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Comment by a1studmuffin | Hacker News Reader

Your health is ultimately your own responsibility - it's your body. You have free will, and your appetite for risk is yours alone. You can choose to ignore expert advice and refuse to wear a seatbelt, skip your rehabilitation exercises, invest all-in on crypto, or smoke cigarettes. None of this responsibility should fall on the expert if they communicated the risks clearly.

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What you're communicating here, perhaps unintentionally, is that what matters is not results, but blame. If the doctor said what to do but the patient didn't do it, all that matters is the patient is to blame.

You've communicated that by ignoring or dismissing the question of whether better outcomes are possible through other means than demanding that everyone follow doctors' orders and blaming them if they don't.

"Who cares if better outcomes are possible, so long as blame is in the right place"? Is that how we want to approach this?

It's hard to help someone that doesn't want to be helped.

Struggling to change is different from not wanting to change. People seem to have trouble with basic distinctions like this when they're heavy into moralizing failure to change.

Profound point. My mother struggled with alcoholism and ultimately succumbed to that disease. In philosophy of mind they use “akrasia” and “akratic thinking” for acting against ones better judgement. It helped me somewhat getting to understand what my mother was going through at that time.

She wanted to change, tried a many multiple of times and it failed. Fault, guilt, blame are useless concepts to use on the Other. And only in moderation should they be applied to the Self. There deep disconnects between what we think, know and do.

I find it helps to explicitly abandon the expectation that each person has a unitary and consistent will.

Bob the gambler wants to quit and wants to wager, sometimes sequentially and sometimes simultaneously.

The question isn't whether the whole Bob "means it", but which version of Bob we want to ally-with to war against the other, and what conditions or limitations we put on that assistance.

Reading this thread it seems like you're the only one moralizing and looking down on people. I don't see anyone here shaming people for their choices. But somehow you seem to have read the worst interpretation of every reply.

Drugs expand what helping yourself means to the point where people will actually do so.

Statins, GLP-1 antagonists, etc isn’t magic, but it changes people’s behavior and bodies in such as way as to diminish the importance of willpower. Thus, it’s not that people are lacking instead our medicine is simply to primitive to help with a wide range of issues.

Not that hard in this case. Just give them a pill.

Or, as we're becoming aware with GLP-1 drugs, an injection. (For now!). It's better to help people behave better with drugs than moral condemnation. Almost infinitely better, as it turns out, regarding a lot of problematic behavior regarded as "untreatable" previously.

Why not both?

The old adage "You can lead a horse to water but you can't make it drink" applies here.

It may not be the case for statins specifically, but my main concern is side effects. If there was a panacea, I would support giving it to everyone, but lifestyle changes are usually more available, if not easier.

Yeah this prickles my hackles too. It took a fairly high dosage of zepbound and many months for me to get to a normal set of eating habits after a couple of decades of bad, but a prediabetes scare surprise on my labs pushed me into the program, but I would not have done it by "white knuckling". I needed some medication to help me along. All these people just saying "calories in and calories out" "just start exercising dude" are making a complex issue into a "simple solution" that almost never works because change takes time; a lot of time that many people don't feel on a deep level that they have to apply to it. So, they just give up after a couple of weeks of "grit" and "will-power". Isn't it like maybe 1-3% succeed over time, while the rest fail when trying to lose significant weight or other health issues that could be resolved with habit only?

To me the terms mix and it helps to separate the things that are externally manageable from the things that are not. The physical is complex but straightforward - the body biochemistry operates on material in, biochemistry mix, expenditure out. The brain is physical - neurons, pathways, etc. The mind, OTOH, is a virtual little candle isolated in a prison of meat and bone trying to understand how to interact with the world around it. External forces can alter the body and brain, but only the mind can change the mind. And does, in ways that are very difficult to control because the sole operator is part of the mechanism. People who try to change on their own and can't aren't failing or weak, it's just really f-ing hard.

If my health is my responsibility, then shouldn't the treatment that I receive be to the standard that I request?

In 2015, https://pubmed.ncbi.nlm.nih.gov/26551272/ showed that medicating all of the way to normal works out better than medicating down to stage 1 hypertension, then insisting on diet and exercise. And yet my request in 2018 to be medicated down to normal blood pressure was refused, because the professional guidelines followed by the experts was to only medicate down to stage 1 hypertension, then get the patient to engage with diet and exercise. The expert standard of care was literally the opposite of what research had shown that they should do.

I agree that experts should not be accountable for my laziness. But can you agree that experts should be accountable for following standard of care guidelines that are in direct conflict with medical research? And (as in my case) refusing the patient's request to be treated in a way that is consistent with what medical research says is optimal?

Maybe 80-90% of people should take doctors at face value, but it is easy and only getting easier to at least access the knowledge to better advocate for your own healthcare (thanks to LLMs), with better outcomes. Of course, this requires doctors that respect your ability to provide useful inputs, which in your case did not happen.

My advice would be to "shop around" for doctors, establish a relationship where you demonstrate openness to what they say, try not to step on their toes unnecessarily, but also provide your own data and arguments. Some of the most "life-changing" interventions in terms of my own healthcare have been due to my own initiative and stubbornness, but I have doctors who humor me and respect my inputs. Credentials/vibes help here I think: in my case "the PhD student from the brand name school across the street who shows up with plots and regressions" is probably a soft signal that indicates that I mean business.

> In 2015, https://pubmed.ncbi.nlm.nih.gov/26551272/ showed that medicating all of the way to normal works out better than medicating down to stage 1 hypertension

Thanks for posting this. While I would generally advise a healthy dose of skepticism for any individual study, this one was very large and seems to be both well designed and executed. While there was a (statistically) significant increase in side effects with more intensive treatments, only about 1% more patients had adverse effects versus the standard treatment group, which seems like a very reasonable risk given the improved outcomes.

I've been trying to get my blood pressure under control recently and was thinking getting down to 12x/8x was good enough, but this has me rethinking that.

You should have bought some illegal street diet and exercise or cholesterol meds or whatever.

What if you have an intrinsically lower ability to perform temporal discounting?

Is that really something intrinsic and fixed or can you improve it over time with deliberate effort?

Open to evidence either way. I haven't seen people improve it even with what seems to be terrible negative consequences associated with poor temporal discounting ability, but I'd love to read differing perspectives.

Research on heritability have found that the amount of temporal discounting we do is moderately heritable. With twin studies ranging from 30-60% of our natural variability explained by genes.

This strongly suggests that genetics definitely slips a thumb on the scale, but ultimately we are able to also impact our personal behavior.

More importantly, research such as https://pubmed.ncbi.nlm.nih.gov/31270766/ shows that there are techniques (such as mindfulness practices) that have been demonstrated to improve our abilities in practice. I have personally seen these have an impact.

Of course if you have a condition such as severe ADHD, you might not be able to reach the same level as is possible for someone with good genetics. But you still have the ability to move the needle. If you have a condition such as traumatic brain injury, even your ability to move the needle may be lacking.

But most of us should be able to make a positive change.

> This strongly suggests that genetics definitely slips a thumb on the scale, but ultimately we are able to also impact our personal behavior.

If it's 30-60% heritable, that leaves 70-40% to split between personal decisions and environment. It does not guarantee that personal decisions matter much at all...

That is why I said "strongly suggests" instead of "guarantees".

And then further followed up with a link to research showing that it is, in fact, possible to change. With advice on how to change it.

What would be the upper bound of the effect of heritability where responsibility is no longer assumed?

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