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Transforming 'more benzene than second hand smoke' to 'worse than second hand smoke' is a criminally bad title that's aĺl too common in science reporting. Benzene is a tiny percentage of the myriad of carcinogens and others issues with second hand smoke.
Reminds me of that time where news was saying a single commercial ship pollutes as much as 3 million cars based on a study that was strictly focusing on sulphur oxides, something cars release very little of and isn't their main pollutant.
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https://dailyhive.com/vancouver/vancouver-city-council-rejects-natural-gas-ban
You're never passing that in the USA, even in a progressive as all hell city, in Canada, we're not going to do it.
Start by mandating heatpumps in all new home builds, with a ban on gas heating in regions where appropriate.
There's a lot of lower hanging fruit to handle.
My friends and I have hotpot nights with butane stoves - that can't be any better and that's still very common to do.
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Okay, so in light of the past few pages, I have the sense that the quoted sentence was poorly worded, but what the doctor might mean makes sense if you do some work.
(a) If by “have obesity” or “have the disease”, she means “have the genetic predisposition to store a lot of fat”; OR (b) if by “optimal diet” she means “best diet reasonably available within people’s solution space” — which is a backwards way of saying it, because the problem is that the best diet reasonably available to many people is suboptimal — then the sentence becomes intelligible.
I agree that this is poor communication and that I did a lot of unpacking there — the quote immediately struck both BlackJack and me as implausible and made my mind leap to examples of societies where very few people are obese, examples which would seem to disprove the quote. I would not have been able to decipher the quote without the aid of the last couple of pages of this thread. With that aid, though, I suspect that this doctor is advocating for the most enlightened approach, and one that is not remotely unscientific.
My interpretation of the enlightened and scientifically sound approach is: “Willpower is not a main explanatory factor in who gets obese. The main explanatory factors are the types of food available and genetic predisposition to obesity. In our society, unhealthy food is so much more readily available than healthy food that the power of individual choice in reducing obesity is almost negligible from a public health perspective. We need to change the relative availabilities of healthy versus unhealthy food at a societal level.”
(Of course, for all I know this doctor says stuff like that all the time — the source from which the quote came seemed a bit cheap/sensationalist. This story was next to “people on Twitter have been mocking Greta Thunberg” and “stepson of guy in vanished submarine is flirting with Onlyfans models.” Kind of a mean-spirited “news for laughing at people” slant. It also raised my eyebrows that the article opened with “a controversial member of ___ panel”; emphasis mine.)
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On June 23 2023 02:35 Djabanete wrote:Okay, so in light of the past few pages, I have the sense that the quoted sentence was poorly worded, but what the doctor might mean makes sense if you do some work. (a) If by “have obesity” or “have the disease”, she means “have the genetic predisposition to store a lot of fat”; OR (b) if by “optimal diet” she means “best diet reasonably available within people’s solution space” — which is a backwards way of saying it, because the problem is that the best diet reasonably available to many people is suboptimal — then the sentence becomes intelligible. I agree that this is poor communication and that I did a lot of unpacking there — the quote immediately struck both BlackJack and me as implausible and made my mind leap to examples of societies where very few people are obese, examples which would seem to disprove the quote. I would not have been able to decipher the quote without the aid of the last couple of pages of this thread. With that aid, though, I suspect that this doctor is advocating for the most enlightened approach, and one that is not remotely unscientific. My interpretation of the enlightened and scientifically sound approach is: “Willpower is not a main explanatory factor in who gets obese. The main explanatory factors are the types of food available and genetic predisposition to obesity. In our society, unhealthy food is so much more readily available than healthy food that the power of individual choice in reducing obesity is almost negligible from a public health perspective. We need to change the relative availabilities of healthy versus unhealthy food at a societal level.” (Of course, for all I know this doctor says stuff like that all the time — the source from which the quote came seemed a bit cheap/sensationalist. This story was next to “people on Twitter have been mocking Greta Thunberg” and “stepson of guy in vanished submarine is flirting with Onlyfans models.” Kind of a mean-spirited “news for laughing at people” slant. It also raised my eyebrows that the article opened with “a controversial member of ___ panel”; emphasis mine.)
Nah, what actually happened here is that people shifted the conversation. We don't need to make these reaches for this doctor like "maybe by optimal she meant optimal in their situation which is suboptimal in general." Sure we have a evolutionary imperative to eat a lot, and sure we have little control over how much "willpower" we have. That's all fine and true but that's not the point that she was making. She was saying that diet and exercise play only a small part of determining your weight and that it's mostly genetic. Here's more of the interview which previously aired on 60 minutes:
https://www.cbsnews.com/news/weight-loss-obesity-drug-2023-01-01/
Dr. Fatima Cody Stanford: But the number one cause of obesity is genetics. That means if you were born to parents that have obesity, you have a 50-85% likelihood of having the disease yourself even with optimal diet, exercise, sleep management, stress management, so when people see families that have obesity, the assumption is, "Ugh. What are they feeding those kids? They're doing something wrong." Actually do you know this? 79-90% of physicians in the United States have significant bias towards individuals that are heavier. Now, doctors listening to me may say, "Oh, it's not me." Hold your horses, because has that patient come to you and told you, "Look, Doc, I'm eating well." "Look Doc, I'm exercising." And the doc says to them, "Are you sure? I don't believe that that's really what you're doing."
Dr. Fatima Cody Stanford: Throw that out the window. My last patient that I saw today was a young woman who's 39 who struggles with severe obesity. She's been working out 5 to 6 times a week, consistently. She's eating very little. Her brain is defending a certain set point.
Surely we all realize that's absurd, right? She's arguing that someone that is "severely obese" and is "eating very little" AND working out 5-6 times a week, and their body is not letting them lose any weight because apparently their brain is telling them they need to be severely obese. Unless she's a crocodile that can get her heart down to 4 beats/min she's going to be burning plenty of calories just by staying alive. You can't not lose weight while eating "very little." We're making excuses of "well what she is really saying is..." because we don't want to accept the reality that people in respected positions don't believe in the laws of thermodynamics.
Anyway most of the interview basically plays as an advertisement for weight loss drug injections that cost $1,300 a month. They are paying 60 minutes as an advertiser and they are paying the doctor as a consultant to promote their drugs. This is what passes for news in America.
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On June 23 2023 05:38 BlackJack wrote:Show nested quote +On June 23 2023 02:35 Djabanete wrote:Okay, so in light of the past few pages, I have the sense that the quoted sentence was poorly worded, but what the doctor might mean makes sense if you do some work. (a) If by “have obesity” or “have the disease”, she means “have the genetic predisposition to store a lot of fat”; OR (b) if by “optimal diet” she means “best diet reasonably available within people’s solution space” — which is a backwards way of saying it, because the problem is that the best diet reasonably available to many people is suboptimal — then the sentence becomes intelligible. I agree that this is poor communication and that I did a lot of unpacking there — the quote immediately struck both BlackJack and me as implausible and made my mind leap to examples of societies where very few people are obese, examples which would seem to disprove the quote. I would not have been able to decipher the quote without the aid of the last couple of pages of this thread. With that aid, though, I suspect that this doctor is advocating for the most enlightened approach, and one that is not remotely unscientific. My interpretation of the enlightened and scientifically sound approach is: “Willpower is not a main explanatory factor in who gets obese. The main explanatory factors are the types of food available and genetic predisposition to obesity. In our society, unhealthy food is so much more readily available than healthy food that the power of individual choice in reducing obesity is almost negligible from a public health perspective. We need to change the relative availabilities of healthy versus unhealthy food at a societal level.” (Of course, for all I know this doctor says stuff like that all the time — the source from which the quote came seemed a bit cheap/sensationalist. This story was next to “people on Twitter have been mocking Greta Thunberg” and “stepson of guy in vanished submarine is flirting with Onlyfans models.” Kind of a mean-spirited “news for laughing at people” slant. It also raised my eyebrows that the article opened with “a controversial member of ___ panel”; emphasis mine.) Nah, what actually happened here is that people shifted the conversation. We don't need to make these reaches for this doctor like "maybe by optimal she meant optimal in their situation which is suboptimal in general." Sure we have a evolutionary imperative to eat a lot, and sure we have little control over how much "willpower" we have. That's all fine and true but that's not the point that she was making. She was saying that diet and exercise play only a small part of determining your weight and that it's mostly genetic. Here's more of the interview which previously aired on 60 minutes: https://www.cbsnews.com/news/weight-loss-obesity-drug-2023-01-01/Show nested quote +Dr. Fatima Cody Stanford: But the number one cause of obesity is genetics. That means if you were born to parents that have obesity, you have a 50-85% likelihood of having the disease yourself even with optimal diet, exercise, sleep management, stress management, so when people see families that have obesity, the assumption is, "Ugh. What are they feeding those kids? They're doing something wrong." Actually do you know this? 79-90% of physicians in the United States have significant bias towards individuals that are heavier. Now, doctors listening to me may say, "Oh, it's not me." Hold your horses, because has that patient come to you and told you, "Look, Doc, I'm eating well." "Look Doc, I'm exercising." And the doc says to them, "Are you sure? I don't believe that that's really what you're doing." Show nested quote +Dr. Fatima Cody Stanford: Throw that out the window. My last patient that I saw today was a young woman who's 39 who struggles with severe obesity. She's been working out 5 to 6 times a week, consistently. She's eating very little. Her brain is defending a certain set point. Surely we all realize that's absurd, right? She's arguing that someone that is "severely obese" and is "eating very little" AND working out 5-6 times a week, and their body is not letting them lose any weight because apparently their brain is telling them they need to be severely obese. Unless she's a crocodile that can get her heart down to 4 beats/min she's going to be burning plenty of calories just by staying alive. You can't not lose weight while eating "very little." We're making excuses of "well what she is really saying is..." because we don't want to accept the reality that people in respected positions don't believe in the laws of thermodynamics. Anyway most of the interview basically plays as an advertisement for weight loss drug injections that cost $1,300 a month. They are paying 60 minutes as an advertiser and they are paying the doctor as a consultant to promote their drugs. This is what passes for news in America.
I'm with Magic Power here and it just seems extremely obvious to me that this doctor is being hyperbolic and it's a really bad clip, but her point is sound: you aren't going to solve obesity by telling people to diet and work out more, no more than you can get people to change their eye color by really really concentrating on it.
Simberto and Magic Power have gone back and forth over the last few pages over what the genetic and environmental components to obesity are and how they interact in a spiral of doom in western society, and worst of all in the US. People can work out all they like if they then sit down for a Super sized Big Mac Menu and a gallon of ice-cream. And unfortunately that is what they have learned to eat as a "normal weekday meal" (well, maybe not a whole gallon of ice-cream). Some people "lucked out" in the genetic metabolism lottery and stay skinny almost regardless of what they eat, but a lot of people also get hit by the double whammy of their brains being essentially addicted to sugary food and their metabolism such that they store lots of fat "for periods of famine".
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BJ, you don't understand what Stanford is saying.
In her own words, obesity is a "complex and chronic disease", more specifically a "disease of the brain".
Quote: "It's a brain disease. And the brain tells us how much to eat and how much to store."
To solve individual cases of obesity, Stanford recommends treatment approaches such as: "diet and lifestyle (i.e. behavioral), medications, and surgery." Diet and lifestyle should be in the forefront, and emphasis should be put on a "high-quality diet, not calorie counting."
About "willpower" she says the following:
"Throw that out the window. My last patient that I saw today was a young woman who's 39 who struggles with severe obesity. She's been working out 5 to 6 times a week, consistently. She's eating very little. Her brain is defending a certain set point."
Her point being that an obese person may lose many pounds, but is likely to gain them all back. This is because the brain of an obese person is wired differently, telling them to eat back everything that was lost.
That is the disease that she's talking about. It's not some miraculous addition of calories that weren't even on the plate to begin with. It's the calories that are being fed right back into the system after losing a certain amount of pounds.
Stanford's conclusion is that obesity is not just a state of being, but a disease of the mind that virtually forces the individual to eat more food.
https://www.cbsnews.com/news/weight-loss-obesity-drug-2023-01-01/
https://www.health.harvard.edu/blog/obesity-is-complicated-and-so-is-treating-it-2018053013943
Edit: this, by the way, is exactly why I gave the examples of anorexic people developing a binge eating disorder, in some cases coupled with insomnia/sleep walking. If Stanford's hypothesis is true, then I'd guess a similar diagnosis would apply in those cases, too.
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On June 23 2023 06:36 Magic Powers wrote:BJ, you don't understand what Stanford is saying. In her own words, obesity is a "complex and chronic disease", more specifically a "disease of the brain". Quote: "It's a brain disease. And the brain tells us how much to eat and how much to store." To solve individual cases of obesity, Stanford recommends treatment approaches such as: "diet and lifestyle (i.e. behavioral), medications, and surgery." Diet and lifestyle should be in the forefront, and emphasis should be put on a "high-quality diet, not calorie counting." About "willpower" she says the following: "Throw that out the window. My last patient that I saw today was a young woman who's 39 who struggles with severe obesity. She's been working out 5 to 6 times a week, consistently. She's eating very little. Her brain is defending a certain set point." Her point being that an obese person may lose many pounds, but is likely to gain them all back. This is because the brain of an obese person is wired differently, telling them to eat back everything that was lost. That is the disease that she's talking about. It's not some miraculous addition of calories that weren't even on the plate to begin with. It's the calories that are being fed right back into the system after losing a certain amount of pounds. Stanford's conclusion is that obesity is not just a state of being, but a disease of the mind that virtually forces the individual to eat more food. https://www.cbsnews.com/news/weight-loss-obesity-drug-2023-01-01/https://www.health.harvard.edu/blog/obesity-is-complicated-and-so-is-treating-it-2018053013943Edit: this, by the way, is exactly why I gave the examples of anorexic people developing a binge eating disorder, in some cases coupled with insomnia/sleep walking. If Stanford's hypothesis is true, then I'd guess a similar diagnosis would apply in those cases, too.
You are inferring a lot of missing words there for her benefit.
She's not saying what you're saying. You're saying the brain is wired differently which leads to the over-eating which leads to the obesity while still ultimately being out of the person's control. She's crucially missing that middle step of the over-eating. In fact she's specifically saying the opposite by talking about "optimal diet" and "eating very littlie" while still remaining obese.
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On June 23 2023 07:13 BlackJack wrote:Show nested quote +On June 23 2023 06:36 Magic Powers wrote:BJ, you don't understand what Stanford is saying. In her own words, obesity is a "complex and chronic disease", more specifically a "disease of the brain". Quote: "It's a brain disease. And the brain tells us how much to eat and how much to store." To solve individual cases of obesity, Stanford recommends treatment approaches such as: "diet and lifestyle (i.e. behavioral), medications, and surgery." Diet and lifestyle should be in the forefront, and emphasis should be put on a "high-quality diet, not calorie counting." About "willpower" she says the following: "Throw that out the window. My last patient that I saw today was a young woman who's 39 who struggles with severe obesity. She's been working out 5 to 6 times a week, consistently. She's eating very little. Her brain is defending a certain set point." Her point being that an obese person may lose many pounds, but is likely to gain them all back. This is because the brain of an obese person is wired differently, telling them to eat back everything that was lost. That is the disease that she's talking about. It's not some miraculous addition of calories that weren't even on the plate to begin with. It's the calories that are being fed right back into the system after losing a certain amount of pounds. Stanford's conclusion is that obesity is not just a state of being, but a disease of the mind that virtually forces the individual to eat more food. https://www.cbsnews.com/news/weight-loss-obesity-drug-2023-01-01/https://www.health.harvard.edu/blog/obesity-is-complicated-and-so-is-treating-it-2018053013943Edit: this, by the way, is exactly why I gave the examples of anorexic people developing a binge eating disorder, in some cases coupled with insomnia/sleep walking. If Stanford's hypothesis is true, then I'd guess a similar diagnosis would apply in those cases, too. You are inferring a lot of missing words there for her benefit. She's not saying what you're saying. You're saying the brain is wired differently which leads to the over-eating which leads to the obesity while still ultimately being out of the person's control. She's crucially missing that middle step of the over-eating. In fact she's specifically saying the opposite by talking about "optimal diet" and "eating very littlie" while still remaining obese.
I'm not going to play this game with you ever again, I've had plenty enough of it. I've come to realize that you have a strong urge to feel superior to scientists whose words you can't or don't want to comprehend.
Furthermore in an interview things are often left out that would be required for a complete understanding. Humans aren't perfect so they'll say something or forget to say something and later they realize that their wording wasn't ideal, but the core message is still intact.
You never give the benefit of the doubt to scientists if they're not pitch perfect in every possible situation. I do. That's one of the key differences between you and I.
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I don't give the benefit of the doubt to scientists being paid by pharma companies to go on television and promote their new weight loss drugs that cost $1,300 a month
It's part of a new generation of medications that brings about an impressive average loss of 15% to 22% of a person's weight and it helps keep it off. Drs. Apovian and Stanford have been advising companies developing drugs for obesity, including the Danish company Novo Nordisk, an advertiser on this broadcast. It makes the drug Wegovy that you inject yourself once a week with, something like an epipen. It's not easy to get. The drug is currently in short supply. And it costs more than $1,300 a month.
Dr. Caroline Apovian: We are frustrated every single day when we see patients who desperately need to lose weight to reduce the diabetes, reduce the hypertension, stroke, heart disease, and we can't give them this fabulous, robust medication that is very effective and safe. And we can't give it to them because insurance won't cover it.
Maybe if they didn't sound like pharma shills I would be more keen to give these doctors the benefit of the doubt. I'll accept the criticism.
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On June 23 2023 07:33 BlackJack wrote:I don't give the benefit of the doubt to scientists being paid by pharma companies to go on television and promote their new weight loss drugs that cost $1,300 a month Show nested quote +It's part of a new generation of medications that brings about an impressive average loss of 15% to 22% of a person's weight and it helps keep it off. Drs. Apovian and Stanford have been advising companies developing drugs for obesity, including the Danish company Novo Nordisk, an advertiser on this broadcast. It makes the drug Wegovy that you inject yourself once a week with, something like an epipen. It's not easy to get. The drug is currently in short supply. And it costs more than $1,300 a month. Show nested quote +Dr. Caroline Apovian: We are frustrated every single day when we see patients who desperately need to lose weight to reduce the diabetes, reduce the hypertension, stroke, heart disease, and we can't give them this fabulous, robust medication that is very effective and safe. And we can't give it to them because insurance won't cover it. Maybe if they didn't sound like pharma shills I would be more keen to give these doctors the benefit of the doubt. I'll accept the criticism.
... and exactly as I expected you would, completely unsurprisingly, you left out the next part where Stanford talks about this exact problem that you just quotemined to paint her as the Devil.
"Lesley Stahl: People in Hollywood can afford these expensive injections. And they're taking them.
Dr. Fatima Cody Stanford: Right.
Lesley Stahl: And they're not necessarily people with obesity.
Dr. Fatima Cody Stanford: Yeah. We have a national shortage on these medications. If those that have the means, are able to get them yet the people that really need them are unable to. Then that creates a greater disparity, right? The haves and the have nots.
The vast majority of people with obesity simply can't afford Wegovy and most insurance companies refuse to cover it partly because, as AHIP - the health insurance trade association – explained in a statement, these drugs "have not yet been proven to work well for long-term weight management and can have complications and adverse impacts on patients."
The blame, as is often the case, goes to insurance companies.
Furthermore Stanford is advising several companies developing products against obesity, of which Novo Nordisk is only one. She doesn't develop these drugs herself.
So you're completely misrepresenting a scientist, and I'm not surprised. Why should I be surprised?
I'm done, and I need to go bed anyway. Enjoy your time alone.
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On June 23 2023 07:42 Magic Powers wrote:Show nested quote +On June 23 2023 07:33 BlackJack wrote:I don't give the benefit of the doubt to scientists being paid by pharma companies to go on television and promote their new weight loss drugs that cost $1,300 a month It's part of a new generation of medications that brings about an impressive average loss of 15% to 22% of a person's weight and it helps keep it off. Drs. Apovian and Stanford have been advising companies developing drugs for obesity, including the Danish company Novo Nordisk, an advertiser on this broadcast. It makes the drug Wegovy that you inject yourself once a week with, something like an epipen. It's not easy to get. The drug is currently in short supply. And it costs more than $1,300 a month. Dr. Caroline Apovian: We are frustrated every single day when we see patients who desperately need to lose weight to reduce the diabetes, reduce the hypertension, stroke, heart disease, and we can't give them this fabulous, robust medication that is very effective and safe. And we can't give it to them because insurance won't cover it. Maybe if they didn't sound like pharma shills I would be more keen to give these doctors the benefit of the doubt. I'll accept the criticism. ... and exactly as I expected you would, completely unsurprisingly, you left out the next part where Stanford talks about this exact problem that you just quotemined to paint her as the Devil. "Lesley Stahl: People in Hollywood can afford these expensive injections. And they're taking them. Dr. Fatima Cody Stanford: Right. Lesley Stahl: And they're not necessarily people with obesity. Dr. Fatima Cody Stanford: Yeah. We have a national shortage on these medications. If those that have the means, are able to get them yet the people that really need them are unable to. Then that creates a greater disparity, right? The haves and the have nots. The vast majority of people with obesity simply can't afford Wegovy and most insurance companies refuse to cover it partly because, as AHIP - the health insurance trade association – explained in a statement, these drugs "have not yet been proven to work well for long-term weight management and can have complications and adverse impacts on patients." The blame, as is often the case, goes to insurance companies. Furthermore Stanford is advising several companies developing products against obesity, of which Novo Nordisk is only one. She doesn't develop these drugs herself. So you're completely misrepresenting a scientist, and I'm not surprised. Why should I be surprised? I'm done, and I need to go bed anyway. Enjoy your time alone.
I don't understand your point. Obviously the average person can't afford to pay $1,300 a month in weight loss drugs. Obviously the real $$$ is to get the insurance companies to cover the cost of the drugs. How does going on TV to shame the insurance companies to cover the drugs of the pharma company paying her make her less of a shill than if she were trying to sell them direct-to-consumer?
+ Show Spoiler +Btw I should mention that it cost $1,350 if it's prescribed for weight loss. If it's prescribed for diabetes it only cost $892. The same drug with the same cost to manufacture and 2 different prices depending on why it's prescribed. The reasoning is simple: there are lots of different diabetes medicines but very few medicines approved for weight loss therefore the market can bear them jacking up the price another 50%. Of course the 2 doctors aren't going to shame the people writing their checks for jacking up the price there so of course all the blame goes to the insurance companies.
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To be honest entire article reads like an advert for a drug. Whether one is anti science for thinking that way, I believe article itself provide the answer:
"In one of her published studies, Dr. Stanford found that most medical schools don't teach that obesity is a disease and in fact don't even offer courses on it, even though it's the second leading cause of preventable death in the country after smoking. "
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I'm glad we can all get on board together in this thread about the problems with healthcare costs and the way the insurance and drug industries abuse the public together in their dance for ever higher profits at the cost of the public.
If only there was an example in other developed nations that we could look to for an answer to these problems and find a way to fight the corruption and waste in healthcare to benefit the public over shareholders.
Does anyone know of any solutions out there or ways other nations have fought this issue to better the lives of their citizens?
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Ultimately this can only be fixed by changing from a fee for service model to a fee for outcome model.
With fee for service, doctors are incentivised to order as many tests and treatments as the insurance will cover, thus inflating costs.
With fee for outcome, we mandate that the outcome is that the patient ends up healthy, and we pay a certain fixed amount depending on the diagnosis and symptoms. We then end up only doing the tests and treatments that are cost effective, and innovations that reduce cost will be financially profitable for the insurers and doctors.
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On June 23 2023 12:10 JimmiC wrote:Show nested quote +On June 23 2023 12:01 gobbledydook wrote:
Ultimately this can only be fixed by changing from a fee for service model to a fee for outcome model.
With fee for service, doctors are incentivised to order as many tests and treatments as the insurance will cover, thus inflating costs.
With fee for outcome, we mandate that the outcome is that the patient ends up healthy, and we pay a certain fixed amount depending on the diagnosis and symptoms. We then end up only doing the tests and treatments that are cost effective, and innovations that reduce cost will be financially profitable for the insurers and doctors. Any where using that and how does it work?
They have actually been trying to promote it in the US since the ACA was passed. There are similar initiatives in other parts of the world. The Australian government recently took steps to move general practice subsidies towards a value based model, but it is still a very new policy and it is only an incremental shift.
It's just really hard to change a system overnight and I cannot say that there are already mature and successful systems.
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Essentially what it is, is instead of charging per visit or procedure, the hospital or clinic gets paid for every patient they treat that reach the desired health outcome.
That might include recovery, or palliative care, or whatever else the best outcome for the patient would be.
In order to do this effectively, you need to collect a lot more data about how well a patient is being served, and completely overhaul the business model, which is a big paradigm shift and that is why progress is slow.
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EPT
