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Comment by reify | Hacker News Reader

This is the problem with the war on drugs and any sort of drug control or prohibition.

Synthetic drugs came about because they fell outside legislation designed to control the different classes of drugs.

The police could not prosecute because there was no law to cover synthetic drugs in the early days.

I saw the slow increase in the damage caused by synthetic drugs as I worked in Substance misuse as a methadome dispenser. Rather than woking predominantly with heroin addiction, clients were presenting more and more with synthetic substance addictions.

For me I would like to see all drugs legalised so that the consumer has a safe way to use drugs of their choice.

I used to smoke hash in the 80's from as far away places as Pakistan, Afganistan, lebanon and morocco.

Now it is all genetically modified skunk which is 10 times stronger than the proper hash I used to smoke.

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> Synthetic drugs came about because they fell outside legislation designed to control the different classes of drugs.

Or just as illegal, but far easier to smuggle (that’s the expensive part), so the weak stuff disappears from the market while potent stuff becomes the only available option.

The weirdest thing to me is that drug use is cracked down on so hard that we even have international treaties against them, but something like obesity in some cases is even celebrated (healthy at every size).

The steelmanned version of this is that morbidly obese people rarely run up and down the street mugging and robbing people to get their next fix. (And that in aggregate people's tolerance to petty crimes is much less than their tolerance against controlling innocent people's lives.)

... and during the 20th century "performative law and order" was -- how should I put it -- big, as in the 1937 Nazi rally was attended by about a million people, and the 1939 one was called Rally for Peace (but cancelled a few days before and instead of the Rally the Nazis attacked Poland)

... fast-forward a few decades later, still September, but spin the globe a bit, and dear Nancy and Ronald are concerned about drugs! oh my ... while they supplied arms to Iraq ... and Iran at the same time, directly violating a law he personally signed.

I think this is basically right, but I would add the suffering of the family as well.

Obesity will not lead you to abuse your spouse or children. Obese people can hold down a job. Obese people don't lose custody of their children.

The closest analogue, I think, is smoking. It will demonstrably take years of your lifespan and healthspan. It does lead to minor harm of people in your immediate vicinity (2nd hand smoke, those kids probably get fat too).

I think smoking is bang on as a comparison. Massive lifetime average costs to the health system, spending on which is by definition zero sum. Both smoking and morbid obesity are enormously damaging life paths. I say this as someone who struggles with their weight.

I want to acknowledge that weight isn't a simple calories in, calories out situation. That other illnesses, medications, childbirth and gut health have enormous impacts on the capacity to maintain or lose weight. And that many people (particularly in the US) live in food deserts. What I'd criticise is the valorisation or excusing of obesity as equivalent to healthy living.

'Healthy at any size' social messaging is enormously damaging on a social and personal level. I've personally known a few people who became politicised in this direction (as a subset of radical queer politics) and went from being highly functional to disabled due to overeating and other health consequences of inactivity and overeating. Life is difficult, aging is terrifying. Making it worse by pretending that these conditions aren't awful is extremely irresponsible.

Maybe not abuse of children per se, but most obese parents have obese children, so the self-caused sickness is passed down. I see it very often in such cases.

It boils down the lifestyle, 2 generations ago their grandparents were most probably skinny due to simple food they ate and physical labor they went through every day. If kids see lazy tired parents, chances of them being athletic and eating healthily are very low, and its a baggage that gets heavier to shed off with each passing year.

I grew up in a relatively high tax country with universal healthcare. My government in particular didn't publish everything I'd need to figure this out, but if they were comparable to similar countries with similar budgets and similar obesity rates, then I'd be paying 100% of my income for about two weeks every year in taxes to pay for the additional healthcare costs caused by obesity.

So if I didn't have to pay for obese people's additional healthcare costs, I could have either gotten myself a rather sizeable tax break, or a couple week of extra holiday free every year.

that sounds very interesting!

I tried to look for some overview, and ... found this study .. and even more interestingly in the Netherlands obesity seems to be cheaper than the alternative (probably because living longer leads to having more cancers, and those are fucking expensive)

https://dom-pubs.pericles-prod.literatumonline.com/doi/10.11...

This one is much easier to interpret as the result is just "In per capita terms, costs of obesity in 2019 ranged from US$17 in India to US$940 in Australia." ... and yeah a thousands bucks could have been spent on something nice. Drugs for example!

https://gh.bmj.com/content/6/10/e006351

A study in my home country (which aligned with my own back of the napkin estimation) put the additional cost of obesity at around 8% of government expenditure. Which given I was giving up over half my salary in taxes (well over half once you count sales taxes), comes out to over two weeks of work exclusively for obese people’s additional medical costs. That’s not too far off the study you linked, which states an average of 1.8% GDP (though I’m not sure that sample of 8 countries is representative of much), which again would be somewhere between 4.5-6% of government expenditure depending on their expenditure to GDP ratios (assuming 30-40% is pretty normal).

Perhaps one week of work dedicated exclusively to subsidising obese people excess medical costs every year would be more reasonable for a more typical tax payer. But that’s still a lot.

I’m not sure I buy the increased mortality bringing that number down story very much either. Obesity tends to only take about 5-10 years off your life expectancy (depending on how obese…), but it’s going to drive your medical care costs up for your whole life. Obesity kills you a lot slower than cancer does.

I was surprised too, and for the other countries in the sample the result is the way you would expect. (But it seems that the Netherlands is an outlier exactly because the cost of end of life care is very expensive compared to "obesity care". But it would probably be much less surprising if we would see the data on graphs, as health problems - so associated costs too - tend to spike waaay up above 80, so in this model it seems that ~5 year difference makes up for a lot of money...)

But drugs aren't all the same. Some will be about the same as smoking or even less. They're still banned.

Obesity in and of itself is not an indicator of health. It can be a symptom of underlying health issues, and can cause other health issues (specifically if sedentary like joint pain and injury, insulin resistance, etc.), but it is not unhealthy to be obese if all other health indicators are fine.

I'm 220 pounds, I can run a 10 minute mile (not the 5:45 I ran in high school, but I'm also 20 years older and don't have the 5-hours per day dedicated to training I did back then). I just completed a 5-day, 125 mile hike through the Scotish highlands with a torn MCL. I'm probably the "healthiest" I've ever been, even though every one of my doctors tells me I need to lose 75 pounds.

Wouldn't manufacturers try to increase potency even if it is legalized? Marketing it as "better bang for your buck"?

One of the biggest drivers towards higher potency is ease of smuggling, which is a lot less of a concern for legal manufacturers. They’re also ripe targets for wrongful death lawsuits so there’s an incentive to keep the potency within reasonable limits unless the drug is relatively harmless. They can also accurately dose their drugs and make large pills, making it harder to accidentally overdose on doses that are measured in milligrams

Getting sued for overdoses typically prevents behavior like that.

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