. Also for asians the numbers are slightly lower.
I find that when I point this out, people often get mad. They feel they aren't obese. But the research doesn't support them, if you are anywhere outside of the "healthy" categorization you are at the same risk (that we know of so far) as "clinically obese" people.
> when I point this out, people often get mad. They feel they aren't obese
We’ve normalised being fat.
Still remember my first time ever setting afoot in USA, Newark airport coming from Norway, in 1999, going to a tech conference.
I saw more grossly obese people at that airport in the first ten minutes than I had back home in probably the previous year. It really stood out to me.
It must be your general dietary makeup and lifestyle. All that corn syrup. Also, I don't see any reason why it would have gotten better since then.
Just calling a spade a spade from an outsider's perspective..
> must be your general dietary makeup and lifestyle. All that corn syrup
It’s not just America [1].
Norway’s obesity rate runs at roughly half America’s [2]. But the trend across the world is increasing rates of overweightness, obesity and--most worryingly--child obesity.
[1] https://news.ycombinator.com/item?id=41634611
[2] https://en.m.wikipedia.org/wiki/List_of_countries_by_obesity...
It's been a minute since then, I've been in Australia for the past two decades as well - and yup, the trend is bad almost everywhere.
Having read (well, listened to) Attia's excellent OUTLIVE, I've reversed my own (slowly turned bad) trajectory by switching my diet to the basics - all home made meals, making my own breads, lots of milk and eggs, meats (not in excess), exclusively extra virgin oil and pure butter in my cooking (zero blends/veg oil etc), and not buying any (sugar) snacks - combined with exercise. Oh and no alcohol for the past few years either - sacrifices had to be made. :-)
Luckily my own kids are showing zero signs of obesity, they are very healthy.
People hate fat people. Everywhere I look, everyone is obsessing with diets and weight. People go to unhealthy extremes to try to loose weight, then predictably fail and cycle.
Disordered eating is a norm and being ashamed is a norm.
I find obesity a weird problem societally because literature to get people to stop being obese on a population level just kind of sucks. All we know is stuff that doesn't really work. Shaming fat people, pointing out their fatness, or other public pressure doesn't do anything. Strict diets like keto or OMAD don't work on a population level (individuals can get great results but I'm talking enough to statistically move the needle as a population). Ozempic and other injectables seem like the best widespread treatment, but that doesn't tell us any causes.
We're not making movement on this because we're not calling it what it is -- an addiction.
We dance around it and call it 'obesity' but the real medical cause of obesity is an addiction to unhealthy food.
This is compounded by the fact that it is completely legal for people to make their food more addictive and therefore unhealthy and advertise it to addicted people with underhanded marketing techniques that take advantage of their addiction.
Until we recognize this as an addiction issue that is compounded by dealers being able to operate with impunity we won't make any headway -- short of technological advancements like Ozempic that allow people to side step their addiction.
To the best of my knowledge, there's actually no diet that has been proven to yield long-term weight loss. (There are of course individual success cases.)
There are tons of diets that have been proven to work. Getting people to adhere to them long-term is the problem.
The issue is that people able to keep doing them long term end up in hospitals diagnozed with eating disorders.
As in, inability to keep them long term is biological defense of organism that does not have genetic predisposition toward anorexia.
> Shaming fat people, pointing out their fatness, or other public pressure doesn't do anything.
Says who? Are you implying that true societal shame is still being enforced right now, without hundreds of refuges in the form of safe spaces and social justice advocacy groups? I'm pretty sure that such shame worked pretty well in the past, and still does in countries like Japan.
In the end, you'll just have to realize that the root issue you're facing is decadence, and that's there's no fighting it.
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We've tried a few decades of fat positively and just pretending that being fat isn't a personal failure, and just a symptom of society.
Fat positivity? It's not really a popular position, and is in fact regarded as a loathesome movement.
You think every fat kid, especially those bullied, don't want to be thin?
You think shaming is going to work? That's an uphill battle, especially against the human body and the urges it generate, the causes we do not fully understand.
Normal healthy humans are supposed to be able to self regulate their weight at a healthy level. I have seen at least one friend who has an atrocious diet, poor eating habit, and yet remain rail thin.
If shaming did work, then it would have been implemented widely and obesity is solved. But it's not. We don't have anything that works as well as ozempic.
I am all for taking responsibility, but we ought to be cognizant about the current limitations of our tools and flexible at how we would solve problems, rather than sticking to dogma or trying the same thing over and over again and expecting different results.
For example, I found a psychological trick that enables me to work long hours. Tricks for eventually getting rid of bad food addiction(sadly, I am at it again).
You may simply not be aware of the extent of the movement. The fat acceptance movement has attempted to recast the issue not as a health issue, but as a civil rights issue, where criticizing fatness is violating the civil rights of fat people. There is a National Association to Advance Fat Acceptance (NAAFA).
https://en.m.wikipedia.org/wiki/Fat_acceptance_movement
Online there's tons of content encouraging fat gain - for example Tiktok women celebrating "BBW" as a sexy thing and the r/PlusSize subreddit, where members encourage each other to remain "big and beautiful" and post anti-science content claiming that being fat is healthy. I saw for example a post by a 20-something woman who was morbidly obese and had had a blood clot in her leg but everyone was still insisting she was a "healthy" type of fat person, herself included.
Of course you will find very few doctors who will endorse this movement or its ideas. And the vast majority of us understand that obesity is unhealthy. But the fat acceptance movement has almost certainly played some role in making people believe that obesity is less dangerous than the research shows.
I won't be shy about my view here, obesity is a terrible disease and if you have it you must take steps to cure it. If you don't your quality of life will be lower in dozens of ways and you will die younger, probably not in a comfortable way. (Not to mention that its economic cost is enormous... a principal way that you can reduce health care costs personally, is to not be fat.)
First and foremost we must renew society's understanding that this is a disease, acceptance is not an option, and it must be prevented, treated and cured.
> If shaming did work, then it would have been implemented widely and obesity is solved. But it's not. We don't have anything that works as well as ozempic.
What kind of reasoning is this? This is only true if you believe good policies always get implemented. You'll notice other countries like Japan don't require every man and child to be drugged to stop eating food, and they have a much stronger sense of shame for being an undue burden on society.
It's pretty easy to believe that fat shaming would be widely implemented, since it is in fact widely implemented even without being policy.
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And reality is to mock them regularly and frequently. In media, in comment section, in real life.
We tried a few decades of letting vendors feed us crap food, and it's led to an obesity explosion, maybe that's the problem.
Let's give a few decades of strict control over food suppliers a try, and if that doesn't work, maybe we could look into alternatives.
Why not both? Nobody wanted seatbelts until they were forced to use them, maybe we could try forcing people to eat safer food.
Is it not the case that as BMI increases the risk increases? My BMI is not healthy - and I don’t deny that makes me subject to increased risk - but I would still think morbidly obese is far worse than obese which is worse than overweight, in terms of risk of diabetes, cardiovascular disease, etc.
Not strictly. Over the past few decades I've occasionally but regularly seen evidence that "overweight but not obese" (BMI 25-30) might actually be healthier than a normal weight (BMI 18.5-25). In those studies obese did have a worse outcome than both.
IIRC mostly they had to do with seasonal sicknesses like the flu, the theory being that your body can burn the extra fat during periods you aren't able to eat well.
That's essentially what "morbidly" means.
I mostly get mad not because obesity isn't a problem, but because BMI is a bad way to measure it. It may work in the general, but it can give bad information in specific cases.
I'm a good example of how it fails. I have long arms and legs which causes my BMI to be fairly low. However, my body fat is fairly high. I need to lose fat but were I to rely solely on BMI I'd think I'm fine.
What I'd want instead of BMI is body fat percentage. I think that gives a much better measure of health problems.
> If you fall above the healthy category, you are part of the obesity rate
No. If you fall above healthy, you are "overweight". You need a higher BMI to be classified as obese.
> I find that when I point this out, people often get mad. They feel they aren't obese. But the research doesn't support them, if you are anywhere outside of the "healthy" categorization you are at the same risk (that we know of so far) as "clinically obese" people.
Depends. All cause mortality is notoriously lower for "overweight" people than "normal weight" people.
Really smells like one of those “some alcohol is healthier than none” things where there’s a subset of the otherwise-healthiest group that’s in the otherwise-healthiest group because they’re very sick.
Normal weight and overweight were determined by percentage of population at some point. The boundaries are not about lifespan, they never were.
Why? "Overweight" and "normal weight" weren't determined by reference to what's better.
A big 30-year Danish study that seems to be one of the main ones referenced for this purpose sure appears to be doing exactly what I worried it was: measuring the predictive power of BMI for mortality, not the healthiest weight for someone to maintain, which are different things. I see nothing in the abstract & methods about correcting for sick people tending to lose weight, and the healthiest BMI creeping up over time as mean population BMI increased, plus the U-shaped mortality curve, really do look like what you’d expect to see if they’re not accounting for that.
My result: 18.5 to 24.9. "Healthy Weight".
I tried adding 10kgs and it said "Overweight".
Seems ok to me.
They even warn that BMI should be used along with other indicators.
Mechanick, J. (2013). “What If” Being Overweight was Good For You? Endocrine Practice, 19(1), 166–168.
https://doi.org/10.4158/endp.19.1.50042678317gx698
The evidence that being overweight is healthier is a bit dubious, but the evidence that having a "normal" BMI is healthier than "overweight" is nonexistent.
Please correct me if I’m wrong, I believe that for aged women, being slightly overweight predicts longevity?
In anyone afaik. The healthiest weight is to be slightly overweight. The worst results are for underweight people and for obese people. The curve makes nosedive in its ends.
> I find that when I point this out, people often get mad. They feel they aren't obese. But the research doesn't support them, if you are anywhere outside of the "healthy" categorization you are at the same risk (that we know of so far) as "clinically obese" people.
"Overweight" is longer-lived than "Normal," and "Grade I Obesity" isn't significantly less longer lived than "Normal." So what you're pointing out is misinformation, which is why people are annoyed by it. There is a case that "Normal" includes more sick and dying people because sick people often lose weight, but the difference still can't be as stark as reddit knowledge makes it out to be.
https://pubmed.ncbi.nlm.nih.gov/23280227/
Conclusions and relevance: Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.
Yeah if I try to handwave obesity impact on diabetes and cardiovascular diseases to the average cardiologist, they are going to tear me a new one within minutes.
I don't know why is this even a question. Do people really think being overweight is a net positive?
https://pubmed.ncbi.nlm.nih.gov/23280227/
Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis
> Conclusions and Relevance: [...]overweight was associated with significantly lower all-cause mortality.
You gotta go higher in BMI for those to kick in. Basically, where you are within normal and slightly overweight bounds is mostly an aesthetic concern with slight lifespan advantage for slightly overweight people.
When you move toward obese or into underweight category, health problems kick in.
I am on track to lose about 40lbs in 2024 and I suspect the main variable is really as simple as we have mastered the art of making really incredible tasting food.
It is so pervasive though it is hard to tell until you go on a really boring and restrictive diet. It is just hard to not gain weight on average when the food tastes this good with such incredible variety.
That is even if you buy something at the store. With our "foodie" culture, restaurants are an entire other level of choice and taste on top of that.
1) Taste is very overrated, IMO. Too much gratification in our society. 2) SALTY is a taste. Once you remove salt and give it a few weeks, you will start finding about tastes you didn't know existed. 3) Once you cook your own food from scratch using quality and healthy ingredients , what you find tasty can change. It has in my case.
I don’t think the taste itself is an issue, it’s the availability. If I have to cook a delicious steak every time I want to eat I’m not going to randomly snack all day since it’s quite a process. My food consumption will remain at a reasonable amount. Whereas if I just pull out a bag of $chips from the pantry I could eat the whole bag without feeling sated.
I hope this isn't a throwaway account(!). This is a good post. Can you share what/why it is working for you? The best stories always share small experiments that people tried where they learned what didn't work.
>> we have mastered the art of making really incredible tasting food.
Corporations have intentionally created incredibly addicting food.
Kind of. The tricky thing here is that most people have a rigid view of "obesity" in their minds as it's easier to shift blame to, but the only thing research has shown is that abnormal BMI leads to increased cardiovascular issues. Which includes slightly overweight people.
Higher levels of body fat (which is almost always the cause of a high BMI unless you are an active athlete) is pretty directly tied to inflammation and pre-diabetic insulin resistance. This subsequently results in the liver producing more triglycerides and lipoproteins that clog the circulatory system and the inflammation itself promotes hypertension. All of this together results in more heart attacks and strokes. There's a pretty clear mechanistic link between obesity and cardiovascular disease.
That doesn't mean obese people are "to blame" for any medical complications they might suffer from obesity. It also doesn't mean that obesity is a death sentence; people's bodies function differently and we've all heard stories of pack a day smokers that lived into their 90s. But there is absolutely a connection between the two.
All those things you mention are almost certainly contributors. Another one for you to investigate if you'd like to get pissed off: endocrine-disrupting chemicals. They are everywhere and many of them are strongly tied to metabolic disorders including obesity.
Wow so ozempic is going to cause expectancy to jump by 10 years over the next decade or so.
What has been the role in demographic shifts?
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Epicureans. No point to live long which means being old for a long period of time. Better to be happy when you are young.
Eating yourself to a point where it hurts your knees to walk, or you get winded going up a flight of stairs, is not the kind of hedonism Epicurus had in mind.
everyone is sick when old
Actual study: https://www.nature.com/articles/s43587-024-00702-3#Sec2
I'm actually a little surprised at the framing here. I didn't realize anyone thought we could overcome aging. I thought the goal was to live longer, but not to completely overcome aging. That sounds somewhat foreign to me. Is that a commonly reasonable goal for folks?
That is to say, I'm not clear that "beating aging" is what is required for "long life." Is that definitionally required and I'm just being dense?
I'm assuming this is a tiered discussion? In that nobody thinks we should freeze aging at baby stages for someone. Such that we would still want some aging, but would then try and fix a point where all aging can be stopped?
> That is to say, I'm not clear that "beating aging" is what is required for "long life."
Ageing is not a perfectly understood process, so what it would mean to overcome aging wasn’t clear, and there was some hope decades ago that maximum human lifespans would just keep going up indefinitely as medicine slowly eliminated the various causes of death.
But now this research concludes what has been suspected for a while - that even under perfect conditions the average human lifespan isn’t going to hit 100. Even if you eat and exercise well and have the best medical treatment, and avoid all the other things that might kill you, ageing will get you.
The medical term for this is “mortality compression”, the idea that as we remove all the ways people die early, the ages of death for everyone end up being squashed up against a limit.
It will take significant breakthroughs in technology (probably some combination of gene therapy, cancer treatments and nanotechnology) to actually stop, or reverse aging.
I think this somewhat makes sense. Just going on the discussion, I was missing that this is using "aging" as shorthand for "the degenerate effects of aging." I'm assuming the growth effects of aging would be more "maturing" or some such.
I still think calling this "defeating aging" is an odd framing. But it makes sense in the standard context here.
It's the bit of life where you can dress yourself and control your bowels that most people would like to extend. I think nobody gets into longevity research hoping they'll be able to dodder around a nursing home with a walker for 25 years instead of 15.
But you could do that by extending the bit of your life where you can do those things. Not necessarily turning off aging?
As I said down thread, this could just be a potato/potahto thing? If this is just definitionally beating getting frail, then that makes sense. But I don't know that I could pin down an age that I would want to freeze progress at. Nor do I think I expected that there would be a general age to freeze aging at. Let me keep my strength longer, but I expect I will be/look/appear older and older the older I get.
Now, granted, I'd be delighted if I have the same strength my 90 year old grandfather in law did. In his 70s, I'm pretty sure the only thing I could beat him at was a race. Lifting things or doing manual work outside, and he was far beyond what I was in my 30s.
> but I expect I will be/look/appear older and older the older I get.
I have a suspicion that something is being miscommunicated between you and many others here. (I admit that I might be wrong. But hear me out.)
It sounds like you are thinking about the visual signs of aging. Like wrinkling of the face, or salt-and-pepper hair. That kind of thing. And sure, there is a lot of vain people who would like to stop that from happening.
But in general the aging people want to defeat is not the wrinkled face. It is things like our immune system demonstrably going to crap as we turn older. Or losing muscle mass. Or becoming senile. Or our bones becoming more fragile.
For young people the flue is basically an inconvenience (by and large). But as we age things like seasonal flue becomes huge issues. People's immune system used to work for decades without a hitch, and then suddenly it decides to crap out. Why?
I can also put it into a more mathematical framework. If maybe that helps? Imagine plotting the probability of a human dying in their x'th year assuming that they have survived before x-1 years. If you plot this now you would see a sort of bath-tub like curve. There is some chance a newborn dies in their first few years of life due to birth defects. Because of that the first few years have a higher probability of death. Then the plot plateaus, and the probability remains basically constant low number for multiple decades. People can still die due to violence, or accidents, or random health issues, but the chance of that doesn't really change much from year to year. And as you approach the other "side" of the bath-tub you see that the probability starts climbing again. And this climb is quite rapid. By the time you are 100ish (plus minus a few years) you have fairly good chances of dying in any given year. And then around 105ish you have about even chances of dying or staying alive in each year. And then we don't have anyone who ever lived to 130.
On this kind of plot if we were to defeat aging what you would see is that the plateau remains constant. That is the chances of a 35 year old dying in the next year where the same as the 135 year old dying in the next year.
Right, this is what I meant with the potato/potahto thing. To me, wrinkled face, graying hair, more hair, etc. are all things that are part of aging.
Which is why I balk at the framing of "defeating aging." We want to defeat the decline that comes with advanced age. But this doesn't necessarily mean we have to freeze the clock at some age, as it were. May be that that is the way it happens.
> Is that a commonly reasonable goal for folks?
Why not? Humans have been pursuing immortality for time immemorial. "The Epic of Gilgamesh", one of the first known stories, features such a pursuit.
I think it is just a difference in how you view it? I'd expect ancient person to be noticeably ancient. Not necessarily frail, but just as an old tree has signs of aging that younger trees don't necessarily have. Not that they stopped aging entirely.
So, if you limit aging to "getting frail," I am fully there. But there are other things that happen as you age.
I honestly thought the whole point was beating aging. Whether that's longer life or cancer or whatever. The point is to stay 20-40 forever, from what I can tell.
But, by the time you hit 20-40, you have already done a ton of aging?
Fair that I don't expect to be as strong in my 60s as I am now. Or when I hit 70+. If I get that far. Light weight training is plenty to get to be in good physical shape, though? Get to where you can do 10-30 pushups and run a continuous mile, and you are probably doing fine?
But why would you not want to beat aging in a medical sense? I don't really understand your logic here.
But this gets to my question, essentially? Is "aging for the elderly" different than "aging for the middle aged?"
So, what does it mean to "beat aging in a medical sense?" If it is just definitionally to not have any of the bad effects of aging, then sure. Of course I would want that. What are the names for the good things that are generally along for the ride with aging?
Going back to my earlier quip, if you could turn off aging for babies/toddlers, how would that be a good thing?
It wouldn't. So you wouldn't do that. It would be like giving an insulin pump to someone who wasn't diabetic. Why would you?
This may somewhat surprise you, but I would ask the same for people in the 30s. 40s even, at this point. Freezing someone at that age doesn't sound appealing to me. At all.
So the heart of my question is why do we view "defeating aging" as the same as "living longer?" Or is this something where the target age that people would want to be generally coalesces on a common number?
"Aging" in the context of "defeating aging" refers to the phenomena of declining metabolism and deteriorating genetic data.
Wrinkling skin, graying hair, loss of muscle mass and bone density, loss of mental acuity, decline of libido, late-life diseases (eg: cancer, Alzheimer's, type-2 diabetes), and so on.
It's scientifically proven that our bodies spend enormous amounts of energy up into our 20s when we reach sexual maturity and then glide through on momentum through our 30s into our 40s when we are raising our children.
Once we're in our late 40s to early 50s we're done spawning new life and our bodies throw in the towel, starting the slow but inevitable deterioration culminating in death.
It's that whole physical process that we as a species want to overcome, we want to defy being just machines for spawning more machines. Life is fucking evil.
Growing wiser from more and more life experiences is also part of aging, but it's not what we refer to when we say "defeat aging".
This makes sense, though I still find the framing odd. I don't mind that I look older now that I'm, you know, older. Defeating aging feels like it would be to find a way to be forever young. Extending life doesn't feel like it would need that.
Obviously, we need some way to not completely lose genetic data and such. If there is a "throwing in the towel" moment, as it were, find a way to prevent that. But living forever doesn't equal forever young, to me. Mayhap I'm just too old for that to have meaning anymore? :D
I always wondered why I personally know almost nobody who has managed to exceed average age. With the only exception of my previous landlady, she became 95. In my family, the average age is roughly 60, with three siblings on my fathers side dying before 50. Both my grandpas died around 50. My best friend died with 18. Many of the fellow blind people I know died below 50. And I am from a relatively rich country, with classical western standards. It is almost as if I was thrown into a local minimum while the simulation was set up. I would understand if the phenomenon was largely limited to my family, call it genes then. But it doesn't end there. I guess the personal statistics becomes only meaningful after your own death and beyond. But really, looking at how many people had to pass away early, I am beginning to get spooked.
> I would understand if the phenomenon was largely limited to my family, call it genes then
Perhaps there are other shared variables besides genes? For one thing, blindness is associated with higher mortality [1]. And even within a country, life expectancy can vary dramatically by region, city, and even neighborhood. Or perhaps the people you know happen to be more likely to share certain occupations, mindsets, levels of physical activity, or diets?
Or maybe it's just coincidence.
[1] https://www.thelancet.com/journals/langlo/article/PIIS2214-1...
I wonder how much impact there will be on average life expectancy uncovering that a lot of the super-long-lived population examples have been pension fraud.
Probably not much because you can find long-lived populations that don't follow the administrative boundaries of pensions.
King County in Washington State, which contains the Seattle metro area, has a life expectancy of 86.3 years. This is higher than any country in the world. If you move one county south (Pierce), it is 75.7 years, slightly worse than the US average currently. Not surprisingly, there are many obvious factors that may contribute to this e.g. the obesity rate in Pierce County is 50% higher and the obesity rate in King County is roughly half the US obesity rate. The Seattle metro is a relatively walkable city and people do, Pierce County is not. As a matter of demographics, King County is significantly more Asian than Pierce County. And so on.
Both counties are geographically large and contain many municipalities. It is difficult to come up with a theory where pension fraud in King County is so high relative to Pierce County that it explains a >10 year difference in life expectancy.
This source gives King County as 81 years: https://www.communitiescount.org/life-expectancy
There is quite a lot of disagreement but I think you are correct. My source appears to be bad AI generated content; I did not dig in too much.
The underlying source of 86.3 matches San Juan county from other sources. Seattle metro areas are a bit over 83, and King County is somewhere between 81-82 from sources that seem more primary.
Internet search is straight garbage these days.
Those people are statistically irrelevant. Not enough of them to drag the average much one way or the other.
For every pension fraud that went on that long and took such an obvious risk with continuing to a notable age, I imagine there were hundreds or thousands of shorter frauds.
In this case, the “shorter frauds” involve dying near the reported date of death? By your definition, the postulated (unreported) deviation is statistically insignificant.
We're not living longer. We're dying more slowly.
i don't think that's generally true. quality of life at old age could be increasing due to several factors. for example: decrease of hard labor and better protections for laborers, doctors telling their elderly patients to go to the gym and train their strength and people generally being more health conscious.
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I'm not surprised; most deaths are attributed to unhealthy diet, lack of physical activity and alcohol consumption. [1, 2]
I'm not noticing people eating more healthily, so it only makes sense that life expectancy isn't going up anymore.
[1]: https://ourworldindata.org/causes-of-death [2]: https://www.who.int/news-room/fact-sheets/detail/cardiovascu...
The youth are drinking less, and great non-alcoholic substitutes are becoming available for a wide variety of beverages. I hope these trends make a difference long term.
I’ve had to make very few compromises to still enjoy life while staying alcohol free - I can even have a decent bottle of wine, or a rum and Coke should I be in the mood for one.
https://theconversation.com/youth-drinking-is-declining-myth...
> The youth are drinking less
What little life expectancy they gain by drinking less - and not stopping completely - is completely overshadowed by their high-sugar, high-sodium, meat-heavy diet.
That's what the ozempic is for. And it's a double whammy - because it stops the new-fangled nicotine addiction pipelines.
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> fixing your diet
What the fuck do you guys think GLP-1 inhibitors do? Why even bother posting if you don't understand the most surface level of what I'm saying.
> drinking habits
GLP-1 inhibitors have also been shown to reduce drinking and smoking. It's essentially an anti-addiction drug.
It's very easy to sit on a throne when you don't have a food addiction. For those who do, it's not as simple as "durrr eat better". Come on guys we have to start putting that meat sack between our ears to use.
We've been trying, and ONLY been trying, the "discipline" approach for the entirety of the obesity epidemic. And it is not working. Point blank, this is not an effective method of treating obesity or diabetes.
If that's your suggestion, it's obvious you don't actually know what's going on. Which is fine, but then perhaps silence would do you some good. Less embarrassment that way.
> GLP-1 inhibitors have also been shown to reduce drinking and smoking. It's essentially an anti-addiction drug.
You think that 33% of deaths are caused by addictions? I don't understand why you brought addictions up.
> It's very easy to sit on a throne when you don't have a food addiction
Yeah, I don't. I'm mindful every day of what I eat and drink.
> We've been trying, and ONLY been trying, the "discipline" approach for the entirety of the obesity epidemic
Except that most overweight people are not food addicts. They are just normal people with bad nutrition, and that's it.
> https://ourworldindata.org/causes-of-death
More people die of Suicide than Malaria aparently.
Somehow what actually kills people, is different from what you think kills people.
They're going to need new excuses for phasing out state pensions oops sorry I mean "raising the pension age".
Talking about the number of people who live over 100 along with the average life expectancy seems to be mixing two unrelated things.
To show that we are hitting a limit on our ability to extend lifetime, we really should look at having reached 95, how many people reach 105 or something like that.
To say that the average life expectancy is dropping and therefore we have reached our limit on their ability to extend the lifetimes ignores the fact that much of the reason for a stage life expectancy drop in my country is lifelong maltreatment, often self-inflicted--death-oriented decisions on drugs, nutrition, and activity.
Anyone know of a good source like Our World in Data for tracking life expectancy across countries?
Our world in data hasn't updated life expectancy past 2021.
I've half wondered if it's because the article is optimistic but life expectancy has stalled since 2020. Coild also be the underlying data hit a snag. Would love to see an update
https://ourworldindata.org/life-expectancy
There is a limit to how far you can postpone death without actually reprogramming the DNA. We have likely plateaued it. We are not going to have people living to 200 by just doing more of what we are doing, with greater fervor.
Isn´t this also an issue with World War's 1 and 2? They both dented life expectancy fairly significantly, and that cohort is now aging out of the figures. If the rate of increase is being measured, then that would presumably play a small part?
The way life expectancy is usually calculated, it shouldn't have an effect. It is calculated is by looking at the mortality rate for each age group, which gives a probability of death for each age, and by simulating people growing up in such conditions, and then taking the average age of death.
By doing so, historical events outside of the study period don't have a major effect. In this study, they deliberately avoided the covid pandemic as it would have caused a significant drop in life expectancy that is not representative of a general trend. Of course, the future is not taken into account either. Despite what the name may suggest, life expectancy is like a snapshot of the studied period (1990-2019 here), not a prediction.
> overall, the study found that children born since 2010 have a relatively small chance of living to 100 (5.1% chance for women and 1.8% chance for men). The most likely cohort to see a full century are women in Hong Kong, with a 12.8% chance.
I do not understand how some of the conclusions about reaching the limitations of reducing aging or reached given this simple data. not to mention a direct quote that is very inspirational in the article itself
"if we cannot imagine it today, does not mean it is not possible"
This will not age well.
It's assumed that the odds of dying at a given age are frozen. So if someone is currently 15, their odds of making it to 100 are their odds of surviving 16 times their odds of surviving 17 times their odds of surviving 18, and so forth. If you're in the US, as of 2021, for all ages over 11 your life expectancy decreases by less than 1 year per year, and if you've attained the ripe old age of 119, your life expectancy is only one month shorter than that of someone 2 years younger than you.
Many demographic trends like fertility rate are treated the same way. While it is not a very accurate prediction for how long a current young person will actually live, it's a consistent metric that doesn't rely on a particular model of future events. It's good for discussions like this where we're more interested in how the value is changing than the actual value itself.
Either they use some prediction model (accuracy of which is comparable to any 100-years-ahead predictions) or they keep hostage time travelers from 2120s.
>”It tells you that something pretty negative is happening among some subgroups of the population to drag the average down, because the wealthier, more highly educated subgroups are actually doing better,” Olshansky says.”
It is expensive to live a healthy lifestyle in the US.
Frustrating that an article with a title like this doesn't include a single graph.
Did we expect it to grow forever?
The actual story here is that it's slowing down because the lower tail is growing, not because the upper tail is compressing as we hit some kind of upper limit of human longevity. That is: more people are actually dying younger, which has been gradually offsetting other people living longer.
That’s the exact opposite conclusion of this paper.
“Our analysis also revealed that resistance to improvements in life expectancy increased while lifespan inequality declined and mortality compression occurred.”
I wonder if "life expectancy" is really such a useful metric, since it aggregates so many different things together. It's kind of like measuring "aggregate years of human life lived".
It's still useful because it provides some information. Specifically, a change in life expectancy, or a change in the rate of change in life expectancy (as here) means something. We just don't necessarily know what that something is without further study.
It leads to a lot of misunderstandings. For example, lower life expectancy throughout history is far more attributable to higher infant mortality than to adults dying young. But people think everybody died at 45.
If not forever, but if 200-ish becomes a norm, it would be super awesome. Now, it is like, “Awesome, I know this, I know that. I need to learn that.” “Hold on, time to die.”
200 at what qualitative life point currently? 80? 90? 100?
Spending an other 100 years like say from 80 to 100... Well you are alive, but still...
My grandfather lived to 104. More impressive was that he still played tennis regularly in his 90s.
It's not his lifespan I aspire to, but his healthspan.
I assure you many aspects of a society where 200 years old becomes a normal life expectancy would be a hellscape and not "awesome." We already currently have a massive societal and economic problem with aging populations as things currently are.
The problems are due to what aging involves and the lack of young people inverting the population pyramid; getting us to 200 at all means solving every age-related biological problem, while also meaning we have longer to start a family and have kids to stabilise that population pyramid.
Lol ok so imagine your dream scenario is everyone, magically and with equality, is able to live and reproduce to absurdly long time frames - that’s also a hellscape in so many easily imaginable ways. you’ll start to see jobs requiring 100+ years experience or with the right genetic modifications to make you insurable enough to invest a 60 year career into. Since this is all science fiction, we can imagine all sorts of things as we understand this is fiction. My only real point is this isn’t a utopian future. we can’t deal with the amount of humans we already have at the ages they live to. I don’t see what solving aging does to solve any of these problems.
> you’ll start to see jobs requiring 100+ years experience
Do you currently see jobs demanding 50+ years experience?
Even if we ignore the fact that most jobs won't require any more experience to do than they take now just because we live longer, longer periods of time won't seem as costly to us either. Right now 100+ years of experience is absurd because the only way they could ever have that much experienced is if they worked from the day they were born until the day they died, and even then they would need to live an exceptionally long life. If we lived to 200, you could start your career in your 30s, get those 100 years experience, and still have 70 years - an entire current lifetime - to reap the rewards afterwards.
Being more realistic, there is some finite amount of money you need to put away to live indefinitely off interest at any given level of comfort. Right now reaching that threshold in the 50ish healthy adult years we have is a difficult but achievable goal for most people. But with more time you can reach that threshold on a less aggressive trajectory and enjoy retirement for substantially longer (all while being healthier to boot).
As a thought experiment, if you want to imagine how you would feel about your doubled lifespan, consider your current lifespan doubled from some previous threshold. Would you prefer to live only 35 years on average with 50 being advanced old age? Sure there might be some benefits, perhaps some jobs might lessen their experience requirements, but would this be overall a more pleasant world with higher quality of life? We did not choose a 75-100 year lifespan to optimize human happiness, it is just the number we happened to wind up at as a result of a process that did not consider human happiness at all.
> Since this is all science fiction
Everything is, before it gets invented. 200 years ago, radio, cars, skyscrapers, anaesthesia, transplants, space travel, plastics, and bioprinting were all scifi. Aluminium was almost exactly 200 years ago.
Voice-to-voice translation and cheap synthetic gem quality diamonds were too, even when I was a kid.
I'm not saying any of this will be easy — from what I've heard, it's sufficiently hard that one would need to do a PhD in the subject just to really understand how hard and I've not done that — but you are made of atoms, and the atoms in your body can be rearranged into a younger form.
That the only mechanism to do so today is called "cannibalism" is an (enormous and repugnant!) implementation detail, even though it's also an existence-proof of the possibility of such a re-arrangement.
Do you know what's not science fiction? People are already experimenting with genetically modifying themselves, because of things as simple as "they don't enjoy lactose intolerance".
> I don’t see what solving aging does to solve any of these problems.
Then you don't understand the actual problems.
Most of the costs we have today from an aging population are that old people are physically weak, get sick a lot, have many expensive complications, and 30 years ago they collectively didn't have enough kids for the next generation to be able to afford to look after them so well.
When you write:
> we can’t deal with the amount of humans we already have at the ages they live to
That's because (1) it's their kids (us) doing the "dealing with", and they didn't have so many; and (2) our natural aging process is awful.
Anti-aging's biggest promise is that it makes age-related degeneration much easier to manage.
(And all that's assuming "you’ll start to see jobs requiring 100+ years experience" isn't obviated by AI).
Kind of ironic that your "hellscape" is created by an increased difficulty to get a job.
Kind of ironic only in that's literally how society works
Societies change, and also plainly ours does not work that way as we don't have a high proportion of jobs requiring even 10 years' experience despite most of us spending ~47 years in the workforce.
you'd rather everyone die than to see experience requirements for certain jobs go up?
What a rude comment.
Everyone already dies.
Come on wouldn't it be great fun with a dozen diseases, broken hip bone, shitting in diapers (if one can afford) people celebrating their 177th birthday. Seems people would sacrifice their first born if such dream life is guaranteed.
Physical exercise is the most potent life extension intervention we have. So it's very unlikely we'll get anyone to 200 if they're stuck in bed with a broken hip.
The macroeconomic implications of that large a fraction of the population being above working age or such a large fraction of one's life not being working years are not exactly great.
Apart from the fact that "working age" doesn't mean the same thing in a world that has anti-aging interventions?
Our economic system is incompatible with the next 200 years irregardless of what specifically gets invented.
At 5%/year, that's a factor (not percentage) of 17292 growth; in energy terms that's not quite boiling the oceans, but it is making the poles the only barely livable zone.
In any sense besides energy, this kind of growth implies automation that makes the meaning of work radically different than today. Human or superhuman AI would be an example of that, but the successful creation of that has other complications that we can currently only guess at with less awareness than the Victorians had of climate change or biodiversity loss.
It seems reasonable to expect it to grow even at a diminished rate until everyone enjoys equivalent access to health care, nutrition, occupational safety etc but that is subject to the political environment, priorities of the electorate and the capacity of the economy. Without pandemic, famine, war or natural disaster a decline in life expectancy is generally the result of public policy for a rich democracy and not an inevitability.
I think we need to distinguish between longevity and health though. Lots of people live with chronic disease and giving them more quality of life counts for more than longer life IMO.
If someone said “my son has stopped wetting the bed”, would you reply “did you expect them to wet the bed forever”? What if someone said “my leg no longer hurts”, would you reply “did you expect it to hurt forever”? How about “my bag of candy is almost empty”, would you reply “did you expect it to be full forever”?
The information that something stopped or slowed down is still useful without having to think it was going to go on eternally. It allows you to adjust your plans for the future.
> my mother died
> did you expect her to live forever?
And then some.
I understand some tech billionaire want to live forever by eating hundreds of pills a day for nutrition, anti-aging, disease control etc. Their life may be "great" for some definition of great.
But do billions of people on earth think that their life will become great in another 50 years even if it is rather miserable right now? I just live under rock to not know the desires of modern human.
I wonder how Ozempic will change this? I really do expect we will all be on this soon and maybe we can resume the increase in lifespan that has been stalled by obesity, lack of exercise, and processed food.
> I really do expect we will all be on this
When antibiotics were first invented some people thought we'd be taking them daily as a vitamin. Turns out that's not such a good idea despite them being life saving in some scenarios
This is a thing that always blows my mind.
The accepted view is a lot like the accepted views to mono-cultures for crops. In that they are bad. The practiced take, though, is quite the opposite? Crops are dominated by mono-cultured fields. And though antibiotics are known not to be used constantly, farms seem to use them at an amazing rate.
I'd love to see a longer exploration of this. Why is it farms seem to be full of practices that we are taught are bad?
> The practiced take, though, is quite the opposite? Crops are dominated by mono-cultured fields.
Not exactly. We have crop rotation because over time a strict mono-culture wasn't very good.
I'm curious on the numbers on this. Every time the general topic comes up, avocados and bananas seem to come up and completely spurn the idea. Googling says 80+% of crops are rotated on a regular basis. Though, it is noted that "cover crops" are sub 10% of rotations. Which seem to be required for fruit farms.
At any rate, I'll be reading more on this some. I have real work I should be doing, after all. :D
My totally off-the-cuff theory is that we’ll only need a lifetime of ozempic and its clones every 3-4 generations to reset the obesity cycle.
I guess we’ll soon be able to measure the impacts on what it does to the children of parents that take it.
How have McDonalds Happy Meal sales been looking lately?
Surprising that you asked. :)
https://www.reuters.com/business/retail-consumer/mcdonalds-p...
I'm not fat or diabetic. Why would I take ozempic?
Assuming you're not on drugs or thinking of killing yourself, you're probably not in the cohort that's dragging the life expectancy stats down.
Life expectancy is a weighted average (no pun intended), and so it's unusually sensitive to outliers. People who die early drag the average down much more than people who live close to the mean life expectancy. The biggest premature killers of Americans are obesity, drugs, car accidents, and suicide. Anything that addresses one of those causes of death has an outsize effect on life expectancy. There are 100M+ obese Americans. There are about 100,000 overdose deaths per year. Obesity, while not as lethal as drugs or suicide, afflicts 1000x as many patients, and so a treatment for it can have a large effect on the numbers.
> The Oxford University research found that moderate obesity, which is now common, reduces life expectancy by about 3 years, and that severe obesity, which is still uncommon, can shorten a person's life by 10 years. This 10 year loss is equal to the effects of lifelong smoking.
https://www.ox.ac.uk/news/2009-03-18-moderate-obesity-takes-...
> According to the CDC, 9.4% of adults in the United States were severely obese between August 2021 and August 2023. This is higher for women (12.1%) than men (6.7%). The prevalence of severe obesity varies by age group, with the highest rates in adults aged 40–59 (12.0%)
Only 9.4% of people are severely obese. Moderately obese people have only a ~4% shorter life-span than healthy weight individuals - much of which can probably be attributed to other lifestyle issues besides simply being overweight.
This will move the needle, but I doubt as much as you think.
There's a lot more smokers than there are severely obese people.
>There's a lot more smokers than there are severely obese people.
Huh, I was going to argue this, but you're right (in the US). 19.5% of the population smokes, so there's about twice as many smokers as severely obese people.
I was sure it had dropped to 5-10%. I guess I'm in a bubble (of fresh air).
Kind of a tangent but I think a big part of the explanation for declining life expectancy is hiding here in plain sight.
Since everyone knows smoking is bad for a long time now, we’re going to eventually need to categorize stuff like lung-cancer as a death of despair, similar to other deaths caused by alcoholism, opioids, or suicide.
A lot of people who otherwise might quit smoking are probably looking at impossible dreams of home ownership or retirement, and thinking consciously or unconsciously that there is more dignity in a death at 50-60ish than one at 80ish when you’re unemployable and the thin promises of social safety nets have fallen through.
Smoking (or other high risk activities) might be a dirty habit but it’s still more socially acceptable than suicide.
That's a bleak view. I doubt a substantial percentage of smokers are smoking specifically to die sooner.
Most of them are smoking primarily because they're addicted.
A few of them actually like smoking.
Dying sooner is certainly not why they started.. rather the bleakness of outlook is a (fairly rational) reason why they don’t quit.
If obesity is supposed to be the other main candidate for why life expectancy is down, you can do a similar analysis there. Is life really good enough to prolong or attempt to improve for people that are in at-risk categories? That’s the question people are looking at when they choose to move towards or away from self-care. For someone who makes minimum wage and already has to choose between paying for a date or paying for rent, it makes less sense for them to care much about losing weight, because it makes a bad life longer but won’t help their love life.
This is how practically all population-level analysis of health is just economics in disguise, even without directly looking at costs of medicine/services
I think your hypothesis is correct but your reasoning is wrong. Few people are morbid enough to think "Oh my life sucks so why bother looking after myself". But if you're constantly stressed because you're struggling in life, small indulgences like smoking, alcohol and fast food/sugar are a lot harder to resist as they provide a much needed outlet/release.
It would be really interesting to see a stat that is like… “life expectancy without morbidities that can be avoided with some effort.”
Which, I recognize is a pretty privileged way of putting it—people struggle with weight, mental health, and drugs, and those are real struggles that shouldn’t be ignored. I just also want to see where things are developing on the upper-bound for reasonably plausible lifespans.
>Life expectancy is a weighted average
Sure, if all the weights are 1. Where i come from, we just call that an average.
>People who die early drag the average down much more than people who live close to the mean life expectancy.
This is true of all averages where all weights are the same.
I should probably have said the change in life expectancy is a weighted average, weighted by how far you are from the average. If average life expectancy is 80, removing a data point where somebody died at 40 has 8x the effect of removing a data point where somebody died at 75.
In case anyone else is curious about the specific term for the concept you are describing, it's https://en.wikipedia.org/wiki/Leverage_(statistics)
(To reproduce exactly the scenario being discussed, you fit a constant-only model to the data using least squares: that gives the average as the best fit. Then, you measure the leverage of each point of interest.)
Ok, that makes a lot more sense in light of your argument!
https://asteriskmag.com/issues/07/how-long-til-were-all-on-o...
https://www.wired.com/story/the-benefits-of-ozempic-are-mult...
> Known as GLP-1 agonists, these drugs were originally developed to help control diabetes. But there's increasing evidence that they have other health benefits, beyond controlling weight. They seem to boost heart health, protect the kidneys, improve sleep apnea, and lower the risk of certain obesity-related cancers.
Because statistically it's unlikely you stay that way. If you do, then great.
Yeah, I'm still kind of confused by this sentiment. There's a cohort that claims metformin somehow extends life as well. I'm pretty sure if a doctor prescribed me Ozempic that'd be grounds for malpractice.
It does. But not exactly in healthy humans by any sizable amount. Works pretty well for diabetics and prediabetics, and in cases of PCOS. Otherwise the effect is rather small and depends on prevention of diabetes and a few kinds of cancer.
It has a side effect of reducing muscle gains from exercise.
As for life extension by GLP-1 active drugs, it's much more of a guess. Mechanism is relatively similar. Side effects might not be...
Ozempic seems to have a large number of positive effects for virtually everyone. It's a little premature to think everyone will be on it "soon" and there are plenty of people who won't take something even if it's universally beneficial.
Not that many. Probably less than or similar to metformin. For the silly cost, it's not very effective at extending life.
And there are potential bad side effects too.
Yeah why would I take a pill if I can get the same effect through discipline and hard work? I understand not everyone can do that but if I can it would be absurd for me to take a drug for the rest of my life. Especially when I enjoy the work involved in changing my weight and body composition.
If a doctor tried to push that on me I would fire that doctor.
> discipline and hard work
Well the ozempic helps you do the discipline and hard work. You don't take ozempic, eat everything, and get skinny. No, it makes it easier to diet and exercise.
For some they don't need the "motivation". For others, their mind is constantly under attack and pushed to eat, like an addict. For them it can be very helpful.
Because you already take many modern shortcuts and conveniences to avoid hard work, why not take this one?
Taking a medication with potentially severe side effects (including perhaps some that we haven't found yet) is hardly equivalent to using a machine to wash my clothes.
Iunno, I don’t think the side effects of a washing machine have been studied at all.
We’re really flying in the dark there.
Because at its core it changes who I am. I had a really bad experience on SSRIs as a teenager, and those were also pitched to me as "low to no side effects."
My washing machine isn't going to make me suicidal if I start or stop using it.
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> I wonder how Ozempic will change this?
It wont. This is about maximum lifespans. Weight loss might mean more people reach their maximum, but that maximum has proved, to quote the article: “resistant to improvements”.
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Why should Americans trust public health or the government after decades of utter failure? Every single measurable data point of health has decreased under the 'experts' watch. Record cancer, obesity, heart disease, mental health disaster, etc. The messaging around the covid vaccines and masking was a disaster.
Same thing is happening in Europe and other developed nations. UK considering giving ozempic to unemployed? How about subsidized or free gym memberships instead? Things are going to get alot worse before getting better. The established intuitions will continue to double down no doubt.
Cutting out sugar and useless carbs, and trying to replace those things with nuts and quality proteins - more nourishing and filling substitutes, can help a bit, I think. Mostly, try to stay away from refined sugar and products containing sugar or corn syrup. And for the love of God, lots more vegetables. Less dairy perhaps?
Get an apartment on at least the third floor, in a building without a lift.
Get a pet dog which needs to be walked several times a day.
Eat lots of chili peppers[0]:
"The analysis included data from more than a half a million people in multiple countries. When compared with people who never or rarely ate chili pepper, those who ate it regularly had lower rates of death due to cardiovascular disease (by 26%), cancer (by 23%), or any cause (by 25%)."
[0] https://www.health.harvard.edu/blog/will-eating-more-chilis-....
A little bit of high-intensity workout each week?
I know people who are incapable of eating lunch or any meal without a large can/bottle of full-strengh coca cola or such, ever single day. Most of whom complain about not being able to lose weight.
The science is pretty clear. Breaking out of old habits is much more challenging.
EDIT: Typos: whole -> whom, mean -> meal
The health effects of nuts are fairly overstated especially since many of them are high in PUFAs.
I think my main point was about reducing all sugar, and reducing the intake of garbage carbs.
"Although nuts are high in fat, it’s mainly healthier unsaturated fat. They contain protein, B vitamins, vitamin E and minerals, including iron, potassium, selenium, magnesium, zinc and copper."[0]
[0] https://www.bhf.org.uk/informationsupport/heart-matters-maga....
I get your main point. My main point is that unsaturated fats, specifically poly-unsaturated fats, are definitely not better than saturated fats and we shouldn't be telling people to eat more nuts. The evidence linking saturated fat to heart disease has been weak, and organizations like the American Heart Association have promoted this claim while also promoting crap products like Crisco while taking money from Proctor & Gamble.
"The idea that saturated fats cause heart disease, called the diet-heart hypothesis, was introduced in the 1950s, based on weak, associational evidence"[0]
[0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9794145/
https://www.health.harvard.edu/staying-healthy/new-thinking-...
>These studies have two main messages: When you eat saturated fat in moderation (contributing 10% or fewer of your daily calories), it has little effect on cardiovascular disease. When you cut back on saturated fat, replacing it with unsaturated fats or whole grains is good for your heart and arteries, while replacing it with easily digested carbohydrates isn't.
That is not a study. It’s science denying storytelling from Nina Teicholz, a frequently debunked charlatan. Every time you replace saturated fat with unsaturated fat, health markers improve.
Google tells me that PUFAs == Polyunsaturated fatty acids
Since when are polyunsaturated fatty acids considered unhealthy? As I recall, the real enemy is saturated fats.
Polyunsaturated fats like omega-3 and omega-6 are beneficial.
“…the rate of improvement in life expectancy in the decade of 2010–19 had dropped below that seen between 1990 and 2000. People were still living longer, but not by as much.”
“The analysis looked at the period of 1990 to 2019, to avoid the distorting impact of the COVID-19 pandemic.”
At least life expectancy was still growing before COVID. Now after the introduction of dirty (mass production was not the same quality as the small batches used in leading studies) COVID vaccines, plus the virus itself which caused some trouble to not fully healthy people, we will see a life expectancy decline. Excess deaths did already rose worldwide.
Meanwhile they want you to get more dirty vaccines..
Edit: typo
In our relentless quest for longevity and a richer life experience, one profound consideration emerges: the role of sleep in our daily lives. Sleep, which consumes approximately one-third of our existence, represents a significant barrier to maximizing our time and productivity. If we could find a safe way to eliminate the need for sleep, we would theoretically unlock vast reservoirs of hours previously devoted to rest, transforming them into opportunities for personal and societal advancement.
> Sleep, which consumes approximately one-third of our existence, represents a significant barrier to maximizing our time and productivity.
"Millions long for immortality who don't know what to do with themselves on a rainy Sunday afternoon." — Susan Ertz, Anger in the Sky (1943)
That question was solved by social media.
I have a hard time imagining this will ever become a reality; the need for sleep is fairly deeply hard-coded in how our brains operate, and I believe it's also needed for some more basic cellular functions.
It's not binary I guess (sleep "once a week" is less than "sleep once a day"), but even some incremental improvements seem very far off.
One also has to wonder if it's actually desirable to have less sleep and be "on" with fewer or no breaks.
> If we could find a safe way to eliminate the need for sleep, we would theoretically unlock vast reservoirs of hours previously devoted to rest, transforming them into opportunities for personal and societal advancement.
While in practice, what would happen is that we’d be doing more of the same. Bosses would be demanding more time in the office, people would be spending more time doomscrolling, nothing would change. It’s a pipe dream to think that if we had more time in the day we’d suddenly start using it more respectfully and responsibly.
we currently spend about half our waking hours during the day at work during the week. if we got those 8 hours of sleep back then presumably we would get 4 more hours of non-working awake time.
seems decent to me. I hate sleeping, the problem is i get tired and cant avoid it.
On the plus side, this would solve the housing problem too. Without the nuisance of sleep requirements we would move to the offices and live, ahem, produce there 24/7. Much like cattle.
This is the great future the visionary OP envisions for us.
One of my favorite science fiction novels deals with this: https://en.wikipedia.org/wiki/Beggars_in_Spain
What a fascinating book series that I've never heard of. It looks like it sort of takes a middle ground between Le Guin and Rand?
It doesn't preach so much as it explores. The author strikes me as being more economically literate than Rand or LeGuin, but not as good a writer as the latter.
The real and staggering excellence of the series is the speculation - it's not such hard SF that it explains the mechanisms by which everything happens, and there are real characters who do more than stand as cardboard observers to technology, but it's crunchier than most.
Read the novella and skip the novel.
The current thinking is that Alzheimers and dementia are caused by the brain’s waste disposal system malfunctioning and results in an accumulation of proteins in the brain that damages a lot of important functions. This waste disposal only happens during sleep.
https://www.medicalnewstoday.com/articles/how-the-brain-flus...
Not suggesting anyone try this but some people claim to sleep only two hours a day with this approach: https://www.sleepfoundation.org/how-sleep-works/polyphasic-s... "Uberman Sleep Schedule: Six 20-minute naps are spaced evenly throughout the day, totaling two hours of sleep per 24-hour period."
A book on sleep and how important it is to learning and health: https://en.wikipedia.org/wiki/Why_We_Sleep "Walker spent four years writing the book, in which he asserts that sleep deprivation is linked to numerous fatal diseases, including dementia. ... The values of sleep and the consequences of sleep deprivation are also brought up in the book. One particular research conducted in the past, where people volunteered themselves to sleep for only six hours in a span of 10 nights, is brought up by Walker. This resulted in the volunteers being "cognitively impaired" along with their brains being heavily damaged, regardless of the three week eight-hour sleep schedule they received later."
Hopefully it doesn't go like the X files episode: https://en.m.wikipedia.org/wiki/Sleepless_(The_X-Files)
I'm all for getting rid of sleep, but given how society is structured I worry that the extra time will just end up being used for longer commutes and more zoom calls. Hardly advancement.
Have you ever considered that sleep can actually make your life richer in interesting experiences?
For some reason I would feel disappointed if sleep was a solved issue. I feel as though perhaps I need that daily break from being conscious for my own mental health.
Enter cocaine
Micro dosing cocaine might have positive impacts over long time periods.
We really don’t know and have made it nigh impossible to study. Obviously governments are trying to hide something.
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Well said. "Youth is wasted on the young"