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.
They do seem to often contain components you need, and do so as you note on very few calories or other downsides. A form of insurance, as it were. But as I note, I almost never eat them, and it's fine.
Sure, there are some micronutrients in vegetables. But in most (if not all) cases, you can get the equivalent from a daily vitamin, which is both easier and cheaper! I remain skeptical that vegetables have any redeeming nutritional value over a multivitamin.
Vegetables are just the human edible plant parts that are not the seed or fruit. Seeing as the bulk of all animals / insects / life forms who ever existed consume plant matter, it is very obviously self evident that they are a good food source. Necessary? Can’t be completely sure, but considering you are taking multi vitamins which consist of processed plant bits, fairly necessary, yes. You can maybe hack around it by eating meat (residual plant matter accumulated from one trophic level higher) or processed foods (processed plant matter), but those are all just complicated hacks around just eating the vegetables in the first place.
This is a new series from Emevas (strength/lifting blogger), but I think it addresses your question on #3 in depth. Series is titled: "DUNGEONS AND DIETS: NUTRITION FROM THE LENS OF DND" so I feel it fits.
The cliff notes are: You 100% need protein and fat, but carbs (i.e. fruits and veg) are to be deployed with caution and need to fit into your plan. This is a powerful way of looking at diet construction because SO MUCH public consumption diet advice proceeds from point of "how can we eat as many carbs as possible?" vs "how do we maintain our body at a healthy weight without going insane?"
It's an extended metaphor, but is one of the best things I've read on diet in a long time.
As a personal note, if I don't eat veg every day (2-3 meals a day with veg) my, uh, internal ecosystem becomes painfully sluggish and leads to cycles of bowel adventures that I do not care for. Eating some fibrous veg 2-3 times daily, taking fiber supplements mid-day or EOD combine to produce a pleasant regularity that is quite unusual in Ashkenazi circles.
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).
I'm spending a few weeks in India and on a whim, I've just started taking semaglutide (7mg oral), which costs a little under $4 per day here.
This was a switch away from metformin, which I've taken for many years and found to be moderately effective for weight loss. Metformin is an older anti-diabetic drug and I don't think it's known to have any effect on willpower/distractibility.
It's hard to tell after a week but I think the semaglutide may be making me more focused, as well as being predictably more effective than metformin as an appetite suppressant. Maybe give it a shot?
+1 for Ozempic (want to try it as well), disagreed on dental care. The best dentists in the US are way better than the dentists I've seen in Europe. After spending a few grand on dental care in the US I was able to fix up all my teeth problems ~permanently, despite not changing anything about my oral hygiene. In Europe I was constantly in and out of the dental chair - and the US doctor noted that their work was somewhat below the US standards.
Ha. I'm on Ozempic for weight loss; I've lost about 12% of my body weight and my BMI has gone from the obese range to the overweight range. But my doomscrolling persists. I used to drink a lot but I quit with the help of Naltrexone. I'm a miracle of modern chemistry. But the doomscrolling persists.
I speculate that GLP-1 agonists purely have an effect on hunger, not anything else.
However, I would bet that being hungry or having cravings for sugar might also make someone more prone to compulsive behaviors.
I think this happens because 1) people get their drives mixed up all the time (thirst for hunger, boredom for sugar cravings, etc.), 2) there's probably also a generalized "seeking" drive that gets activated by hunger or food cravings, and then motivates seeking out other pleasures too.
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.
> By log-linear regression analysis of the relative risk estimates for infectious disease markers among paid and unpaid donors from 28 published data sets, evidence was not found to indicate that the difference in risk for infectious disease markers between paid donors and unpaid donors had diminished over time (P = 0.128, not significant). Paid donors are still more likely than unpaid donors to donate blood in the period during which infectious donations escape detection by blood-screening tests (the "window-period"). Therefore, paid donations have a higher risk that labile blood components (such as red blood cells and platelets) are infected.
An example of what sort of thought process may explain the above:
> Mellstrom and Johannesson (2008) find that Swedish female college students are less willing to undertake a health test in order to be able to donate blood afterward if they are offered monetary incentives.
"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?
I think before Canada had assisted dying, they were refusing to pay for Hail Mary therapies but not offering assisted dying. If that's what you're going to do, offering assisted dying becomes an improvement.
Obviously this patient received a tragic medical diagnosis but the story doesn't persuade me that Canada is doing it wrong.
I won't try to persuade you, but I've visited the USA from Canada for healthcare twice, and both times you could see a specialist the same day (for a lot of $$) that in Canada woulda taken 6 months. In general I like the Canadian system, but there are certainly tradeoffs.
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'm pretty sure flossing to remove noticable food specks is hella effective (even if it somehow does nothing for cavities it noticably prevents pain and infection for me). I can buy that flossing when you don't have any major food bits stuck in your teeth does basically nothing though.
I left out major food bits because I figured there was no way anyone could really disagree with the desirability of that one, almost irrespective of its effect on dental health.
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.
They do seem to often contain components you need, and do so as you note on very few calories or other downsides. A form of insurance, as it were. But as I note, I almost never eat them, and it's fine.
Sure, there are some micronutrients in vegetables. But in most (if not all) cases, you can get the equivalent from a daily vitamin, which is both easier and cheaper! I remain skeptical that vegetables have any redeeming nutritional value over a multivitamin.
Something being good does not mean that it is part of the best solution...
The evidence of 'daily multivitamins' is that they're (slightly) bad overall, tho I don't know how strong the relevant evidence is.
I prioritize eating 'leafy greens' almost entirely for better pooping, but otherwise am lazy about eating vegetables (while also not avoiding them).
Can’t take this as a serious good faith argument.
Vegetables are just the human edible plant parts that are not the seed or fruit. Seeing as the bulk of all animals / insects / life forms who ever existed consume plant matter, it is very obviously self evident that they are a good food source. Necessary? Can’t be completely sure, but considering you are taking multi vitamins which consist of processed plant bits, fairly necessary, yes. You can maybe hack around it by eating meat (residual plant matter accumulated from one trophic level higher) or processed foods (processed plant matter), but those are all just complicated hacks around just eating the vegetables in the first place.
This is a new series from Emevas (strength/lifting blogger), but I think it addresses your question on #3 in depth. Series is titled: "DUNGEONS AND DIETS: NUTRITION FROM THE LENS OF DND" so I feel it fits.
The cliff notes are: You 100% need protein and fat, but carbs (i.e. fruits and veg) are to be deployed with caution and need to fit into your plan. This is a powerful way of looking at diet construction because SO MUCH public consumption diet advice proceeds from point of "how can we eat as many carbs as possible?" vs "how do we maintain our body at a healthy weight without going insane?"
It's an extended metaphor, but is one of the best things I've read on diet in a long time.
https://mythicalstrength.blogspot.com/2023/12/dungeons-and-diets-nutrition-from-lens.html
https://mythicalstrength.blogspot.com/2023/12/dungeons-and-diets-nutrition-from-lens_29.html
https://mythicalstrength.blogspot.com/2024/01/dungeons-and-diets-nutrition-from-lens.html
https://mythicalstrength.blogspot.com/2024/01/dungeons-and-diets-nutrition-from-lens_11.html
As a personal note, if I don't eat veg every day (2-3 meals a day with veg) my, uh, internal ecosystem becomes painfully sluggish and leads to cycles of bowel adventures that I do not care for. Eating some fibrous veg 2-3 times daily, taking fiber supplements mid-day or EOD combine to produce a pleasant regularity that is quite unusual in Ashkenazi circles.
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).
I'm spending a few weeks in India and on a whim, I've just started taking semaglutide (7mg oral), which costs a little under $4 per day here.
This was a switch away from metformin, which I've taken for many years and found to be moderately effective for weight loss. Metformin is an older anti-diabetic drug and I don't think it's known to have any effect on willpower/distractibility.
It's hard to tell after a week but I think the semaglutide may be making me more focused, as well as being predictably more effective than metformin as an appetite suppressant. Maybe give it a shot?
I thought oral semiglutide was still in research stages? Or am I way behind the times?
Maybe it's not approved yet in the US? Not sure, but Google "Rybelsus"
+1 for Ozempic (want to try it as well), disagreed on dental care. The best dentists in the US are way better than the dentists I've seen in Europe. After spending a few grand on dental care in the US I was able to fix up all my teeth problems ~permanently, despite not changing anything about my oral hygiene. In Europe I was constantly in and out of the dental chair - and the US doctor noted that their work was somewhat below the US standards.
Ha. I'm on Ozempic for weight loss; I've lost about 12% of my body weight and my BMI has gone from the obese range to the overweight range. But my doomscrolling persists. I used to drink a lot but I quit with the help of Naltrexone. I'm a miracle of modern chemistry. But the doomscrolling persists.
Maybe the underlying problem is the doom, not you
Plan:
step 1) solve every problem in the world
step 2) this allows me to stop doomscrolling
step 3) ...profit?
I speculate that GLP-1 agonists purely have an effect on hunger, not anything else.
However, I would bet that being hungry or having cravings for sugar might also make someone more prone to compulsive behaviors.
I think this happens because 1) people get their drives mixed up all the time (thirst for hunger, boredom for sugar cravings, etc.), 2) there's probably also a generalized "seeking" drive that gets activated by hunger or food cravings, and then motivates seeking out other pleasures too.
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.
> Missing words in the link "claims that vaccination before first infection greatly".
Looks like Zvi accidentally.
> Paying for blood donations... incentivizes people to lie about transmissible health problems that may not be testable in the resulting blood
The mechanism makes sense to me. I wanted to see what sort of research it's based on.
(https://pubmed.ncbi.nlm.nih.gov/12437514/)
> By log-linear regression analysis of the relative risk estimates for infectious disease markers among paid and unpaid donors from 28 published data sets, evidence was not found to indicate that the difference in risk for infectious disease markers between paid donors and unpaid donors had diminished over time (P = 0.128, not significant). Paid donors are still more likely than unpaid donors to donate blood in the period during which infectious donations escape detection by blood-screening tests (the "window-period"). Therefore, paid donations have a higher risk that labile blood components (such as red blood cells and platelets) are infected.
An example of what sort of thought process may explain the above:
(https://cepr.org/voxeu/columns/incentives-altruism-case-blood-donations, regarding https://econpapers.repec.org/article/tprjeurec/v_3a6_3ay_3a2008_3ai_3a4_3ap_3a845-863.htm)
> Mellstrom and Johannesson (2008) find that Swedish female college students are less willing to undertake a health test in order to be able to donate blood afterward if they are offered monetary incentives.
An abstract that lets you quickly get at some numbers: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329090/
But this meta-analysis says (https://pubmed.ncbi.nlm.nih.gov/34742615/):
> The available studies are not suitable to estimate... transmittable infectious disease risks.
Didn't read any of the research itself - and won't, unless I need a blood donation - so take the above as incomplete in the extreme.
Bonus read, semi-related: https://www.pennmedicine.org/news/news-blog/2023/june/blood-donation-blog
"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?
I think before Canada had assisted dying, they were refusing to pay for Hail Mary therapies but not offering assisted dying. If that's what you're going to do, offering assisted dying becomes an improvement.
Obviously this patient received a tragic medical diagnosis but the story doesn't persuade me that Canada is doing it wrong.
I won't try to persuade you, but I've visited the USA from Canada for healthcare twice, and both times you could see a specialist the same day (for a lot of $$) that in Canada woulda taken 6 months. In general I like the Canadian system, but there are certainly tradeoffs.
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'm pretty sure flossing to remove noticable food specks is hella effective (even if it somehow does nothing for cavities it noticably prevents pain and infection for me). I can buy that flossing when you don't have any major food bits stuck in your teeth does basically nothing though.
I left out major food bits because I figured there was no way anyone could really disagree with the desirability of that one, almost irrespective of its effect on dental health.
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.
Every doctor I know has explicitly said they don't want end of life care for themselves. Seems relevant here.
Thank you. I came here to ask that very question.
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.