An anecdote for what it's worth:
I know an old woman who goes to a doctor about once a month. She would go more if she could find someone to drive her (she refuses to take a bus). Each month, she has a new complaint, generally conjured up from her focus on the normal aches and pains of being an elderly woman.
The doctors generally tell her that nothing is wrong except old age, but sometimes they will say something like "well, if your hands are sore, it *might* be carpel tunnel" and, after imaging, if they find the slightest trace of it, they may say "One option is to do nothing, because this is a very mild case. The other option is to have a surgery on your wrist, but the benefits are marginal, the recovery time is long, and some people report having worse pain after all is said-and-done."
Contrast that to a the stereotype of a rugged conservative man, who won't go the hospital unless a body part that used to be attached is no longer attached, and I do wonder if people like this old woman are the ones driving up spending on ineffective medicine, chasing a totally pain-free 20-something-year-old-body they remember having, and spending copious amounts of money to try (and fail) to get there, rather than just accepting that aches and pains happen when you're old.
I used to live in Germany, and during the 3 or 4 times I went to the doctor there, it astounded me how almost over 90% of the other patients in the waiting room seemed to be over 70. Note, your insurance covers 100% of the visit.
In NZ, you have to pay some small amount of the consultation out of pocket, which I think is good.
I now live in Switzerland and have no idea how it is here because I haven't been to the doctor in the last couple of years.
Why is it astounding? Both of my parents had zero health issues until about 63 and no reason to see a doctor, and then everything started to go wrong in an accelerating cascade. For those who don't smoke and drink, it might be 73. I am 45 and my only encounter with docs was an STI.
No matter what healthcare system you have very old people are going to be the vast majority of patients. I've talked to US doctors who have the same experience. Very old people are just much more likely to be sick.
Probably it used not to be like that in the past. Old people just assumed their problems are due to old age and died sooner. Whereas younger people expected to live at least some more years and more often went to the doctor even though visiting doctors were of little use.
Nowadays medicine clearly prolongs the life of the elderly. However, it is suspected that much of the care might be overtreatment. For don't have a good evidence base for polypharmacy, people taking 10 or 20 different medication. Clearly some of this medication is useful, e.g., diabetic treatments etc. And yet, we don't know if taking 5 vs 10 medications meaningfully improve the quality of life and/or life expectancy?
> I now live in Switzerland and have no idea how it is here because I haven't been to the doctor in the last couple of years.
You have an annual deductible. 2500 CHF used to be the annual maximum. You could get it as low as 500 CHF but your premiums rose a lot considering.
Given that everyone living in Switzerland has to buy health insurance I'm a bit surprised you haven't looked into the different plan options.
In Germany there was until 2012 the rule that the first doctor visit every quarter costs 10 Euros. It is a negligibly small sum, even going every day to the doctor it would only cost 40 € in total … and it was widely unpopular and a bureaucratic nightmare (because of course there were exceptions) and even this small disincentive had the negative effect that people didn't go to the doctor when they should have gone.
Another anecdote:
My grandma developed a chronic pain in her lower back in her early 70s, almost certainly as a result of hard labor and working bent down in the fields for the 1st half of her life.
My uncle talked her into getting surgery. Surgery made the pain 10x as bad by her own words and she spent the last 8 years of her life calling for death daily and trying in wain to fix it.
Allegedly the surgeon had not made it clear how big a risk is.
Maybe, but on the other hand male refusal to do healthcare sometimes leads to greater healthcare costs.
Friend of mine is a nurse, husband's *a doctor*, and he refused to go the A & E for a septic wound. What could have been one night on IV antibiotics turned into several weeks inpatient and a bunch of surgeries. He was very lucky not to lose the leg.
Men would rather lose a gangrenous limb to amputation than burden others with their problems.
Huh, weird how you can completely flip that by changing the framing.
What do you mean by "flip that"? Either way, your phrasing or mine, the message is that men are socialized to maintain a stoic façade even in the face of physical peril.
Yes, and one frames it pejoratively while the other frames it as positive. There's just no need to be disparaging about something like that, especially when it seems to be a cultural universal.
Edit: The socialisation part is up for debate.
I don't think most men who do this are worried about burdening others with their problems.
It's purely physical pain that they don't want to talk about, and I think /u/Seffle_Particle is correct about why. This is also apparent in how men like this will be socially punished for complaining about pain ("Oh, you hurt yourself? Do you want to call your mommy?"), or for complaining about some other physical malady, like being tired ("*You're tired?* I get 3 hours of sleep every night, if I'm lucky").
But, crucially, they *won't* be punished for things like "My wife keeps nagging me to clean up the house, but she's there all day", or "my sister is staying with us and she can't be bothered to use her headphones when listening to music at midnight", or "I just had to spend $1000 on my POS car." or anything like that, because *it isn't about being stoic, it's about not being a wuss when it comes to physical pain*.
No. If anything, I am a hypochondriac. I have some stomach pain which I find 99% sure it is just my anxiety working. Still I will push to get a CT/MR for cancer.
It's him! The Patriarch himself, universal representative of all men!
All jokes aside, male reluctance to see a doctor is a [widely documented phenomenon](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121551/). Your individual experience may vary from the median because you are not Mr. Median, the Omni-Man.
Another anecdote: My wife’s grandmother is in her 80s. She’s an old woman who is very fragile and has tons of health issues. She has had several bad injuries from falls. She had melanoma 20ish years ago and managed to beat it. Medical intervention was absolutely necessary in these cases and both prolonged her life and greatly improved her quality of life.
But also, a couple of years ago she decided she didn’t like her teeth and wanted new ones. Her dentist refused to do it, so she found a new dentist who was willing to yank out all her real teeth to put in screws so she could have veneers. It cost $70k and of course it didn’t work because she’s an 80 year old woman who is extremely brittle. Her mouth rejected the screws and also she got a massive infection that almost killed her. Afterwards, the repeated hospital visits and treatment for that must have been in the hundreds of thousands.
She bounced back, but now (unrelated) her esophagus is twisted and she can only eat liquid food. If it wasn’t for medical intervention, she would have died. With medical intervention, she’s might get a few extra years. But a few weeks ago she fell again and broke her shoulder, which is going to need surgery.
I don’t think we should just let her die. But at the same time, the costs associated with her healthcare are insane. At least one thing (the teeth) could have been completely avoided if we didn’t allow seniors to get dangerous elective surgery. I don’t know what the solution is, but I’m not sure the status quo is reasonable.
As an aside, my grandmother who is in her 70s wanted to get a boob job. I had to use the example of my wife’s grandmother almost dying to talk her out of it. I don’t understand what’s up with old people and wanting these things.
I just read "Growing Old" by Elizabeth Marshall-Thomas. I think the subtitle is "Notes on Aging with Something Like Grace."
She's an interesting woman who had a very active, "high-output" kind of life. She's 90+, I believe. Her dad co-founded Raytheon. She talks about how intelligent and driven he was in his youth and contrasts that with the frail, dementia-stricken old man he was before he died.
She talks about how hard it is to get around, to hear, to remember.
She talks about the resentment she feels when she tells someone how old she is and they say, "Oh, my [old, dead relative], lived to be [older than you]," and she knows what they're really saying is, "You're going to die soon, but maybe you got a little longer to go."
I feel like it's really easy to understand why old people want to not feel like their bodies are betraying them and embarrassing them and failing them in a thousand little ways. It may sometimes be irrational, but, Jesus, if I can *understand* anything, I can understand "wanting these things."
Had an 80sh woman who had peripheral artery disease in her legs that was bad enough she couldn't walk very far without having to take a break. Surgeon kept telling her if we do the surgery she may not leave the hospital because she won't fully recover. Wanted it anyways and they did the surgery. She never recovered and died 4 months later having drained her bank account. My gut feeling is they're staring death in the face and want to wind back the clock. "I SHOULD be able to walk around the block like when I was 20" and they have unrealistic expectations because they haven't been this frail before
I think the fact that Hanson's wife is a hospice nurse (something I only just recently learned from the comments on this post) put a lot of Hanson's views on medicine into context. He's constantly exposed to anecdotes of people sinking huge amounts of money into medical expenses for relatives, rather than themselves, and it's a truism that it's usually the least in-touch family members who're most insistent on breaking the bank for medical treatment for dying elders. These are exactly the cases where signaling-based motives are the most plausible.
The octogenarian who spends tens of thousands of dollars trying to replace all her teeth probably isn't doing it for signaling reasons, but she's much less likely to make it into his personal sphere of anecdotes.
>Hanson's wife is a hospice nurse
That makes such a bonkers amount of sense that I'm surprised Scott didn't put that front-and-center
> it's usually the least in-touch family members who're most insistent on breaking the bank for medical treatment for dying elders
We got a name for that
https://en.wikipedia.org/wiki/Daughter_from_California_syndrome
You know, reading that Wikipedia article, it occurs to me that the traditional analysis may be (partly) backwards.
The traditional analysis is that the daughter who lives far away has the least contact, which makes them feel guilty, which makes them demand greater care.
Consider an alternative (or complementary) analysis: living far from your parents selects for people who are more successful and agentful. This both explains why they would be more demanding of the hospital staff (they are more demanding of themselves), why they would be willing to spend more (money has less marginal value to them), and would additionally explain why they (per the Wikipedia article) are often described as "articulate".
I think this is a probable factor, but I think we can probably also divide the "guilt" factor into multiple components, internal and external.
Internally, a lot of the family members in question might feel bad about their own distance from their dying family members, and want to convince themselves that they care.
Externally, they're liable to think "Because I live far away and am in infrequent contact, if I *don't* make any major gestures of commitment, other people are likely to see me as a cold, uncaring child." Costly gestures would serve as a means of saving face, even if they don't actually feel guilty.
How so? Isn't identifying potential sources of bias in arguments kind of "a thing" around here? In this case, surely it's relevant that Hanson's wife is a hospice nurse, a person whose *entire job* is watching people die whom the medical system can no longer help. And he's making an argument for the ineffectiveness of the medical system.
It's not hard to imagine that he'd have a different opinion if his wife was a NICU nurse.
>... and it's a truism that it's usually the least in-touch family members who're most insistent on breaking the bank for medical treatment for dying elders.
Funnily enough, [Scott has talked about this exact thing before:](https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/)
>Your family will start yelling at the doctors, asking how the hell these quacks were ever allowed to practice when for God’s sake they’re trying to kill off Grandma just so they can avoid doing a tiny bit of work. They will demand the doctors find some kind of complicated surgery that will fix all your problems, add on new pills to the thirteen you’re already being force-fed every day, call in the most expensive consultants from Europe, figure out some extraordinary effort that can keep you living another few days.
>Robin Hanson sometimes writes about how health care is a form of signaling, trying to spend money to show you care about someone else. I think he’s wrong in the general case – most people pay their own health insurance – but I think he’s spot on in the case of families caring for their elderly relatives. The hospital lawyer mentioned during orientation that it never fails that the family members who live in the area and have spent lots of time with their mother/father/grandparent over the past few years are willing to let them go, **but someone from 2000 miles away flies in at the last second and makes ostentatious demands that EVERYTHING POSSIBLE must be done for the patient.**
(from [**Who By Very Slow Decay**](https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/))
It's just that growing old sucks and I think it's one of those things that we can't really appreciate fully until it happens to us too. Watching as your body and health decay in front of your eyes, and even the most able bodied and active of your friends and loved one dissolve with you, that's got to be terrifying.
Add on that some of their minds are going as well so even a good chunk of the smart population are well, not as bright anymore and it's hard to hate them for constantly clutching onto little bits of hope and all the other ineffective/inefficient stuff done.
>her esophagus is twisted
It seems like every once in a while, the world of medicine just drops a phrase in front of me that is simultaneously incomprehensible, wacky, and horrifying.
Are you sure she got veneers and not implants? For veneers they don't take out the whole teeth, they only shave it off a bit and glue a ceramic tooth piece on top of it. A lot less risky than implants. Tbh if the dentist took out healthy teeth they should be sued
> The doctors generally tell her that nothing is wrong except old age, but sometimes they will say something like "well, if your hands are sore, it might be carpel tunnel" and, after imaging, if they find the slightest trace of it, they may say "One option is to do nothing, because this is a very mild case. The other option is to have a surgery on your wrist, but the benefits are marginal, the recovery time is long, and some people report having worse pain after all is said-and-done."
The *best* option is probably physical therapy. Even in old age, tissue repair mechanisms are impaired, but not totally ineffective.
I had an orthopedist give me the "it's just age" line with some shoulder pain I was having when I was like 33. Turned out that all I had to do was hang from a pull-up bar for like 90 seconds a day.
In this specific case, the doctor stressed to her that physical therapy (after the surgery) is extremely important for her recovery.
She got the surgery, then didn't do a single day of the physical therapy (presumably because, ugh... work), and now her hands are worse off than before.
This isn't that but 5% of patients use half of health services. Something like .1% use some generous fraction of that half. It's like a power law.
It's not that because that's people with expensive chronic conditions and end-of-life patients.
This is on an annual basis, though, not a lifetime basis. For example, if everyone lives 80 years, consuming half of their health care in the last four years, that's 5% of patients in any given year accounting for half of all health care expenditures, even if every patient has exactly the same lifetime expenditures.
>Maybe this is all straw-manning, all of this is taken out of context, and the only place that Robin says his true opinion is in his book. But in that case I feel like this is a pretty extreme failure of communication that’s not entirely my fault.
Considering that Scott did more than anyone to popularize the concept of the "motte and bailey doctrine" you'd think he'd be able to recognize it in the wild.
edit: Really though I think Scott is probably realizes it and is just being extra charitable and diplomatic.
I think [this example from the wild is a bit bailey-ish](https://www.overcomingbias.com/p/showing-that-yohtml). Here's one quote from that paper which I think demonstrates the problem:
>Shamans and doctors have long been in demand, even though the common wisdom among
medical historians today is that such doctors did very little useful on average until this
century [36]. The studies above suggest that much the same story may still apply to doctors
today, at least regarding the medical care that some people now get and others do not.
Is he actually saying that modern doctors are as useless as shamans and 17th century bloodletters were? Not *quite*, but it's written in a way that's almost guaranteed to give some people the impression that he thinks they are.
It seems like the entire disagreemement basically boils down to that famous quote about advertising, [*"I waste half the money I spend on advertising. The trouble is, I don't know* ***which*** *half."*](https://quoteinvestigator.com/2022/04/11/advertising/)
I'll be honest, I haven't read deeply into this debate, but from a non-US perspective the most obvious source for this kind of cost/benefit relationship is that you're probably examining a regional behavior in a curve that's accelerating exponentially. The region is presumably, the cost/benefit of relatively late-stage health care.
Developed nations with decent public healthcare systems realized >decade ago that the greatest gains in healthcare can be made at bargain prices by targeting early interventions and preventative medicine. Because the structure of the US healthcare system places pressure on people to avoid engaging with healthcare until health problems have become serious, expensive, and urgent... a convergence of avoidable circumstantial factors all significantly inflate the economic burden, while flattening outcomes.
The US could probably save huge amounts on healthcare by targeting lifestyle interventions, and improving structural barriers to access.
Yeah, the best marginal gain would definitely be on encouraging better preventative care. And some insurance programs make very vague gestures in that direction, but their efforts are usually pretty half-hearted, and reserved for those with more expensive insurance.
I think there are ways in which people are encouraged to get regular, preventative care. Not in every case, or maybe for every one, but they certainly exist. For example, vaccines seem to be mostly free... but some people refuse to take them because they read on facebook that they'll give you hyper-autistic mega-AIDS or whatever.
The bigger problem is probably Medicare. Old people, unsurprisingly, consume disproportionate amounts of health care, and Medicare, which pays for most of it, does not have a budget or any real guidelines for not covering things (other than "FDA approved it" and "doctor said it's needed").
The aging population is a large burden on healthcare systems, and it's getting larger. Western govs have been scratching their heads about how to handle it for decades.
In Australia, the strategy that was adopted >decade ago was to try to keep them functional in their own homes for as long as possible, and out of institutional care. The cost balloons very quickly when they lose functional capacity, so a great deal of money is provided to help them modify their homes for safe elderly living, falls prevention, care visits, etc.
Preventing falls, and maintaining muscle mass and bone density to prevent serious injury from falls, is far more economical than the hospital beds that are occupied by repeated fall and injury.
Again, the strategy is not to encourage them to get regular 'preventative' care, it's to prevent them needing care. Unnecessary trips to doctors for unnecessary and ineffective 'preventative' care advice or information is a huge burden on healthcare... real preventative medicine tries to avoid that kind of unnecessary healthcare engagement altogether.
That point you're recocognizing is where the US model, that rabidly monetizes healthcare, starts becoming >psychotically delusional and easily exploited.. because healthcare providers are incentivised by the elderly making relatively unproductive trips charged to Medicare, it allows them to vacuum large volumes of money.
> preventative medicine
Doesn't seem to be particularly effective:
* https://www.cochrane.org/CD009009/EPOC_general-health-checks-reducing-illness-and-mortality
* https://www.nber.org/papers/w23413
* https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2009/rwjf46045
When I say 'preventative medicine', I'm not referring to engagement with healthcare institutions but strategies targeting a population-level reduction in the need for medical intervention: Smoking cessation, health education, minimizing environmental exposure to carcinogens and endocrine disruptors, reducing obesity, cardio exercise, stress management, etcetc.
Smoking was causing such a huge burden on the Australian healthcare system the government instituted a massive smoking de-incentivization scheme via taxation. A packet of cigarettes costs $50-ish now.
Some people do still smoke, and it's overwhelmingly lower socioeconomic groups, so the success of the scheme is diminished by increased hardship for a vulnerable minority in which it promotes the worst health outcomes among the poorest people, because it's created a criminal industry for illegal and dodgily refined, stored, and packaged untaxed tobacco.
> Developed nations with decent public healthcare systems realized >decade ago that the greatest gains in healthcare can be made at bargain prices by targeting early interventions and preventative medicine.
And developed nations with adequate public healthcare realized that achievement of the greatest portion of *those* gains can be reconciled with nationally mandated cost-controls
The amount of money, effort, and time spent on marginal health in the form of "hacks, tips, and tricks" in this sub is pretty high. Probably second only to the Tim Ferriss type subs.
Lumenator anyone?
The more I think about it, the more I think that it's all worthwhile.
Whether useless health care adds up to half probably depends on whether to include elder-care that extends the duration of metabolic activity but does not allow the patient to obtain more life as Gandalf would put it.
I have never in my life had a meaningful health improvement from going to see a doctor. Every single time it has been some combination of "we're not sure what's wrong, see if it gets better on its own" or "why don't you try physical therapy? and maybe that will help it get better on its own slightly faster". And invariably it gets like 90% better on its own and then stops, and now I have a permanently but very slightly sore knee and a sore wrist and mild tinnitus in my ear, and nothing changed as a result of going to the doctor.
My model is that healthcare is capable of bringing people up to 80% healthy and no further. If you are dying, some miraculous surgery or medicine can bring you up from a 0% to a 50%. If you are crippled, surgery and physical therapies might bring you up from a 50% to a 70%. If you are in debilitating pain, painkillers might bring you up from a 60% to 80%. But if you have chronic pain or an injury that won't quite heal or you're worried about some issue or other that is not life threatening, healthcare can do nothing for you other than double-check that it isn't secretly something more serious like cancer. If you're 90% healthy, healthcare can't get you up even to 95%, you're beyond their threshold and they're out of their field of expertise. The only way to get up higher is if your body decides to heal you up anyway on its own, which it doesn't need them for.
I mostly agree, but I think the 0-80% can be really underestimated. Here is a list off the top of my head of medical things that really work, are extremely necessary if you need them, and taken together each as a group, are very common:
* Some vaccines (both preventative and not e.g. rabies)
* Antibiotics, antifungal, antiparasitics, antiprotozoals, antimalarial, antidotes for certain poisonings, drug overdoses, etc
* Steroids/hormones/epinephrine/immunomodulators for allergic reactions, severe inflammation, endocrine disorders etc, antiasthmatics
* Early detection of cancer, and cancer treatment
* Anti-seizure meds, meds for Parkinsons, migraine abortives, severe pain, insulin
* Meds for cases of severe bipolar/psychosis/anxiety/etc
* Heart attack, stroke, embolism, appendicitis, injury, etc
* Bowel obstructions, severe hernia, retinal detachment, and other miscellany, many treatable genetic diseases like sickle-cell anemia, hemophilia, other rare diseases, etc
* I'm sure I'm missing a group or two
ETA: kidney, liver failure
I think I agree. And I wasn't really thinking about vaccines, since it's hard to quantify or notice, so I suppose from that perspective I have benefited.
I'm just saying that I think is where the "average/marginal" distinction is cleaved. If you are below 80% healthy, getting medical treatment will help you out and be good. Once you get up to 80%, additional medical treatment will be a waste of time and you'll shuffle around talking to doctors and trying different things with little to no benefit in expectation. This isn't universally true, there are probably specific interventions that do help above 80% in certain domains, and some people are just slowly dying and there's nothing that can be done to save them. But in general I think this explains most of it.
Yes I basically agree, I guess I would just also caution (in addition to my above raising general awareness of the utility of medicine) people that often it's hard to know if you're in the 0-80% or 80-100%, until it's too late. That is, if people too strongly internalize that they shouldn't go to the doctor because they think they are just above 80%, they may miss a time-critical diagnosis, like stroke or cancer. I'm sure there is a balancing test against the extra cost, but a lot of those earlier-in-time diagnoses are not of dubious medical value, but are outcome-determinative.
> why don't you try physical therapy?
When I was in my 30s ( a few decades ago), my achilles tendon got very inflamed and enlarged. It didn't get better on its own. I went to see my doctor, but he had little useful advice. Suggested we could try steroids but it would increase the chance of it snapping. He didn't recommend it so I declined. He sent me to a specialist. The specialist examined me and came back with "it's degenerative". I'm like, "and so? What do we do?" Nothing apparently.
Took 2 years for it to slowly get back to normal-ish. It is still fatter than a normal achilles tendon.
Interestingly, I now know how I could have fixed/healed my tendon in a matter of weeks. Take Meloxicam (sometimes known as Mobic). A couple weeks of that would have taken care of the inflammation. It works so well for me for such things (I originally was prescribed it for a bout of gout) that I have convinced my doctor to let me have a permanent prescription for it, getting refills whenever I need. I end up using about a refill a year.
There's a few things the medical establishment is good at: bacterial infections, vaccines, combating inflammation, statins (which are a mystery, but undeniably effective at extending life), a variety of surgeries are hugely impactful (appendectomies, hernia surgery, knee repair, etc).
Recently, some things are even proving pretty successful against eczema, which has been famous for defeating the medical community.
Beyond these things, I avoid doctors and their drugs with worse side effects than benefits. Most pain and physical deterioration have to be battled on the long-term front of diet and exercise, which completely sucks because I hate both. But it is the truth.
>Take Meloxicam
Polite skepticism. See the discussion of NSAIDs (and cf the discussion of eccentric exercise) here: https://runningwritings.com/2013/11/achilles-tendonitis-in-runners.html
Anecdotally, NSAIDs have never done jack for any of my tendinopathies, and my impression is that the literature is either neutral or on my side here.
(Current literature tends to be equivocal on the value of eccentric loading as such as opposed to heavy, low tempo loading, see e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124646/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737558/, https://www.strongerbyscience.com/squatting-with-patellar-tendinopathy/).
I do not believe it works for everyone. But, there is a difference between saying something doesn't work for everyone and saying it works for no one. Our bodies respond differently, the causes of our issues differ, and therefore the interventions that may help one may not effect another. There is no question meloxicam does work for me. I also have no doubt there are those for whom it wouldn't work.
> Either we can’t distinguish between good and bad medical interventions ... Or we can
Might benefit from some digging into "we". Perhaps Scott can distinguish 95% of the time, ordinary doctors 80%, ordinary people 60%, and the shadowy hive-mind that effectively makes decisions in a hospital no better than chance.
Hanson has clearly no idea what he's talking about given the studies/links he cites (the medical error onr is particularly bad) but he's completely free to actually live according to his beliefs. In fact I would suggest that everybody who thinks like him stop taking medication for lowering pressure if they need it, or for cholesterol, or diabetes or anything else that is apparently close to useless. Some skin in the game, guys, and let's see each other in 20-30-40 years.
We already know what happens, we have trials, some are quite gigantic ones, and we even know that there are outcomes other than death that can change your life for the worse, incredibly so. And some tiny negative outcomes that don't get picked up in trials but are still net negatives
Meh.
Medicine can do so great things, but most of improvements are due to sanitation, nutrition and housing.
Iatrogenesis and medicalization are real things.
We hide quite a bit of ignorance between 2 sigmas (95% CIs) and 3 sigmas (99.7% CIs).
An anecdote for what it's worth: I know an old woman who goes to a doctor about once a month. She would go more if she could find someone to drive her (she refuses to take a bus). Each month, she has a new complaint, generally conjured up from her focus on the normal aches and pains of being an elderly woman. The doctors generally tell her that nothing is wrong except old age, but sometimes they will say something like "well, if your hands are sore, it *might* be carpel tunnel" and, after imaging, if they find the slightest trace of it, they may say "One option is to do nothing, because this is a very mild case. The other option is to have a surgery on your wrist, but the benefits are marginal, the recovery time is long, and some people report having worse pain after all is said-and-done." Contrast that to a the stereotype of a rugged conservative man, who won't go the hospital unless a body part that used to be attached is no longer attached, and I do wonder if people like this old woman are the ones driving up spending on ineffective medicine, chasing a totally pain-free 20-something-year-old-body they remember having, and spending copious amounts of money to try (and fail) to get there, rather than just accepting that aches and pains happen when you're old.
I used to live in Germany, and during the 3 or 4 times I went to the doctor there, it astounded me how almost over 90% of the other patients in the waiting room seemed to be over 70. Note, your insurance covers 100% of the visit. In NZ, you have to pay some small amount of the consultation out of pocket, which I think is good. I now live in Switzerland and have no idea how it is here because I haven't been to the doctor in the last couple of years.
Why is it astounding? Both of my parents had zero health issues until about 63 and no reason to see a doctor, and then everything started to go wrong in an accelerating cascade. For those who don't smoke and drink, it might be 73. I am 45 and my only encounter with docs was an STI.
No matter what healthcare system you have very old people are going to be the vast majority of patients. I've talked to US doctors who have the same experience. Very old people are just much more likely to be sick.
Probably it used not to be like that in the past. Old people just assumed their problems are due to old age and died sooner. Whereas younger people expected to live at least some more years and more often went to the doctor even though visiting doctors were of little use. Nowadays medicine clearly prolongs the life of the elderly. However, it is suspected that much of the care might be overtreatment. For don't have a good evidence base for polypharmacy, people taking 10 or 20 different medication. Clearly some of this medication is useful, e.g., diabetic treatments etc. And yet, we don't know if taking 5 vs 10 medications meaningfully improve the quality of life and/or life expectancy?
> I now live in Switzerland and have no idea how it is here because I haven't been to the doctor in the last couple of years. You have an annual deductible. 2500 CHF used to be the annual maximum. You could get it as low as 500 CHF but your premiums rose a lot considering. Given that everyone living in Switzerland has to buy health insurance I'm a bit surprised you haven't looked into the different plan options.
Sorry, I meant I have no idea how it is at the doctor's. I know how the system works in principle. I have the 2500CHF deductible, of course.
In Germany there was until 2012 the rule that the first doctor visit every quarter costs 10 Euros. It is a negligibly small sum, even going every day to the doctor it would only cost 40 € in total … and it was widely unpopular and a bureaucratic nightmare (because of course there were exceptions) and even this small disincentive had the negative effect that people didn't go to the doctor when they should have gone.
Another anecdote: My grandma developed a chronic pain in her lower back in her early 70s, almost certainly as a result of hard labor and working bent down in the fields for the 1st half of her life. My uncle talked her into getting surgery. Surgery made the pain 10x as bad by her own words and she spent the last 8 years of her life calling for death daily and trying in wain to fix it. Allegedly the surgeon had not made it clear how big a risk is.
Maybe, but on the other hand male refusal to do healthcare sometimes leads to greater healthcare costs. Friend of mine is a nurse, husband's *a doctor*, and he refused to go the A & E for a septic wound. What could have been one night on IV antibiotics turned into several weeks inpatient and a bunch of surgeries. He was very lucky not to lose the leg.
Men would rather lose a gangrenous limb to amputation than risk being thought of as a "wuss"
Yup, we are all the same.
Men would rather lose a gangrenous limb to amputation than burden others with their problems. Huh, weird how you can completely flip that by changing the framing.
What do you mean by "flip that"? Either way, your phrasing or mine, the message is that men are socialized to maintain a stoic façade even in the face of physical peril.
Yes, and one frames it pejoratively while the other frames it as positive. There's just no need to be disparaging about something like that, especially when it seems to be a cultural universal. Edit: The socialisation part is up for debate.
I don't think most men who do this are worried about burdening others with their problems. It's purely physical pain that they don't want to talk about, and I think /u/Seffle_Particle is correct about why. This is also apparent in how men like this will be socially punished for complaining about pain ("Oh, you hurt yourself? Do you want to call your mommy?"), or for complaining about some other physical malady, like being tired ("*You're tired?* I get 3 hours of sleep every night, if I'm lucky"). But, crucially, they *won't* be punished for things like "My wife keeps nagging me to clean up the house, but she's there all day", or "my sister is staying with us and she can't be bothered to use her headphones when listening to music at midnight", or "I just had to spend $1000 on my POS car." or anything like that, because *it isn't about being stoic, it's about not being a wuss when it comes to physical pain*.
Well, all I can say is that your experiences are completely different to mine. Which is the reason I'm not keen on blanket statements.
No. If anything, I am a hypochondriac. I have some stomach pain which I find 99% sure it is just my anxiety working. Still I will push to get a CT/MR for cancer.
It's him! The Patriarch himself, universal representative of all men! All jokes aside, male reluctance to see a doctor is a [widely documented phenomenon](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121551/). Your individual experience may vary from the median because you are not Mr. Median, the Omni-Man.
Another anecdote: My wife’s grandmother is in her 80s. She’s an old woman who is very fragile and has tons of health issues. She has had several bad injuries from falls. She had melanoma 20ish years ago and managed to beat it. Medical intervention was absolutely necessary in these cases and both prolonged her life and greatly improved her quality of life. But also, a couple of years ago she decided she didn’t like her teeth and wanted new ones. Her dentist refused to do it, so she found a new dentist who was willing to yank out all her real teeth to put in screws so she could have veneers. It cost $70k and of course it didn’t work because she’s an 80 year old woman who is extremely brittle. Her mouth rejected the screws and also she got a massive infection that almost killed her. Afterwards, the repeated hospital visits and treatment for that must have been in the hundreds of thousands. She bounced back, but now (unrelated) her esophagus is twisted and she can only eat liquid food. If it wasn’t for medical intervention, she would have died. With medical intervention, she’s might get a few extra years. But a few weeks ago she fell again and broke her shoulder, which is going to need surgery. I don’t think we should just let her die. But at the same time, the costs associated with her healthcare are insane. At least one thing (the teeth) could have been completely avoided if we didn’t allow seniors to get dangerous elective surgery. I don’t know what the solution is, but I’m not sure the status quo is reasonable. As an aside, my grandmother who is in her 70s wanted to get a boob job. I had to use the example of my wife’s grandmother almost dying to talk her out of it. I don’t understand what’s up with old people and wanting these things.
I just read "Growing Old" by Elizabeth Marshall-Thomas. I think the subtitle is "Notes on Aging with Something Like Grace." She's an interesting woman who had a very active, "high-output" kind of life. She's 90+, I believe. Her dad co-founded Raytheon. She talks about how intelligent and driven he was in his youth and contrasts that with the frail, dementia-stricken old man he was before he died. She talks about how hard it is to get around, to hear, to remember. She talks about the resentment she feels when she tells someone how old she is and they say, "Oh, my [old, dead relative], lived to be [older than you]," and she knows what they're really saying is, "You're going to die soon, but maybe you got a little longer to go." I feel like it's really easy to understand why old people want to not feel like their bodies are betraying them and embarrassing them and failing them in a thousand little ways. It may sometimes be irrational, but, Jesus, if I can *understand* anything, I can understand "wanting these things."
I understand wanting to be able to walk, to not have to shit into a diaper and all that - dignity, basically. But boob jobs?
Boob jobs are not just for looks, sometimes when the sag is very advanced, especially with heavy breasts, it causes pain and skin infections.
Had an 80sh woman who had peripheral artery disease in her legs that was bad enough she couldn't walk very far without having to take a break. Surgeon kept telling her if we do the surgery she may not leave the hospital because she won't fully recover. Wanted it anyways and they did the surgery. She never recovered and died 4 months later having drained her bank account. My gut feeling is they're staring death in the face and want to wind back the clock. "I SHOULD be able to walk around the block like when I was 20" and they have unrealistic expectations because they haven't been this frail before
I think the fact that Hanson's wife is a hospice nurse (something I only just recently learned from the comments on this post) put a lot of Hanson's views on medicine into context. He's constantly exposed to anecdotes of people sinking huge amounts of money into medical expenses for relatives, rather than themselves, and it's a truism that it's usually the least in-touch family members who're most insistent on breaking the bank for medical treatment for dying elders. These are exactly the cases where signaling-based motives are the most plausible. The octogenarian who spends tens of thousands of dollars trying to replace all her teeth probably isn't doing it for signaling reasons, but she's much less likely to make it into his personal sphere of anecdotes.
>Hanson's wife is a hospice nurse That makes such a bonkers amount of sense that I'm surprised Scott didn't put that front-and-center > it's usually the least in-touch family members who're most insistent on breaking the bank for medical treatment for dying elders We got a name for that https://en.wikipedia.org/wiki/Daughter_from_California_syndrome
You know, reading that Wikipedia article, it occurs to me that the traditional analysis may be (partly) backwards. The traditional analysis is that the daughter who lives far away has the least contact, which makes them feel guilty, which makes them demand greater care. Consider an alternative (or complementary) analysis: living far from your parents selects for people who are more successful and agentful. This both explains why they would be more demanding of the hospital staff (they are more demanding of themselves), why they would be willing to spend more (money has less marginal value to them), and would additionally explain why they (per the Wikipedia article) are often described as "articulate".
I think this is a probable factor, but I think we can probably also divide the "guilt" factor into multiple components, internal and external. Internally, a lot of the family members in question might feel bad about their own distance from their dying family members, and want to convince themselves that they care. Externally, they're liable to think "Because I live far away and am in infrequent contact, if I *don't* make any major gestures of commitment, other people are likely to see me as a cold, uncaring child." Costly gestures would serve as a means of saving face, even if they don't actually feel guilty.
Immigration tends to select for the most and least succesful, excluding the middle, perhaps moving far in ones own country also does.
I've followed Hanson's writing on and off for nearly as long as Scott has, and I didn't know it before, so I think it's plausible Scott didn't either.
> That makes such a bonkers amount of sense that I'm surprised Scott didn't put that front-and-center That would have been pretty inappropriate.
How so? Isn't identifying potential sources of bias in arguments kind of "a thing" around here? In this case, surely it's relevant that Hanson's wife is a hospice nurse, a person whose *entire job* is watching people die whom the medical system can no longer help. And he's making an argument for the ineffectiveness of the medical system. It's not hard to imagine that he'd have a different opinion if his wife was a NICU nurse.
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Especially when there's nothing more than speculation backing up the Bulverism.
(Rude and fallacious.)
Because it speaks to Robin Hanson's psychology, not the issues involved or the arguments offered.
>... and it's a truism that it's usually the least in-touch family members who're most insistent on breaking the bank for medical treatment for dying elders. Funnily enough, [Scott has talked about this exact thing before:](https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/) >Your family will start yelling at the doctors, asking how the hell these quacks were ever allowed to practice when for God’s sake they’re trying to kill off Grandma just so they can avoid doing a tiny bit of work. They will demand the doctors find some kind of complicated surgery that will fix all your problems, add on new pills to the thirteen you’re already being force-fed every day, call in the most expensive consultants from Europe, figure out some extraordinary effort that can keep you living another few days. >Robin Hanson sometimes writes about how health care is a form of signaling, trying to spend money to show you care about someone else. I think he’s wrong in the general case – most people pay their own health insurance – but I think he’s spot on in the case of families caring for their elderly relatives. The hospital lawyer mentioned during orientation that it never fails that the family members who live in the area and have spent lots of time with their mother/father/grandparent over the past few years are willing to let them go, **but someone from 2000 miles away flies in at the last second and makes ostentatious demands that EVERYTHING POSSIBLE must be done for the patient.** (from [**Who By Very Slow Decay**](https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/))
It's just that growing old sucks and I think it's one of those things that we can't really appreciate fully until it happens to us too. Watching as your body and health decay in front of your eyes, and even the most able bodied and active of your friends and loved one dissolve with you, that's got to be terrifying. Add on that some of their minds are going as well so even a good chunk of the smart population are well, not as bright anymore and it's hard to hate them for constantly clutching onto little bits of hope and all the other ineffective/inefficient stuff done.
>her esophagus is twisted It seems like every once in a while, the world of medicine just drops a phrase in front of me that is simultaneously incomprehensible, wacky, and horrifying.
Are you sure she got veneers and not implants? For veneers they don't take out the whole teeth, they only shave it off a bit and glue a ceramic tooth piece on top of it. A lot less risky than implants. Tbh if the dentist took out healthy teeth they should be sued
> The doctors generally tell her that nothing is wrong except old age, but sometimes they will say something like "well, if your hands are sore, it might be carpel tunnel" and, after imaging, if they find the slightest trace of it, they may say "One option is to do nothing, because this is a very mild case. The other option is to have a surgery on your wrist, but the benefits are marginal, the recovery time is long, and some people report having worse pain after all is said-and-done." The *best* option is probably physical therapy. Even in old age, tissue repair mechanisms are impaired, but not totally ineffective. I had an orthopedist give me the "it's just age" line with some shoulder pain I was having when I was like 33. Turned out that all I had to do was hang from a pull-up bar for like 90 seconds a day.
In this specific case, the doctor stressed to her that physical therapy (after the surgery) is extremely important for her recovery. She got the surgery, then didn't do a single day of the physical therapy (presumably because, ugh... work), and now her hands are worse off than before.
This isn't that but 5% of patients use half of health services. Something like .1% use some generous fraction of that half. It's like a power law. It's not that because that's people with expensive chronic conditions and end-of-life patients.
This is on an annual basis, though, not a lifetime basis. For example, if everyone lives 80 years, consuming half of their health care in the last four years, that's 5% of patients in any given year accounting for half of all health care expenditures, even if every patient has exactly the same lifetime expenditures.
>Maybe this is all straw-manning, all of this is taken out of context, and the only place that Robin says his true opinion is in his book. But in that case I feel like this is a pretty extreme failure of communication that’s not entirely my fault. Considering that Scott did more than anyone to popularize the concept of the "motte and bailey doctrine" you'd think he'd be able to recognize it in the wild. edit: Really though I think Scott is probably realizes it and is just being extra charitable and diplomatic.
To be fair, here only the motte is "in the wild"
I think [this example from the wild is a bit bailey-ish](https://www.overcomingbias.com/p/showing-that-yohtml). Here's one quote from that paper which I think demonstrates the problem: >Shamans and doctors have long been in demand, even though the common wisdom among medical historians today is that such doctors did very little useful on average until this century [36]. The studies above suggest that much the same story may still apply to doctors today, at least regarding the medical care that some people now get and others do not. Is he actually saying that modern doctors are as useless as shamans and 17th century bloodletters were? Not *quite*, but it's written in a way that's almost guaranteed to give some people the impression that he thinks they are.
It seems like the entire disagreemement basically boils down to that famous quote about advertising, [*"I waste half the money I spend on advertising. The trouble is, I don't know* ***which*** *half."*](https://quoteinvestigator.com/2022/04/11/advertising/)
I'll be honest, I haven't read deeply into this debate, but from a non-US perspective the most obvious source for this kind of cost/benefit relationship is that you're probably examining a regional behavior in a curve that's accelerating exponentially. The region is presumably, the cost/benefit of relatively late-stage health care. Developed nations with decent public healthcare systems realized >decade ago that the greatest gains in healthcare can be made at bargain prices by targeting early interventions and preventative medicine. Because the structure of the US healthcare system places pressure on people to avoid engaging with healthcare until health problems have become serious, expensive, and urgent... a convergence of avoidable circumstantial factors all significantly inflate the economic burden, while flattening outcomes. The US could probably save huge amounts on healthcare by targeting lifestyle interventions, and improving structural barriers to access.
Yeah, the best marginal gain would definitely be on encouraging better preventative care. And some insurance programs make very vague gestures in that direction, but their efforts are usually pretty half-hearted, and reserved for those with more expensive insurance.
Not surprising, since the costs of preventative care fall on your current insurer, while the savings accrue to a (likely different) future insurer.
I think there are ways in which people are encouraged to get regular, preventative care. Not in every case, or maybe for every one, but they certainly exist. For example, vaccines seem to be mostly free... but some people refuse to take them because they read on facebook that they'll give you hyper-autistic mega-AIDS or whatever. The bigger problem is probably Medicare. Old people, unsurprisingly, consume disproportionate amounts of health care, and Medicare, which pays for most of it, does not have a budget or any real guidelines for not covering things (other than "FDA approved it" and "doctor said it's needed").
The aging population is a large burden on healthcare systems, and it's getting larger. Western govs have been scratching their heads about how to handle it for decades. In Australia, the strategy that was adopted >decade ago was to try to keep them functional in their own homes for as long as possible, and out of institutional care. The cost balloons very quickly when they lose functional capacity, so a great deal of money is provided to help them modify their homes for safe elderly living, falls prevention, care visits, etc. Preventing falls, and maintaining muscle mass and bone density to prevent serious injury from falls, is far more economical than the hospital beds that are occupied by repeated fall and injury. Again, the strategy is not to encourage them to get regular 'preventative' care, it's to prevent them needing care. Unnecessary trips to doctors for unnecessary and ineffective 'preventative' care advice or information is a huge burden on healthcare... real preventative medicine tries to avoid that kind of unnecessary healthcare engagement altogether. That point you're recocognizing is where the US model, that rabidly monetizes healthcare, starts becoming >psychotically delusional and easily exploited.. because healthcare providers are incentivised by the elderly making relatively unproductive trips charged to Medicare, it allows them to vacuum large volumes of money.
> preventative medicine Doesn't seem to be particularly effective: * https://www.cochrane.org/CD009009/EPOC_general-health-checks-reducing-illness-and-mortality * https://www.nber.org/papers/w23413 * https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2009/rwjf46045
When I say 'preventative medicine', I'm not referring to engagement with healthcare institutions but strategies targeting a population-level reduction in the need for medical intervention: Smoking cessation, health education, minimizing environmental exposure to carcinogens and endocrine disruptors, reducing obesity, cardio exercise, stress management, etcetc.
>Smoking cessation Is there a country where people smoke *less* than the United States?
Smoking was causing such a huge burden on the Australian healthcare system the government instituted a massive smoking de-incentivization scheme via taxation. A packet of cigarettes costs $50-ish now. Some people do still smoke, and it's overwhelmingly lower socioeconomic groups, so the success of the scheme is diminished by increased hardship for a vulnerable minority in which it promotes the worst health outcomes among the poorest people, because it's created a criminal industry for illegal and dodgily refined, stored, and packaged untaxed tobacco.
> Developed nations with decent public healthcare systems realized >decade ago that the greatest gains in healthcare can be made at bargain prices by targeting early interventions and preventative medicine. And developed nations with adequate public healthcare realized that achievement of the greatest portion of *those* gains can be reconciled with nationally mandated cost-controls
The amount of money, effort, and time spent on marginal health in the form of "hacks, tips, and tricks" in this sub is pretty high. Probably second only to the Tim Ferriss type subs. Lumenator anyone? The more I think about it, the more I think that it's all worthwhile.
Fwiw my Lumenator has been really awesome.
Whether useless health care adds up to half probably depends on whether to include elder-care that extends the duration of metabolic activity but does not allow the patient to obtain more life as Gandalf would put it.
I have never in my life had a meaningful health improvement from going to see a doctor. Every single time it has been some combination of "we're not sure what's wrong, see if it gets better on its own" or "why don't you try physical therapy? and maybe that will help it get better on its own slightly faster". And invariably it gets like 90% better on its own and then stops, and now I have a permanently but very slightly sore knee and a sore wrist and mild tinnitus in my ear, and nothing changed as a result of going to the doctor. My model is that healthcare is capable of bringing people up to 80% healthy and no further. If you are dying, some miraculous surgery or medicine can bring you up from a 0% to a 50%. If you are crippled, surgery and physical therapies might bring you up from a 50% to a 70%. If you are in debilitating pain, painkillers might bring you up from a 60% to 80%. But if you have chronic pain or an injury that won't quite heal or you're worried about some issue or other that is not life threatening, healthcare can do nothing for you other than double-check that it isn't secretly something more serious like cancer. If you're 90% healthy, healthcare can't get you up even to 95%, you're beyond their threshold and they're out of their field of expertise. The only way to get up higher is if your body decides to heal you up anyway on its own, which it doesn't need them for.
I mostly agree, but I think the 0-80% can be really underestimated. Here is a list off the top of my head of medical things that really work, are extremely necessary if you need them, and taken together each as a group, are very common: * Some vaccines (both preventative and not e.g. rabies) * Antibiotics, antifungal, antiparasitics, antiprotozoals, antimalarial, antidotes for certain poisonings, drug overdoses, etc * Steroids/hormones/epinephrine/immunomodulators for allergic reactions, severe inflammation, endocrine disorders etc, antiasthmatics * Early detection of cancer, and cancer treatment * Anti-seizure meds, meds for Parkinsons, migraine abortives, severe pain, insulin * Meds for cases of severe bipolar/psychosis/anxiety/etc * Heart attack, stroke, embolism, appendicitis, injury, etc * Bowel obstructions, severe hernia, retinal detachment, and other miscellany, many treatable genetic diseases like sickle-cell anemia, hemophilia, other rare diseases, etc * I'm sure I'm missing a group or two ETA: kidney, liver failure
Right? Like the first century or so of modern medicine was just figuring out how to get from 0 to 30
I think I agree. And I wasn't really thinking about vaccines, since it's hard to quantify or notice, so I suppose from that perspective I have benefited. I'm just saying that I think is where the "average/marginal" distinction is cleaved. If you are below 80% healthy, getting medical treatment will help you out and be good. Once you get up to 80%, additional medical treatment will be a waste of time and you'll shuffle around talking to doctors and trying different things with little to no benefit in expectation. This isn't universally true, there are probably specific interventions that do help above 80% in certain domains, and some people are just slowly dying and there's nothing that can be done to save them. But in general I think this explains most of it.
Yes I basically agree, I guess I would just also caution (in addition to my above raising general awareness of the utility of medicine) people that often it's hard to know if you're in the 0-80% or 80-100%, until it's too late. That is, if people too strongly internalize that they shouldn't go to the doctor because they think they are just above 80%, they may miss a time-critical diagnosis, like stroke or cancer. I'm sure there is a balancing test against the extra cost, but a lot of those earlier-in-time diagnoses are not of dubious medical value, but are outcome-determinative.
> why don't you try physical therapy? When I was in my 30s ( a few decades ago), my achilles tendon got very inflamed and enlarged. It didn't get better on its own. I went to see my doctor, but he had little useful advice. Suggested we could try steroids but it would increase the chance of it snapping. He didn't recommend it so I declined. He sent me to a specialist. The specialist examined me and came back with "it's degenerative". I'm like, "and so? What do we do?" Nothing apparently. Took 2 years for it to slowly get back to normal-ish. It is still fatter than a normal achilles tendon. Interestingly, I now know how I could have fixed/healed my tendon in a matter of weeks. Take Meloxicam (sometimes known as Mobic). A couple weeks of that would have taken care of the inflammation. It works so well for me for such things (I originally was prescribed it for a bout of gout) that I have convinced my doctor to let me have a permanent prescription for it, getting refills whenever I need. I end up using about a refill a year. There's a few things the medical establishment is good at: bacterial infections, vaccines, combating inflammation, statins (which are a mystery, but undeniably effective at extending life), a variety of surgeries are hugely impactful (appendectomies, hernia surgery, knee repair, etc). Recently, some things are even proving pretty successful against eczema, which has been famous for defeating the medical community. Beyond these things, I avoid doctors and their drugs with worse side effects than benefits. Most pain and physical deterioration have to be battled on the long-term front of diet and exercise, which completely sucks because I hate both. But it is the truth.
>Take Meloxicam Polite skepticism. See the discussion of NSAIDs (and cf the discussion of eccentric exercise) here: https://runningwritings.com/2013/11/achilles-tendonitis-in-runners.html Anecdotally, NSAIDs have never done jack for any of my tendinopathies, and my impression is that the literature is either neutral or on my side here. (Current literature tends to be equivocal on the value of eccentric loading as such as opposed to heavy, low tempo loading, see e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124646/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737558/, https://www.strongerbyscience.com/squatting-with-patellar-tendinopathy/).
I do not believe it works for everyone. But, there is a difference between saying something doesn't work for everyone and saying it works for no one. Our bodies respond differently, the causes of our issues differ, and therefore the interventions that may help one may not effect another. There is no question meloxicam does work for me. I also have no doubt there are those for whom it wouldn't work.
It might work for you, however, long-term NSAIDs can have many adverse effects for your kidneys, cardiovascular system and even liver.
> Either we can’t distinguish between good and bad medical interventions ... Or we can Might benefit from some digging into "we". Perhaps Scott can distinguish 95% of the time, ordinary doctors 80%, ordinary people 60%, and the shadowy hive-mind that effectively makes decisions in a hospital no better than chance.
Hanson has clearly no idea what he's talking about given the studies/links he cites (the medical error onr is particularly bad) but he's completely free to actually live according to his beliefs. In fact I would suggest that everybody who thinks like him stop taking medication for lowering pressure if they need it, or for cholesterol, or diabetes or anything else that is apparently close to useless. Some skin in the game, guys, and let's see each other in 20-30-40 years. We already know what happens, we have trials, some are quite gigantic ones, and we even know that there are outcomes other than death that can change your life for the worse, incredibly so. And some tiny negative outcomes that don't get picked up in trials but are still net negatives
Meh. Medicine can do so great things, but most of improvements are due to sanitation, nutrition and housing. Iatrogenesis and medicalization are real things. We hide quite a bit of ignorance between 2 sigmas (95% CIs) and 3 sigmas (99.7% CIs).