Now that we have a new thread, in order to ensure that this thread continues to meet TL standards and follows the proper guidelines, we will be enforcing the rules in the OP more strictly. Be sure to give them a complete and thorough read before posting!
NOTE: When providing a source, please provide a very brief summary on what it's about and what purpose it adds to the discussion. The supporting statement should clearly explain why the subject is relevant and needs to be discussed. Please follow this rule especially for tweets.
Your supporting statement should always come BEFORE you provide the source.
On June 24 2023 20:49 Magic Powers wrote: You're trying to paint Stanford as either corrupt or otherwise financially driven when the facts do not support your claim. Now instead you're holding onto a minute disagreement about terminology, when that is irrelevant to the point at large. Just admit that Stanford is not corrupt.
I don't think she's corrupt. I think there's a high likelihood that she believes what she is saying. That's the problem. You and others are the ones saying "well when she says this what she really means is..." I'm saying I'm not giving the benefit of the doubt to someone on TV that's being paid to promote prescription drugs.
Yes, the problem is always other people and especially the scientists. If scientists say something it's a problem, and people believing scientists is a problem.
Do you remember when I explained that conservatives are inherently anti-science?
Why do you seem to think scientists are beyond reproach? There can be scientists in the same field that have competing theories that are contradictory to one another. Now I'm no big city detective but I'd say that pretty much guarantees that at least one side of that argument is severely off the mark. She's arguing for one theory of obesity (set point theory) and there are other theories as well. What you like to do is elevate the theory that you favor and then dismiss anyone that disagrees as being "anti-science."
Your claim of Stanford pushing pills is false. Admit it first and then we can talk.
What’s your explanation for why that entire interview reads like an advertisement? With novo nordisk paying both the doctors they interviewed and paying CBS as a sponsor. One of the doctors is calling their drugs “fabulous and safe and effective.” Like seriously who refers to a pharmaceutical as fabulous…
If it was an advertisement the FDA would have required they disclose the potential risk of thyroid cancer, pancreatitis, hypoglycemia and kidney failure, among other things, which they didn't, so it obviously can't be an ad /s.
Just the idea that a program like 60 minutes can run this "totally not an advertorial" is problematic af on its own, that the clear conflict of interest and lack of critical analysis passes for "news" in the US is an embarrassment.
As for the "highest bidder" nonsense, it's just flat out not true.
Stahl reported that Wegovy is “not easy to get. The drug is currently in short supply. And it costs more than $1,300 a month.” But her only questions about that cost concerned why insurance companies wouldn’t cover it—not why it costs so much in the first place.
Novo Nordisk recently predicted record earnings as a result of demand for Wegovy, with operating profits expected to increase by up to 19% (Bloomberg, 2/1/23)—from a company that made $8 billion in profit last year. And this is in an industry that already regularly expects profit margins of 15–20%—Novo Nordisk’s 2022 profit margin was 31%—as compared to 4–9% for non-drug companies.
In Norway, where the Norwegian Medicines Agency recently denied granting reimbursement for it, Wegovy costs up to $425 a month out of pocket (MedWatch, 1/19/23). The price is similar in Denmark (Alt, 12/20/22).
And Wegovy is exactly the same drug—just at a higher dosage—as Nordisk’s older and more widely available diabetes drug Ozempic, which 60 Minutes also discussed as being used “off-label” (meaning not FDA-approved) for weight loss. ... It can cost less than $200 a month without insurance in Canada.
US capitalism and fixing these problems are mutually exclusive and the US political leaders of both parties are far more committed to perpetuating capitalism (and all the crimes against humanity that comes with that) than they are fixing problems like these so they'll continue indefinitely until that changes.
On June 23 2023 18:57 gobbledydook wrote: 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.
That sounds like a bureaucratic nightmare to implement, although a welcome shift in overall approach.
I'd imagine that payment based solely on successfully treating the patients, rather than based on how many patients are seen, could lead to a very difficult balancing act of quality vs. quantity. On one hand, the hospital or clinic would be more incentivized to make sure the patients that they do see get full care of the highest caliber; on the other hand, it might be the case that only certain (easier?) patients end up being selected, while the harder-to-diagnose/help patients might be turned away? Or are patients not allowed to be turned away?
I’m not sure how you qualify the effectiveness of care for more complex conditions, especially mental health ones. How is that tracked?
Guy I knew started to benefit from additional support, albeit from third parties, got onto a jobs program and all sorts.
Then he died from an accidental OD. How would such an outcome be logged?
From personal experience in psych wards I mean some people are kind of just fucked, they’re never going to be functionally independent. Sad but it is what it is. What does their healthcare provision look like?
On June 23 2023 18:57 gobbledydook wrote: 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.
That sounds like a bureaucratic nightmare to implement, although a welcome shift in overall approach.
I'd imagine that payment based solely on successfully treating the patients, rather than based on how many patients are seen, could lead to a very difficult balancing act of quality vs. quantity. On one hand, the hospital or clinic would be more incentivized to make sure the patients that they do see get full care of the highest caliber; on the other hand, it might be the case that only certain (easier?) patients end up being selected, while the harder-to-diagnose/help patients might be turned away? Or are patients not allowed to be turned away?
I’m not sure how you qualify the effectiveness of care for more complex conditions, especially mental health ones. How is that tracked?
Guy I knew started to benefit from additional support, albeit from third parties, got onto a jobs program and all sorts.
Then he died from an accidental OD. How would such an outcome be logged?
From personal experience in psych wards I mean some people are kind of just fucked, they’re never going to be functionally independent. Sad but it is what it is. What does their healthcare provision look like?
On June 23 2023 18:57 gobbledydook wrote: 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.
That sounds like a bureaucratic nightmare to implement, although a welcome shift in overall approach.
I'd imagine that payment based solely on successfully treating the patients, rather than based on how many patients are seen, could lead to a very difficult balancing act of quality vs. quantity. On one hand, the hospital or clinic would be more incentivized to make sure the patients that they do see get full care of the highest caliber; on the other hand, it might be the case that only certain (easier?) patients end up being selected, while the harder-to-diagnose/help patients might be turned away? Or are patients not allowed to be turned away?
I’m not sure how you qualify the effectiveness of care for more complex conditions, especially mental health ones. How is that tracked?
Guy I knew started to benefit from additional support, albeit from third parties, got onto a jobs program and all sorts.
Then he died from an accidental OD. How would such an outcome be logged?
From personal experience in psych wards I mean some people are kind of just fucked, they’re never going to be functionally independent. Sad but it is what it is. What does their healthcare provision look like?
Great questions.
There are still many unanswered questions. I still think it is fundamentally better than fee for service, because it better aligns the value for the patient and the value for the provider. There are already private practices that do this sort of pricing and it works as a business model, although of course they are still in the minority.
I’m just not sure it scales. Private practices can do things here because they’re the preserve of generally wealthier folk, but the wider health service has to cover everyone. Granted that’s over here with the NHS, where private care is a layer on top, other places have different systems of course.
One area that could revolutionise healthcare is tech IMO, in ways that dovetail with what you’re talking about but I feel there are too many cultural and political objections
We’ve increasingly got various data collection available via commercial wearables as it is. We’ve got more and more tools to make sense of giant datasets.
A few wee tweaks and you’ve got a big linked-up early warning system that could also track certain outcomes post-treatment.
But considering the conspiracy theories around vaccines and big government in general, I don’t think a system where the government (or insurance providers) actually has access to health data would remotely be able to deliver on its potential as there’d be too much resistance
the problem I think is important to look at is that even with all this new tech it won't matter at all in america when the health care system doesn't care about preventative medicine and only functions well in emergency situations.
the wild fact that a guy set up an online pharmacy that saves everyone money by not involving insurance in any way is just a perfect way to show that you can't run a private healthcare industry.
On June 25 2023 21:10 WombaT wrote: I’m just not sure it scales. Private practices can do things here because they’re the preserve of generally wealthier folk, but the wider health service has to cover everyone. Granted that’s over here with the NHS, where private care is a layer on top, other places have different systems of course.
One area that could revolutionise healthcare is tech IMO, in ways that dovetail with what you’re talking about but I feel there are too many cultural and political objections
We’ve increasingly got various data collection available via commercial wearables as it is. We’ve got more and more tools to make sense of giant datasets.
A few wee tweaks and you’ve got a big linked-up early warning system that could also track certain outcomes post-treatment.
But considering the conspiracy theories around vaccines and big government in general, I don’t think a system where the government (or insurance providers) actually has access to health data would remotely be able to deliver on its potential as there’d be too much resistance
NHS already doesn't pay doctors for a prescription. They pay for the medicine. The doctor has 0 incentive to prescribe a pill vs not prescribe a pill. Similarly, the hospital has 0 incentive to overprescribe fancy machines like MRI, because the NHS paid for the machine rather than the hospital paying for it and needing to earn that money back from the NHS. So the whole system is (in theory) outcome oriented by merit of the fact that doctors are simply left to do what they do best: diagnose and treat illnesses, without their payment depending on how many expensive medicines they prescribe or whether they meet this month's quota for CAT scans.
I notice the difference quite clearly here in Spain where we have a similar mix of public health and private care for "extras" and faster access to specialists. When I go to the public hospital with some ailment, the advice is generally: painkillers and wait it out at home. If it hasn't gone away in a few weeks, come back and we'll run some tests. The private hospital, it's almost unheard of to leave without a prescription for something. Of course, I have to pay for those medicines out of pocket unless I get their use validated by my doctor from the public service...
I'm posting this video essay because it confirms something that I've been suspecting. McDonalds has been aware since the early 2000s, or perhaps longer, that individual choices are not the reason for the obesity epidemic. It's so important for McDonalds that people believe in the myth of choice that they made a marketing campaign pushing that specific slogan.
You should probably cite the creator of that video for completeness. Was her family run over by a McDonalds truck delivering food? Probably not, but still.
While the video seems to raise some good points about what was really going on, and tries to avoid making claims without admitting when they can't be backed up, I still struggle a bit to see how this shows that McDonalds realizes that choice is a myth. I don't think your conclusion is wrong... I just think you really need to read between the lines to get that message purely from the video.
She began the video saying she found "no evidence" that McDonalds collaborated with this guy to go on an all McDonalds diet and lose weight, and then spends a good chunk of the video calling it "sus" and "fishy" and hinting that the guy was in cahoots with McDonalds the whole time. Why doesn't the science teacher get the benefit of the doubt but the doctor does? Especially when there's "no evidence" the science teacher colluded with McDonalds but we know the doctor is getting paid by Novo Nordisk.
btw it seems like the point the science teacher was making is that nothing trumps calories in vs calories out. Again this is immutable scientific fact. Dr. Stanford on the other hand believes:
Obesity isn’t just about energy balance, i.e., calories in/calories out. “That’s simplistic, and if the equation were that easy to solve we wouldn’t have the prevalence of obesity that we have today,” Dr. Stanford explains.
I've conceded multiple times now, you could make the point that what she's really saying is a lot of people lack the willpower through no fault of their own to maintain a caloric deficit. But I think it's pretty obvious she purposefully tries to tip toe on the line by saying things that make it sound like she doesn't believe in CICO without explicitly saying so and the examples speak for themselves, e.g. remaining obese while following "optimal diet."
In other words, her beef is really with the extent any of us really possess free will vs simply being the victim of our genetics and environment but instead of beefing with that she beefs with calories in vs calories out
On June 26 2023 07:02 Magic Powers wrote: I'm posting this video essay because it confirms something that I've been suspecting. McDonalds has been aware since the early 2000s, or perhaps longer, that individual choices are not the reason for the obesity epidemic. It's so important for McDonalds that people believe in the myth of choice that they made a marketing campaign pushing that specific slogan.
I just watched it. The "choices" narrative for me was more about how you can "choose' to eat at McDonalds all the time, but still "choose" your food in a way so you lose weight. That it is possible to get really fat really quickly by eating their products can also be viewed as a choice.
We are not taught well enough to withstand the constant hammering to satisfy our cravings for fat and sweet foods. It is a perfect setup, where money can be earned both by gaining and losing weight.
I hope the buzzword "ultra processed food" dies a horrible death very soon, though. How processed something is does not necessarily say how healthy something is, and a lot of food needs to be processed for humans to digest it.
This is less a McDonalds thing and more a ‘capitalism in general’ thing I guess.
This isn’t to dispute some degree of agency of course, but a widespread belief in unencumbered choice is extremely useful if you’re a company who wants to throw unhealthy food down people’s throats, run a gambling site, sell booze and what have you.
I’d wager a majority of people have their first experiences, mostly happy ones with McDonald’s in relatively early childhood, so there’s already a positive link established pretty early doors.
Most evidence I’ve ever seen points to us being quite malleable and influenceable creatures, very prone to addictive behaviours of all kinds, some less benign than others.
But yet much of society is set up on the presumption that we are not, and are these beings that can just make choices independent of all these other factors ultimately.
Bit of a tangent but hey, cheers for the link Magic!
On June 26 2023 07:02 Magic Powers wrote: I'm posting this video essay because it confirms something that I've been suspecting. McDonalds has been aware since the early 2000s, or perhaps longer, that individual choices are not the reason for the obesity epidemic. It's so important for McDonalds that people believe in the myth of choice that they made a marketing campaign pushing that specific slogan.
On June 26 2023 07:02 Magic Powers wrote: I'm posting this video essay because it confirms something that I've been suspecting. McDonalds has been aware since the early 2000s, or perhaps longer, that individual choices are not the reason for the obesity epidemic. It's so important for McDonalds that people believe in the myth of choice that they made a marketing campaign pushing that specific slogan.
Maybe I'm misunderstanding this whole discussion, but I don't think anybody believes choice is a myth? It's more the realisation that individual choice isn't what's causing the increase in obesity in society, but that 'environmental' (as far as you can consider capitalism and the food industry environment) pressures are the driving force behind it.
It's not a single individual choice that makes an epidimec. Its a sum of milions of them. Just like a single vote doesnt elect a president but many milions do. Like a single soldier doesnt make an army, but a a milion do.
Suggesting that we dont really have a choice and are just a result of enviromental preassures and genes is a dengerous path to follow. I mean, if You dont have a choice eating at McDonalds then perhaps owners of McDonald doesnt have a choice but offer You a junk food. Afterall, we all just product of genes and environment...
On June 26 2023 16:27 Silvanel wrote: It's not a single individual choice that makes an epidimec. Its a sum of milions of them. Just like a single vote doesnt elect a president but many milions do. Like a single soldier doesnt make an army, but a a milion do.
Suggesting that we dont really have a choice and are just a result of enviromental preassures and genes is a dengerous path to follow. I mean, if You dont have a choice eating at McDonalds then perhaps owners of McDonald doesnt have a choice but offer You a junk food. Afterall, we all just product of genes and environment...
Of course we have a choice, but the nature of that choice can change. Otherwise there would be no need for marketing, PR and that kind of thing.
On June 26 2023 08:38 WombaT wrote: This is less a McDonalds thing and more a ‘capitalism in general’ thing I guess.
This isn’t to dispute some degree of agency of course, but a widespread belief in unencumbered choice is extremely useful if you’re a company who wants to throw unhealthy food down people’s throats, run a gambling site, sell booze and what have you.
I’d wager a majority of people have their first experiences, mostly happy ones with McDonald’s in relatively early childhood, so there’s already a positive link established pretty early doors.
Most evidence I’ve ever seen points to us being quite malleable and influenceable creatures, very prone to addictive behaviours of all kinds, some less benign than others.
But yet much of society is set up on the presumption that we are not, and are these beings that can just make choices independent of all these other factors ultimately.
Bit of a tangent but hey, cheers for the link Magic!
The comparison to gambling is very apt. The book "Irresistible" by Adam Alter explains this as well, I randomly picked it up years ago in Amsterdam when I was visiting my mom. It completely altered my understanding of substance abuse, behavioral addictions, etc.
I'm not disputing that people have agency, but I am arguing that the role of choice in our decision-making is severely overstated. The myth is that our choices are 100% our own. Regarding the consumption of food, I believe nowadays we're quite lucky if we're predominantly self-determined. Not only does our brain chemistry tell us what foods to focus on, but the environment further assists this process and pushes us over the edge, often cutting our level of agency short. And that's all it takes. It's not necessary to brainwash us completely, we only need to get nudged sufficiently to start seeing big changes in our behavior.
Here's a list of the most addictive foods as opposed to a list of the least addictive foods. It should be fairly obvious why the amount of agency people have goes down in an environment that's filled to the brim with the former.
On June 26 2023 07:43 micronesia wrote: You should probably cite the creator of that video for completeness. Was her family run over by a McDonalds truck delivering food? Probably not, but still.
While the video seems to raise some good points about what was really going on, and tries to avoid making claims without admitting when they can't be backed up, I still struggle a bit to see how this shows that McDonalds realizes that choice is a myth. I don't think your conclusion is wrong... I just think you really need to read between the lines to get that message purely from the video.
I discovered Kiana Docherty's Youtube channel only very recently and I don't know anything about her, but I found her presentation in that video very compelling. Her critical stance seems free from most bias, as she questions Spurlock as well as Cisna, although her agenda clearly motivates her to research Cisna more. She also seems self-reflective enough to understand her own biases. So I think it's easy to have a fair amount of trust in her work.
On June 26 2023 16:07 Mikau wrote: Maybe I'm misunderstanding this whole discussion, but I don't think anybody believes choice is a myth? It's more the realisation that individual choice isn't what's causing the increase in obesity in society, but that 'environmental' (as far as you can consider capitalism and the food industry environment) pressures are the driving force behind it.
Totally offtopic, but plenty of people believe Free Will is an illusion. I don't think that is part of this discussion, but yes, technically if you believe that free will is an illusion, then democracy is also an illusion. That said, Daniel Dennett makes a great point that as long as we are part of the illusion, it's real to us. So the mechanisms of "how we have free will" are rather irrelevant as long as the reality is that we perceive we have free will, which is the only thing we can act upon. So democracy is alive again and we get to choose how we are governed. Huzzah!
EPT
