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Comment by philipkglass | Hacker News Reader

There seem to be basically two arguments against "exercise pills."

1) Self-discipline is virtuous in and of itself. We shouldn't develop alternative ways to control weight and/or maintain muscle tone without controlling food intake and exercise, because that undermines the tangible rewards of virtue.

2) Biology is extremely complicated, and the drug that keeps you compact and muscular in your 40s might end up promoting the growth of cancerous tumors all over your body in your 60s. (As happened to the older mice who received high doses of GW501516.)

I don't agree at all with the first argument. The second one is alarming enough that I'm not going to be the first or even the millionth person in line to obtain these compounds through grey-market channels and dose myself. Similarly, I would love a drug cocktail that prevents the unwanted physical effects of aging, but I'll let other people blaze a trail with human trials (clinical or self-experimentation.)

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I find #1 funny, in that appetite and "self-discipline" seem to be biologically inversely correlated in at least some sense. Boost dopamine (such as with the old amphetamine-based "diet pills"), and you get more control over your impulses... but also your appetite goes away, so you don't even need to exert control over it. Lower dopamine (such as with a typical antipsychotic), and you get hungry, but also find it harder to override your impulses in general. (If you're curious, this is thought to help in psychosis because "skepticism"/"being realistic" is one of the lower-level impulses that dopamine overrides.)

If self-discipline were virtuous, would the "best" exercise pill be one that only enhances self-discipline (with no stimulant-like side-effects)—and thus makes it easy to be one of those people who just "decide to exercise and eat healthy" and end up doing so? Or would people likely still consider that "cheating" in some sense? And if so, do you think such people would be able to be convinced at that point that they're literally just measuring the "virtue" of people's genetics, rather than of their choices?

This line of reasoning is why giving children (or anyone, really) medication for moderate behavioral problems is an ethical gray area. If there is a pill that helps an unruly-but-otherwise-healthy kid sit still and stay focused, do you have them take it? At what point does an element of your personality become a medical issue?

Also why are issues past an arbitrarily-drawn "medical" line the only ones we can treat via medication?

No one thinks working out should be illegal. So why should doing the same thing via other means be illegal?

Maybe it's the lingering Protestant-work-ethic-laced morality of the U.S., but we seem to be disproportionately likely to exaggerate the dangers of anything that seems like a drug, relative to things that don't seem like drugs (even when they clearly are -- i.e., alcohol).

Or sugar because apparently we don't need fructose in our diet at all.

I'm 28 and I'm still recovering from the stimulants I took to 'help me sit still' in school.

It's part of my life's work to make sure that kind of drugging of children becomes a thing of the past. It's criminal.

Can you imagine giving a child amphetamines to 'help' them in a non-coercive environment like a Sudbury School? https://ia801305.us.archive.org/19/items/TheSudburyValleySch...

I have taken stimulants on and off through my life. I certainly don't need them, but it is very unlikely I would own a tech company if I hadn't taken them. They have almost certainly improved my life immensely.

The GP said 'during school', so I assume it wasn't voluntary and instead something they had to do.

In your post you talk about on and off and don't give us any insight whether you (always? most of the time?) made that decision yourself.

Are you against any and all use of methylphenidate?

I'm against giving addictive pharmaceuticals to children as a solution to structural problems in compulsory schooling. Consenting adults should be able to make their own choices.

As a once-kid who was fundamentally incapable of paying attention to uninteresting topics for longer than about 30 seconds, I'd have loved to take that pill any day.

It's not that I didn't care about paying attention, I really wanted to pay attention, it just wasn't happening. I think that's the difference - you wouldn't be forcing me to do something I didn't want to do, you'd be helping me do something I did want to do.

Yeah I understand there are benefits, and I didn't mean to make it sound like I am against medication. It is just interesting because our culture dictates what behaviors are successful, which in turn informs which behaviors are undesirable. In the end we medicate against unwanted behavior not for medical reasons but for cultural ones.

3) There other benefits to exercise, including stretching and loosening joints and ligaments, building coordination and body awareness, mental benefits, etc. Sweating has benefits as well. I'd find it really hard to imagine that some pill that mucks with metabolism or muscle growth or some other single dimension would cover even a small portion of the benefits of exercise.

There are lots of benefits, and it's very unlikely a pill, or even a cocktail of pills, could emulate all those benefits.

That said, if you found a safe pill that would merely give the cardiovascular benefits of exercise, or help elderly patients maintain muscle mass, or move obese people to just being overweight, it would be worth tens or hundreds of billions of dollars.

When discussing a thought experiment, it’s helpful to assume that you are in The Least Convenient Possible World[1]. In this case, the GP is considering a pill that actually provides any actual effect of exercising that you deem useful or important. In a world where we had such a pill, is having such simple solutions to problems, having to avoid things like learning self-discipline or commitment, too big a downside?

In this case your point that such a pill wouldn’t help with your joints being limber or sweating is a cop-out. It’s not actually addressing the point of the discussion, instead focusing on details irrelevant to the point of the thought experiment.

[1]: http://lesswrong.com/lw/2k/the_least_convenient_possible_wor...

I don't see any reason you couldn't take the pill and exercise. In many cases people who aren't doing any sort of exercise are held back by being so out of shape that they can't really get into the habit, in which case having a pharmaceutical head start might be reasonable.

I would love it if I had some help with something other than a straight up pain pill. My body hurts all the time with arthritis and from using a cane for the past several years. To be able to simply move around again without constant pain would be a Godsend.

Have you looked into LDN (low dose naltrexone)? Ask your doctor about it if you haven't tried it yet. http://tinyurl.com/y7sgmr7s

edit: link

The article has a certain bias and tone. A lot of points are just kind of swept under with this quote "the biological processes unleashed by physical activity are still relatively mysterious. For all the known benefits of a short loop around the park, scientists are, for the most part, incapable of explaining how exercise does what it does."

The biological process in the human body that depend on upright motion include far more than just simple muscle stimulation and growth. The circular system is meant to work against gravity in concert with muscle contraction. It should be relatively obvious that there's indeed far more to exercise and basic bodily functions than this pill covers.

A lot of the exercise we get is sort of implicit: it's "non-exercise activity thermogenesis" — a.k.a., fidgeting.

I'd expect a drug that "mimicked exercise" would really do so in part by making you exercise more, without realizing you're doing so: i.e., by making you fidgety (and sweaty, and achier in your joints so you'd want to stretch more, etc.)

Meth?

Aside from the neurotoxicity and the fact it destroys appetite, it certainly does work well for burning fat I believe. If one could gain the effects minus the amphetamine downsides, I wonder what it would be like.

Look at all the people kinda sorta microdosing on Adderall. It's ubiquitous in some domains.

Do people really bother "microdosing on Adderall"? The drug companies have already handled that bit for you. That's what Adderall XR is (and in a funkier way, Vyvanse, also): Adderall that is manufactured in such a way that it will enters your system a little at a time.

I dunno, I know a lot of people that are prescribed stonking doses of the high-test original formula, and break their tabs into quarters or eighths. Then again, the going rate in the cubicle streets is, I've been told, $30-$50 a pill, so that might have something to do with it.

Yes and no.

Look around. When, as the article mentions, the option is no pill vs some pill that helps in some way; for most people the pill makes sense.

As it is today, many people could alter their diets and improve their health. Yet they do not.

In an ideal world this pill makes little sense. But our First World world of today is far from ideal. Put another way, they say that worldwide more people die from eating too much than not eating enough.

Sure. I was just saying there are other arguments against these pills. I'm not a luddite or a perfectionist and can see their use case though.

I hear ya. I do, in theory, agree with you. But the reality is most people don't care to take care of themselves. And they wonder why healthcare costs are so high.

But there is a third option: make that First World world more ideal.

Sugar water and other high calorie stuff could see the same treatment tobacco got; cars could be banned from city centers to make room for bicycle lanes and lush pedestrian zones, parking lots could be required to be at least half a mile from offices and shopping malls, with nice walking paths between the two, etc.

Or maybe we could just play loud patriotic music over loudspeakers every morning, and use armed guards to force people to fall out for PT.

"cars could be banned from city centers to make room for bicycle lanes and lush pedestrian zones, parking lots could be required to be at least half a mile from offices and shopping malls,"

Screw old people and the handicapped, eh?

Here's a better idea: live your life the way you want. Don't force others to live the way you want.

Because, you know, granting government that level of power that doesn't end up where you imagine that it ends up.

Old people and the handicapped would IMO be fine. Car free streets make street crossings a lot less scary and allow for streets that are less wide.

Those that still need it could safely use strollers and wheelchairs.

There also would likely be fewer handicapped. Allowing healthy people to drive huge four-wheel drive “wheelchairs” from the time they are 18 doesn’t make the population healthier.

I also doubt people currently live the way they want. If you ask a 40 year old with diabetes and a BMI of >30 whether they do, do they say so?

“Government of the people, by the people, FOR the people, shall not perish from the Earth.”.

Governments should shape society to make people happier. Just as with other tasks (product design, educating kids) that doesn’t mean giving them what they say they want.

Judging by things such as https://en.wikipedia.org/wiki/Human_Development_Index, some governments are better at providing what their people want then others. Call me an optimist, but I think the top ones have been granted “that level of power”.

I think you make a great point. Too often the size of government is confused with its role.

For example, there is a difference between enabling (positive behaviors X, Y or Z) and enslavement (e.g., addiction, obesity, etc.)

So you are saying that if we grant our governments the awesome power of city planning (which the government already has, do you think cities are just a random collection of buildings brought up by the first person who could buy a spot of land?) what slippery slope would we go down? Yes cars are harmful, to everyone, and they don't make a city more accessible (old people also can't drive when they start losing their sight for instance). Public transport makes cities accessible. You can live your life however you want, until you start hurting everyone else's.

>There other benefits to exercise, including stretching and loosening joints and ligaments.

There's some debate that stretching is actually a problem.

https://well.blogs.nytimes.com/2013/04/03/reasons-not-to-str...

Yes, but there are also negatives associated with exercise: injuries, joint wear and tear. Many, many people who where athletes in their prime end up with permanent damage to their body by the time they are middle aged.

Athletes may exercise, but I suspect most of their injuries come from competing, not exercising. They are different activities.

Exercise done with proper form doesn't cause joint wear and tear. That's really a myth. Frequent exercise actually keeps your joints healthy.

My plantar fasciitis, tendonitis, and damaged menisci beg to differ.

Anything can be overdone.

The first argument is flat-out ridiculous. The same argument could be used against farming or housing or even building communities.

The second is very real and of course requires us to tread very carefully but shouldn't be a reason to stop investigating something.

It's ridiculous, but it's ubiquitous (and thus worth bringing, at least to acknowledge its existence in the discourse and decision making around this topic). Most people simply don't think very hard, and "no pain no gain" virtue arguments are apparently deeply ingrained in most people's approach to things like this.

> I don't agree at all with the first argument

What if some of the commonly known positive effects of exercise, such as battling depression, are actually psychological effects of that discipline and motivation rather than physical fitness? I find it hard to argue this can't be the case.

Then that would be another point in favor of actually exercising, if the pills don't hit enough of the same biological systems to mimic the anti-depressive effect. I'm not rejecting any benefits of exercise that can be empirically demonstrated. I just want to distinguish "X has historically been the best way to achieve Y" from "X is virtuous, and should not be neglected even if technical progress provides easier ways to achieve Y."

There is virtue in working hard to achieve good outcomes, but not in working harder than actually necessary to achieve those same outcomes. (If you want to do things a harder way than strictly necessary because it's a fun pastime for you, that's fine too. Then the experience itself rather than the end state is what you are seeking.)

Ah fair enough, I misunderstood. I agree doing things for the sole reason of being virtuous doesn't make sense.

Although I do think the origin of "virtue" is because some things had good general effects, but nobody was able to explain why or how. Of course the concept has been abused since then.

Some societies found it virtuous to kill anyone not of the right race/religion. Some societies found/find it virtuous to genitally mutilate women.

I'm not sure we can come up with a principled way to distinguish the "good" kind of virtuous from the "bad" kind of virtuous without just deciding by ourselves what is virtuous and what isn't, at least to some degree.

Yeah, but 'some' is different than most.

It's pretty dang universal to feel "good" after putting in effort to achieve something.

If that would be true, then anything that requires discipline and motivation would help with depression. That is not the case - regular washing dishes or reading or most crafts don't have the same reported effect.

That being said, the help with depression is not because you become physically fit. Exercise works even if you train in an ineffective way. It has more to do with chemistry (e.g. endorphins) in your brain then with overall result.

Nobody is suggesting that a pill should replace exercise in all scenarios; most of us do it because it's damn enjoyable which is why there are so many different forms. Depression is a problem that would exist regardless, the difference is that with a pill existing depressive people would only be depressed instead of depressed and suffering from the other problems caused by lack of exercise.

Well, it's not germane to the discussion. The issue of whether there are positive psychological consequences of discipline and motivation and whether there are positive moral implications of virtue are completely unrelated topics. Pancakes taste good with maple syrup, but it doesn't do much to address the thing the first argument actually says.

In terms of ways in which "discipline" and "motivation" might provide benefits such as battling depression... I could see arguments both for and against as plausible. Feeling that restrictions on your actions are entirely of your own choosing is tremendously helpful at reducing the negative consequences of harmful stimulus, that is supported by research. I am unaware of any research that says it can actually tip the needle the other direction and make a negative stimulus into a positive, but it could be possible. Then again, there are a billion other ways in which our volition is infringed upon on a daily basis by society flagrantly which probably contribute far more to depression and anxiety and similar problems than anything minor like what limits you might put on yourself, so taking away just that bit should probably not be a noticeable change.

The problem most people have with "virtue" arguments (and I share in this) is that if there is a REASON something should be avoided, then the reason suffices. If there is no reason, then you are inherently wrong to advocate that other people avoid it. And trying to paper over the situation with societal shame is just repugnant.

The discussion is about benefits of exercise being replaced by a pill.

Whether the mood/psychological benefits come (or don't) with the pill as opposed to exercise, I think is germane to the discussion.

I think 2a is 20 minutes per day of exercise produces known benefits with known risks. It's not like it's an exercise pill or nothing. It's crazy to me that people are willing to take drugs that would require 70 year clinical trials to understand their safety rather than putting in 20 minutes per day of work...

1.) People who exercise because they want to look good or like it are no more virtuous. That is pretty much an equivalent of saying that if you spend hours choosing just the right dress and makeup, you are more virtuous.

I exercise because I enjoy it and partly to look better. I really don't think it makes me more virtuous then, say, fat people who don't exercises, but are overall nicer or more helping to people around then I am. Or simply people who read more book then I am or people who teach kids in their free time or whatever.

That shows more your lack of understanding of the word virtuous than anything.

If something is hard, takes a long time to do and makes you better you are right to feel virtuous.

A better argument against this line of development is that it is demonstrably expensive and low-yield.

There are far better R&D approaches to maintaining health over the course of aging, but they get a tiny fraction of the effort lavished on exercise and calorie restriction mimetics, despite the continued absence of concrete therapeutic outcomes resulting from all of that investment.

The reason for this is probably that exercise and calorie restriction mimetic research dovetails well with the real underlying scientific goal of mapping metabolism, where as better approaches tend to bypass this need for mapping, focusing instead on well-known forms of damage that cause age-related decline.

> I don't agree at all with the first argument.

Makes sense (not agreeing). The whole culture of modern society is all about not agreeing with such arguments.

That is, finding any idea of value in some authenticity that shouldn't be replicated technologically, silly.

I'm almost regretting including item 1, because the percentage of HN commenters who embody that attitude appears to be much lower than in comment sections on other parts of the web. Anecdotally, I can tell you that a significant minority of modern humans who comment on news articles are just furious about actual or projected technological advances that allow people to prevent e.g. obesity or pregnancy without relying on strenuous mental and/or physical discipline. That's why I mentioned it.

"Anecdotally, I can tell you that a significant minority of modern humans who comment on news articles are just furious about actual or projected technological advances that allow people to prevent e.g. obesity or pregnancy without relying on strenuous mental and/or physical discipline."

Yep. And yet you never see these people volunteering to make their livings as agricultural stoop labor peasants or (if female) volunteering to have 15 or 20 pregnancies over the course of their lives.

So? That's a non sequitur.

Someone wanting e.g. avoiding pregnancy to rely on "physical discipline" doesn't mean they are in favor of anybody having 15 or 20 pregnancies -- just that they are in favor of people having the discipline.

I have no idea why you're getting down voted here and I agree completely - see the reactions to the mere existence of Soylent as a concept.

I mean, you're not wrong. If I'm reading his comment correctly, coldtea holds exactly the view you're describing.

Somebody has to.

"Let's do X just because we can" has often lead us to more trouble than merely not doing X.

Especially when we half-understand X and what it affects.

Case in point, as others mentioned, albeit positively, Soylent.

Just so we're clear, I wasn't saying that negatively. Just pointing out that the parent commenter's assumption was backwards.

I agree with that judgment. I think we have seen that some in the cultural reaction to Soylent, which is mentioned in the article. Even setting aside questions about nutrition, cost, and cultural weirdness, some people are simply opposed to it as a matter of principle, and feel extremely strongly about it.

There is another argument, these pills don't seem to do anything for bone density even though the article suggested it for astronauts lower bone density - it appears to be an entirely muscular effect.

If one has to exercise to help build bone density anyways ( a concern for anyone who wants to have a healthy life after 40) the pill if it worked would only eliminate one component of an exercise regime.

I still lean on item 1 being the most correct. I know modern society is built on a "do anything" approach but in reality we're under the gun of biology and evolution and as such only certain behavioral patterns are actually successful. I found losing weight and staying fit got a lot easier when I focused on discipline instead of quick fixes like Atkins. There's an art to pushing back on that neurological trigger craving that dopamine shot and it can be learned. (Of course, if a pill comes out to help you with that trigger, then we're golden). Or more practically, a way to produce leptin and ghrelin in the body so hunger and craving response goes way down.

I'm not saying I'm "against" the pill, but no pill is going to magically erase 1,000+ calories of over-eating or clear out all the awful things excess sugar and other carbs may do. It may certainly mitigate them, but like the person I know who got lapband surgery eventually found out, his eating just adapted to his new limitations (ice cream, sweets, etc dont take much room and are very high energy) and he gained weight after a while. We'll pop the pill, eat like pigs, and be at the same weight or higher after a while.

I imagine if this becomes a mass market medicine, its effective applications will be outside of weight control and more towards helping people achieve a certain level of fitness especially those with limited mobility or illness. Its not something you're going to buy able to buy over the counter for 'free' workouts. The same way you can't buy testosterone or steroids OTC.

The situation with GW was really interesting, the study had incredibly high doses, but I don't doubt that they had reasons for pulling the drug, although I'm sure WADA pressure didn't help.

In argument 1:

I agree with the premise: "Self-discipline is virtuous per se."

I don't agree with the argument that follows: "We shouldn't develop alternates."

with regards to #2, it is controlling its use that will be problematic. seems far too often new methods to reduce fats and sugars in foods becomes a inhibitor remover for too many.

remember the horror stories from olestra's introduction, people shoving tons of chips because they were guilt free down their maws only to have digestive issues

1) will never happen, so, bring on the pill!

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