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Comment by Theodores | Hacker News Reader

Fascinating how these tests are something that is an option in America with people getting them.

In the UK we have the NHS and, although private healthcare is available, the NHS are gatekeepers with long waiting lists to see the doctor.

In UK culture you are just not going to 'waste NHS time' by asking for the tests that could inform you on what lifestyle choices you might need to make in order to head off chronic non-communicable diseases. You have to get a chronic disease, then the doctor will interpret the test results and not let you know what the numbers are, just what medication to take, optionally with lifestyle changes.

As a consequence, nobody in the UK knows what their cholesterol levels and whatnot are, yet, in the USA, plenty of people know these numbers.

Do healthcare providers actively upsell testing in the USA?

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>Do healthcare providers actively upsell testing in the USA?

In my experience, normal doctors do not, but there are a lot of private businesses that make their living selling testing.

Also, consider that despite a lot of people knowing their levels in the US through testing availability, health outcomes are not better. So, we know more, but don't do anything about it. I don't know what's worse.

They are better. Life expectancy at birth in the US is dragged down by myriad societal issues but if you survive to middle age, life expectancy begins climbing to the highest in the world.

Really you just need to look at it by state to see the huge difference. There is almost a 10 year difference between the best and worst states.

I think, politely, this perspective misses the forest for the trees (or maybe the trees for the forest).

Out of the approx. 250 million adult americans, a large cross section do manage their health.

While average outcome might be better in the UK, it's useless to lump the 60% (150 million) of americans who are not obese in with the 40% (100 million) who are obese. And while this is easily the most major, it is just one measure of health.

As an anecdote, I saw just this morning plastic adirondack chairs for sale outside a grocery store, and they had a large sticker on them proclaiming in 4-inch lettering that they are rated for 350 pounds(!). That says something sad about the U.S.

As an aside, I am amazed that chairs can be sold without some redundancy, in case of breakage. 350 pounds is not exceptional these days, that is only 160Kg, which is only 90 Kg more than what I weigh with clothes, cup of tea and plate of food... 80Kg is reasonable for a healthy person and two people should be supportable by the chair.

However, chairs get left outside and they can rot. This can lead to collapse even if a 50Kg person gets on. This can be incredibly dangerous. Hence every chair should have a secondary support structure, in some cases this can be wire under tension, other times it might have to be steel tubing.

There are thousands of chair designs, none of them built for the ultimate eventuality of catastrophic failure.

No. There's a *big* difference between the load limit printed on something and it's true expected failure point. As somebody could be hurt by the chair failing I would expect the real strength to be in the ballpark of 3,000 pounds or even more. Figuring the permissible % of expected yield point is handled by the engineers, normally not by the end users.

Load ratings near the failure point are only done when the failure will not cause a problem, or when the failure is actually a desirable property (breakaway tethers of various types.)

> That says something sad about the U.S.

That a lot of couples like to share the same chair??

And is that really so horrible? I would not own a chair flimsy enough that my wife couldn't sit on my lap when I was sitting in the chair.

In the UK, a cholesterol test is offered free of charge to everyone over the age of 40 by their GP, as well as younger people if they have a BMI over 25 or have a family history of high cholesterol levels or heart problems.

They're also available from most community pharmacies (again free of charge for at-risk patients, but for everyone else it should be about £10 for a simple finger-prick test or £30-50 for a full lipid profile).

That is interesting to know, clearly I never knew. It takes about two months to get an appointment where I live so I am not inclined to get a cholesterol test with no good reason. When I registered a blood pressure test, height and weight was all that was needed. With healthy blood pressure and a BMI of 19.5, I would like to see that full lipid profile. However, if I was in the overweight category, the last thing I would want to see is the lipid profile!

By community pharmacy, does that include a typical Boots the Chemist?

Yep, community pharmacy = anything outside of a hospital or similar setting. So Boots, Superdrug, or your nearest no-name chemist on your local high street.

I know my cholesterol numbers going back almost twenty years, over something like 15 tests. This is because that first test around 2007 showed my HDL was ridiculously low. So I took steps to modify it, and tested again (and again...) to see how it was progressing.

How can you increase your HDL?

N=1, but: I read that carbs lower HDL, and I was eating a very carb-heavy diet.

So over about two months I switched to an informal low-carb diet. e.g. I stopped drinking milk, I ate Carl's Jr. six-dollar burgers as lettuce wraps for lunch, and sometimes just roast beef and mayo.

Over three months I lost something like 30 pounds, hitting a body fat percentage around 12% -- this wasn't the goal, but FWIW.

My HDL before was 17, after those three months, 25.

Then I added in various forms of exercise and got it up to about 55.

I've since engaged in various diets, and levels of exercise -- although I've never gone back to the original diet where whole meals consisted of a quart of ovaltine. My HDL has never dropped below 40, nor been higher than 65.

Upsell? It's never been a matter of discussion. Doctors orders some standard bloodwork every year. HDL and LDL are part of it.

We don't even have the phrase 'bloodwork' in the UK. Also, in the UK, you can go to the doctor regularly for a checkup to never get this 'bloodwork' thing you Americans speak of. I have never had any done myself, all I get is my iron level when I donate blood, and I only ask about that after curiosity.

Healthcare is very different in America and I am not seeing the benefits of yearly 'bloodwork', it must be an upsell so they can get people onto statins and whatnot for life.

Multiple things are much better caught earlier. Off the top of my head:

Catch the elevated A1c before it does any damage, or get diagnosed from a hypoglycemic episode?? (By which point a lot of damage has been done.)

Catch the elevated TSH and supplement before there are any symptoms, or wait until the patient presents with hypothyroid? Note that the patient will have been through a fair amount of blah before the diagnosis is made. And thyroid hormones are very dose sensitive and it's a couple of months to stabilize on a new dose, so bringing the patient back to normal can take quite a while. US approach, my wife's TSH was high, they put her on some thyroid hormone, no symptoms of hypothyroid and no rush to dial in the dose because it's still within the body's ability to compensate and thus causes no problem.

And the subject of this thread, statins. Again, much, much better caught before it does damage.

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