Hacker News Reader

Comment by icegreentea | Hacker News Reader

Failure implies responsibility. Which is the entire point of the article. We've shifted death from something that just happens, to something that we're responsible for. We've come to believe that we are somehow above death, and that every death is due to a human failure. Which is nonsense.

Similarly taking your position, we could say that computer science's inability to factor numbers in polynomial time is a failure. Clearly the fact that solving the problem may actually be impossible should play a role in assigning the label 'failure'.

View on HN

Failure implies responsibility.

And I think that's a fair point, actually. Death is a responsibility. Ascribing it solely to medicine is unfair, but it is our responsibility.

Could we extend the average lifespan of adults by 10 years by spending money? Easily. Most people live thoroughly unhealthy lives, many of them because they simply don't know better. Consider the whole "obesity epidemic". A large number of people will die comparatively young because of a complete failure of our society to teach them how to eat decent food.

Beyond simply curing gross mistakes in self-care, what about positives? Could we find ways to get the average healthy person to treat their body even better, and squeeze out some more life expectancy? I'm sure we could. More thorough study of the effects of nutrients and toxins, more efforts to reduce the amount of crap in people's food and other items that they come into daily contact with, etc, those would probably net another few years of improvement.

And that's only looking at western society. If you look at poorer countries, there are countless avoidable deaths there. Some organisations, like the Gates foundation, are trying to address some of the more obvious killers, like Malaria, which have been neglected for decades (if we'd really wanted to get rid of Malaria in the 50s, we would have done so).

Overall, I think it's fair to state that we could raise the life expectancy of almost every human on this earth by 10 years if we really tried. But we choose not to. There are 7 billion humans on this planet, and every day, we, as a society, make a choice, to not bother to create 70 billion man-years of life-expectancy.

It is a choice, or rather a lack of choice, and so yes, it is a responsibility. We all (me included) choose to give up on 70 billion years of human life, every day.

Not at all. We do teach people how to eat decent food, but many choose not to.

We do? Watch this: http://www.youtube.com/watch?v=bGYs4KS_djg

Most people have no clue what constitutes a healthy meal. Moreover, they are strongly incentivised to eat crap by the fact that crap food is (much) cheaper than healthy food. Combine the two, and you have vast numbers of people who basically eat sausage rolls, pizzas, burgers, chips and chinese takeaways (probably not the worst of the bunch), along with epic-size sugary sodas and mega-calorie coffees on a pretty much daily basis.

I had to stop watching this show after 4 or 5 episodes.

It was just too depressing.

Many people complain that healthy food is "too expensive." However, a more accurate explanation is "crappy food is cheap."

There's definitely an important difference.

What do you suggest, making them both expensive?

Er, no. But there's an important psychological difference between "X is expensive." and "Y is cheap."

Honda Civic's aren't cheap. A Lexus is expensive.

Agreed. I find it hard to believe that so many people can be so ignorant of the very basics of healthy eating despite all the public health initiatives and mandatory classes in schools (at least in my country). I think people have the knowledge but just not the incentives to eat healthily. Convenience generally trumps everything else.

Convenience generally trumps everything else.

And taste. Pizza is really good.

Careful, this is a very dangerous path you're walking down.

This is the same thing as "why don't those homeless people just get jobs?!" - it's a failure to understand the complexities of the situation.

It feels nice though, because their failure is not on us (society as a whole), but wholly on them. Moral responsibility defeated!

swombat nailed it on the head: crap food is way cheaper than good food, to the point where a lot of this country does not have reasonable access to healthy foods. There are also other angles - e.g., single mother of two juggling two jobs - do you find something microwaveable or do you cook something healthy with the time you don't have?

In any case, this whole thing is way more complicated than just "hurr durr stupid plebes".

But swombat specifically referred to obesity, which suggests that you eat too much, not just that you eat the wrong foods.

If you are already eating too many pies, you can afford to replace some of them with cabbage or sprouts (at least here in England; Maybe it's not as cheap/easily available in other parts of the world?)

Don't confuse it with malnutrition, which is a real (but different) problem.

> "obesity, which suggests that you eat too much, not just that you eat the wrong foods."

It suggests no such thing. The obesity epidemic is all about eating the wrong things.

Obesity is not only a problem of quality of food, it also IS linked to quantity. You will never get obese if you only get a small amount of crap food everyday, but eating lots of it will surely put you on the right way. There are some genetic exceptions (some people get fat even when eating reasonably) but this is a tiny minority. Most of the obese epidemic is lifestyle related (no or not enough exercise / too much food ). There's no way you can get away from personal responsibility there. It is nothing like homeless unable to find jobs. You are directly responsible of what you put in your mouth everyday, and how much of it.

I'm a hypothetical poor person, so I must feed myself on cheap subsidized carbohydrates, which leave me feeling hungry, or eat an amount that sates me after working one to two normal jobs and taking care of zero to more children, which conveniently is an amount that will contribute to my obesity. Helpfully, my busy schedule lets me eat one big meal a day instead of several smaller meals.

The problem is that personal responsibility is disproportionately more expensive for poor people - they don't have the time or the money to do it right, and when they do manage an attempt, equal results will cost more time and much more % income.

> "You are directly responsible of what you put in your mouth everyday, and how much of it."

Well, yes, technically. Of course, you're conveniently forgetting about the effects of pricing, geographic proximity (seen many organic produce stands on skid row lately?), culture, education, and most importantly: time.

> "Most of the obese epidemic is lifestyle related"

And yes, you're right, but only in the most technical and of ways. Of course the obesity epidemic is lifestyle-related, but that's not what we're on about. We're on about a system that punishes healthy lifestyles and makes them unreasonably difficult for the poor to attain - harder than any of us pansy-ass rich folk have to contend with.

Let's re-enumerate very quickly:

1 - Eating too much is not the issue. Eating too much of the wrong things is the issue.

2 - Unhealthy foods are cheaper than fresh fruits, veggies, and meat by an almost comically large margin. This is due to a number of causes, most saliently massive government subsidization of unhealthy food industries.

3 - Time is the scarcest resource, and the poor have the least of it, and the least to spare towards maintaining a healthy lifestyle (which, despite what you might insist, is a time-intensive activity).

3a - The poor are disadvantaged in choice of living space. My commute is an order of magnitude shorter than what it'd be from the nearest poor suburb. I pay for the privilege, and it earns me easily an extra 1.5h each day.

3b - The poor are disadvantaged in transportation. While most people simply hop on a car between A and B, the American poor spend an enormous amount of time navigating the clusterfuck that is North American public transit. Here in SF, even with its good-by-American-standards transit system, transit anywhere takes about twice as long as it does in car.

3c - The poor are disadvantaged in just sheer lifestyle. You might live next to a nice park where you can jog after work - what do the poor have except crime-ridden streets?

This is the thing I can't stand about this line of argument, not only does your position fail to account for the many, many ways the cards have already been stacked against the poor, but it also fails to appreciate just how many natural advantages you and I enjoy in every day life. It's a combination that really irks me: the failure to appreciate one's own good fortune, and conversely the willingness to blame others for not having such good fortune.

Side note: time really is the deciding factor in just about anything poverty-related. Part of the reason for the persistence of homelessness (disregarding even bigger fish like mental health and substance abuse) is that the homeless spend the majority of their day queuing for resources. They spend hours lining up for a meal. They spend even more hours lining up for a bed. 98% of their waking hours is spent ensuring the status quo (i.e., homeless, but unlikely to die tonight), with nothing left to make actual, lasting improvements. This same problem applies to the poor and dietary habits.

Good comment. I do not agree with everything you said, so let me elaborate a little.

1 - Eating too much is not the issue. Eating too much of the wrong things is the issue.

No, I assure that even if you eat too much healthy food, you will grow fat and obese the same. Unhealthy food may make it worse for a number of reasons, but excess is anyway going to be a problem, no matter what you eat.

First, I would not classify "meat" as healthy food. That probably depends on your education and your view of meat, but you get a lot of fat percentage for the amount of calories. 50 years ago people were eating meat probably like 10 times less that we are and were (probably, I dont have numbers with me now) less sick. For your second point, "unhealthy" food is, I think, rather the result of people not considering food as important. Therefore food becomes a commodity. People prefer spending their money on vacation, video games, buying the latest smartphone and so on. Even those who HAVE the money. It's clearly a cultural problem: food has lost "value" per se. I do not know where you live so I cannot comment on that, but in most developped countries governments are also massively subsidizing small-sized farms (true in Europe and some parts of Asia at least).

3a. I agree with the time element, but I disagree in the responsibility. Of course, if one feels like you have to watch 4 hours of dumb TV shows every night to be satisfied with their lives, then there will no time for cooking. But anyone who can spare 30-45 mins a day in the evening can cook something healthy. Of course, it will not be something complex, but it is feasible. Please do not tell you need longer than that, of I will have to film myself cooking to prove my point.

3b. Now if you cannot even afford a car I admit this is a problem, especially in North America. Then it makes access to quality food more difficult. I can't argue on that one.

3c. Allright, of course there are poors who live in the worst conditions ever, and putting good food on the table is far from their priorities. But come on, when we talk about the obesity epidemic, we are talking about something like 33% of the whole US population having this obesity problem. You cannot seriously tell me that 33% of the US is composed of poor people living in crime-ridden suburbs. (http://www.cdc.gov/obesity/data/trends.HTML)

A number of these 33% HAVE the money, HAVE the time, HAVE the means to eat good food, but decide not to. For a lot of these people, this IS a lifestyle choice. There is noway around that, and there would be no epidemic if this was confined to the "poor/rich" rhetoric.

Here we go with the stereotyping again. The point you make has validity, but I simply cannot get behind it for the amount of stereotyping you are doing of the poor.

You are subscribing to the all-too-common "poor people with big screens and iPhones? What's that all about?" fallacy, except you ascribe even more universality to it than most.

> "People prefer spending their money on vacation, video games, buying the latest smartphone and so on"

This is a stereotype, unless you have convincing data to back it up. It is also about as offensive and useful as "black people! fried chicken! watermelons!"

See how far the conversation gets when this happens?

The "poor people are poor because they waste their money on lavish stupid spending" is a refrain we've heard way too many times. It's simply not true, fails to comprehend the complexity of the situation, and is frankly a complete moral cop-out.

I've had the fortunate/unfortunate experience of living on the wrong side of the tracks for part of my college years. I've lived with and befriended many of the people we upper-middles love to stereotype, victim-blame, and mock, and while there's always a sliver of truth to every stereotype, the characterization that the poor are poor, or that the poor are fat, because they're too stupid to act responsibly, is a pernicious and toxic lie.

Let's enumerate, for the record. You seem to believe that the poor:

- Spend their money on vacation, video games, and the latest smartphones instead of being smart about their finances.

- Need to watch 4 hours of "dumb TV shows" every night to be satisfied with their (presumably pathetic and meaningless) lives.

I honestly don't think we can have a discussion about the broader point of diet/obesity while you're chiseling at these points.

> "You cannot seriously tell me that 33% of the US is composed of poor people living in crime-ridden suburbs."

Have you been to the US lately? Despite what you might see in major cities or in the Valley, the majority of this country is poor as fuck. The notion that the vast majority of America enjoys a standard of living lightyears ahead of the rest of the world... is simply not true. Fully 42% of this country has an annual income of under $25,000.

The obesity epidemic in the USA is at its core tied to socioeconomic status. Hell, the fact that state-by-state obesity rates is highly correlated with state economic strength should be very telling.

> The obesity epidemic in the USA is at its core tied to socioeconomic status. Hell, the fact that state-by-state obesity rates is highly correlated with state economic strength should be very telling.

You need to check your numbers, because that's not what studies are saying. http://frac.org/initiatives/hunger-and-obesity/are-low-incom...

Quote: "Among men, obesity rates were fairly similar across income groups, although they tended to be slightly higher at higher levels of income. In fact, among Black and Mexican-American men, those with higher income were significantly more likely to be obese than those with low-income."

Shocking, it says the exact opposite of what you were trying to prove. So there actually ARE people with higher income who are obese, it seems.

> No, I assure that even if you eat too much healthy food, you will grow fat and obese the same.

This isn't true. If you eat lots of healthy food, and get even a little bit of exercise, then you will gain weight, but it'll be muscle instead of fat. If you eat only a little, then you will lose weight, but the quality of what you do eat will determine whether the losses come from fat or from muscle.

> A number of these 33% HAVE the money, HAVE the time, HAVE the means to eat good food, but decide not to.

What has actually happened is that people decide to eat healthy, but society lies to them about what is and isn't healthy.

> If you eat lots of healthy food, and get even a little bit of exercise, then you will gain weight, but it'll be muscle instead of fat.

Seriously, do you have anything to substantiate that claim? I have seen obese people even in countryside where they were eating nothing but so-called "healthy food". Since when "healthy food" becomes muscles ?

Not dangerous, this poster is absolutely right. I know how to eat healty, and I have the means, but I often eat unhealthily anyway. It is not the same class as being homeless.

I'm not saying that everyone is in the position to choose, but many are, and that is all that was said.

Living a healthy lifestyle has many benefits, but there's obviously an upper bound to this as a life extension approach. Who was it who said "Eat right, Exercise Regularly, Die Anyway"? :)

Sure, but if you take all the people who will die before 60 because of their weight (what's that, 1/3 of the population in the US?) you can basically add 15-20 years to their lifespans just by having them eat properly. That's the equivalent of adding 5 years to the US's average life expectancy.

I frankly don't understand why you were downvoted. I agree with this opinion...

No, that can't be right. Do you have sources to those statistics, as they seem way more drastic than I would have thought.

E.g., after looking around online for a bit, I found this[1] which indicates 300,000 deaths each year are attributable to obesity, which is 12.5% of deaths[2].

Furthermore, the magnitude of the the effect doesn't seem to be 15-20 years. This wikipedia section[3] indicates that being "obese" lowers life expectancy by 2-4 years. Being "severely obese" lowers it by 10 years. But according to these statistics[4], "severely obese" is ~10% of the population.

So I think 1/3 of the US population dying before age 60 because of obesity is way, way off the mark. More like 10% dying at 68 and maybe half the population dying at 75 because of obesity rather than 78.

[1] http://www.wvdhhr.org/bph/oehp/obesity/mortality.htm [2] http://www.cdc.gov/nchs/fastats/deaths.htm [3] http://en.wikipedia.org/wiki/Obesity#Mortality [4] http://www.nber.org/papers/w13181

Yes, everything you say there is true. But in the context of the article, and the parent post, we are not talking about preventative healthcare, or first lines of treatment, or stuff that can generally fall under the umbrella of "treating people right".

The context of the article is about extraordinary actions at the end of life. This is not about keeping people healthy, it is about making very ill people live a bit longer. We clearly have a responsibility to keep people healthy. There is no excuse for allowing malnutrition to just happen (though there is an 'excuse' for it to continue while we try to rid it). Those are failures. We are responsible for those.

Those responsibilities are very different from the situations being discussed by the article, and what I thought that mistercow was talking about (which would be death in general).

I'm entirely in favor of extending healthy life worldwide, but I worry that you're missing the point: death will still come. We are certainly responsible for not doing the best we can with what paltry time and resources we have.

This may seem like I'm belaboring a meaningless distinction, but it has practical implications. We spend extraordinary sums on futile end-of-life care instead of on the things you name. And people who are unprepared for death, their own or that of loved ones, suffer immensely.

Deciding that every death is a failure is denying a reality that we must confront if we really want to make the most of what we have.

We are responsible for death. We as a worldwide society have enough resources to seriously tackle death but because of our inability to coordinate effectively we don't apply those resource. NIH budget $30 billion Defense budget $700 billion Coordination is the problem web startups exist to solve, and so readers of hackers news are a particularly culpable in failing to address death.

We as a worldwide society MAY MAY have enough resources, that's assuming it's even a solvable problem.

Also "web startups" as a class don't exist to solve anything other than maybe the question "why don't I have more money".

We MAY be able to solve, so why not try it? I'd put avoiding death at the top of any list of priorities.

To make money you should be solving a problem (stealing and monopolies being exceptions). Web startups exist to coordinate people, that's the only thing they are capable of - they cannot "physically" do anything else. (the exception is personal data backup such as dropbox).

Reply on news.ycombinator.com