Saving up medical and health related stories from several months allowed for much better organizing of them, so I am happy I split these off. I will still post anything more urgent on a faster basis. There’s lots of things here that are fascinating and potentially very important, but I’ve had to prioritize and focus elsewhere, so I hope others pick up various torches.
After reading Bottle of Lies I just can't get excited about abolishing the FDA, for similar reasons to Scott. There's a harrowing anecdote about the sketchiest batches being routed to the global south, such that African physicians are forced to distinguish between a generic medication and "that same generic medication, but purchased in the West, so it's more likely to actually have some active ingredient in it". I think basically no matter how bad of a job the government does, it's the kind of job that governments are for (long term custody of a process, capacity to shut out an entire firm that misbehaves, no incentive to build a reputation then sell it for profit) and we have to just make that work instead of trying to have private firms handling it which definitely won't work for the reason it's already not working with dud generics being produced overseas from plants the FDA has a harder time regulating.
"1. Different people work very, very differently here.
2. There are things you need, often but not always your body lets you know.
3. Vegetables good.
4. Sugar bad."
I think there is reasonable evidence for 1, 2, and 4, but why have you concluded 3 is true? My mental model for why vegetables are "good" (inasmuch as they are) is that they are a replacement for sugar-rich food and, to a lesser degree, the fiber. But most of the benefit of eating vegetables would also accrue by subsituting them with eating literally nothing, in that model.
Re Ozempic: I don't have a significant weight problem or diabetes, but I do have a doomscrolling/distractibility problem and I'm severely tempted to try and get my hands on some just to see if it helps with that (has anyone actually tried that?)
Re Dentistry: An underrated strategy for americans who regularly travel abroad to a reasonable country (e.g. to visit family in Israel or something) is to get all your dentistry done on those visits. Generally much higher quality (as the MattY piece notes, american dentists massively overprescribe), also usually much cheaper (even without insurance).
The American Hearth Association, a professional body for fireplace builders and chimneysweeps...
I feel you on the vegetable thing. The ones I was socialized to like in childhood have stuck through the ages, everything else is inherently...suspect. It has to be exactingly similar to an Approved Food. Like, a potato is okay, sure...but a "sweet" potato? What is this weird alien thing, do not want. Sometimes this means entire categories are effectively banned, since they're too far from any existing reference class. It's irrational and unfortunate, but like exercise, spending "food budget points" to make myself gag on strange gooey things is counterproductive. I just don't like avocados and no one can make me! (So much potentially good sushi ruined by obligatory avocado.)
Thanks for the writeup, informative as always. It's always cool when the future becomes a little more evenly distributed. Some of my fellow grocery baggers are taking GLP agonists now, it's exciting times. And now you've got me wondering if there's a throughline from there to reduced sales of our impulse-buy junk..."Ozempic is disinflationary"
FWIW, just based on the 2/3 of the debate that I've watched, I disagree with Zvi: I'd put zoonosis at ~90%. I also think that even if you only put zoonosis at ~30%, you should care a lot about stopping future zoonotic spillovers (altho people in rich countries who don't eat civets and raccoon dogs have less levers there perhaps).
Missing words in the link "claims that vaccination before first infection greatly".
Paying for blood donations increases the amount of blood donated, but measurably degrades the quality of blood, because it changes significantly who gives towards poorer people with higher infection rates, and incentivizes people to lie about transmissible health problems that may not be testable in the resulting blood (e.g., IIRC, early enough AIDS). That said, I guess it could increase the amounts of blood coming from populations originating from sub-Saharian Africa, which would be a good thing as that blood (with proper matching of blood sub-types) is particularly suited for typical sickle-cell patients (more common in that demographic) which need many blood transfusions throughout their lives. The overall impact of paying is not so obvious and I expect that it depends on the country. By the way, it would be interesting to differentiate the expected QALYs of a blood donation according to the donor's blood type; I wouldn't be surprised if there was a factor of 10 difference there.
"Yes, a lot of the reason Canadian health care is cheaper is that they sometimes tell you they’re not going to give you the surgery and instead suggest you consider assisted dying instead"
How long has Canadian healthcare been cheaper ? And how long have they had assisted dying?
Re: drop in life expectancy among the non-BA group attributed to cardiovascular disease, you would imagine that extending Medicaid benefits to more people would move the needle on CVD, but disappointingly, this is not what the Oregon Medicaid experiment showed.
This is especially shocking because CV risk factors are both fairly easy to measure and easy to modify.
Sorry I don't have more solid suggestions, just wanted to rebut the conclusion of the article a bit.
“Flossing isn’t effective” just doesn’t pass the smell test for me as far as being a reasonable null hypothesis. Far too much visible effect as far as removing bacterial biofilms and far too easy to observe the correlation between “flossing regularly results in no bleeding when flossing, flossing for the first time results in significant bleeding.”
I’m open to debates about the magnitude, but as regards *direction* I think that this seems like something in the core class of “short-loop tangible feedback + obvious and clear-cut causative mechanism” where we expect intuitive Bayesian reasoning to come up with pretty good priors.
I think the Elon meme and Yann LeCun are talking past one another.
I think the Elon meme has a hidden premise in that it's speaking for the non-elderly and non-chronically-ill. For certain demographics COVID was especially dangerous. For most it was not. You could reasonably predict whether or not you were in danger based on your current health conditions and age. It's also a very common experience to have been vaccinated and contracted COVID anyway.
LeCun's graph shows that the vaccine is effective at preventing death from COVID. But this is compatible with the above. Only certain demographics had a serious risk of death. It reduced overall deaths from about 5 per 100,000 people per week to 1 per 100,000 people per week.
As it happens, I called the New York Blood Center last weekend and they told me "well, we'd be happier if you make an appointment but if you show up to the GCT location they should be able to fit you in anyway!" (I have yet to test this, on my list...)
Re: "Yes, a lot of the reason Canadian health care is cheaper is that they sometimes tell you they’re not going to give you the surgery and instead suggest you consider assisted dying instead, whereas in America they will operate on you."
So, did the treatment she had done in the US actually save her life? Did it improve the quality of her life? It's kind of implied, but doesn't rule out the possibility she had a lot of treatment done that wouldn't actually help. That is, perhaps Canada was just being realistic while the US system was happy to sell a desperate, terminally ill cancer patient some expensive treatments that were unlikely to help.
Wegovy is a GLP-1 agonist, not antagonist. I'm not trying to nitpick, but those things are more or less opposites. Agonists and antagonists both bind to their intended receptor, but agonists stimulate the receptor and antagonists suppress it.
Dentist Stuff seems spot on to me. The incentives are too aligned against the consumer. However, while I don't carry dental insurance, I think it's generally a good idea as a compliance device. If you tell someone "you have to pay 200 dollars twice a year for checkups" they probably go to a lot less checkups than if you tell them "it's 33 dollars a month, your checkups are free/low cost and we discount the rest".
As a result of general laziness and a terrible experience with double billing, collections threats (sorry bae, I don't pay paid bills twice) and angry phonecalls I sort of neglected to go to the dentist for a while. In the last decade I've spent ~400 dollars on dentists + dental insurance (but I was extremely low carb for a goodly portion of that time, plus I don't eat candy outside of holidays or very many processed carbs ever (now)). Last summer I had a weird pain in my palate, went to dentist to see if I needed a root canal. Random infection, 0 cavities. Paid him for emergency visit + cleaning + prescription mouth to use till pain/infection went away.
I don't know if I just got lucky, or genetics, or mouth bacteria, or diet, but my oral hygiene routine is average at best and I'm happy to have come out well ahead on that accidental gamble.
After reading Bottle of Lies I just can't get excited about abolishing the FDA, for similar reasons to Scott. There's a harrowing anecdote about the sketchiest batches being routed to the global south, such that African physicians are forced to distinguish between a generic medication and "that same generic medication, but purchased in the West, so it's more likely to actually have some active ingredient in it". I think basically no matter how bad of a job the government does, it's the kind of job that governments are for (long term custody of a process, capacity to shut out an entire firm that misbehaves, no incentive to build a reputation then sell it for profit) and we have to just make that work instead of trying to have private firms handling it which definitely won't work for the reason it's already not working with dud generics being produced overseas from plants the FDA has a harder time regulating.
"1. Different people work very, very differently here.
2. There are things you need, often but not always your body lets you know.
3. Vegetables good.
4. Sugar bad."
I think there is reasonable evidence for 1, 2, and 4, but why have you concluded 3 is true? My mental model for why vegetables are "good" (inasmuch as they are) is that they are a replacement for sugar-rich food and, to a lesser degree, the fiber. But most of the benefit of eating vegetables would also accrue by subsituting them with eating literally nothing, in that model.
Re Ozempic: I don't have a significant weight problem or diabetes, but I do have a doomscrolling/distractibility problem and I'm severely tempted to try and get my hands on some just to see if it helps with that (has anyone actually tried that?)
Re Dentistry: An underrated strategy for americans who regularly travel abroad to a reasonable country (e.g. to visit family in Israel or something) is to get all your dentistry done on those visits. Generally much higher quality (as the MattY piece notes, american dentists massively overprescribe), also usually much cheaper (even without insurance).
Mouse immune system and human immune system are very close, one reason mice are used for immunology research.
The American Hearth Association, a professional body for fireplace builders and chimneysweeps...
I feel you on the vegetable thing. The ones I was socialized to like in childhood have stuck through the ages, everything else is inherently...suspect. It has to be exactingly similar to an Approved Food. Like, a potato is okay, sure...but a "sweet" potato? What is this weird alien thing, do not want. Sometimes this means entire categories are effectively banned, since they're too far from any existing reference class. It's irrational and unfortunate, but like exercise, spending "food budget points" to make myself gag on strange gooey things is counterproductive. I just don't like avocados and no one can make me! (So much potentially good sushi ruined by obligatory avocado.)
Thanks for the writeup, informative as always. It's always cool when the future becomes a little more evenly distributed. Some of my fellow grocery baggers are taking GLP agonists now, it's exciting times. And now you've got me wondering if there's a throughline from there to reduced sales of our impulse-buy junk..."Ozempic is disinflationary"
By now almost all of the Rootclaim COVID origins debate is published. Videos are here: https://youtube.com/@tgof137?si=b_mmFy79lQRIyYhq
And links to slides, written judge questions, and written debate answers are in the comments of the manifold market on the debate: https://manifold.markets/chrisjbillington/will-bsp9000-win-the-rootclaim-chal?r=RGFuaWVsRmlsYW4
FWIW, just based on the 2/3 of the debate that I've watched, I disagree with Zvi: I'd put zoonosis at ~90%. I also think that even if you only put zoonosis at ~30%, you should care a lot about stopping future zoonotic spillovers (altho people in rich countries who don't eat civets and raccoon dogs have less levers there perhaps).
Also re: the blood donation thing, the US currently has a pretty bad blood shortage, so now is a good time to donate. https://www.redcross.org/about-us/news-and-events/press-release/2024/red-cross-declares-emergency-blood-shortage-calls-for-donations-during-national-blood-donor-month.html
Missing words in the link "claims that vaccination before first infection greatly".
Paying for blood donations increases the amount of blood donated, but measurably degrades the quality of blood, because it changes significantly who gives towards poorer people with higher infection rates, and incentivizes people to lie about transmissible health problems that may not be testable in the resulting blood (e.g., IIRC, early enough AIDS). That said, I guess it could increase the amounts of blood coming from populations originating from sub-Saharian Africa, which would be a good thing as that blood (with proper matching of blood sub-types) is particularly suited for typical sickle-cell patients (more common in that demographic) which need many blood transfusions throughout their lives. The overall impact of paying is not so obvious and I expect that it depends on the country. By the way, it would be interesting to differentiate the expected QALYs of a blood donation according to the donor's blood type; I wouldn't be surprised if there was a factor of 10 difference there.
"Yes, a lot of the reason Canadian health care is cheaper is that they sometimes tell you they’re not going to give you the surgery and instead suggest you consider assisted dying instead"
How long has Canadian healthcare been cheaper ? And how long have they had assisted dying?
Re: drop in life expectancy among the non-BA group attributed to cardiovascular disease, you would imagine that extending Medicaid benefits to more people would move the needle on CVD, but disappointingly, this is not what the Oregon Medicaid experiment showed.
This is especially shocking because CV risk factors are both fairly easy to measure and easy to modify.
Sorry I don't have more solid suggestions, just wanted to rebut the conclusion of the article a bit.
“Flossing isn’t effective” just doesn’t pass the smell test for me as far as being a reasonable null hypothesis. Far too much visible effect as far as removing bacterial biofilms and far too easy to observe the correlation between “flossing regularly results in no bleeding when flossing, flossing for the first time results in significant bleeding.”
I’m open to debates about the magnitude, but as regards *direction* I think that this seems like something in the core class of “short-loop tangible feedback + obvious and clear-cut causative mechanism” where we expect intuitive Bayesian reasoning to come up with pretty good priors.
I think the Elon meme and Yann LeCun are talking past one another.
I think the Elon meme has a hidden premise in that it's speaking for the non-elderly and non-chronically-ill. For certain demographics COVID was especially dangerous. For most it was not. You could reasonably predict whether or not you were in danger based on your current health conditions and age. It's also a very common experience to have been vaccinated and contracted COVID anyway.
LeCun's graph shows that the vaccine is effective at preventing death from COVID. But this is compatible with the above. Only certain demographics had a serious risk of death. It reduced overall deaths from about 5 per 100,000 people per week to 1 per 100,000 people per week.
As it happens, I called the New York Blood Center last weekend and they told me "well, we'd be happier if you make an appointment but if you show up to the GCT location they should be able to fit you in anyway!" (I have yet to test this, on my list...)
Re: "Yes, a lot of the reason Canadian health care is cheaper is that they sometimes tell you they’re not going to give you the surgery and instead suggest you consider assisted dying instead, whereas in America they will operate on you."
So, did the treatment she had done in the US actually save her life? Did it improve the quality of her life? It's kind of implied, but doesn't rule out the possibility she had a lot of treatment done that wouldn't actually help. That is, perhaps Canada was just being realistic while the US system was happy to sell a desperate, terminally ill cancer patient some expensive treatments that were unlikely to help.
Wegovy is a GLP-1 agonist, not antagonist. I'm not trying to nitpick, but those things are more or less opposites. Agonists and antagonists both bind to their intended receptor, but agonists stimulate the receptor and antagonists suppress it.
Dentist Stuff seems spot on to me. The incentives are too aligned against the consumer. However, while I don't carry dental insurance, I think it's generally a good idea as a compliance device. If you tell someone "you have to pay 200 dollars twice a year for checkups" they probably go to a lot less checkups than if you tell them "it's 33 dollars a month, your checkups are free/low cost and we discount the rest".
As a result of general laziness and a terrible experience with double billing, collections threats (sorry bae, I don't pay paid bills twice) and angry phonecalls I sort of neglected to go to the dentist for a while. In the last decade I've spent ~400 dollars on dentists + dental insurance (but I was extremely low carb for a goodly portion of that time, plus I don't eat candy outside of holidays or very many processed carbs ever (now)). Last summer I had a weird pain in my palate, went to dentist to see if I needed a root canal. Random infection, 0 cavities. Paid him for emergency visit + cleaning + prescription mouth to use till pain/infection went away.
I don't know if I just got lucky, or genetics, or mouth bacteria, or diet, but my oral hygiene routine is average at best and I'm happy to have come out well ahead on that accidental gamble.