US government to withdraw longstanding warnings about cholesterol (2015)
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Because the link between excessive LDL cholesterol and cardiovascular disease has been so widely accepted, the Food and Drug Administration generally has not required drug companies to prove that cholesterol medicines actually reduce heart attacks before approval. See: http://www.nytimes.com/2008/01/17/business/17drug.html
Meanwhile drug companies are making billions selling cholesterol lowering medicines called statins. But lowering cholesterol using drugs is not useful. Read more about that here: https://www.bloomberg.com/news/articles/2008-04-15/heart-dis...
Not only that, these statins are dangerous drugs. Its side effects include loss of short term memory, for example. Read more about that here: https://www.scientificamerican.com/article/its-not-dementia-...
The real danger is not fat, even saturated/trans-fats, but starches and sugar. The increase in these types of carbohydrates in products like baby formula is actually leading to obesity in infants!
Excess sugar can stress arteries and damage them. Cholesterol is carried to these artier by lipids (LDLs and HDLs, which are not actually cholesterol, but proteins that carry it through your bloodstream). If you eat a lot of sugar, cholesterol can build up between the walls of arteries as they fix the damage. They can eventually break down the wall, releasing plaque into the bloodstream and potentially causing heart complications.
I highly recommend Dr. Lustig's video (UCTV) to learn more:
https://www.youtube.com/watch?v=dBnniua6-oM
A few years back I switched to a keto normal fat/very low carb (excluding fiber) diet. I've lost weight, gained energy and have felt a lot better. Of course this isn't for everyone. Some people have a body type that lends itself to higher carb intake (I knew a runner who'd eat 30 bananas a week) and as always do your research, consult with your doctor, dietitian, etc. before drastic changes in your diet.
It's a common myth that Adkins died of his own diet. He didn't, and Reuters rededicated their column implying that he did. I honestly wonder if the obesity epidemic would have gone down today if the world didn't dismiss his ideas, or the ideas of many nutritionist for decades before him that made similar claims about the dangers of sugar.
> observed facts
These are not the same thing.
I'm not denying an anecdote is not valuable to the individual. It is, for the individual who made the anecdote; not the rest of us, not the readers.
I'm also will admit I, too, use anecdotal evidence. But that does not mean one has strong evidence when they do; they don't, and neither do I.
The bullshit that's been pushed on us for decades about cholesterol isn't science.
And to add to that, I've never heard any anecdotal evidence that goes "I went on a low cholesterol diet and my symptoms improved".
The scientific method is valuable. Science as it is practiced...? Let's just say it's reputation has been tarnished.
It's true that we're still making sense of how to operationalize those observations (restrictive diet, exercise, statin therapy, etc). This doesn't make the science worthless; it's just an intermediate step in this particular area of research.
Why wouldn't you? It seems like it would be unambiguously helpful both in general for the thread, and specifically for your argument.
For evidence that the lowering of LDL cholesterol lowers the risk of heart attacks, though, the evidence can't just be an association between heart attacks and naturally high cholesterol, which could obviously both spring from the same cause. An association between low cholesterol diets and heart attack rates, or good evidence that statins lowered mortality would both be interesting.
No, one anecdote is not pretty good [scientific] evidence against anything.
I can give you an anecdote about how I drove through red lights multiple times. That does not mean you should follow the example.
Why not? You have no idea about the circumstances. I was actually talking about driving a bike, I was a teenager, and there was barely (if any) traffic. There's pro and cons there, but what matters is I omitted the details. Hence, YMMV. Plus, the statistical evidence is too small (sample size is one). Good luck reproducing the outcome, too.
Its the same in our runner's example. There's simply hardly any -if any- evidence presented to even make the anecdotal claim. Which still lacks any statistical evidence.
What anecdotal evidence can lead to is scientific research. But we should not conclude on the outcome yet. We must keep an open mind, accept on a method and test circumstances, and gain statistical relevance.
It is absolutely mind blowing, btw, how much 'scientific' research these days is not statistical relevant yet gets passed good grades (and yields the paper) at say college & universities. I'm not sure if its incompetence or laziness or lack of time or lack of money. I've even witnessed this first hand recently when my significant other was completing an assignment for her higher education degree which I was reviewing. Four interviews lead to a conclusion. Which, yes, is anecdotal ;)
As evidence for what? If you're trying to disprove an assertion that everyone running a red light gets hit, it's good evidence.
> You have no idea about the circumstances. I was actually talking about driving a bike
Assume good faith.
That point when you have exhausted your glycogen stores is what they call bonking. Now you can fine-tune your low carb diet to hopefully have enough glycogen at any point to sustain you through an exercise session (more realistic for running than cycling) but everyone else just eats a high-carb diet.
They would do well on more like 25% carbs aka Paleo.
As a distance runner, I don't perform well at 25% carbs. I need more like 40% carbs. So not "high carb", but "higher carb then a sedentary person needs".
Edit: Where "paleo" is defined roughly as "eating only foods that [I think] were available ~10,000 years ago": http://www.abc.net.au/science/articles/2013/09/10/3842158.ht...
It doesn't make sense that your cells could become more efficient to the degree that you "don't need to eat that many calories at all". Typical efficiency values are on the order of 1-1.5 kcal/kg/km, so your 80 mpw represents at least 1200 calories per day above baseline. Furthermore, this 1200 calories is just while running - after stopping the workout, you'll need to metabolize protein to help your muscles recover from exertion, and rebuild the glycogen stores which are larger in volume as a result of training, and which are more effectively drained as a result of training, and to rebuild the fat stores which you'll use on your long runs.
And yes, I may be biased in this reasoning due to the fact that I can sit here and type this out while munching on this delicious caramel popcorn and not worry about weight gain. There's no denying that it's high-calorie.
And there was a whole bunch of nutritionists, doctors, "advocates" that went after him after he was six feet under.
I'd like to see those prominent people that went after him held to account now.
So you are right, statins are indeed useful in a lot of people: people who have already had a heart attack. But that's not who statins are being marketed to. See here: http://www.nytimes.com/2008/07/08/health/08well.html?fta=y
Why don't people link to the actual studies?
It's true that the evidence is not overwhelming (ref. 1) but I am not aware of studies that show no benefit.
[1] http://jamanetwork.com/journals/jama/article-abstract/258403...
Quite a few of them are having heart attacks: "So my first heart attack, 8 years after a stroke, was unexpected. My heart is determined to kill me. I've had at least 4 attacks, the last one keeping me in hospital 6 days"
Yet they still all stay on that diet, because of some convincing bloggers with no credentials as doctors or researchers and some conspiracy theories.
The reason we have these publications is that medicine is continually reevaluating its recommendations. Your statement is about as unreasonable as saying 'we don't need computers since sometimes computers stop working'.
Also, if you've ever spoken to a doctor about this, few would disagree that nutrition is an area where we still need more research.
Finally, ask yourself: in the absence of evidence, is a diet that avoids fats/cholesterol (which, a priori, are associated with heart vessel disease[1]) such a silly idea? Now, we know more, and are changing recommendations accordingly.
1. https://www.nhlbi.nih.gov/health/health-topics/topics/athero...
1b. (in case you don't trust a governmental source) https://en.wikipedia.org/wiki/Atherosclerosis
The problem with nutrition is that for a very long period of time it wasn't, at all. It was citing ancient half-assed studies and anecdotes, never bothering to reassess or confirm them, and recommendations for low-salt and low-cholesterol are remnants of that time. I have no doubt that since a lot of that stuff has been called out, there will be money available for scientists to improve our understanding in the near future. My only irritation is that there are massive financial interests in maintaining the common wisdom, and that as a consequence, good findings will be ignored or suppressed.
As it is, the latest findings on salt and cholesterol are still not general knowledge, and the old common wisdom (as exemplified by popular science articles sparked by industry press releases, advice from primary care doctors) is nearly as dominant as it was before. A large part of that is that there's not been a lot of new advice to replace the old bad advice, leaving a hole, but the fact that statins and "diet" food are such a huge category creates a very dominant voice. That the loudest advocates for new findings come from faddish diets whose rationales reek of crank is also depressing.
> Finally, ask yourself: in the absence of evidence, is a diet that avoids fats/cholesterol (which, a priori, are associated with heart vessel disease[1]) such a silly idea?
We don't need science if we are just going to rely on easy, intuitive explanations of everything. Anybody can decide that eating fat makes you fat and fills your arteries with fat; you don't need any particular expertise for that.
Science comes in when you want to know how plaque consisting of macrophages containing fats/cholesterol on arterial walls are embedded, and how macrophage uptake of fats/cholesterol is increased/decreased. There's current work in trying to understand the role of TMAO (primarily from animal foods) in increasing macrophage uptake of fats/cholesterol:
http://journals.lww.com/co-lipidology/Abstract/2016/04000/Tr...
The research in this area is promising enough that insurance may derive TMAO-based measures of heart health:
https://www.thepermanentejournal.org/files/Winter2015/Artery...
I for example have Thyrodid disease, and every single doctor I went, including "free" ones (paid with public money) and the most expensive ones (I tried paying a famous expensive guy that help celebrities), all of them failed on me a lot, to the point I am mostly self-treating, I go to the medic only as a "ritual" of sorts, but I read my own blood tests, and decide my own medication.
I tried with many of them, presenting research I found about it, and they all said it was bullshit, that researchers know nothing about medicine, that only experience matters, and so on...
Some told me that the wrong blood test numbers they use, are correct because the laboratory says so, and they just do what the lab says.
After hearing this multiple times, I decided to take my blood test papers, and read them carefully, and found they do quote their source for the numbers! It is there, written where the numbers came from.
Yet, when I went to read the source... the research paper I was trying to show the medics were there! So, the medics claim to follow the guidelines and the lab values, that in turn cite a bunch of research, yet the medics insist in using outdated values, and claiming the research is bullshit.
To be honest, I don't even understand what is going on, I met so many medics like that, that now I mostly refuse to go to medics and fix my health in the way I can, I now assume that medics are literally evil, since they intentionally lie to me, or are intentionally negligent and ignore the guidelines they claim to follow.
The few medics I trust, sometimes I go to them even when what I need from them is completely unrelated to their field (one medic that greatly helped me with my thyroid, was specialized in eye diseases, another one that helped me with vitamin D deficit, was an medic specialized in arthritis, and I don't even have arthrists, I went to that medic out of desperation after hearing good things about her...)
https://www.ncbi.nlm.nih.gov/pubmed/26780009
"SUMMARY: The naturally randomized genetic evidence suggests that LDL-C has a causal and cumulative effect on the risk of CHD, and that the clinical benefit of exposure to lower LDL-C is determined by the absolute magnitude of exposure to lower LDL-C independent of the mechanism by which LDL-C is lowered."
Imagine if the FDA, instead of blocking new drugs for 10 years and $1B, it simply withheld its endorsement until satisfied by the clinical trials. Consumers could then take the government's recommendations into consideration when making a decision and drugs could get to market much faster.
The history of medical reversals -- and in this case, nutrition reversal -- shows that the government isn't magic.
A whole raft of restrictions could be converted to warnings and recommendations, freeing up industry to innovate and consumers to take a little more responsibility for themselves.
Imagine the history of the past few decades if the state had outlawed any foods with more than X% cholesterol. Or trans-fats. Or any of the other food fads over that time. It would have been terrible, especially now that the recommendation is reversed. The whole time, consumers were allowed to factor government warnings into their decisions, but food producers weren't breaking the law by selling foods with (X+1)% cholesterol.
I'd go one step further. Give the FDA competition. Have private companies (similar to UL for electronics) that can endorse and test drugs.
You can argue that no rational company that cares about its reputation would do such a thing, but history has shown time and time again - yes corporations do waive all consideration for public safety in lieu for money.
The government is the perfect institution to endorse safety of substances/drugs/whatever for use by it's citizens. That doesn't mean they are perfect though, but I would trust them a thousand times more than a corporation.
It's extremely wreckless to apply free market economic theories to things like this. In the real world, consumers and businesses are irrational.
Outright bribery in the US is rare, difficult, and if caught, will land you in federal prison for a long time. Remember Blagojevich?
Government officials are under much more scrutiny than a private sector executive. There are independent investigators general that have broad latitude to look for malfeasance. The FOIA exists to bring government records to light; there is no equivalent in the private sector. Heck, we spent ~$80mm investigating Clinton over the Lewinsky affair.
The government isn't perfect, but it's a damn sight more transparent and directly accountable to the public than private companies are.
I was proposing something like UL which is independent from the companies being overseen.
Do you also only blame the police for not catching a criminal, and not care about the criminal at all?
The ratings agencies actively marked bonds as AA which they knew darn well were in reality B or worse. They committed fraud at the behest of the banks.
There is a massive difference between inaction and fraud. That's why the SEC doesn't get a lot of blame.
If the European/Japanese/Other Reputable Country authorities have approved a drug, it could be allowed it in the US, with a clear label, of course.
Foreign physiology and science is the same as American.
Experts estimate that the drug thalidomide led to the death of approximately 2,000 children and serious birth defects in more than 10,000 children, about 5,000 of them in West Germany.
While within a country a given barrier may be too high or low, it will probably be somewhat randomly too high or low around some appropriate level of safety. With the multi-country scheme, the bias will be towards too low on nearly every drug.
Because that worked so well with risk analysis in finance. 2008 is calling.
The current extremely tough FDA approval process has the benefit you mention: Fewer people are injured by unsafe drugs.
But it also has a big (but harder to observe) cost: If disease X kills 1000 people/year, then each year a cure is delayed kills 1000 people.
The main argument against the current system is that it weighs the deaths of people in the first category vastly more than those in the second.
How many people the FDA process kills this way is hard to calculate, and you can find wildly different estimates. But most discussion assumes it doesn't even exist...
So we already have experience with some alternatives to the current scheme.
On the other hand national statistics on deaths caused by various diseases have been compiled for decades. We can know with certainty the upper bound of people killed per year (which in your example isn't 1000 but some fraction of that - no drug is 100% effective). Also, many drugs don't prevent deaths but merely comfort the patient or remove some symptoms. Many drugs have alternates which could be taken. Many drugs have an upper bound of deaths prevented of 0. Why should we risk any lives for a drug which cannot save any additional lives?
In general humans prefer taking a known risk with known odds rather than an unknown risk with unknown odds.
If an informed consumer wants to make a different choice than the FDA, nobody is stopping them from traveling to a country where the drug is already available.
[0] http://www.npr.org/templates/story/story.php?storyId=5470430
> The history of medical reversals -- and in this case, nutrition reversal -- shows that the government isn't magic.
What it shows is that nutrition science is hardly 'solved' and you'd be hard pressed to find a researcher in the field suggest otherwise.
> A whole raft of restrictions could be converted to warnings and recommendations, freeing up industry to innovate and consumers to take a little more responsibility for themselves.
The problem with this is that the average consumer is both A) dumb, and B) doesn't know what they need. Alternative medicine skirts very cleanly around FDA regulation by not making any medical claims on it's product. They still market their product as a solution for various diseases and conditions, but they never make a formal claim. It's a $30,000,000,000 industry of people buying stuff that does nothing, or worse yet, can cause potential harm. To suggest their is no value in regulation of the drug markets is to suggest that people's health has no value. The defense of, 'well, people are responsible for their own decisions' doesn't hold any water when we know that the direct consequences of that mentality can be measured in literally tens of billions of dollars.
>nutrition science is hardly 'solved' and you'd be hard pressed to find a researcher in the field suggest otherwise.
You'd be hard pressed to find a climate scientist not in agreement with the consensus on climate change, at least one that isn't already promoting book deals on Fox.
Scientists in no field are punished for disagreement. Even in really fringe science, disagreement is not only well-funded, but encouraged. A great example is String Theory: It has a lot of supporters and a lot of people saying it's untestable bunk, but research for both sides continues.. Consensuses happen when there is sufficient data to collapse to a consensus, not because 'funding'. Disagreements are extremely common in research and suggesting that the overwhelming consensus on the state of climate change is somehow a conspiracy or due to research pressures (that don't seem to exist anywhere else...) is complete garbage.
If you haven't experienced the cut throat nature of science or the immensely aggressive politics you may need to reassess your rose colored view.
The mantra, is your haven't heard it, is publish or perish.
Disagreement is well funded? What are your talking about? Good data is well funded. Doesn't matter how much you disagree, if the data is missing or bad you get no money.
This is a bit rambly, but the gist of it is that it's naive to pretend that many nominally scientific fields are actually entirely objective and free from politics.
You'd also be hard pressed to find a numerologist not in agreement with the consensus that numerology is effective.
Argument from authority isn't appropriate in this forum.
Note that the customer for prescription drugs is a licensed doctor.
Who can be bought and misled like anyone else.
Changing the composition of an entire nation's schoolchildren's food supply ... should require something like skyscraper-failure-prediction accuracy.
It's no defense that "science learns and revises". If the learning and revising is still that big, you don't have a basis for telling others to do it your way.
(IMHO, this is, at root, the same mentality as "fake it till you make it" / "all self doubt must be Impostor Syndrome and never an accurate assessment".)
Unfortunately, a significant number of bureaucrats and statists would prefer consumers to be dumb (or at least say that they are) in order to maintain power.
Oh and let me guess, you're not one of the dumb ones....it's the other guys right? ;)
Do you just blindly take whatever the doctor prescribes to you without doing your own research? How do you know your doctor is an expert? I'm pretty sure my doctor is not an expert in lots of things pertaining to medicine. He's not studying all the new research. That doesn't mean I can't have a conversation with him, but it's healthy to be skeptical of doctors too...that's why we get second opinions.
I don't have a huge problem with the FDA, but I'd rather have a number of choices of where to get information, and at the end of the day make my own choice on what to consume.
Also if people are so stupid like the OP suggested why not ban a whole plethora of foods like Twinkies, potato chips, soda, etc..?
Yes. I'm do not have a medical background and at best, I could gain a surface-level understanding of the drug, which is not useful to determine which drug(s) are best for me.
> How do you know your doctor is an expert?
They went to 10 years of school and several years of residency to do doctor things. These things are also regulated by several boards which have the power to revoke medical licenses if doctors suck.
Yes, and the more serious or painful the issue is, the more likely I am to blindly take the stuff. I'm simply not rational: I know this happens to a few other people as well, who all have migraines. Some folks willingly admit that when the migraine gets bad enough, it really doesn't matter if they overdose on pain medication because that would make the pain stop: I was similar with my gall bladder pain. Didn't care what they shot into my veins, so long as I stopped dropping to the floor in pain.
"if people are so stupid like the OP suggested, why not ban a while plethora of foods like twinkies, potato chips, soda, etc?"
We have to an extent: A lot of schools have taken such snacks out, for example, and some have tried to stop folks on welfare from buying any of it. And we tax it. But the real reason we don't do that is because food carries its own risks that aren't nearly as instantly deadly as drugs. The main exception is new food products, colorants, and flavors. Now, I'm a little fuzzy on the actual regulation, but there are approved and non-approved things to use for food, and I was thinking you had to prove it generally safe for humans. I could be wrong on this bit, however.
If you show me a rack of food product, I probably can't identify which is the best for a particular person given a set of goals. I probably can't even tell you which ones are 'bad' or 'good', because I don't really know. While food is but one subject, this applies to nearly everything I purchase. Which plastics are the best for a given task? What ingredients in a shampoo would actually give me results I want? What kind of bed or bedding is the best for my comfort? To all these questions: I have no idea. I'm at the mercy of google or a salesman, the latter which has a different motive than me which immediately calls that in to suspicion.
I'd be a fool to say I'm an all-knowing consumer, but so would anyone. Most people don't know what the need. They know what problem they want to solve, but they have no idea what the best product or solution is to solve said problem. Acknowledging this, we can easily see why when it comes to our health, it's probably best to see some regulation lest people do what they do best: make really dumb choices.
The way you'd like the FDA to work is literally the way it already works. You're allowed to buy basically any drug you want unless it's scheduled by the DEA. Companies just aren't allowed to market them as being effective for a specific disease without passing clinical trials.
No, not without specific examples of how government regulations are a burden on innovation. Whenever people argue this point in industry X it always seems difficult to come up with concrete examples.
> and consumers to take a little more responsibility for themselves.
Secondly, again no. Consumers are not rational machines who make rational decisions based on time spent researching what they are consuming.
https://www.ncbi.nlm.nih.gov/pubmed/18955056
You have a theory that the average person will wisely assume the responsibility to vet the health effects of what they consume, but empirical reality disagrees with your theory. Right now people are injuring themselves with products at the margin of regulation.
There's a societal cost for lots of people injuring themselves, and offloading the responsibility of researching safety to the average consumer will cause fear and superstition, limiting people's willingness to try new products, and I would argue that that reduces innovation. Regulation in this area has been a net societal benefit.
I suspect this line of thinking just leads to too many problems, however.
Examples:
Why is it advertising regulated drugs to uninformed consumers is legal?
In the current state of things, we've grown accustomed to seeing warnings when the government thinks there is a potential danger with a particular FDA regulated drug. So perhaps the lack of warnings with supplements is giving people a false sense of security about the dietary supplements...ie, "if they were dangerous, surely there'd be a warning". If, as the parent comment suggests, the paradigm shifts so that the government's position is one of several factors to consider, perhaps then people would look at supplements with a greater degree of caution and suspicion. In other words, changing the paradigm may change people's behavior in terms of how they approach both drugs and supplements.
Meaning a single FDA approved over-the-counter drug is responsible for over 20 times as much liver failure as all dietary supplements. Some regulation may be beneficial but the current policies are clearly suboptimal.
It's thus a poor selection if one wishes to discredit the FDA's efficacy; indeed, some other widely-used therapeutics (e.g., aspirin) came into use before drug efficacy was required for new drug approval.
At the same time, there are numerous examples of drugs either not approved by the FDA or withdrawn from the US market by the FDA. It's not clear how less regulation would achieve this type of nation-wide safety benefit.
[1] http://s3.documentcloud.org/documents/793731/mcneil-history-...
Why are we so sure that we can't trust people to make an educated decision about an experimental drug or any of the many other things we regulate, many of which only impact themselves and don't put the general public at risk in any way. Yet one of our most deeply held values is trusting them to make an educated decision about who should run the country. It's certainly not any less complex of a topic when you consider all of the policy areas that there are to evaluate politicians across.
Are there examples of pharmaceuticals you were considering?
The issue is education. It's very difficult to tell what is healthy and what isn't. There is a lot of research coming out that shows us sugar and starches are very bad for us. The stress from those carbs can damage our arteries and is what allows cholesterol to build.
The industry has a vested interest in people not knowing/believing in that. Sugar and HF Corn Syrup is a massive industry. Soda companies have been losing money as people finally move away and now we start to see the tides change.
Regardless, we need good education about what is and isn't health. Otherwise people struggle with weight and just get frustrated and resolve themselves to eat unhealthy because nothing seems to help reduce their weight or cravings.
Most software does not involve life-and-death situations. In cases that do, e.g. the space shuttle, they don't use rapid iteration [1].
You can't protect all people from themselves, but you can protect a lot of people from themselves.
If you look at smoking [1] in the US, smoking went from 42.4% in 1965 to 16.8% in 2014. Raising awareness, taxing cigarettes, outlawing advertising, warnings on packaging, these things work.
The same could be done with alcohol if society wanted. One of the reasons why it hasn't happened with alcohol is because alcohol is ingrained into our culture.
> by the percentage of people saved by life saving drugs that make it to market faster/would otherwise be blocked.
Do you have any estimates for this? Do you have estimates about how many people would die by allowing poorly-vetted drugs on the market?
> which of course goes down significantly when people realize that they shouldn't blindly trust everything in our markets
How would you suggest the average person go about evaluating a drug/treatment?
> sentenced to die directly by rejecting appeals from terminally ill patients to get access to experimental drugs/procedures
sentenced to die implies that experimental drugs/procedures would save them. Undoubtedly some could be saved, but I doubt it would be more than a small fraction.
[1] https://www.cdc.gov/tobacco/data_statistics/tables/trends/ci...
Government bureaucrats are not special or different from us regular folk. Why should we expect them to be?
I know this is an incredibly callous opinion but isn't this natural selection at work?
People even go further and knowingly partake of substances known to be harmful (cigarettes). We don't stop them from that, why should we stop them from consuming medication that hasn't yet been deemed safe?
Educating and providing support for those that need it I agree with but if people freely and knowingly choose to act in a self destructive manner with a sound mind, I'm not convinced it benefits society or themselves to forcibly preserve their life.
We as a society have decided that, generally, profiting from causing harm to others incentives bad things.
I don't want cough medicine that might stop my breathing, but heroin was regularly sold as just that before the FDA.
History has shown that without regulation the quality, efficacy, composition, safety and side-effect profile of drugs might stray from reality because of market incentives. The unfortunate truth is that sometimes it is more profitable if those five things are ignored and people get hurt or die. Hence, regulation.
> People even go further and knowingly partake of substances known to be harmful (cigarettes).
Tobacco products are heavily regulated. One could argue that because of lobbying and the amounts of wealth involved, that tobacco companies have been spared some of the stronger regulations they could have faced.
Murder is bad for society, as people who can benefit society through say their knowledge of medicine or physics aren't adept at self defence.
A similar argument could be made that people who aren't very good at taking care of themselves are valuable to society somehow and should be protected from idiotic self-harm but I believe a person's autonomy trumps society's interest in preserving whatever value they have.
> I don't want cough medicine that might stop my breathing, but heroin was regularly sold as just that before the FDA.
Heroin was sold as cough medicine that might stop your breathing? If it tells you you might die and you choose to ingest it, that's on you. If you choose to play Russian Roulette, nobody's stopping you.
In case it wasn't sold with a warning that it might stop your breathing, you could have chosen to verify that it did what you expected before ingesting it. The modern FDA could also warn of the dangers without forbidding the sale of the substance.
> Tobacco products are heavily regulated.
They may be regulated but any adult can still choose to partake of however much they like regardless of the damage to their health.
I think cigarettes is actually a pretty good example of regulation that's not restrictive. I don't want to deregulate to enable business to sell more crap for higher prices with disinformation and attractive pitches. I want deregulation so that I am free to use any drug I would decide to use for myself. Granted, I would need to be guaranteed access to the correct information. Even today, there's not enough regulation around package labels. A lot of products don't mention important facts about them, or are allowed to lie on certain facts.
Yes, heroin was sold as children's cough medicine by Bayer [1]. It stops coughing because it slows breathing. Take enough and you stop breathing, then die. This how 30k+ Americans die from (non-)prescription opioid overdoses each year.
No, it did not indicate that it could harm or kill you. Why? Because regulations didn't exist that mandated purchasers were informed of all potential side-effects. Regulations didn't exist that mandated testing to determine those side-effects or the safety profile.
> In case it wasn't sold with a warning that it might stop your breathing, you could have chosen to verify that it did what you expected before ingesting it.
It does exactly what it says: stops coughing. You might be able to take 10 bottles over time, but the next time you dose from the 11th bottle, you don't wake up. It could be a multitude of reasons: lack of quality assurance means different batches have different concentrations of the active ingredient, your tolerance for heroin lowered after disuse and you take the same dose you're used to taking and die, what's in the bottle isn't the product you thought it was or you happened to have a drink of alcohol before taking it and overdose from a normal dose. These are the same problems heroin users face in the unregulated black market for drugs. How does "verifying that it did what you expected" help in any of those cases? Why offload the responsibility to ensure a product's safety, side-effect profile and drug interactions on the user when it could just as easily be done at the source by knowledged professionals and save laymen lives from being needlessly ruined?
How does one verify the medicine they bought does what they expected and not give them cancer in a couple of years?
Also, this is a children's medicine. They aren't consenting adults. How can you suggest in good faith that a child verifies the medicine they're given by a doctor, parent, nanny, babysitter, teacher or friend does exactly what it should? What if they're old enough to buy it themselves, but still a minor with underdeveloped decision making processes? What if the child finds the medication? Child proof packaging and bottling exist because of regulation.
But here's the thing:
> History has shown that without regulation the quality, efficacy, composition, safety and side-effect profile of drugs might stray from reality because of market incentives. The unfortunate truth is that sometimes it is more profitable if those five things are ignored and people get hurt or die. Hence, regulation.
With or without regulation, you will have a market of desperate people who need treatment so that they don't end up in pain, injured or dead. Snake oil salesmen took advantage of this. The world doesn't need a Pfizer that, instead of making the investment to develop drugs that treat diseases, pushes a variety of unproven harmful cures because it is immediately profitable to do so. Before you say the market will ensure that drugs are safe, effective, etc: this wasn't the case at all until the FDA. The market didn't incentivize these things and we all suffered for it.
Later we got dextromethorphan: technically an opioid and morphine derivative, like heroin, that suppresses a cough but doesn't completely stop breathing at any dose.
Heroin is cheaper to produce. The market would decide that a certain number of dead children are acceptable because people will buy the cheaper, deadlier medication. Unknowingly, because they lack the necessary information to make an informed decision due to the lack of regulation. The type of information needed for a market to function.
They might not even have the option of purchasing DXM, as it was developed by the government as an non-addictive alternative to codeine. Years later it was brought to market as an antitussive because the market was lacking cough suppressants. The market was lacking because the FDA banned morphine and heroin as OTC cough suppressants.
>They may be regulated but any adult can still choose to partake of however much they like regardless of the damage to their health.
Anyone that purchases cigarettes in America is not purchasing the cigarettes Philip Morris et al want to be selling in their ideal world. Cigarette composition, manufacturing, marketing and price are all heavily regulated by decades of legislation in response to more toxic, addictive cigarettes being introduced and the advertising campaigns behind them.
Without regulation, cigarettes would be more toxic and deadly; and they would cause more damage to someone's health.
[1] http://www.businessinsider.com/yes-bayer-promoted-heroin-for...
RESULTS: DILI was caused by a single prescription
medication in 73% of the cases, by dietary supplements
in 9%, and by multiple agents in 18%. More than 100
different agents were associated with DILI;
antimicrobials (45.5%) and central nervous system
agents (15%) were the most common.
CONCLUSIONS: DILI is caused by a wide array of medications,
herbal supplements, and dietary supplements. Antibiotics are
the single largest class of agents that cause DILI.
Yes! We could replace those flawed and lobbied against restrictions with advice. The market would be free once again to innovate.
Bayer could once again offer Heroin as an addiction free drug. We could get long missed radium cures and snake oil. They could be free to advertise to their heart's content. They can tell us cigarettes are good for us.
The companies can be trusted to have our health at heart. They can spend adequately on SEO to ensure their messages are dominant. Silly government warnings and or indivduals having problems with side effects or Heroin forum posts can sensibly be lost in the far reaches of search.
</s>
Seriously? I can't think of anything more stupid, even though the system is horribly flawed.
Want to go back to food adulteration, and poisons sold as cures? Endless advertorials pushing pointless product? We have an entire vitamins and supplements industry that's pointless (and problematic) for most people.
Go read the history of those regulations and restrictions. I don't want the pre-drug and food adulteration acts world back, thank you very much. How is this the highest voted post?
It wasn't that long ago that Phen-Phen (sp?) was legally marketed and sold.
We currently allow prescription of extraordinarily strong methamphetamine to children, who often spend their formative years under the influence.
---
We still have a long ways to go.
> currently allow prescription of extraordinarily strong methamphetamine to children
As someone adult diagnosed ADHD and taking "extrordinarily strong amphetamine" from my 40s I'd like to point out they do not affect ADHD sufferers in the same way as neuro typicals. They're used at tiny dosages compared to using recreationally. I would not wish children with the condition to have my hugely damaged teen years because of horribly misinformed popular rhetoric about amphetamines. Using meth is the last resort option when other forms haven't worked.
That popular rhetoric meant I spent an additional 10 years before gaining effective treatment. I had to read and interpret actual papers to get past the media bullshit and gain an informed opinion.
I doubt you can even imagine how much I wish I had been taking "extraordinarily strong", ie correctly dosed, amphetamines from my earliest years. I will add that I'm not in favour of use for weight - many other tactics can work there.
Do you use the term "extrordinarily strong" when you mean "correct dosage" or speaking of paracetamol? Paracetamol is the cause of many deaths unlike amphetamines. Now add the liver damage.
The issue at hand is how to balance the outcomes. Based on increased prescription rates (600k diagnosed in 1990 to 3.5 million in 2012 [0]), it seems probable to me that we've passed the breakeven point. I bet that increase in diagnoses corresponds with an increase in marketing spend for these drugs, which is another indicator that gives me pause.
You as an adult were able to decide for yourself. Many diagnosed nowadays are young; they do not have the ability to give informed consent to the medication, nor the ability to roll back the effects. Younger brains are more easily harmed as well.
Further complicating the fact is that it requires an assessment of relative importance: is it better to harm by inaction (your situation) or by over-action?
It's really hard to try and fairly balance these and other issues that I'm sure I'm missing. However, thank you for sharing; although uncomfortable, I thought about the issue from a perspective that quickly embarrassingly had not previously occurred.
[0] http://www.nytimes.com/2013/12/15/health/the-selling-of-atte...
Research seeems to indicate a global prevalence of around 5-10%, settling around 7.8%. So those areas, and there are some, diagnosing >10% are overdoing it. Until we have blood or genetic tests it's too reliant on self-reporting. Even so, many still struggle to get diagnosed or are suspected of just seeking recreational amphetamines.
If it does turn out to be 7%, that's over 22.5m in the US, 4.5m in the UK. It's doubtful all would need or want prescription as not everyone is affected similarly.
I wouldn't have hesitated to push for diganosis if I'd recognised it in my own children (It's strongly determined by heredity).
Thus, in lieu of 100% of humans being 100% rational, 100% of the time, a nonzero amount of government, creating nonzero amounts of regulation it is an absolute necessity.
Such an open policy would only work if all information (including internal information proprietary to the maker) was available to inform buyers, and while I think a fully informed market w would be great, I don't see any real chance of that happening.
Result: highest rate of obesity in history
When I look at how little regard people have for this when taking supplements, I find it hard to believe they'll take more responsibility for themselves.
Not against all supplements myself, but once I learned how poorly controlled they are - how there is virtually no manufacturer I can trust who is actually giving me what the label claims (so many mg of nutrition per capsule, harmful ingredients not on the labeling, etc) - I pretty much stopped taking all of them. The risks outweigh the benefits.
http://time.com/4485710/sugar-industry-heart-disease-researc...
https://www.theguardian.com/society/2016/apr/07/the-sugar-co...
> Fats, oils, sweets: sparingly
> Bread, cereal, rice & pasta: 6-11 servings
Yes I am in the camp that believe fats and proteins are both much healthier than carbs, and especially refined sugars. The latest nutrition supports low carb diets, as can be seen with Atkins and Keto diets.
The "latest nutrition" supports nothing of the sort. Dietitians still recommend you get roughly 50% of your calories from healthy carbs.
Source: my wife is a registered dietitian and has a PhD in nutrition.
But to me, PhD in nutrition doesn't mean much, it is like PhD in underwater basket weaving, I am yet to met a single nutrition professional that could help me, and believe me, I looked really, really hard.
In the end the only people that could help me, were endocrionologists, biologists, and other scientists in fields that are not directly relation to nutrition.
And the reason for that, is precisely because of that high-carb recommendation, that is just insane, many cultures on earth lived just fine with low, or even zero carbs (extreme example: north-pole inhabitants, that in some places have diets that are 100% meat, organs included, since "regular" meat lacks some nutrients, like Vitamin C).
In more tribal places (all over the world too, Africa, Asia, Americas...) hunter tribes also tend to be healthier than farmer tribes (but also tend to have much lower population numbers).
And in many places, before FDA push for the vegetable agenda (I am not talking about veganism or vegatarianism, but about FDA constantly defending vegetable based food, including by accepting research that was fraudulent), people would happily eat lots of animal fats and meat, and live just fine. (example: in my country before the 60s, everyone used pork fat to fry stuff, and even make soap, but after vegetable oils became popular, and the government started to give strong subsidies to wheat, obesity, diabetes, etc... exploded, many common people still believe egg and cheese is absolutely evil, and prefer to stuff their faces with artificial sweeteners, soy milk, and salad with enough oily dressing to lubricate a car, than eat some eggs).
In 15 years or so, what gets taught will reflect that.
That statement is not supported by any reliable studies.
The latest nutrition supports a healthy mix of carbs and fats, specifically whole grain and unsaturated fats. Not a monodiet of fat, nor a monodiet of carbs, nor processed carbs, nor saturated fats.
Focusing too much on a fat-based diet causes massive kidney issues, just as a too much carb-based diet causes circulatory issues.
But someone else in this thread posted sources on the claim, so you might want to read those sources.
I am fine with people taking "religious" positions when it comes to a text editor or the latest web framework, the problem is that nutritional choices have environmental and health-related consequences, so I would rather them be fact-based.
Also, I wonder what we're going to see next on HN, flat earth? Chemtrails? After a recent submission which was also related to nutritional topics, I have been considering leaving HN altogether.
(Not getting at you for your viewpoint - I'm making this comment to a few people in this thread who say that the latest research supports their argument. You may well be right, but I don't know enough about your background to take your word for it, so I'd be interested to see your sources. )
Our planet would like to differ though http://www.sciencedirect.com/science/article/pii/S0306919211...
At any rate, it's very easy to design a diet for humans without grains in it that's healthy and that you can thrive on, but impossible to design one without fat. So in that respect at least, literal fat is better than grains.
[1] http://www.sciencedirect.com/science/article/pii/S0306919211...
Carbs/sugars trigger insulin production...fats don't do that. Just look at the Western diet and the substitution of fats with sugars in the food industry in the 70's and you will trace origins of type 2 diabetes that would begin appearing in children - yes, it used to be called adult onset diabetes - now over a million cases.
Carbs are not inherently bad, but there is no doubt way to much in the Western diet and from poor sources.
Choosemyplate.gov is a great first step to changing the dietary habits of children.
Unfortunately it does not highlight the danger of sugar & processed food. Someone can follows these dietary guidelines and still be able to have a high intake of sugar, HCFS, processed food and all sorts of food chemicals (emulsifiers etc.), all prevalent in the american food industry, and get cardiovascular disease.
We are not going to reverse the obesity epidemic anytime soon!
I would like to see a different approach: show the actual best diet guidelines, and then explain which partial steps will do the most good. Or something like that. It's better to be up front with what's known and then proceed to harm reduction rather than telling people that these partial steps are where they should end up.
I am sure there is a meta-analysis somewhere but this would take a bit of time to find
From the guidelines: When added sugars in foods and beverages exceed 10 percent of calories, a healthy eating pattern may be difficult to achieve.
Third year nutrition undergrad. Was told that this recommendation will likely be reduced further as more future research justifies doing so.
For most people that follow the recommendations, their diet may not be optimal but it will be markedly improved from average, at least in regards to preventing chronic diseases that are among the top causes of death (CVD, diabetes, etc) and improving overall wellness/health.
I disagree that the recommendations do not sway people toward healthier/less processed foods. See Table 1-1.
Just one example-- that fat causes heart disease. Pure nonsense pushed by the soda and sugar industry.
https://www.theguardian.com/society/2016/apr/07/the-sugar-co...
Just eat a balanced diet, don't overeat, and don't eat too much processed food and red meat, and you'll probably be fine.
And what exactly counts as "processed" food?
You're also implying everything with added flavor is junk food. Flavored Seltzer is the only thing that got my husband off of soda. Sure it's acidic due to the carbonation, but other than that it's pretty harmless especially compared to soda.
Artificial flavors and natural flavors are exactly the same thing, the only difference is how they are synthesised.
But I'm pretty sure my body doesn't care what color something is.
>Just eat a balanced diet, don't overeat, and don't eat too much processed food and red meat, and you'll probably be fine.
Wait, what? Why is the evidence against red meat so much stronger than that against cholesterol or fat?
Edit: or processed food for that matter, although I grant that a higher prior as being bad because of how far it is from what we would have eaten in our ancestral environment (depending, of course, on what you count as processing).
"Eat a variety of foods, avoiding large amounts of any one thing, and don't overeat; you'll probably be fine."
- Michael Pollan
If your diet is complex carbs with lots of fiber, you probably won't be hungry after ingesting a decent amount of calories. Most people don't do that (myself included), so instead I add in a lot of protein, which also fills me up reasonably quickly on a per-calorie basis.
It's not simply calories that fill you up, so choose the right calories. I can eat a thousand Calories of chocolate chip cookies and still be hungry, but a thousand calories of protein bars or broccoli will usually fill me up reasonably well.
(Actually, I've never managed a couple thousand Calories of just broccoli. I usually do 200-300 Calories of broccoli, but that alone does as much as all those cookies for satiety, so I can then eat a filling-but-sane second dinner and be full+healthy.)
It's really a matter of how long we've been overeating. Over time, our body adjusts to accept that as the new norm, or set point for food intake. It just takes more time to sensitize yourself again to less food making you feel "full".
- supposedly derived from H. L. Mencken
.
Point here being, just because it sounds good doesn't mean it's well supported.
I believe everything else you've said is correct. But the health effects of red meat and dietary saturated fats have not been unequivocally established.
There are studies saying it is harmful, there are studies saying it is not:
https://en.wikipedia.org/wiki/Beef#Health_concerns
> The Harvard School of Public Health recommends consumers eat red meat sparingly as it has high levels of undesirable saturated fat.[34] This recommendation is not without controversy, though. Another study from The Harvard School of Public Health appearing in Circulation (journal) found "Consumption of processed meats, but not red meats, is associated with higher incidence of coronary heart disease and diabetes mellitus."[35]
> This finding tended to confirm an earlier meta-analysis of the nutritional effects of saturated fat in The American Journal of Clinical Nutrition which found "[P]rospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart disease or cardiovascular disease. More data are needed to elucidate whether cardiovascular disease risks are likely to be influenced by the specific nutrients used to replace saturated fat."[36]
Meanwhile, well, you know, Aaron Swartz.
<<<The greater danger in this regard, these experts believe, lies not in products such as eggs, shrimp or lobster, which are high in cholesterol, but in too many servings of foods heavy with saturated fats, such as fatty meats, whole milk, and butter.
Here is my paraphrased takeaway:
Cholesterol you see in your blood results is still bad. Whole milk, butter, and fatty meats is still bad. Foods like eggs, shrimp, and lobster might be good.
I don't think this changes any of my mental models. The foods that I always thought of as "probably not great" are still classified as such, according to this article.
You're sure of that?
http://www.npr.org/sections/thesalt/2014/02/12/275376259/the...
My main takeaway:
> "Almost every single nutrient imaginable has peer reviewed publications associating it with almost any outcome," John P.A. Ioannidis, a professor of medicine and statistics at Stanford and one of the harshest critics of nutritional science, has written.
Pubmed studies show that butter is not related to heart disease https://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines...
This is an illuminating comment on the state of research, and it needs more awareness.
"Probably not great" food has vacillated greatly over the decades, eggs being the cliche example. Dietary cholesterol and blood cholesterol are often not directly connected.[2] The relationship between (any) saturated fats and blood cholesterol is not clearcut.
[1] http://www.metabolismjournal.com/article/S0026-0495(03)00070...
I'm throwing my lot in with Linus, he was as smart or smarter than probably anyone in history, and he wasn't making money from his discovery.
Also he was making money from the sale of his books.
You mean "might not be bad". There's a whole lot of gray area between "bad" and "good".
Blood cholesterol, on the other hand, seems to be essentially a thing the body does while storing excess quantities of fat. The obese will usually have high blood cholesterol, the non-obese will usually not have high blood cholesterol... whether they're on a zero-fat zero-cholesterol diet or not.
So basically, they're two different things: Long-term, blood cholesterol is mostly created endogenously independent of diet, and dietary cholesterol does not convert to blood cholesterol.
This seems like a much better approach in convincing people what to eat anyway. Look at the results and imitate healthy people if you want to look and stay healthy.
Translation: the lobbyists for various polyunsaturated "edible plastics" are currently in the lead.
- Grandfather, 89, ate everything moderately during his life, mostly organic. He evites fat and bread and walks every day. Low energy person.
- Grandmother, passed at 82, cancer. Same diet as my grandfather. Much less exercise though.
- Grandmother, 92, ate a lot until 50's, mostly organic, obese. Since then barely eats, mostly vegetables and yogurt. Right weight and good health. No exercise.
- Grandfather, passed at 71. Ate more fat than anyone I know. Death by heart attack or stroke. Very energetic person with a lot of exercise.
Can you see a pattern? I can't.
Don't pick the one study that shows what you want. Pick all the studies and go with whatever the preponderance of evidence suggests. That's science, and it's by far our most effective and reliable way of learning useful and non-obvious truths about the world.
Anecdotally, I've read 50% of people who go on Keto see a huge 2-3x increase in triglycerides and LDL-P (Particle count as measured by NMR) - the #1 risk factor for cardiovascular disease. More LDL particles bouncing around in your arteries = bad. People with a condition that makes them break down more LDL have much less artheroscleriosis: http://www.nejm.org/doi/pdf/10.1056/NEJMoa054013 People with a condition that makes them have more LDL particles get more artheroscleriosis: https://en.wikipedia.org/wiki/Familial_hypercholesterolemia Read Peter Attila's exposition that goes in detail (eating cholesterol is fine though): http://eatingacademy.com/nutrition/the-straight-dope-on-chol... Keto could work, but it's a hyper-pro level high-risk diet requiring frequent blood work and still avoiding saturated fats keeping them primarily monounsaturated which makes it very hard to follow. Plus it sucks for weightlifting..
Surprisingly, very low fat diets might be great for you, it might not be the absolute macronutrient composition that matters, but rather the specifics of the nutrients (GI, fiber, other nutrients etc) and your genetic makeup: https://deniseminger.com/2015/10/06/in-defense-of-low-fat-a-... Scary correlations about saturated fats and neurodegenerative disease therein too.
Personally I'm sticking with a "balanced" ~10/45/45 carbs from protein, low GI carb/monounsaturated fat vegan diet - not wanting to risk side effects of any extreme (although I'm having to ensure adequate calcium, K2, D, B12 and DHA and EPA intake - If I didn't find it unethical to eat fish a pescetarian variety would likely be easier/healthier/less gassy). Tip for you vegetarians/vegans: look up low FODMAP foods; foodstuffs low in carbs indigestible in the small intestine which tend to produce more gas.
Also I've been on statins since 37 after feeling my heart race and not being able to catch my breathe after being with girlfriend at the time. That was some scary stuff and after the statin and change of diet I no longer have those type of bouts anymore. So maybe it's my change in diet (cut out 75% fried food and sugar intake is 50% less) and the statin combined and or maybe the statin is just a placebo and my change is diet helped eliminate those heart racing attacks?
I had a lot of those attacks from 37 to about 39...im now 41 and haven't dealt with any such attacks unless I eat a say Five Guys or In and Out.
- Michael Pollan
The last time I checked, average woman in the U.S. is 5'4" but weighs 165lbs; average man clocks in at nearly 200lbs. We can do better.