This "miasmist approach" to public health starts from a belief, not a basis of fact or empiricism. There are certainly circumstances in which malnutrition makes someone more susceptible to infectious disease, but what evidence is there that this is a significant contributor to infectious disease in countries like the US? What evidence is there that an otherwise healthy immune system could be "boosted" with proper nutrition and elimination of environmental toxins to the point that it would have a meaningful impact on infectious disease?
No one's against nutritional public health measures or elimination of environmental toxins to improve public health. The fact is lifestyle interventions are ALWAYS first-line recommendations by medical doctors for things like obesity, but Americans are stressed out, overworked, inactive, eating garbage food, and have clamored for easy solutions like taking a pill for a long time rather than making lifestyle changes. There's been no neglect of "living a healthy life", it's just that Americans don't want to do it because it requires lifting a finger. There are many positive public health impacts HHS and the Trump admin could have, but they are talking out of both sides of their mouth when they claim "MAHA" while cutting food access entitlements, rolling back environmental regulations for clean air and water, and of course "drill baby drill". RFK Jr. made a deal with the devil to be HHS secretary.
There's endless studies looking at the relationship between exercise and just about everything. It can do everything from substantially reduce your risk of cancer [1] to dramatically reducing your risk of getting a cold [2] and resulting in equally dramatically less severe symptoms if you do catch one.
And nobody really knows why this is, though there are plentiful hypotheses. And exercise is just one aspect of living healthy, though a very important one. You find similar strong associations between 'clean' eating and all other sorts of aspects of a living a healthy life.
Not only does it have effects but rather dramatic ones. I'd think most people would probably see this in their daily lives as healthfulness has dramatic effects on both physical and psychological wellbeing.
Also, excuse the double reply, but there are simple solutions to also help push society in the right direction. For instance requiring employers over 'x' employees (let's say 1000) to provide free access to a specified minimal set of exercise equipment and grant employees at least 'x' hours per week of paid exercise time which must be spent within this area exercising at a reasonable intensity (in other words not taking an hour break to go play on your phone in the gym).
Other things would be to offer a 100% tax credit for things like gym memberships. If this actually incentivized people, then it'd probably pay for itself through better health outcomes for society. It could also be paid for by adding a health tax, such as already exists on cigarettes, to e.g. highly processed foods, candy, and cola.
Similarly, the FDA should have some sort of an accreditation that restaurants and other food services can apply for that confirms some standard of minimal healthfulness of their food. This accreditation would be extremely critical since, in general, just dumping salt and sugar into food makes it more addictive, which increases margins, so when you go for health - you do so at profit loss. Such an accreditation could help combat this by giving people something to look for.
I didn't contest the relationship between regular exercise and health. The questions I raised were: what evidence is there that [malnutrition] is a significant contributor to infectious disease in countries like the US? What evidence is there that an otherwise healthy immune system could be "boosted" with proper nutrition and elimination of environmental toxins to the point that it would have a meaningful impact on infectious disease?
I agree with all of these solutions for encouraging regular exercise, and I'm open to the solutions for encouraging healthier nutrition.
The most clear example of this in the US is obesity. It correlates extremely negatively with basically every disease in existence, in every single way (susceptibility, severity, outcomes, recovery, etc) and is driven by malnutrition.
Solutions are not difficult to find for this specific manifestation of malnutrition. The primary issue is crap foods and cola which enable one to consume far more calories than you'd even be able to if eating a comparable amount of healthy food. For instance 2400 calories is 15 100g (cooked size) chicken breast servings. Or it's less than 2 McDonalds Big Breakfasts.
Not difficult to find? Maybe, maybe not. Effective public health solutions for obesity for which there is political will to implement them seem difficult to find to me. At the individual level, if you can manage to cut out ultra-processed food, exercise a few times a week, and get any comorbid medical conditions treated you're probably in the clear. All that is to say, it is relatively easy to identify at least some of the determinants of obesity for solutions.
I don't agree there at all. Our society has become so screwed up with unhealthful practices that there's low hanging fruit all over the place. For instance don't offer soft drinks, junk food, "sports drinks", etc. at public schools or allow vending machines for such. Offer water, milk, naturally non-caffeinated teas, and so on. Vending snacks could include things like wasabi peas and other extremely low calorie + high flavor type items.
Another thing is to remove the ability to purchase junk foods and cola with government food assistance. There's an extreme inverse correlation between obesity and income (hah.. imagine people of a couple hundred years ago hearing that) and so steps like this could actually have a tremendously positive overall impact on overall social health and wellbeing. This is even more true when you consider that twinkies and cokes are being bought on strictly limited budgets which means that much less money (and now more) for healthy foods.
I thought we were talking about public health interventions. How would "don't offer soft drinks, junk food, etc." be implemented? Are you going to propose a law or regulation that bans offering those things?
There's merit to the government food assistance (SNAP in the US) idea, though if you're trying to ban "junk food" from SNAP you're going to run into definition issues. Banning things like Twinkies and cola from SNAP is one thing, but "junk food" may also include ready-made ultra-processed food depending on your definition, and that may be the only type of food typical SNAP recipients can use (e.g. homeless who do not have access to cooking, people who live in food deserts). There is also a valid concern about micromanaging the food people eat, because SNAP recipients are normal humans and we tend to give normal humans leeway to indulge in a treat every now and then.
A lot of the malnutrition of students is driven by money. For instance Coca Cola has contracts with a massive chunk of all US school districts. And schools are obviously signing those with complete disregard for the health of their student in exchange for money. But because money is the motivation, this can just as easily be fixed by executive order (amongst a million other ways). Cut Federal funding to schools that sell soft drinks or other sorts of unhealthy products to children and Coke will disappear pretty much overnight.
Food deserts are largely irrelevant. Things like rice, beans, canned goods, and other such products are widely available and provide sufficient nutrition. There is also online food ordering (from Amazon etc) that allows payment with things like SNAP. And the sort of products we're talking about are not "treats", and should not be seen that way. They are highly addictive and harmful trash that, in the future will almost certainly be completely banned, certainly in anything like their current formulations.
I remember thinking it couldn't be true when the local schools first put in soda machines. Yes, banning the sale of soda and junk food in taxpayer-funded schools is an obvious, easy way to improve health. It would get major pushback from school boards which would cry about the lost funds, but they're always doing that anyway.
You can force exercise by doing periodic checks the way we do with disease or addiction. If your score is below some point you require a different kind of healthcare with a different price tag. If stats don't improve there should be special hospitals
You can force minimal exercise by doing periodic checks the way we do with disease or addiction. If your score is below some point you require a different kind of healthcare with a different price tag. If stats don't improve there should be special hospitals (with public funding)
Rather than have the stores and restaurants pay for changes they can be required and tax funded. Do it gradually.
I know I'm coming to the discussion late, but actually there is good evidence that improvements in nutrition, working conditions, and sanitation are a big factor in improving resistance to infectious diseases.
Look at "The Questionable Contribution of Medical Measures to the
Decline of Mortality in the United States in the Twentieth Century", by Mckinlay and McKinley (1977). I know it's an old paper, but it has some fascinating and, to me, very persuasive time series. Those plots show mortality from various infectious diseases over the 20th century.
Example: death rates (per 1000) from scarlet fever dropped from 0.1 in 1900 to effectively 0 in 1940. There is NO VACCINE for scarlet fever.
Example: death rates from measles (lately very much in the news) dropped from 0.12 in 1900 to 0 in 1960 (a vaccine for measles was introduced in 1960).
A similar trend exists for many other infectious diseases: huge drops in mortality PRECEDE the introduction of vaccines or antibiotics for the disease. Surely we can't credit vaccines with such a drop in death rates. I don't see how anybody could come to such a conclusion.
No one is contesting the role of nutrition, working conditions, and sanitation in infectious diseases generally. What I asked was: what evidence is there that this is a significant contributor to infectious disease in countries like the US? (I should clarify that I'm referring to present-day US, because we're discussing in context of MAHA which is present-day US)
Yes, measles death rates had dropped precipitously (fortunately), however incidence (new cases) had only dropped a little. It wasn't until the vaccine was introduced that incidence dropped to nearly zero[1]. Yours is a common anti-vaxx talking point, and one that seems to neglect that death is not the only negative outcome from measles. It's understandable to take the talking point at face value when it appears to be scientifically-supported, though this is a good example of how a talking point uses a cherry-picked fact and reframes the issue for a presupposed conclusion (that vaccines are unsafe or ineffective), because the origin of that talking point had no interest in comprehensively informing people but converting them to believers.
Yes, the measles vaccine is effective. It reduces cases of measles. But the paper in question says that deaths were reduced to almost zero before the vaccine was introduced. The graph that you linked to shows the same thing.
For me the paper shows not just that good sanitation and nutrition help reduce deaths from many infections diseases, but that they are the primary agent in that reduction. I thought it was a very cool paper, although you don’t seem moved in the same way as me.
When I was a child, my parents weren’t upset when I got measles (I was, because it meant missing a trip to the seashore). It meant that you were going to be miserable for a week, but would be immune afterwards. So I became one more case, but not one more death.
I mean, that good sanitation reduced infectious disease incidence and mortality was something I was already aware of so I've already been "moved" so to speak. As for nutrition, the paper cites one researcher who concludes nutrition was a major factor, and it probably was a factor, though the magnitude of its impact is not firmly established by that one researcher.
> For example: most people assume vaccines are tested against an inert placebo like water, and will only be approved as safe if it doesn't cause more problems than the placebo does. This isn't what happens. The "placebo" in vaccine trials is usually another vaccine.
First, please consider from where and whom you received this information. It was probably RFK Jr. or someone on social media or maybe a news article, right? Did you bother to scrutinize that information? Because it's not true. All vaccines (like other medications) are tested against the standard of care. For a first-in-class vaccine, that's going to be a saline placebo because there is no standard of care yet; for subsequent vaccines, it will whatever is the current vaccine. This is completely sensible. The idea that the vaccines on the market now were never tested against saline placebo is mis/disinformation promulgated by a lawyer whose name escapes me; some of those saline placebo-controlled trials for vaccines are listed [here](https://docs.google.com/document/d/1pUMNBewb0kgTU7g3augmOtPG...).
If you have a passing understanding of common anti-vaxx talking points, RFK Jr.'s arguments are easy to debunk.
> it's not true ... [the placebo] will be whatever is the current vaccine. This is completely sensible ... [it] is mis/disinformation
Or rephrased, "that's not happening and it's good that it is". This kind of thing is called the Law Of Salutary Contradiction [1] and originates in confused, ideological thinking. If you want to argue with RFK Jr about something you need to decide if what he's saying isn't true, or if it is true but you disagree it's a problem. You can't pick both.
The "first in class" approach isn't illogical but it's an ultra-high risk strategy. If just one unsafe vaccine gets through the systerm that will lead to a chain of erroneous approvals that result in dangerous substances being labelled as safe. In other words it only seems completely sensible if you have absolute and total faith in the entire testing and regulatory infrastructure. Anyone who lacks your iron-clad faith will view this practice as obviously crazy.
Given that the medical profession have routinely lied as a group about many things in the past, it is unreasonable to use practices that demand quasi-religious faith in them. They refused to accept this and are now paying the price.
1. We used known safe and effective vaccines as placebos. Keyword KNOWN. We're not gonna debate the efficacy of the fucking polio vaccine, just be for real.
2. The reason we do this is because it's very unethical to deny medication that we currently administer and know works to human subjects. That would be treating people worse than we treat the general population. That's unethical.
3. We don't just do this vaccines, but ALL medication. When we make new drugs to treat cancer, we don't compare them against saline. Because that's evil. We compare them against known effective chemotherapy regimes.
4. All of this is besides the point, because using an inert placebo wouldn't help anything. How does using an inert placebo make a new medication more effective or more safe? It doesn't.
5. We DO use inert placebos all the time - just not in human trials. Because we want to give humans real medicine so they don't fucking die.
Known safe according to who? The panel of people RFK Jr just fired, or the other credentialed experts he replaced them with who say the safety wasn't actually known at all?
People who are given placebos in trials aren't "denied medication". They can always take it after the trial has ended and they're unblinded, if the trial succeeds.
> How does using an inert placebo make a new medication more effective or more safe?
Imagine - bear with me here - imagine that an unsafe vaccine got approved. It uses some technology that's unsafe. We know this happens because vaccines are sometimes pulled from the market for being unsafe after approval.
Now imagine you have a second vaccine in trial, which shares some technology with the first, and it gets tested against the first before it's realized that was unsafe. People suffer or even die but the FDA declares it to be perfectly safe because the control group are suffering at the same rate, and for the same reasons.
Now consider what happens when it's discovered by the population that the government claimed a vaccine was safe but it was actually hurting people, and those who never took it at all were better off. It destroys their trust in the system of course.
That's why you have to use inert placebos. There's nothing unethical about this. It's a standard safety precaution. The alternative, as you are now discovering, is that the entire system is torn down and one day there may be no vaccines at all - banned by constitutional amendment - because the sort of people who are pro-vaccine kept making false claims about safety due to dangerously optimistic testing practices.
> That's why you have to use inert placebos. There's nothing unethical about this. It's a standard safety precaution.
This isn't true.
We do use inert placebos, but for some medications, we are not going to be doing that in human trials for obvious safety and ethical concerns. Keep in mind: we do NOT just jump to human trials. We also do cellular trials and animal trials.
Again, if we're trying out a new cancer drug, we're not going to give the control group saline - we're going to give them a chemotherapy regime that we know works. I don't understand what's not clicking for you because it's actually very simple and intuitive.
And, as an aside: the government has not recommended any vaccines that are unsafe. You may feel the COVID vaccines were not safe. That doesn't mean they're unsafe. In addition, there are numerous reasons why a medication might be pulled, and it's quite rare that the reason is safety in absolute. Some medication may be less safe than another so we obsolesce said medication - but even that does not mean that it is unsafe. Just inferior.
With any medication, or in fact any substance, including even water, there are risks. We're generally very aware of the risk before the medication is administered and we work to minimize them in various ways. The simple reality is that dozens have vaccines have worked together to eradicate many diseases in the US, and these health initiatives have been very successful. Other countries are not so lucky, so they are dealing with diseases that we haven't touched in decades.
Please bare in mind that viruses and bacteria are not risk-free, nor are they necessarily the type of thing you can just recover from. For example, about 2% of people who contract Polio will develop paralysis. 2% is extraordinarily high. Just because you might be fine, or you know people who are fine, doesn't mean that the disease is low-risk. With COVID specifically, we're still uncovering long-term effects of infection. With viruses like HSV, we're also uncovering long-term effects like increased risk of cancer and potentially dementia.
Just because you get sick and seem to recover, doesn't mean that what happened was safe and done.
Nah, that's is just an artifact of an conflated claim made by RFK Jr. and others and the more complex reality that needs to be underlined to refute it. If the claim is "no vaccine products on the market were tested against a saline placebo", that is untrue because new first-in-class vaccines were. If the claim is "no vaccine classes on the market were tested against a saline placebo", that is untrue because as far as I can tell all classes were tested against a saline placebo at some point. If the claim is "some vaccine products on the market were not tested against a saline placebo", that would be true and it would not be a problem if those vaccine products were of vaccine classes that were previously tested against saline placebo.
How are you qualifying this strategy as "ultra-high risk"? How well do you understand the new drug and vaccine regulatory process in the US? An "unsafe" (vague) vaccine will be discovered via postmarketing surveillance (e.g. Rotashield). If two unsafe vaccines are trialed comparatively and the adverse event rate is unusually high for both groups than what was previously reported, that's not going to go unnoticed even if it appears like there's no significant difference between the two statistically. Your concern also assumes that because the first approval was erroneous that all subsequent ones will be too, which is an unfounded assumption.
If you want to claim that the medical profession have "routinely lied as a group about many things in the past", you'll have to back that up because I don't agree and will not accept your assertion at face value.
The problem is that anti-vaxx concerns are based on unfounded beliefs (especially in conspiracy), misunderstandings, or out-right misinformation some of which RFK Jr. himself has helped sow over the past twenty years. This "I'm not anti-vaxx, I'm pro vaxx-safety" is merely a guise.
I don't know on what all (every single one) anti-vaxx beliefs are based, which is why I generalized based on my experiences with the beliefs I've encountered. I can't readily form an opinion on a belief I haven't encountered, can I? All of the common anti-vaxx talking points fit the criteria I listed above, and I know this from my experiences reviewing and researching them. So yes, it is a good idea to generalize for the sake of conveying my experiences here, though I'm not going to prejudge any new anti-vaxx views I haven't previously encountered.
From what I have explored, those beliefs are based on misinformation or misunderstandings drawn from scientific research. In contrast, the vaccine orthodoxy is drawn from a strong body of evidence "where trials and statistics matter". If you are going to assert otherwise, then please provide specific examples.
I wondered if that would be the case. If rain is falling in the desert where it previously didn't, that means rain is not falling elsewhere it previously did.
I was thinking the water eventually, mostly, makes it to the sea in any case. But, it probably reduces oxygenation of surface water (?) and maybe increases levels of chemical transfer from land to sea? I wouldn't expect either of those to be significant though.
Any thoughts on other possible effects, or is it just a general 'it's probably shit in a way we don't realise' feeling?
I'll second Monarch. I had issues with connections when I first started a month or so ago, but they've since been resolved. They seem to have a very active customer service team AND a roadmap (which is something Mint hasn't had in years). Budgeting is much better than Mint. Transactions are much better than Mint. Rules are much better than Mint.
You have to subscribe to it, but you get to try it out for a month for free and in that time I genuinely felt a subscription would net me more than my money's worth.
Seems like a problem of applying a "one-size-fits-all" approach to all patients with autism spectrum disorder (ASD). It's clearly inappropriate to try and change behaviors that are not harmful, but clearly appropriate to change behaviors that are. Banning ABA would throw out the baby with the bathwater.
I'm all for reducing inefficiencies if it reduces costs and/or improves service, but that is not the goal here. The goal is to make as much profit as possible as quickly as possible. Seems like that's what happened with a lot of these ABA clinic consolidations. The fact that successful clinics had to shut down because of this is sickening.
Christianity is faith, not a model of reality, so it can't be "wrong" but nor does it purport to be "right". It comes down to whether or not you continue to believe in its tenets.
Glad somebody pointed this out. If I'm going to get better sleep it's going to be for the sake of honoring my body's needs, not for the sake of productivity.
No one's against nutritional public health measures or elimination of environmental toxins to improve public health. The fact is lifestyle interventions are ALWAYS first-line recommendations by medical doctors for things like obesity, but Americans are stressed out, overworked, inactive, eating garbage food, and have clamored for easy solutions like taking a pill for a long time rather than making lifestyle changes. There's been no neglect of "living a healthy life", it's just that Americans don't want to do it because it requires lifting a finger. There are many positive public health impacts HHS and the Trump admin could have, but they are talking out of both sides of their mouth when they claim "MAHA" while cutting food access entitlements, rolling back environmental regulations for clean air and water, and of course "drill baby drill". RFK Jr. made a deal with the devil to be HHS secretary.