[HN Gopher] Almost half of cancer deaths are preventable
       ___________________________________________________________________
        
       Almost half of cancer deaths are preventable
        
       Author : LinuxBender
       Score  : 185 points
       Date   : 2022-09-04 16:12 UTC (6 hours ago)
        
 (HTM) web link (www.nature.com)
 (TXT) w3m dump (www.nature.com)
        
       | sxg wrote:
       | This article is saying a lot less than the title leads on. The
       | article states half of all cancer deaths are caused by smoking,
       | alcohol, and obesity. Nearly every patient in the developed world
       | is aware that all three of these are bad, but the struggle is in
       | changing course on these three behaviors rather than a lack of
       | knowledge that they're bad.
        
         | AdrianB1 wrote:
         | It used to be true that people know these three are bad, but
         | this changed a few years ago when aggressive corporate
         | marketing on the "body positivity" changed the perception about
         | big BMI incredibly, many people these days believe it is
         | perfectly healthy to be seriously overweight. I am quite upset
         | by the marketing around this matter, it is ruining lives.
        
         | blacksmith_tb wrote:
         | It seems possible that articles like this which help quantify
         | the risk might do more to change behavior than the vague
         | understanding that smoking, drinking, and being overweight are
         | "bad for you". Many people will have had family or friends who
         | developed cancer and if lucky, endured harrowing treatment and
         | lived. Or did all that and didn't survive. Connecting those
         | dots is a powerful motivator.
        
           | Godel_unicode wrote:
           | Is it? I think in the US that connection is quite well known,
           | and yet I have seen people lose parents and grandparents that
           | way and keep eating McDonald's at a prodigious rate.
        
         | photochemsyn wrote:
         | Workplace exposure to carcinogens is another major factor, as
         | the article notes:
         | 
         | > "In 2019, half of all male deaths from cancer, and more than
         | one-third in women, were due to preventable risk factors
         | including tobacco and alcohol use, unhealthy diets, unsafe sex
         | and workplace exposure to harmful products, such as asbestos.
         | From 2010 to 2019, global cancer deaths caused by these risk
         | factors increased by about 20%, with excess weight accounting
         | for the largest percentage of increase -- particularly in
         | lower-income nations."
        
           | loeg wrote:
           | Is unsafe sex an oblique reference to cervical cancer, or is
           | there some other known connection I'm not aware of?
        
             | zaroth wrote:
             | I would assume they are talking about HPV which causes
             | cervical, oral, and other cancers effecting men and women.
             | 
             | Condoms are at best ~70% effective at preventing HPV
             | transmission so the "unsafe" part doesn't really strike me
             | as apt. Generally everyone who is sexually active has at
             | least one strain of HPV.
             | 
             | HPV vaccination seems like the optimal strategy. It's so
             | weird to me that initially it wasn't even offered to boys.
        
             | photochemsyn wrote:
             | There's quite a long list of viruses which have a knock-on
             | effect of increasing cancer risk, although often by
             | indirect routes. HIV of course damages the human immune
             | system, and one immune function is the detection and
             | elimination of cells that have escaped the normal cell
             | cycle control (i.e. potentially cancerous). Hepatitis
             | damages the liver and (often in conjunction with alcohol
             | use) that can raise chances of cancer. HPV I think has a
             | more direct effect, in that the virus actually can
             | integrate into DNA and potentially (depending on the
             | specific strain) disrupt cell cycle control. Here's a list:
             | 
             | https://www.healthline.com/health/cancer-virus
        
             | epistasis wrote:
             | HPV causes a wide variety of cancers, and we are learning
             | more all the time. (I'm still furious that this is not a
             | population wide vaccine, and is so limited in its
             | availability.)
             | 
             | Epstein Barr spreads primarily through saliva, and also
             | causes 1-2% of cancer, the last time I checked. So that
             | could spread from unsafe sex, but it could also come from
             | picking up slobbery toddler's toys.
             | 
             | There's a whole world of virus and infectious disease that
             | is only becoming visible because of the huge advances in
             | nucleic acid sequencing and other massive biotech advances.
             | We may find lots of surprises in the coming decades from
             | this new technology.
        
             | graeme wrote:
             | Probably hpv. Causes a variety of cancers:
             | 
             | https://en.wikipedia.org/wiki/Human_papillomavirus_infectio
             | n...
        
             | lkschubert8 wrote:
             | There is a pretty strong relationship with HPV and a few
             | different cancers.
             | 
             | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120915/#:~:te
             | x....
        
             | icegreentea2 wrote:
             | > The researchers used 'unsafe sex' as a proxy for cancer
             | risks associated with human papillomavirus (HPV) and other
             | sexually transmitted viruses. Cervical cancer, which is
             | caused by certain strains of HPV, is the leading cause of
             | cancer deaths among women in sub-Saharan Africa.
             | 
             | HPV also plays into a variety of other cancers
             | (throat/mouth, anal, penile, vaginal). Though cervical
             | cancer has by far the strongest link.
             | 
             | Throat/mouth/neck cancers are actually strongly correlated
             | with smoking, alcohol consumption, and HPV
             | (https://www.cancer.gov/types/head-and-neck)
        
               | mc32 wrote:
               | Was this what struck Michael Douglas?
        
               | freeone3000 wrote:
               | It's a good thing we have a vaccine for several of the
               | cancer-causing HPV variants now. It's essentially a
               | vaccine against some cancers -- I would get it if you
               | can.
        
               | skeeter2020 wrote:
               | and yet we run into a strong religious resistance because
               | if some skewed logic around HPV vaccine => wanton
               | premartial sex. Once again the patriarchy strikes.
        
               | rayiner wrote:
               | Apparently the patriarchy was protecting people from
               | cancer until this vaccine was invented five minutes ago.
        
         | antegamisou wrote:
         | > The article states half of all cancer deaths are caused by
         | smoking, alcohol, and obesity.
         | 
         | Add chronic sun (UVA) exposure, #1 leading cause of skin cancer
         | yet still not addressed by popular media.
        
           | Cupertino95014 wrote:
           | No, don't add chronic sun.
           | 
           | The reason it's not in there is because almost no one dies of
           | basal cell, the most common skin cancer. Malignant melanoma
           | is another matter, but that is much more rare, and also quite
           | treatable.
           | 
           | I've had several myself and know lots of other people who
           | have, too. They're handled via outpatient surgery and there
           | is no followup.
        
           | skeeter2020 wrote:
           | skin cancer is a serious medical issue, but not when we're
           | talking fatalities.
        
         | kortilla wrote:
         | > Nearly every patient in the developed world is aware that all
         | three of these are bad,
         | 
         | Not so much. The whole body positive movement has swung the
         | pendulum too far to where obese people are "healthy" now.
        
         | [deleted]
        
         | dionidium wrote:
         | > _Nearly every patient in the developed world is aware that
         | all three of these are bad_
         | 
         | Smoking, yes, we seem to have broad support for that one (way
         | beyond what the facts support, even, but that's probably for
         | the best). But the other two? I don't think so. There's a lot
         | of confusion out there about alcohol use. Most people still
         | think small amounts are basically fine (maybe even good!), even
         | though more recent studies [0] suggest that isn't true.
         | 
         | And we're trending the wrong way on obesity, too. [1]
         | 
         | [0]
         | https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
         | 
         | [1] https://www.scientificamerican.com/article/can-you-be-
         | health...
        
           | Scoundreller wrote:
           | > Most people still think small amounts are basically fine
           | (maybe even good!)
           | 
           | Legalize safer alternatives now!
        
             | [deleted]
        
           | Izkata wrote:
           | > But the other two? I don't think so.
           | 
           | IIRC the argument about obesity is simply more cells = more
           | chances for something to go wrong that turns into cancer.
        
             | copperx wrote:
             | Does cancer ever start in adipose tissue?
        
               | pessimizer wrote:
               | Yes, but fat people also have more muscle and skin.
        
             | oaktrout wrote:
             | Obesity also contributes to inflammation,fat cells release
             | pro-inflammatory adipokines.
        
             | lupire wrote:
             | Also, more food => morr oxidation => more damage.
        
           | mattmaroon wrote:
           | It's practically impossible to to do a controlled study on
           | any of these, so we'll likely never know for sure. If you
           | were tasked with creating a study to determine, for any
           | reasonable definition of "certainty", whether small amounts
           | of alcohol increase or decrease one's lifespan, you'd never
           | be able to come up with anything that passed any sort of
           | moral or practical sniff test.
           | 
           | So what you are left with is trying to tease causation out of
           | relatively loose correlation, which is and always will be so
           | problematic as to be near useless. The results will always
           | just support the researchers' pre-conceived notions.
           | 
           | Smoking is only so obvious because the rates of lung cancer
           | there are an order of magnitude more. 80-90% of lung cancer
           | is in smokers, while only 12% of Americans smoke. No other
           | health issue is so clear, people who are moderate drinkers
           | only have very slightly elevated risks of almost everything,
           | so it could be confounded.
        
           | TaupeRanger wrote:
           | The article you linked (and in fact , no study exists) to
           | support your claims about small amounts of alcohol. In fact
           | plenty of evidence exists to the contrary.
        
             | jnovek wrote:
             | "The level of alcohol consumption that minimised harm
             | across health outcomes was zero (95% UI 0*0-0*8) standard
             | drinks per week." Seems pretty clear.
             | 
             | It's likely that the risk of,(e.g.) one drink per month is
             | also very low. What's not here is the inflection point
             | where alcohol consumption goes from a (subjective) minimal
             | risk to an elevated risk.
        
               | dionidium wrote:
               | I would just note here that the CDC is unequivocal on
               | this point with respect to cigarettes, saying always that
               | there is "no safe level of consumption."
               | 
               | I think that sort of language is basically absurd, but
               | the message it sends is crystal clear: this thing is bad
               | for you, even in small amounts, and you're doing harm
               | when you use it.
               | 
               | I think the CDC could easily settle on the same language
               | with respect to alcohol, if there weren't socio-cultural
               | reasons not to.
               | 
               | Another aspect of this is that we discourage even light
               | cigarette use because of the fear that users might become
               | addicted and escalate their usage. [0] It's interesting
               | how rarely you hear that kind of an argument against
               | drinking alcohol, and yet, unlike with smoking, increased
               | usage can actually be ruinous. On the day you take your
               | first sip of alcohol you're accepting a 1 in x risk that
               | you'll end up a problem drinker (where x is anywhere from
               | 3 or 4 to 20, depending on what definition of "problem
               | drinker" you're willing to accept).
               | 
               | [0] I remember many years ago when I was a very light
               | smoker trying to find statistics online about moderate
               | cigarette use and it was basically impossible, because
               | every single statement about cigarettes was of the form,
               | "you won't be able to only smoke a little, so don't even
               | bother trying."
        
               | lupire wrote:
               | Smoking a cigarette makes you want more. Drinking a beer
               | doesn't do that.
        
               | MandieD wrote:
               | You know there's a reason you don't offer even a single
               | drink to a recovering alcoholic, right?
               | 
               | A single drink is unlikely to hurt anyone, as long as it
               | stays a single drink.
               | 
               | There are a lot of people who can do a good job of not
               | having that first drink, but have a really hard time
               | stopping once they've had it.
               | 
               | And beer is the beverage of choice of a surprising number
               | of alcoholics.
               | 
               | So yeah, for a lot of people, drinking a beer makes them
               | want more.
        
               | kortilla wrote:
               | > Drinking a beer doesn't do that.
               | 
               | There are a lot of binge drinkers that beg to differ.
        
               | sarchertech wrote:
               | I know plenty of people who have 1 drink a day, I know
               | absolutely no one who smokes 1 cigarette per day. I'm
               | sure they exist, but not in my n of several hundred, so
               | I'd bet that's it's pretty rare.
               | 
               | Smoking is also much more obnoxious and directly harms
               | anyone near. This is a first order effect, not a 2nd
               | order effect like increased risk of car accidents.
        
               | robocat wrote:
               | You are splitting hairs. A lot of drinking is due to
               | social effects, for example drinking behaviours due to
               | being around friends who are drinking.
               | 
               | Many cancer societies are now recommending zero alcohol,
               | for example in New Zealand (where I have some reasons to
               | trust the organisation):
               | https://www.cancer.org.nz/cancer/reducing-your-cancer-
               | risk/a...
        
               | Cupertino95014 wrote:
               | Nice to meet you.
               | 
               | In college, for a year or so, I smoked one cigarette a
               | day. Eventually, I decided _any_ number was too much, and
               | stopped entirely.
               | 
               | So yeah, it's a population that probably either graduates
               | to a big habit, or gives it up completely. Fortunately
               | I'm in the latter group.
        
               | dionidium wrote:
               | Lots of people smoke cigarettes socially. There are in-
               | jokes amongst smokers about the people who "don't smoke"
               | who want to bum a cigarette in the smoking area outside
               | at bars.
               | 
               | It's extremely common.
               | 
               | > Smoking is also much more obnoxious
               | 
               | I'm not sure I've ever disagreed more with a claim than I
               | do this one. People who have consumed alcohol are
               | _practically unbearable_ to the sober. And that 's before
               | we get into stuff like the fact that alcohol is
               | implicated in some staggering percentage of all violent
               | crime. Or drunk driving. Etc, etc.
        
               | sarchertech wrote:
               | We're talking about light use here. I very rarely drink,
               | and people who consume a drink or 2 with dinner are
               | totally fine to be around.
               | 
               | On the other hand, a person smoking 1 or 2 cigarettes
               | near me is actively harmful to my health. If you want to
               | find a field somewhere to smoke sure, I won't find it
               | obnoxious, but no one does that.
               | 
               | >Extremely common
               | 
               | sure I've met those people, I've never met one who does
               | it anywhere near daily. Also most of the ones I've known
               | drift in and out of periods of being heavy smokers.
               | 
               | Again I have met many people who can drink a glass of
               | wine every night. I have never met a single person who
               | smokes a single cigarette after dinner. To me that says
               | there is something different about cigarettes that makes
               | them harder to moderate.
        
               | fiddlerwoaroof wrote:
               | > I have never met a single person who smokes a single
               | cigarette after dinner.
               | 
               | On the other hand, there are people who smoke one cigar
               | occasionally: cigarettes, for whatever reason, seem to be
               | a lot more addictive than other forms of tobacco
               | consumption.
        
               | rrrrrrrrrrrryan wrote:
               | Cigarette breaks are a great -feeling way to punctuate
               | your day because they force you to step outside for a
               | brief moment once in a while with only your thoughts, and
               | so they easily become tremendously habit-forming.
               | 
               | The good thing about cigars is that they're terribly
               | inconvenient. They're harder to acquire, harder to store
               | properly, harder carry around, and they take nearly 10x
               | as long to smoke. I've smoked a few cigars per year for
               | almost 2 decades, and I can't imagine doing the same with
               | cigarettes. Nobody really buys and smokes an entire pack
               | of cigarettes in one night every few months (because it
               | would be insane), but if they did, it's unlikely they'd
               | become addicted.
        
               | [deleted]
        
               | dionidium wrote:
               | > _On the other hand, a person smoking 1 or 2 cigarettes
               | near me is actively harmful to my health._
               | 
               | This would be impossible to verify and strains credulity.
               | People have gotten a little too comfortable making
               | outlandish claims about the effects of secondhand smoke.
        
               | MauranKilom wrote:
               | I'm not going to pull up statistics based on arbitrary
               | consumption thresholds, but I would reason there are
               | _way_ more consumers of alcohol around me than smokers.
               | Yet the number of times I 've had to bear nuisance from
               | smokers vs from drunkards is higher.
               | 
               | Generally speaking, (here) smoking is forbidden in most
               | indoor-ish spaces - which is the only reason smoking is
               | anywhere close to the same level of nuisance as drunk
               | people. Note that the same people that would enforce "no
               | smoking" can also do something about the "practically
               | unbearable" drunk person. And in outdoor-ish spaces, you
               | can often avoid being affected - except in e.g.
               | restaurants, where someone chain-smoking on the neighbor
               | table can ruin the evening.
        
               | TaupeRanger wrote:
               | That does not support the claim that avoiding or stopping
               | drinking lightly/socially will make you less likely to
               | die or less likely to have disease. Drinking _at all_ is
               | associated with other unhealthy behaviors, alcohol
               | drinking is just easy to tease out of data, but not
               | necessarily causal. If you are a healthy person with
               | healthy behaviors who drinks lightly (probably almost
               | everyone reading this thread), there is no evidence that
               | mortality or morbidity are increased with light drinking.
        
               | jnovek wrote:
               | You really believe that light alcohol consumption carries
               | no risk?
               | 
               | For example, no one has ever, in the history of humans,
               | had a single beer which has impaired them enough to get
               | into a fatal crash? Even a single such accident would
               | raise the impact of alcohol above the baseline by some
               | tiny amount.
               | 
               | Perhaps the impact is minimal but it certainly exists.
        
               | lupire wrote:
               | _Someone_ in history has also teetotaled, failed to make
               | friendships, and died choking on a piece of food while
               | sitting at home alone.
        
               | rowanG077 wrote:
               | I'm not sure what your point is. Yes if humans wouldn't
               | need to eat to survive it would obviously be better to
               | never eat anything.
        
               | pjerem wrote:
               | The point is about the "social lubricant" role of
               | alcohol.
               | 
               | We may like it or not, but since prehistory, alcohol
               | helped groups, friendships and couples to spawn from
               | nothing.
               | 
               | It is reasonable to ask if being sober and lonely at home
               | is healthier than making social connections that alcohol
               | helps to create and maintain.
        
               | rowanG077 wrote:
               | That's a pretty strong claim there. Yes you are right
               | that alcohol has a role a social lubricant. But to claim
               | not having leads to being lonely at home is extreme.
        
               | lazyasciiart wrote:
               | You have no idea of the actual baseline though. Perhaps
               | the effects of one glass of alcohol on blood pressure and
               | some random internal protein already give light drinkers
               | an average extra three days of lifespan, which would far
               | outweigh your one time a beer killed someone.
        
             | dionidium wrote:
             | There's reason to believe those earlier studies used flawed
             | methodologies:
             | 
             | > _But there was a problem with many of these studies: They
             | compared drinkers to non-drinkers, instead of comparing
             | only lighter drinkers to heavier drinkers. And people who
             | don't drink are pretty fundamentally different from
             | drinkers in ways that are hard to control for in a study.
             | Their lives probably look dissimilar.
             | 
             | > Most importantly, they may be sicker at baseline (perhaps
             | they quit drinking because of alcoholism, or because of a
             | health issue like cancer). And something in these
             | differences -- not their avoidance of alcohol -- may have
             | caused them to look like they were in poorer health than
             | the moderate drinkers. (This became known as the "sick
             | quitter" problem in the world of alcohol research.)
             | 
             | > Lately, researchers have been trying to overcome that
             | problem by comparing lighter drinkers with heavier
             | drinkers. And the benefits of modest amounts of alcohol
             | wash away._
             | 
             | And that even moderate amounts of alcohol are harmful:
             | 
             | > _Their findings were stark: Drinking more than 100 grams
             | of alcohol -- about seven standard glasses of wine or beer
             | -- per week was associated with an increased in risk of
             | death for all causes, they concluded. In the US, the
             | government suggests men can drink double that amount -- up
             | to two drinks per day -- but advise women who are not
             | pregnant to drink up to one drink per day.
             | 
             | > A person's risk of death shot up as they drank more. The
             | researchers used a mathematical model to estimate that
             | people who consumed between seven and 14 drinks per week
             | had a lower life expectancy at age 40 of about six months;
             | people who drank between 14 and 24 drinks per week had one
             | to two years shaved off their lives; and people who imbibed
             | more than 24 drinks a week had a lower life expectancy of
             | four to five years._
             | 
             | My sort of baseline here is that nobody would think twice
             | about this if they weren't motivated to justify continued
             | consumption. It's fairly obvious that it's bad for you.
             | 
             | Source: https://www.vox.com/2018/4/24/17242720/alcohol-
             | health-risks-...
        
               | TaupeRanger wrote:
               | But those weren't problems at all with many such studies.
               | For example, this one showed light drinking reduces risk
               | of leukemia by 10%: https://pubmed.ncbi.nlm.nih.gov/24986
               | 108/#:~:text=Compared%2....
        
               | lupire wrote:
               | Come on
               | 
               | > the relative risks (RRs) for all leukemia were
               | 
               | > 0.94 0.85-1.03 "any"
               | 
               | > 0.90 0.80-1.01 "light"
               | 
               | > 0.91 0.81-1.02 "moderate to heavy"
               | 
               | There is no signal there.
        
               | MichaelCollins wrote:
               | > _between seven and 14 drinks per week_
               | 
               | That's already heavy drinking in my book; drinking every
               | day of the week, or binge drinking at least once every
               | week? Somebody drinking that much already has a clear
               | habit and is probably developing an alcohol tolerance, a
               | major step towards alcoholism.
               | 
               | To me, a light drinker is somebody who has a drink on
               | special occasions but not otherwise. One drink a week or
               | less, so they're going several days if not weeks between
               | drinking. I suspect the long-term harm from that is next
               | to immeasurable.
        
           | dijonman2 wrote:
           | Alcohol is enjoyable and I prioritize happiness and
           | satisfaction. I'll gladly trade in some risk for a delicious
           | beverage and a buzz every once in awhile.
        
             | gambiting wrote:
             | Smoking is also enjoyable and gives people happiness and
             | satisfaction. That isn't the point. The point is that
             | cancers caused by drinking/smoking/being obese are
             | preventable by behavioural changes.
        
               | [deleted]
        
               | pantalaimon wrote:
               | Smoking has a pretty bad risk/reward ratio.
               | 
               | It's better with alcohol and that is already not an ideal
               | drug in that regard
        
           | pessimizer wrote:
           | > And we're trending the wrong way on obesity, too.
           | 
           | It's absolutely creepy how there's a constituency of people
           | who are upset by any scientific possibility that fat people
           | could be relatively healthy, or be made relatively healthy,
           | without losing weight. The desire for fat people to conform
           | or be punished, damn the science, is fetishistic. That's the
           | only motivation I can think of for being upset by the
           | exploration of the precise effects that being fat has on
           | health.
           | 
           | I'm nowhere near fat right now, but if there were an
           | injection that saved fat people from insulin resistance and
           | inflammation, the farthest thing from my mind would be to get
           | upset about it. If you believe that gluttony is a mortal sin,
           | no need to be upset if the only ways fat people are punished
           | on earth are cardiovascularly, through their knees, and
           | through the aggression of bullies; your deity can punish them
           | after death for not eating as moderately as you would have
           | preferred.
        
             | ravenstine wrote:
             | I don't necessarily disagree, because yeah, having lots of
             | adipose tissue doesn't necessarily mean anything is wrong
             | at the moment. In my experience, the perpetually healthy
             | fat person is a rarity. The possibility of being fat and
             | otherwise healthy is used as an excuse the vast majority of
             | the time to not actually address one's own health. If
             | someone is fat, it would really be a good idea to get a
             | DEXA scan to confirm that they don't have too much visceral
             | fat. As any one who's pro-fat or body positive if they know
             | what their level of visceral fat is and chances are they
             | couldn't tell you what visceral fat is.
             | 
             | There should be a reasonable medium where fat people aren't
             | outright shamed for being towards one end of the bell curve
             | but red flags for unhealth aren't ignored for the sake of
             | other's feelings. America and now many parts of the west
             | are facing various health crises to such an extent that I
             | don't think obesity should be brushed off as perhipheral to
             | other problems. Being fat has many comorbidities, and just
             | focusing on losing fat is usually the best way to address
             | those issues.
             | 
             | > I'm nowhere near fat right now, but if there were an
             | injection that saved fat people from insulin resistance and
             | inflammation, the farthest thing from my mind would be to
             | get upset about it.
             | 
             | I agree, and there kinda sorta are medications currently
             | available that would tremendously help. Off the top of my
             | head, I don't know what it's called, but I know some people
             | who've been on next-generation medications for obesity that
             | target the ghrelin-leptin balance, basically correcting
             | one's sense of hunger and satiety. Having seen the results
             | myself, it works insanely well.
             | 
             | On the other hand, solving obesity with a pill still has
             | some moral issues. If everyone could just consume anything
             | they want in massive amounts and not get fat, I don't think
             | that's really good for a person's psychology in a similar
             | sense that giving someone a bunch of money often doesn't
             | end well. It's not a scientific argument, but a
             | philosophical one; I know. Such drugs may also give someone
             | the idea that they can just eat whatever they want because
             | they don't gain weight, but just because you don't get fat
             | doesn't mean there aren't other consequences to eating lots
             | of sugar, carbs, odixated oils, etc.
             | 
             | The question should be why we are so fat now. But that
             | would mean believing that experts can be compromised and
             | that a century of nutrition policy has been a failure,
             | which many people aren't ready for. Just my opinion.
        
         | joe_the_user wrote:
         | Smoking and alcohol consumption are behaviors. Obesity is a
         | condition and what behavior can change it is subject to intense
         | debate and not at all settled imo.
        
         | v7engine wrote:
         | I have been smoking for close to 15 years now and I'm 40. I
         | still struggle with quitting smoking even though I tell myself
         | daily today is the last day.
        
           | Clockface12 wrote:
           | The older you are when you smoke, the worse it is for you.
           | Smoking in your twenties is far less harmful in terms of its
           | likelihood to cause cancer than smoking in your forties,
           | fifties, or sixties. The damage gets worse with every decade
           | of your life.
           | 
           | Just stop. In five years' time, you'll wonder why you didn't
           | stop sooner.
        
             | skeeter2020 wrote:
             | > Just stop.
             | 
             | Not a smoker but my initial reaction to you is probably
             | pretty close to that of a smoker, and not particularly
             | favourable. How can you possibly think that a deeply
             | physiological addiction is going to respond to either
             | logical arguments or simplistic slogans? Once you fix
             | smoking, can you please stop the opioid crisis?
        
           | oaktrout wrote:
           | I would look into varenicline (chantix), talk with a doctor.
           | I know some people will bring up incredibly rare side effects
           | as reasons not to try, but I think those are sort of like
           | plane crashes, they happen sometimes and cause a very
           | visceral response, but the majority of people will do fine
           | flying on a plane. Also, smoking will contribute to an early
           | death, so the risk benefit calculation makes sense to me.
        
           | amanaplanacanal wrote:
           | I found getting a prescription for bupropion from my doctor
           | made quitting much easier. That was 20 years ago now.
        
           | tmountain wrote:
           | You can do it.
           | 
           | One thing I've seen work for people is making a significant
           | investment into a smoking counter measure. Extreme example,
           | hire a personal trainer for $75/hr and go to the sessions 3x
           | per week.
           | 
           | Now you are investing $225/week into your health, and you're
           | going to want to get maximum ROI from that investment, right?
           | Well, smoking is diminishing that ROI. Secondly, you have
           | someone encouraging you to do the best possible work you can
           | do with your body every time you go to a session. You'll
           | naturally want to avoid disappointing that person. You'll
           | also want to see continued progress in the results they are
           | measuring. Smoking will impede that progress, and again,
           | minimize your ROI.
           | 
           | This worked for someone very close to me after everything
           | else failed. Incidentally, that person stopped going to the
           | trainer after a while, but only after quitting "stuck". Good
           | luck in your journey and never quit quitting.
        
           | gibolt wrote:
           | Would be great if today actually is the last day! Maybe visit
           | this post everytime you get an urge? Don't bring a pack with
           | you. Make it a nuisance to even access one.
        
           | Thlom wrote:
           | The one thing that helped me quit smoking was snus. It's not
           | healthy, but much much better than cigarettes.
        
           | pandoro wrote:
           | I can recommend to read Allen Carr's "Easyway to stop
           | smoking" if you haven't already. I had been smoking for 15
           | years total as well, tried to stop at least 6 times
           | (sometimes for 18 months, with the help of Nicorette and
           | e-cigs) and was telling myself "today is the last day" every
           | single day. But I was constantly tempted and was always
           | picking it up again. A lot of ex-smokers I knew kept
           | recommending me this book with almost magical claims. I
           | finally begrudgingly read it and stopped from one day to the
           | next. The craziest thing is that it was actually easy to stop
           | this time and gave me great satisfaction. I have stopped for
           | 2 years now and am confident that I will never smoke again
           | (contrary to all other attempts).
        
             | nilsbunger wrote:
             | Congratulations! What clicked for you from reading this
             | book compared to everything else?
        
             | rzazueta wrote:
             | I'm not a smoker, but know many, many people who are
             | legitimately addicted to tobacco. What is it about the
             | content of this book that made such a change in you? I'd
             | love to hear about your experience - it sounds like an
             | extraordinary approach if it indeed works as well as you're
             | saying, which makes me think it's some kind of written
             | neurolinguistic programming thing, a technique that could
             | be helpful in a lot of other situations.
        
               | [deleted]
        
               | md224 wrote:
               | I don't smoke, but my understanding of that book is that
               | it basically reprograms your associations re: smoking and
               | quitting smoking.
               | 
               | Before you read that book, quitting smoking is perceived
               | as a loss of something that made you feel good. The
               | permanence of this loss -- the anticipation of living the
               | rest of your life without this source of comfort -- leads
               | to cravings.
               | 
               | What the Carr book does is install a new set of
               | associations: smoking is disgusting and your life is
               | going to be so much better once you free yourself from
               | this completely unnecessary weight that's been dragging
               | you down. Instead of viewing quitting as the loss of
               | something good, you learn to view it as the act of
               | freeing yourself from something bad. Now, when you think
               | about a future without smoking, the anticipation is
               | _positive_ : you get to live the rest of your life
               | without this terrible thing intefering with it! And all
               | you have to do is just stop doing it! Sure, you might
               | have a little bit of physical withdrawal for a little
               | while, but isn't that worth it to be permanently free of
               | this awful thing that's been ruining your life?
               | 
               | That's the basic gist, as far as I can tell. In a way,
               | it's just about being optimistic about a life without
               | cigarettes instead of pessimistic.
        
               | pandoro wrote:
               | That's a very good summary of the approach. It stems from
               | the observation that every single smoker already know
               | about all the reasons they should not smoke (health,
               | financial, social,...) yet they still do it.
               | 
               | You know it's probably going to kill you, you know it
               | costs a lot of money and you know it's anti-social. The
               | book wastes no time trying to convince you about those
               | things. However, it dispels in a very systematic and
               | repetitive way all the positive myths you believe (or
               | repeat to yourself) about cigarettes ("the
               | brainwashing"). It does not actually relax you or bring
               | you pleasure, it just relieves a nicotine addiction and
               | allow you to get back to a state you already had before
               | smoking. It does not taste good. It does not help you
               | focus. Nicotine withdrawal is actually extremely mild.
               | Etc.
               | 
               | As the parent comment explains it's a re-framing, a
               | change of paradigm. By the end of the book I could very
               | clearly see that quitting would not be a sacrifice or "a
               | pleasure i would loose" but something that would make my
               | life better. And to be honest, this has felt like magic.
               | A few days after finishing the book I just threw my pack
               | in the trash and it really has been easy and at times
               | actually even pleasant to quit. Every cigarette you do
               | not smoke brings you a feeling of pride, accomplishment
               | and liberation.
        
               | bmy78 wrote:
               | "This Naked Mind" by Annie Grace takes a similar approach
               | with alcohol.
        
           | sosborn wrote:
           | Don't say it is the last day. Start by saying today is a day
           | that I won't have one. Then, maybe you can say that tomorrow
           | too.
        
           | gausswho wrote:
           | You have some good news because recent longitudinal studies
           | show a 90 percent reduction in cancer risk if you stop at 50.
           | 80 percent if 50. If you're older than that, your body can't
           | keep up the same.
        
           | wikitopian wrote:
           | Just switch to vaping.
           | 
           | It's easier to step down with it, and if you fail to step
           | down, you're still getting fewer carcinogens.
        
       | surfsvammel wrote:
       | "In 2019, half of all male deaths from cancer, and more than one-
       | third in women, were due to preventable risk factors including
       | tobacco and alcohol use, unhealthy diets, unsafe sex and..."
       | 
       | How does unsafe sex cause cancer? What is unsafe sex in this
       | context?
        
         | retSava wrote:
         | Probably cancer from HPV virus, which (at least in Sweden) is
         | vaccinated against in 10 (11? 12?) year-olds, before their
         | sexual debut. HPV is so transmissible and so common that on
         | average, if you have had 2-3 partners, you can kind of count on
         | having HPV.
        
           | yieldcrv wrote:
           | It's been a decade since 12-18 year olds were getting the
           | vaccine
           | 
           | You can just stick with adult Gen Z people now
           | 
           | Finally a _good_ excuse to not hook up with older people
        
       | geysersam wrote:
       | The other direction is rather more interesting in my opinion: No
       | matter _what you do_ , you can only reduce your chance of getting
       | cancer by 50% compared to the average population.
        
         | _trackno5 wrote:
         | "Only" and "50%" don't make much sense together in this
         | sentence.
         | 
         | 50% is a lot.
        
           | sgtnoodle wrote:
           | 50% of a tiny number is a tiny number. If the absolute risk
           | of dying from any cancer is small, decreasing that risk by
           | 50% isn't that much of an improvement overall.
        
       | beefman wrote:
       | Virtually all deaths from solid cancers are preventable with
       | routine scans to find tumors before they metastasize. Doctors
       | have for decades refused to learn to use this
       | technology.[1-4][5-9] *
       | 
       | Meanwhile, population studies like the one this article is based
       | on[10] are horseshit because they are subject to unknown degrees
       | of sampling bias, rely on enormous assumptions (such as linear
       | relationships which may not hold at all being applied over many
       | orders of magnitude), and cannot in any case establish causality.
       | 
       | [1] https://www.pocus.org/ [2] https://www.butterflynetwork.com/
       | [3] https://www.exo.inc/ [4] https://vavehealth.com/
       | 
       | [5] https://ezra.com/ [6] https://www.halodx.com/ [7]
       | https://www.prenuvo.com/ [8] https://www.simonone.com/ [9]
       | https://www.lifeimagingfla.com/
       | 
       | * Compare the experience of getting an x-ray from a dentist to
       | getting one from a doctor. Or getting an ultrasound from an OB to
       | getting one from any other doctor.
       | 
       | [10] https://pubmed.ncbi.nlm.nih.gov/35988567/
        
         | mfer wrote:
         | There is a fair amount of scientific study that has linked diet
         | to some cancers. Those same diet attributes that can make one
         | obese also lead to higher rates of cancer.
         | 
         | In cancer prevention, lifestyle matters.
        
         | loxias wrote:
         | > Virtually all deaths from solid cancers are preventable with
         | routine scans to find tumors before they metastasize.
         | 
         | Fantastic. I take it from those links this would be detectable
         | with a full body MRI? I already wanted an excuse to start
         | getting those regularly.
         | 
         | > Compare the experience of getting an x-ray from a dentist to
         | getting one from a doctor. Or getting an ultrasound from an OB
         | to getting one from any other doctor.
         | 
         | Can you expand on this? It sounds like you're implying
         | something (I might agree with), but am not sure.
        
           | PragmaticPulp wrote:
           | > Fantastic. I take it from those links this would be
           | detectable with a full body MRI? I already wanted an excuse
           | to start getting those regularly.
           | 
           | There is a lot of research on the topic but it doesn't agree
           | with the OP's thesis. Full body scans can be purchased if you
           | have the funds, but you are far more likely to get false
           | positives than to actually catch a cancer this way. The
           | ensuing medical costs and possibly even unnecessary surgeries
           | are statistically likely to cause you more detriment than any
           | benefit you might receive. This is counterintuitive to many,
           | but the truth is that it's not actually easy to spot nascent
           | pre-symptomatic cancers from full body scans without
           | incurring a massive number of false positives along the way.
           | Something like 1 in 8 people will end up getting flagged for
           | "warning signs of potential cancer" during these scans that
           | turns out to be nothing upon further investigation. Few
           | people continue to get the tests for this reason.
        
           | lupire wrote:
           | I think the difference is that ultrasound/imaging is routine
           | annual from dentist and monthly or whatever from OB during
           | pregnancy, but otherwise requires a specialist referral for a
           | specific injury or complaint.
           | 
           | It's also the case that a pregnancy is a hugely obvious
           | invisible but major health situation, and teeth are expected
           | to rot frequently.
        
           | aaaaaaaaaaab wrote:
           | >I already wanted an excuse to start getting those regularly.
           | 
           | Psychotherapy can help with hypochondria.
        
             | loxias wrote:
             | Hahaha :) Close, but no. Regularly I mean "roughly yearly",
             | and I'm a signals processing dork, not much of a health
             | nut.
        
               | sgtnoodle wrote:
               | If you're looking for a hobby, it's 2022 and you can buy
               | better-than-a-potato ultrasound gear on eBay for less
               | than $1000. Also, cheap ECG amplifiers are quite
               | available these days.
        
         | mikotodomo wrote:
         | Wait, so I've been avoiding McDonalds all this time for no
         | reason? I literally lost a GF because I decided to skip eating
         | one afternoon when the only place close to us was McDonalds!
        
         | picture wrote:
         | Routinely scanning people without symptom or otherwise cause
         | for concern is not a good idea. The human body is very messy
         | and variable, and it's hard for anyone or anything to reliably
         | spot thing that are actually worth acting on. If the doctor
         | spots a vague blob - how can they know what it is without any
         | symptoms? The course of action is then "come back in three
         | months for another scan."
         | 
         | Subjecting a population to unnecessary routine full body scans,
         | especially with radiation, will cause harm statistically. There
         | are also countless examples of people undergoing unnecessary
         | operation and suffering complications, like losing a perfectly
         | fine healthy heart and requiring transplant.
        
           | landryraccoon wrote:
           | Wouldn't the skill of analyzing scans improve if they were
           | done more frequently?
           | 
           | It seems like you're promoting a self fulfilling prophecy.
           | Doctors aren't good at reading scans, so scans will cause
           | false positives.
           | 
           | But doctors are capable of learning and improving their
           | skills. They will surely rapidly learn to screen a lot of
           | false positives, thereby saving lives.
        
             | MauranKilom wrote:
             | You seem to assume that radiologists currently see patient
             | scans too rarely to deliver accurate diagnosis. That seems
             | very unfounded to me.
             | 
             | "More frequent scans per patient" != "More scans seen per
             | clinician". You would just end up having to hire more
             | clinicians.
             | 
             | (Yes, your family doctor might end up seeing more scans in
             | this scheme, but it is implausible that they would be
             | better at evaluating them than a trained radiologist, which
             | is who this would almost surely be deferred to anyway.)
        
               | landryraccoon wrote:
               | Is the argument then that scans are intrinsically error
               | prone, as in the noise level is so high that even a team
               | of highly trained radiologists can't accurately determine
               | if cancer is present from a scan?
        
               | MauranKilom wrote:
               | It's not the quality of the scan (although that can
               | certainly be a factor). It's that there is a lot of
               | variation in human anatomy, and "these pixels are
               | brighter than the rest" can mean any of many things.
               | 
               | Relatedly, for many types of brain tumors, you simply
               | don't know what exact kind of tumor it is until you
               | actually do a biopsy (= you undergo surgery). This can be
               | important information ("how aggressive is it?"), so in
               | some hospitals it is common practice to send a tissue
               | sample for identification and get back the result while
               | the surgery is still going on.
        
             | moonchrome wrote:
             | This is a very naive argument, it assumes the entire
             | problem is lack of skill and that early intervention on
             | positive diagnosis is always a good thing.
             | 
             | Mammography is a really good candidate for random screening
             | and it's still debated because of false positives and the
             | impacts of misdiagnosis.
        
           | paulpauper wrote:
           | the screening guidelines take into account those risks and
           | it's still deemed worthwhile because cancer can grow and
           | become lethal despite being asymptomatic. colon cancer is the
           | mid-life killer...plenty of ppl in their 50s or even 40s get
           | it despite no risk factors. Screening is the only option to
           | catch it early.
        
           | valenterry wrote:
           | We need yearly scans or even monthly scans (MRI) for
           | everyone. Privacy concerns aside, I think we would learn an
           | awesome lot. We could then monitor changes over time and
           | machine-learning could probably get really good at
           | recognizing what changes are harmless and which are harmful
           | and need a doctor to look into.
           | 
           | It's a dream scenario, but maybe some day it will be like
           | that. Or it will be like that and be dystopia. :)
        
             | discardable_dan wrote:
             | MRIs would need to take a fraction of the time for this to
             | be viable.
        
               | derefr wrote:
               | Or, y'know, we could have 10x more MRI machines, thus
               | incentivizing them to be cost-optimized in ways they
               | absolutely aren't today.
        
               | likeabbas wrote:
               | Not necessarily, we just need cheaper ones. I interviewed
               | at Hyperfine last year and they seemed to have a
               | promising product
               | 
               | https://hyperfine.io/
        
               | throwaway09223 wrote:
               | No they don't. I would happily take a few hours each year
               | to get an MRI done.
               | 
               | We would need more machines, but even now the prices
               | aren't too exorbitant for something done annually (or-
               | even every few years)
        
               | lazyasciiart wrote:
               | 20% of americans havent even seen a doctor in the last
               | year. MRI prices for a fun test are far beyond a huge
               | percentage of the country.
               | https://civicscience.com/20-u-s-adults-not-seen-doctor-
               | past-...
        
               | throwaway09223 wrote:
               | "20% of americans havent even seen a doctor in the last
               | year"
               | 
               | And 80% have. The needs of the 80% are not determined by
               | the behavior of the bottom 20%
               | 
               | Rich people get better everything, including better
               | medical care. The upper 30% or so can afford better
               | diagnostics and they should be getting those better
               | diagnostics.
               | 
               | Many of us in the software industry could afford a few
               | extra thousand a year for preventative care -- but it is
               | very difficult to obtain care commensurate with one's
               | ability to pay. This is a real problem.
        
               | valenterry wrote:
               | Well, I wouldn't call them "fun tests" but otherwise
               | that's true.
               | 
               | However, there is also a chance to save a lot of money by
               | recognizing illnesses early. Sometimes it's possible to
               | prevent a life-long need to take expensive
               | medicamentation or it allows to detect cancer and allow
               | for easy surgery in an early stage allowing for complete
               | cure instead of requiring expensive chemotherapy AND
               | surgery for a long time with a worse outcome. It might
               | also very well prevent people from being unable to work
               | due to illnesses if they are detected early enough.
               | 
               | And that all isn't even considering the changes in
               | quality of life of course.
        
               | cableshaft wrote:
               | Yeah I think my last MRI was $800, with insurance. And
               | they didn't find anything. I'm not exactly champing at
               | the bit to spend the money to do that every year.
               | 
               | If it were $50-100, maybe then.
        
               | throwaway09223 wrote:
               | Everything's relative. I've had about 8 MRIs in the last
               | few years.
               | 
               | I also wouldn't bat an eye at spending $1k on
               | preventative care each year. Many Americans are paying
               | that annually for premium TV shows.
        
               | cableshaft wrote:
               | I've had like 4 MRI's total. The most recent one was I
               | had a scare about a possible aneurism, which is what they
               | didn't find anything for, and then had a couple for
               | looking at my neck and back, where they found two bulging
               | disks, one in the middle of my back and one in my lower
               | back. And they had to check my leg for something once,
               | maybe blood clots? I haven't needed to get one for
               | several years now.
               | 
               | MRI's don't seem that great for an annual preventative
               | check, since they are usually checking a pretty small
               | area (or at least mine were). Like those were 4 different
               | MRI's to check me from head to one of my calves. Getting
               | 4+ of those a year would add up quick. And that's not
               | even taking into account any of a myriad of other tests
               | that could be done every year. I'm sure I could probably
               | take a different test every week of the year, but I'd be
               | bankrupt quick.
        
               | throwaway09223 wrote:
               | Why would you jump to an absurd scenario like one every
               | week?
               | 
               | It would be an enormous benefit to do one MRI a year,
               | rotating between areas of interest, at a relatively
               | negligible cost ($500-1k or so per year - about what it
               | costs for an annual physical).
               | 
               | It's extremely cheap compared to your Dr's hourly
               | billable rate and would get cheaper at scale.
        
           | dan00 wrote:
           | Yes, the breast cancer screening already has quite
           | questionable results.
        
           | ssivark wrote:
           | > especially with radiation, will cause harm statistically.
           | 
           | Ultrasound is not radiation (as in photons). To the best of
           | our understanding (from a physics/engg perspective)
           | ultrasound imaging capped by appropriate energy/etc limits is
           | expected to be perfectly safe. Likewise with MRI. If we want
           | more pointed study to be sure of this, that's fair, but let's
           | be clear & specific about it and commit to figuring it out
           | one way or another so we don't repeat the same discussion a
           | couple of decades down the line. (We have to think of moving
           | the state of the art forward, instead of festering in
           | unresolved disagreements)
           | 
           | Further, if you're concerned about under-studied possible
           | side-effects of radiation from occasional diagnostic testing,
           | what do you plan to do about being blanketed by mm waves once
           | 5G gets deployed more ubiquitously?
           | 
           | > There are also countless examples of people undergoing
           | unnecessary operation and suffering complications
           | 
           | This sounds far more serious (and fixable) compared to the
           | physics/biology interaction of diagnostic testing. Why do we
           | continue to bury our heads in the sand collectively, instead
           | of trying to fix this with better decision-making tools?
        
             | DanBC wrote:
             | > Likewise with MRI
             | 
             | MRI isn't radiation, but is sometimes used with contrast
             | dye. People can be allergic to the dye. For one person this
             | is a small risk. Across a population we'd be causing harm.
             | We'd balance the risks of harm against the benefits, and so
             | far no-one can find a benefit to routine whole body MRI
             | scans. And if the benefit was there the MRI machine
             | companies probably would have found it by now because it'd
             | massively increase the numbers of machines they could sell.
        
               | robocat wrote:
               | MRI uses electromagnetic radiation. MRI uses a magnetic
               | field with a radio-frequency pulse and then the protons
               | emit a radio-frequency response - that response location
               | is used to synthetically generate the image. MRI does not
               | use ionising radiation. Nice overview here:
               | https://www.nibib.nih.gov/science-education/science-
               | topics/m...
        
           | voldacar wrote:
           | This is just silly. You are never disadvantaged by knowing
           | more about what's inside your body. What you don't know can
           | easily kill you, though.
           | 
           | Hopefully in the long term future we will have extremely
           | cheap & frequent MRI and blood testing so you can assemble a
           | high resolution digital history of your body. Doctors are
           | generally not very innovative people though and they will
           | probably resist it to the end.
        
             | bagels wrote:
             | It's not silly. Look at how the mammogram guidelines are
             | set. If the scans are too frequent, the harm done from
             | false positives (unnecessary surgeries and risks from those
             | surgeries) can become too great. The standards were relaxed
             | to include fewer scans in the last few years because of
             | this.
             | 
             | Apply this to more invasive exploratory surgeries, and you
             | see people dying from internal surgery complications for
             | benign cysts and lumps.
        
               | derefr wrote:
               | That's because single datapoints are used to trigger
               | intervention. We should be intervening based on growth
               | trends from time-series data. Time-series data which can
               | only be collected by... frequent scans.
        
               | Sebb767 wrote:
               | Don't discount psychological stress. "You have something
               | growing in your breast which might be cancer, just wait a
               | few months and we'll scan again" is not something that
               | gives people a good nights sleep.
        
             | jghn wrote:
             | It can be hard to predict how aggressive a tumor will be.
             | It isn't uncommon for people to obtain cancers that they
             | "die with" instead of "die of". In those cases, treatment
             | can be worse for the patient than the cancer. But since you
             | don't know which it'll be, people get the treatment and
             | sometimes wind up worse off than they otherwise would have.
             | 
             | And as the GP post cites, the scans themselves can cause
             | health problems down the road. Performing them on massive
             | scale will increase the occurrences of those side effects.
        
             | gzer0 wrote:
             | Full body scans, as they currently exist, are not
             | recommended for routine-usage. These scans use large
             | amounts of radiation. This can increase your risk of
             | cancer. If you have more tests, your risk increases.
             | 
             | Further, they are costly, and often times insurance does
             | not reimburse or cover it. They can cost anywhere from
             | $500-1000.
             | 
             | Unless you find a way to make this viable for the general
             | population and lower the radiation exposure, this will
             | never become viable for use.
        
             | DanBC wrote:
             | > You are never disadvantaged by knowing more about what's
             | inside your body.
             | 
             | Yes, you are. This has a name - over-testing, over-
             | diagnosis, and over-treatment. It's a significant cause of
             | harm in healthcare.
             | 
             | https://www.bmj.com/content/358/bmj.j4070
             | 
             | https://qualitysafety.bmj.com/content/31/1/54
             | 
             | https://www.choosingwisely.org/patient-resources/whole-
             | body-...
        
             | closeparen wrote:
             | Knowing that there is something weird in your body sets off
             | a cascade of medical care that easily escalates to surgery,
             | anesthesia, medication to manage complications, side
             | effects of that medication, time in the hospital being at
             | risk for infection, etc. These things absolutely can kill
             | you, or at least put you through hell. When there was
             | actually nothing wrong with you in the first place. That is
             | why the medical establishment is so conservative about it.
        
               | telchior wrote:
               | Isn't the danger of knowing there's something weird there
               | caused by the rarity of knowing anything at all?
               | 
               | I'd imagine that if there was consistent, good
               | information available, we'd figure out how and when to
               | act on it. The real issue is the massive cost of
               | performing any given scanning procedure to everyone
               | alive.
        
               | lazyasciiart wrote:
               | No. Doctors already think about this. Why do you think
               | they aren't doing prostate scans and mammograms
               | constantly on everyone?
        
               | closeparen wrote:
               | The question is not even what doctors think warrants a
               | follow up. The question is what a malpractice attorney
               | could construe as warranting a follow up, if it turns out
               | later to have been real.
               | 
               | Once a scan exists, doctors are essentially forced to act
               | on it. If an algorithm for deciding which scan results to
               | pay attention to were so solid that it would hold up in
               | court, that might make more scanning reasonable on the
               | margin? I dunno though.
        
         | _qua wrote:
         | What is your medical background? I am a physician and do not
         | agree with your thesis. Linking to ultrasound websites is not
         | really evidence of anything.
         | 
         | There simply isn't good evidence that "all solid tumors caught
         | early are curable." Some cancers, like localized breast cancers
         | and certain renal cancers, are highly curable when caught
         | early. Some other non-solid cancers like certain pediatric
         | leukemias are also extremely responsive to therapy and highly
         | curable. Conversely, some solid tumors, even when caught early,
         | have dismal prognosis due to micrometastasis and the underlying
         | biology of the tumor. I would recommend "The Hallmarks of
         | Cancer" for a high level overview of the current understanding
         | of what drives cancer:
         | https://doi.org/10.1016/j.cell.2011.02.013
        
           | saiya-jin wrote:
           | He has no actual clue, thats for sure. On top of all correct
           | items you mention, some stuff is completely benign and should
           | be left alone. Nobody will know that until operation or
           | other, very invasive procedures are taken which have their
           | own risks anf consequences.
           | 
           | Especially at older age, many things killing slowly are just
           | too slow and other items will surpass them in achieving that
           | kill, ie prostate cancer in basically all men (according to a
           | close friend who is swiss urology surgeon its only question
           | of time we all males get it, but most of the time you dont
           | know about it and it progresses super slowly).
           | 
           | There are many things like this. That doesnt mean there isnt
           | a room for improvement. I have some bad experiences too, but
           | my wife is a doctor and medicine is HARD, every case properly
           | unique. IT and stuff google et al do is trivial and
           | deterministic by comparison.
           | 
           | We all would like this idea that medicine can cure it all,
           | but we are far, far from it. But some folks apparently just
           | love reading "10 things THEY don't want you to know about
           | XYZ" articles and actually believe them.
        
           | paulpauper wrote:
           | much of this discussion is bad, whether it's people who
           | insist their healthy lifestyles will prevent cancer or
           | thinking that all cancer is preventable
        
           | bagels wrote:
           | Some of those devices are not decades old either, regardless
           | of the other problems with the thesis.
        
           | echelon wrote:
           | Does a physician have a globally optimal understanding?
           | 
           | Do you actively read medical journals? Developments in
           | biochemistry? Even amongst the best read physicians and
           | researchers, I would bet my life that we're doing a lot of
           | things suboptimally or have improper understanding of many
           | diseases.
           | 
           | I'm not trying to belittle your understanding or your
           | credentials, which I understand to be far better than
           | untrained laymen.
           | 
           | The current state of medical care leaves a lot to be desired.
           | We have a long way to go to detect and cure every disease
           | state.
           | 
           | If more money is spent on developing better tooling, assays,
           | imaging, etc. we will undoubtedly improve patient outcomes.
        
             | lazyasciiart wrote:
             | A globally optimal understanding would involve far more
             | than biochemistry and medical journals - population
             | analysis, behavioral economics, regular economics, risk
             | analysis, and a crystal ball would all be needed to avoid
             | "doing a lot of things suboptimally". The fact that you
             | haven't even mentioned those fields of study makes it clear
             | you're not familiar with even the scope of the problem, let
             | alone how to solve it.
             | 
             | Hell, we could improve patient outcomes enormously by
             | paying for everyone to receive basic dental care, today.
        
             | PragmaticPulp wrote:
             | > Does a physician have a globally optimal understanding?
             | 
             | I'm far more inclined to trust a trained physician than a
             | random HN commenter whose first four citations are just
             | random ultrasound device manufacturer websites. The parent
             | comment makes bold claims and tries to overwhelm the reader
             | with non sequitur citations, but it's clear they don't
             | actually understand the subject matter.
        
               | adventured wrote:
               | While I agree with your premise, how the hell do we know
               | the parent is a trained physician? This is an anonymous
               | forum. Without a long, elaborate history on HN or public
               | credentials, to be of meaningful value in terms of trust
               | (in the context we're discussing) the reply needs to
               | bring a lot more to the conversation than a one line
               | statement and claim of being a doctor. Maybe they are a
               | doctor, great: they can add a lot more to the counter
               | reply if so, information that they are in theory
               | particularly equipped to discuss.
        
               | DanBC wrote:
               | > While I agree with your premise, how the hell do we
               | know the parent is a trained physician?
               | 
               | We don't know, but it doesn't matter. We can go to
               | websites like the BMJ and see trained physicians and
               | researchers saying the same thing across a range of
               | different articles.
               | 
               | We can go to research organisations like NICE, or
               | Cochrane, or the UK National Screening Committee to see
               | doctors and researchers saying the same thing. For mass
               | screening, the harm often outweighs the benefits.
        
           | spaghettiToy wrote:
           | A scientist posts data, then a physician comes in and let's
           | everyone know they are the authority and confidently uses
           | their gut feeling to say "wrong!"
           | 
           | What an iconic duo...
           | 
           | I really hope we get AI to take over medicine, after being
           | misdiagnosed for a decade and having 2 kids misdiagnosed I've
           | lost faith in Authority based medicine.
        
         | oaktrout wrote:
         | POCUS is used commonly in my experience and there are large
         | amounts of curriculum devoted to it. We haven't had affordable
         | access to POCUS for decades so I don't see how doctors have
         | refused to learn it for decades.
        
           | ssivark wrote:
           | Do you think that affordability is the biggest hurdle holding
           | back POCUS from being used ubiquitously for diagnostic
           | imaging, or is it something else?
        
             | oaktrout wrote:
             | Probably not. Costs have come down immensely, most HN users
             | could afford a butterfly if they wanted to play around with
             | it.
             | 
             | Ultrasound has limited penetration for deeper tissues so
             | you aren't going to see lung cancer with it (especially
             | behind ribs), and overweight patients don't image as well,
             | again because of limitations in imaging depth. Regardless
             | of uptake it's not going to solve all our diagnostic
             | challenges.
             | 
             | It also takes skill to know what you are seeing and to know
             | how to find what you're looking for. Anyone could learn,
             | but it's a time investment and physicians have limited time
             | as is.
             | 
             | Still, it is becoming more popular and soon it won't be
             | uncommon for your primary care doc to pull out the probe
             | and see if your gallbladder is inflammed or if that abscess
             | is going to be amenable to in office drainage.
        
         | [deleted]
        
         | PragmaticPulp wrote:
         | Your first four links are just random ultrasound device
         | companies. Doctors are very well-versed in ultrasound
         | technology so your claim that doctors refuse to learn this is
         | patently false.
         | 
         | Full-body scans have been marketed for years by companies
         | looking to drum up business for their machines, but they mostly
         | lead to false positives. Notice how your fifth link clearly
         | says it has helped people find "warning signs of potential
         | cancer" instead of that it helps people find cancer? These
         | machines are basically false positive generators in most cases.
         | If someone had effectively infinite time and money to dedicate
         | to routine cancer screenings from these machines, they are more
         | likely to end up harmed by unnecessary procedures stemming from
         | false positive results than they are to catch and remove a
         | specific cancer occurring randomly in their bodies.
         | 
         | Contrary to your claims, we _do_ actually screen for certain
         | cancers in cases where a clear net positive benefit can be
         | demonstrated. Mammograms for breast cancer are one common
         | example.
         | 
         | Doctors definitely aren't just burying their heads in sand.
         | These are common research topics and the tradeoffs of false
         | positives are constantly being investigated. Full-body
         | screenings aren't necessarily a net benefit.
        
           | sigmoid10 wrote:
           | There's also a lot of politics and social psychology involved
           | in these things. From the government side, it can be decades
           | between arranging, deploying and evaluating large scale,
           | population-wide cancer screenings. These are timescales on
           | which scientific consensus can easily change. Mammograms in
           | particular are a touchy subject, since newer metastudies only
           | show a statistically significant reduction in mortality for
           | women above the age of 50 and below the age of 74 [1].
           | However, many policy makers still offer screenings starting
           | at the age of 40 with no upper limit, despite evidence that
           | annual mammograms will result in a false positive result over
           | 10 years with up to 61% probability [2]. Below the age of 50,
           | regular mammograms may even _increase_ the risk of dying from
           | breast cancer [3]. Ultrasound screenings on the other hand
           | would be much safer from a radiation-exposure point of view
           | and metastudies suggest they can detect cancers under
           | difficult conditions more reliably, but they also suffer from
           | more false positives [4]. This is where the social aspect
           | comes in, where many woman fear getting their breasts removed
           | for no reason. This is especially concerning when more than
           | 50% of positive results are found to be false positives [5].
           | To summarize: It 's really hard to figure out what amounts to
           | "net positive benefit" when it comes to general public
           | screenings.
           | 
           | [1] https://www.aeaweb.org/articles?id=10.1257/jep.35.2.119
           | 
           | [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3209800/
           | 
           | [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189562/
           | 
           | [4] https://bmccancer.biomedcentral.com/articles/10.1186/s128
           | 85-...
           | 
           | [5] https://ebmh.bmj.com/content/16/4/115
        
         | n8henrie wrote:
         | What in the world are you talking about?
         | 
         | I'm a physician that uses ultrasound every shift, and I'm
         | pretty darn good at it. I've even used one of the specific
         | devices you linked to.
         | 
         | Virtually every physician I know is foaming at the mouth to
         | learn more ultrasound and to apply it to new indications and
         | with new approaches. Inappropriate use of ultrasound for
         | harebrained indications (for which we have far superior
         | alternatives) is on of my pet peeves.
         | 
         | I am not a cancer doc, but I am drawing a blank as to what
         | solid tumors you could possibly be referring to for which
         | ultrasound is the preferred screening or diagnostic technique,
         | or what kind of conspiracy you're vaguely implying that
         | prevents its use. IME, virtually everyone is (over?) eager to
         | use ultrasound for every condition under the sun, and I am
         | sincerely perplexed as to what experiences have led you to form
         | your opinion on this matter.
        
         | Ovah wrote:
         | "Doctors have for decades refused to learn to use this
         | technology" In Sweden this is actually standard practice. It's
         | used for patients who have syndromes that guarantee them to get
         | cancer several times over in their lifetime. IIRC some get an
         | MRI every 6 months. The reason it's not done to a wider
         | population.. well you can't justify the cost in a state funded
         | healthcare system. The health benefit just isn't justifiable
         | when MRIs are so scarce and expensive to run.
        
       | giantg2 wrote:
       | Yeah, and 100% of automobile deaths are preventable too (by not
       | driving, which is the same logic applied in the study).
        
         | defterGoose wrote:
         | This isn't at all borne out by the data yet, unless you're
         | talking about the purely tautological case.
        
         | pimlottc wrote:
         | Or by improved road design and better transit alternatives. The
         | point is, we can do something about it.
        
           | giantg2 wrote:
           | Theoretically you might be right, but feasibly/politically
           | that claim is tenuous.
        
       | irrational wrote:
       | My brother in laws sister was recently diagnosed with cancer.
       | Before she was diagnosed, she quit her job with benefits to stay
       | home and take care of her father with advanced Parkinson's. Her
       | cancer is treatable and has a high probability of being curable,
       | but she doesn't have and can't get insurance and doesn't qualify
       | for government help. Her choice is death or go into such
       | incredible debt that she will never have hope to pay it off. She
       | is 29. She has chosen death.
        
         | synaesthesisx wrote:
         | I'm not following. Can't she just take on debt and eventually
         | file bankruptcy and get it discharged?
         | 
         | Bankruptcy only has temporary repercussions, and is objectively
         | preferable to death, which is permanent.
         | 
         | Medical debt is the leading cause of bankruptcy in the United
         | States. Things like cancer can easily result in 7 digit bills,
         | even WITH insurance.
        
           | deltaonenine wrote:
        
         | neilv wrote:
         | This is in the US? Has she worked with hospital staff, social
         | workers, and lawyers (and maybe even federal/state
         | representatives/officials) on all the possible ways to swing
         | this? (Examples: maybe there's some way to get into ACA
         | marketplace insurance soon, or to get onto Medicaid, or to do
         | asset protection?)
         | 
         | Stress, and being in the mode of taking care of someone with
         | advanced illness, might have her feeling down, and approaching
         | and thinking about this differently than she would normally.
        
       | mmaunder wrote:
       | Interesting seeing alcohol appear more often as an underlying
       | cause of disease. It used to be that alcohol in moderation was
       | going to save us all.
        
         | skeeter2020 wrote:
         | "Alcohol in moderation" is far less than most think. Depending
         | on study, closer to 3 drinks per week or 4 oz of red wine
         | daily. How many people do you know who drink, but only 1/2 a
         | beer a day?
        
           | mod wrote:
           | I own a bar. I don't know any customers who drink 3 only
           | drinks per week.
           | 
           | We definitely have some that don't drink, or only a couple
           | times per year. They come in and play pool, etc.
           | 
           | But I would guess 95% of our customers drink close to 5
           | drinks per DAY, averaged. (It's a local regulars bar, so we
           | see the same faces every day).
        
       | visava wrote:
       | The solution to obesity is simple. People want tasty food . It is
       | possible to make it with healthy ingredients. But market is
       | flooded with white flour,sugar,wheat and milk products. It takes
       | effort to prepare it yourself.
        
         | colechristensen wrote:
         | It's not simple. Tasty food that has a considerable amount of
         | water in it which can be produced and distributed on an
         | industrial scale cheaply... is not an easy problem.
         | 
         | Really we just need to evolve so that these high energy density
         | foods aren't such a problem.
        
           | elcritch wrote:
           | I agree if we can sustain these food levels that subtle
           | genetic modification would likely be best long term.
           | 
           | Why not up regulate our energy usage and boost our bodies
           | self-healing mechanisms, etc?
        
         | anonporridge wrote:
         | The solution isn't simple, because the problem is that we have
         | bodies that are evolutionarily designed for a world of extreme
         | calorie scarcity that are living in a world of extreme calorie
         | abundance.
         | 
         | Our deep genetic firmware hasn't been programmed to deal with
         | this kind of extremely unnatural corner case, and we're
         | collectively breaking because of it.
        
           | yomkippur wrote:
           | We just take 3 meals a day for granted without asking where
           | this movement really came out of. Hint: agriculture/produce
           | won't do well if people only eat 1 meal a day.
           | 
           | Eating one/two meals a day is something that nobody talks
           | about as much as this other food conscious movements like
           | gluten, carbs, now keto. All of this seems driven at pushing
           | demand towards certain sector.
        
         | loeg wrote:
         | I think tasty food (regardless of composition) might be the
         | problem. If food was less tasty people might moderate their
         | consumption better.
        
           | bowsamic wrote:
           | I don't think so, I think it's more that we grew to live in a
           | "feast famine" environment, but suddenly we are now in an
           | environment with infinite food. It goes against our instincts
           | to not eat food that is there. Instead we have to hope we
           | have the willpower to overcome it with our rational thought
           | processes. Most people, if they are not busy with other
           | things, will want to eat. "Thankfully" we have capitalism and
           | so people are busy and pushed to be even busier. I think
           | without that, if we really had time to sit and relax without
           | those mental pressures of progression, we would be much
           | fatter.
           | 
           | It is just one of the ways that human material conditions has
           | quickly changed way faster than the human animal has managed
           | to evolve for it, and so it is unsuited for such
           | environments. I think we might eventually have a
           | technological solution (everyone on appetite suppressants)
        
           | vorpalhex wrote:
           | hyper-palatable is the word that has come to be used
        
           | pengaru wrote:
           | It's a sort of arms race. Unprepared plain raw organic
           | produce is delicious, if you haven't been eating prepared
           | food covered in salt and other seasoning for years. Once you
           | start adulterating your food with flavor crystals, you
           | _require_ that stuff just to move the needle.
           | 
           | A flavor tolerance develops, similar to drug tolerance.
        
             | mod wrote:
             | > Unprepared plain raw organic produce is delicious
             | 
             | Yeah, although I doubt it was as delicious before modern
             | farming. Or even if it was, we didn't have most of it.
             | 
             | But an animal roasted over a fire is equally as delicious;
             | just ask an Alone contestant. One woman ate the gut
             | contents of a rabbit and said it was one of the best things
             | she'd ever eaten.
             | 
             | Hunger is the best condiment, as the saying goes.
        
         | denimnerd42 wrote:
         | I don't think that's simple. People want tasty food with the
         | least effort involved. This is a genetic programming.
         | buffalo:bear::mcdonalds:healthy_cooking
        
         | capitainenemo wrote:
         | Lustig claims there was a catastrophic shift from fats to
         | sugars due to blaming fats for obesity. Supposedly fructose
         | doesn't trigger the satiation signals that fats do however.
         | 
         | https://www.youtube.com/watch?v=dBnniua6-oM
        
           | watwut wrote:
           | Satiation is more complicated then that. You can eat pure fat
           | or pure sugar and neither option will make you feel full.
           | Both will also cause malnutrition in you, no matter how much
           | of them you consume.
        
           | vorpalhex wrote:
           | Fats come with their own issues too, especially the shelf
           | stable fats that processed food uses as opposed to a bit of
           | real butter.
           | 
           | The truth is less exciting: avoid too much sugar or fat. Some
           | is fine. Your "fine" and your "too much" may be different
           | from someone elses.
        
             | capitainenemo wrote:
             | Yeah, fats definitely have issues, but, they come with rate
             | limiters - satiation triggers. Heart of his argument is
             | that fructose triggers nothing, so you keep chugging it,
             | and with almost identical stress to liver as alcohol, which
             | also has a limiter for most people (you pass out :) )
        
           | arcticbull wrote:
           | Fructose also has different glycemic profile - it doesn't
           | trigger the same big spike is blood sugar that glucose does.
           | It has to be metabolized by the liver first, which is the
           | rate-limiting step. Although, too much can lead to a
           | cirrhosis-like condition called non-alcoholic fatty liver
           | disease [1]. Sugar is bad, even fructose.
           | 
           | With that in mind, there's no such thing as a minimum
           | required daily intake of carbohydrates.
           | 
           | [1] https://en.wikipedia.org/wiki/Non-
           | alcoholic_fatty_liver_dise...
        
         | nevrherd wrote:
        
         | smarkov wrote:
         | While eating healthier things would probably help to an extent,
         | nothing's stopping people from just eating more of those
         | healthier foods and still becoming obese. Healthy or not, food
         | is calories and a surplus of those calories will lead to weight
         | gain.
        
           | brazzy wrote:
           | Technically correct but practically beside the point. That's
           | not how humans work.
           | 
           | What stops people from just eating more of those healthier
           | foods is that they make you feel full more quickly and longer
           | with the same amount of calories.
        
             | smarkov wrote:
             | I agree that they make you feel full more quickly and for
             | longer but a good amount of obese people don't overeat
             | because they're hungry, they overeat because it's their way
             | of dealing with problems. It's an unhealthy coping
             | mechanism like alcohol and drug abuse and should be treated
             | as such.
             | 
             | Don't get me wrong, I'm all for having higher food
             | standards and healthier foods, I just don't think it'll
             | help with obesity as much as you'd think.
        
               | [deleted]
        
               | hombre_fatal wrote:
               | I would be surprised if any of the large people in my
               | life were overeating healthy foods like oats, chickpeas,
               | bananas, lentils. Usually those were the things missing
               | from their diet.
               | 
               | Frankly, it seems like low satiating, high dense foods
               | are the only foods up to the task of making someone
               | obese. e.g. The ease of drinking a liter of Coke vs
               | eating that same amount of calories in beans.
               | 
               | I would be interested to see the food diary of someone
               | who claims to overeat healthy food. I think it would
               | illuminate our mass confusion about "healthy food". The
               | healthy foods I think of are the kinds you can eat ad
               | libitum without much consequence.
        
       | anonymous344 wrote:
       | It's funny how cr is still billions / year, but there has been
       | this natural clinic that has cured thousands of people.. .from
       | 1970. was it something like gerrison miracle etc..
       | 
       | of course big pharma does not like "free" medicine
        
         | [deleted]
        
       | UIUC_06 wrote:
       | The argument that "more knowledge is better, always" is just not
       | viable. Not when you look at all the people driving alone in
       | their car, or walking alone on the street with a mask on.
       | 
       | There are, as any doctor will tell you, large numbers of people
       | who will see their doc for _any_ questionable data and demand
       | treatment. Preferably a pill they can take once a day. They are
       | not willing to be reassured and will happily go to a different
       | doctor who gives them what they want.
        
       | solidist wrote:
       | Everything in moderation. Those who are conscientious achieve
       | longevity but trade off with less than ideal experiences of
       | anxiety.
        
       | darepublic wrote:
       | Early detection important but in Canada you aren't going to get
       | it unless you are very lucky
        
       | wbc wrote:
       | Anyone know of promising cancer startups? Was listening to a
       | podcast that mentioned pancreatic cancer mortality rates and it's
       | basically a death sentence (stage 1 85%+, later 95%+)
       | 
       | I don't drink or smoke but would love to avoid cancers. Wife was
       | working at a great one but it basically shutdown cause clinical
       | trials are so expensive.
        
         | xtracto wrote:
         | We need more advanced clinical trial /organ-body simulations.
         | 
         | That's what we as Computer Scientists can do... if we could
         | have a sufficiently good virtual representation of the human
         | body (at least enough parts of it)the cost and time of human
         | trials would be reduced so much... it would be revolutionary.
        
       | yomkippur wrote:
        
       | zaptheimpaler wrote:
       | Fitter, happier, more productive       Comfortable (Not drinking
       | too much)       Regular exercise at the gym (Three days a week)
       | Getting on better with your associate employee contemporaries
       | At ease       Eating well (No more microwave dinners and
       | saturated fats)       A patient, better driver       A safer car
       | (Baby smiling in back seat)       Sleeping well (No bad dreams)
       | No paranoia       Careful to all animals (Never washing spiders
       | down the plughole)       Keep in contact with old friends (Enjoy
       | a drink now and then)       Will frequently check credit at
       | (Moral) bank (hole in wall)
        
         | [deleted]
        
         | quadcore wrote:
         | _Careful to all animals (Never washing spiders down the
         | plughole)_
         | 
         | Whats that?
        
           | [deleted]
        
           | thenerdhead wrote:
           | Rinsing insects down the drain which drowns and kills them in
           | the process.
        
             | quadcore wrote:
             | Dont get me wrong I hate to terminate any life, but whats
             | the issue regarding health I still dont get it.
        
               | thenerdhead wrote:
               | It's a song that talks about the perfect person.
        
         | wikitopian wrote:
         | Thank you, fellow nineties emo kid.
        
       | viktorcode wrote:
       | > Data show that smoking, drinking alcohol and obesity are the
       | biggest contributors to cancer worldwide.
       | 
       | Does this mean that the predominantly muslim states have far less
       | cancer cases?
        
       | nativecoinc wrote:
       | My paternal grandmother got dementia and eventually died. My
       | oldest uncle got dementia and eventually died. My father (the
       | middle one) has dementia now. Now my youngest uncle is afraid
       | that he only has a few good years left.
       | 
       | My fortunate paternal grandfather just had a heart-related
       | incident and died quickly at a much younger ager than his wife.
       | 
       | I follow a good lifestyle to the degree that I do only because I
       | want a good quality of life in my middle years and a bit beyond
       | that. I am not interested in subsisting on carrots, cauliflower
       | and exercise bands so that I can become a fit 75 year old with
       | dementia.
       | 
       | Hopefully I'll be lucky and die in early old age or I'll get
       | cancer. Dementia can fuck off.
        
       | retSava wrote:
       | Anyone know what the curve for alcohol looks like?
       | 
       | I know no amount of alcohol is "safe", and a lot of alc is very
       | bad, but in between, what does it look like? Is it a cliff after
       | more than 2 drinks a week? 10? Does it matter if it's beer or
       | whiskey?
        
         | laurencerowe wrote:
         | > Adults drinking seven to 14 drinks per week could expect, on
         | average, a six-month shorter life expectancy as of age 40
         | 
         | > Those drinking 14 to 25 drinks per week could expect a
         | shorter life expectancy by one to two years
         | 
         | > Those drinking more than 25 drinks per week could expect a
         | shorter life expectancy by four to five years
         | 
         | https://www.health.harvard.edu/blog/sorting-out-the-health-e...
        
         | acidburnNSA wrote:
         | I don't know, and that is very hard to measure definitively due
         | to confounding variables. In the nuclear industry we have a
         | similarly hard question for ionizing radiation dose. Since the
         | 50s we just use a dumb linear no threshold curve, assuming
         | every little bit hurts.
        
       | kazinator wrote:
       | When speaking about cancers attributable to lifestyle, why does
       | it have to be deaths? Why not incidences of cancer? Not all
       | incidences of cancer lead to death.
       | 
       | When a death is prevented, that can be at any stage, from
       | avoiding the lifestyle choice like smoking and drinking, to the
       | doctors spotting the cancer early and intervening in time.
       | 
       | So if we are talking about cancer deaths preventable through
       | lifestyle changes, that is just mixing in too many variable. Some
       | incidences of cancer attributed to lifestyle may have been
       | prevented from becoming deaths due to medical intervention, which
       | clouds the numbers.
        
       | AnonCoward42 wrote:
       | The obsession that you can live longer by doing this healthy
       | trick is not really helpful. Ultimately you are going to die of
       | cancer if you avoid any other cause of death (and even that is
       | impossible).
       | 
       | What's annoying me is the survivor bias. How do you know that
       | people wouldn't have died earlier if they didn't do what
       | supposedly caused the death over decades? Let alone that you
       | cannot actually pinpoint what caused the cancer (but guess of
       | course).
       | 
       | I think you shouldn't smoke and you probably should avoid alcohol
       | or only consume in considerate amounts and don't eat like it's
       | your last meal over and over, but you can't just say don't drink,
       | smoke and overeat (or even don't eat this, but that) and pretend
       | that it is better.
        
         | onion2k wrote:
         | _The obsession that you can live longer by doing this healthy
         | trick is not really helpful._
         | 
         | It's not simply a matter of 'avoiding cancer' but more
         | 'avoiding a slow, painful death due to cancer'. It's not even a
         | matter of "you have to die of something!" Most forms of cancer
         | are _not_ a nice way to die. If you can avoid getting it so
         | that you die of something else, especially something really
         | nasty like lung cancer, you _definitely_ want to give that a
         | go.
         | 
         | I'm old enough to have seen friends and relatives die of cancer
         | and I _really_ don 't want to go that way. Seeing the affect on
         | those people, and even more on their families who had to watch
         | them fade away, was $^&%ing horrible.
        
           | Otek wrote:
           | What I really want is more approachable Euthanasia. I'm not
           | afraid of dying, it will happen to all of us, but I dont want
           | for me or my relatives a months of pain when everyone knows
           | it will only lead to death.
        
         | hombre_fatal wrote:
         | Well, you could use your reasoning to justify drinking and
         | smoking. Why did you stop there? People live to old age despite
         | doing those things. And how can you actually be sure that it's
         | the drinking/smoking that killed you? People get lung cancer
         | and cardiac events without doing either.
         | 
         | The truth of the matter is that all we can do is try to stack
         | the deck in our favor. A major part of life is deciding which
         | trade-offs matter to you.
        
           | AnonCoward42 wrote:
           | > The truth of the matter is that all we can do is try to
           | stack the deck in our favor. A major part of life is deciding
           | which trade-offs matter to you.
           | 
           | Which is, what I said. And the trade-off can even be smoking
           | or drinking alcohol, even if this does not seem right (to you
           | or me). Paracelsus applies.
        
         | autosharp wrote:
         | > you can't just say don't drink, smoke and overeat (or even
         | don't eat this, but that) and pretend that it is better.
         | 
         | Okay then, nothing you can do I guess. You're hereby absolved
         | from behaving responsibly towards your own body. Is that
         | better?
        
           | AnonCoward42 wrote:
           | > Okay then, nothing you can do I guess. You're hereby
           | absolved from behaving responsibly towards your own body. Is
           | that better?
           | 
           | >> I think you shouldn't smoke and you probably should avoid
           | alcohol or only consume in considerate amounts and don't eat
           | like it's your last meal over and over, but you can't just
           | say don't drink, smoke and overeat (or even don't eat this,
           | but that) and pretend that it is better.
           | 
           | I addressed it already, but let me add this: Just be sensible
           | and do what is best for you (in terms of health). There is no
           | single way for everyone to do it right.
        
         | oaktrout wrote:
         | Large population based studies tell us what caused the cancer.
         | If smokers are 20x more likely to get lung cancer we know that
         | smoking causes cancer.
        
         | DanBC wrote:
         | The advice can be more nuanced.
         | 
         | We know that processed red meat definitely causes cancer. We
         | also know that it doesn't cause very much cancer. Our message
         | isn't "stop eating processed red meat", it's "if you have a
         | family history of colon cancer; if you know you have a genetic
         | predisposition to colon cancer; if colon cancer is something
         | you're worried about, then you may wish to reduce the amount of
         | processed red meat that you eat".
        
         | yieldcrv wrote:
         | Avoid it long enough for more effective treatments of cancers
         | to exist
        
       | Cupertino95014 wrote:
       | Following on the discussion yesterday about "science is political
       | and that's bad" (and posters saying "no, it's not"):
       | 
       | Nature Magazine has soiled itself irrevocably with its political
       | stances. Now when you read anything like this, you have to ask,
       | "was this written because of some new scientific information, or
       | was it just in furtherance of their agenda?"
        
         | freeone3000 wrote:
         | Furtherance of their agenda to... Get people to stop smoking,
         | drink less, and lose some weight? Is this even an agenda or
         | just good advice?
        
           | Cupertino95014 wrote:
           | It's certainly good advice. However, _Nature_ is there to
           | publish new science, not to provide generic advice.
        
         | oaktrout wrote:
         | Ahh yes, the evil big vegetable lobby is trying to undermine
         | the good that has been done by poor old Philip Morris.
        
           | Cupertino95014 wrote:
           | It's certainly good advice. However, _Nature_ is there to
           | publish new science, not to provide generic advice.
        
       | hamiltonians wrote:
       | then why do doctors do cancer screening by age and family history
       | and not lifetyle? hmm. except for smoking, a lot is unkown about
       | who gets cancer.
        
         | robobro wrote:
         | Read the two lines of the article:
         | 
         | > Data show that smoking, drinking alcohol and obesity are the
         | biggest contributors to cancer worldwide.
         | 
         | > Nearly 50% of cancer deaths worldwide are caused by
         | preventable risk factors, such as smoking and drinking alcohol,
         | according to the largest study of the link between cancer
         | burden and risk factors
         | 
         | Interested to see what your response is to the article once you
         | finish reading it :-)
        
           | toomuchtodo wrote:
           | Life causes cancer. :) The symptom is cancer, the problem
           | statement is a fix is needed for the human immune system to
           | be more targeted and aggressive in purging cancer from the
           | body, as well as more robust cellular repair mechanisms.
           | 
           | The human body can take enormous amounts of environmental
           | abuse, but there's clearly room for improvement.
        
             | kingkawn wrote:
             | A more aggressive immune system can cause cancers, such a
             | myeloma or lymphoma. Gotta watch what you wish for
        
               | toomuchtodo wrote:
               | Improvements should be designed to balance self
               | preservation with self destruction. Immunotherapy, gene
               | therapy, and CRISPR are still in their infancy.
        
             | fredgrott wrote:
             | ahem metabolism by animals in of itself does not cause
             | cancer. Biology wise cancer is the miss fire of a nature
             | aging process.
        
             | blacksmith_tb wrote:
             | "Approximately 39.5% of men and women will be diagnosed
             | with cancer at some point during their lifetimes (based on
             | 2015-2017 data)."[1]
             | 
             | Many lives will experience cancer, but not the majority. So
             | it seems to be more complex that immune inadequacy (unless
             | 60% of immune systems are working really well, which would
             | be noteworthy). It seems like a reasonable hypothesis that
             | environment is playing a larger role than individual
             | genetic variations. So encouraging people (or even scaring
             | them) to not smoke, not drink, eat better and exercise more
             | seems like a reasonable approach - it won't cure cancer,
             | but it could reduce rates?
             | 
             | 1: https://www.cancer.gov/about-
             | cancer/understanding/statistics
        
           | hamiltonians wrote:
           | doesnt change my point. docs screen by age, not lifestyle
           | unless u smoke
        
         | explaingarlic wrote:
         | Are the majority of these risk factors not predictable
         | epigenetically or genetically?
        
           | AdrianB1 wrote:
           | I read somewhere (I don't remember the source, but it was
           | some medicine journal) that 4% of smokers are genetically
           | more inclined to die from lung cancer; while lung cancer is
           | correlated with the number of cigarettes (intensity and
           | length of time), these people will have lung cancer even with
           | a very low number of cigarettes.
           | 
           | I know a few anecdotal cases where entire families of smokers
           | died from lung cancer, while their partners, also smokers,
           | had no problem, but I don't put much weight on that. Also I
           | heard that smoking can cause other cancers like colon cancer
           | in specific genetic conditions, but I don't know more
           | details.
        
         | steve_adams_86 wrote:
         | There are all kinds of carcinogenic compounds we know are
         | avoidable but people are exposed to nonetheless. The article
         | points out several examples.
         | 
         | Some cancers are more likely to occur based on gender and more
         | predictable gene expressions, but these aren't mutually
         | exclusive. You can be more likely to get cancer without doing
         | anything special while still vulnerable to an increased risk of
         | cancer through exposure to carcinogens (like alcohol, smoke,
         | processed meats, etc).
        
       | dec0dedab0de wrote:
       | It could be argued that smoking, alcoholism, and obesity are all
       | means of coping with a high stress lifestyle. I wonder how many
       | more people would die from other reasons if they were no longer
       | able to use those coping mechanisms. Or maybe more importantly,
       | how much total happiness would they have in their life if they
       | had the extra time. I say this as a fairly recent cancer survivor
       | if that matters.
       | 
       | edit: Does anyone know if psychologists or sociologists have a
       | formula for quantifying happiness? Something like mechanical
       | advantage. It seems intuitive that certain behaviors can act like
       | a fulcrum by increasing happiness now at the expense of sadness
       | later, either born by you or those close to you. I'm sure we've
       | all had smokers joke that you can keep the last 20 years of life,
       | maybe they're on to something.
        
         | oaktrout wrote:
         | I think if people didn't have smoking / drinking / overeating
         | as coping mechanisms they might find healthy alternatives like
         | exercise / altruism / creativity. Look at seventh day
         | Adventists in Loma Linda (not a member myself), they live a
         | long time and are very happy. For many, the last 20 years are
         | only miserable because they didn't take care of themselves.
         | It's possible to be 80 and active / healthy/ happy.
        
           | siftrics wrote:
           | As a cancer survivor and former alcoholic, I am one example
           | of a person who has found healthy coping mechanisms.
           | 
           | Instead of coping with alcohol, I read math textbooks and do
           | problems.
           | 
           | This has improved my life dramatically. I feel good. I feel
           | proud. And despite optimizing for happiness as opposed to
           | wealth, this coping strategy has made me loads of money.
           | 
           | I should mention my cancer occurred in my childhood, so it's
           | not as though my drinking was a cause.
        
           | [deleted]
        
         | BeetleB wrote:
         | > It could be argued that smoking, alcoholism, and obesity are
         | all means of coping with a high stress lifestyle.
         | 
         | Hate to be that guy, but two of the 3 above are easily handled
         | by simply not starting at all. People who don't start do _not_
         | get the urge to go to these when under stress.
         | 
         | Addressing stress is a lot more difficult than simply not
         | starting. In the US, the rate of tobacco use continues to drop,
         | and it is an outcome of a fairly significant campaign. Put all
         | those resources into reducing stress and you simply won't move
         | the needle.
        
       | jjallen wrote:
       | I think it should be postponable. If everyone wasn't obese and
       | didn't smoke or drink guess what... we would still get cancer or
       | die of heart disease or dementia. At least this goes for the US
       | and much of Europe.
        
         | AdrianB1 wrote:
         | It is preferable to die of "old age" (including heart disease
         | or dementia) at 90 than from cancer at 35. Yes, eventually
         | everyone dies, but some early deaths are preventable, it seems
         | to be half of cancer deaths, some car crashes, suicides etc.
         | This means we can and should do something about it.
        
           | tester756 wrote:
           | >It is preferable to die of "old age" (including heart
           | disease or dementia) at 90 than from cancer at 35.
           | 
           | Dementia shouldn't be preferable, you'll make life of your
           | relatives painful
        
             | mod wrote:
             | My grandmother died at 99 with dementia. It didn't last too
             | long, thankfully--it came only in the last few months.
             | 
             | I'm so thankful even just for the last couple of years she
             | got to spend with us. She was my neighbor, so we got to
             | spend a lot of time together, and we had always been close.
             | 
             | There was in fact a bit of pain seeing her at the end, but
             | I don't remember her that way, and I wouldn't change any of
             | it.
             | 
             | It's definitely preferable to RISK dementia. It's not like
             | it's a guarantee at some certain age.
             | 
             | A lot of the joy in my life would have been diminished if
             | she hadn't lived so long.
        
             | telotortium wrote:
             | (Virtually) no-one dies of lifestyle-related cancers at 35.
             | I still wouldn't want to die of cancer or heart disease at
             | 60-80 (my grandmother was very unhealthy, had her first
             | heart attack before 65, and died at 72), but I think
             | dementia is a scarier prospect (my great grandmother died
             | at 96 but had dementia for at least a decade before that).
        
             | AdrianB1 wrote:
             | Living with one case in the extended family, we are still
             | glad she is alive and able to recognize most of us and have
             | a discussion, but probably this is a very subjective matter
             | and your experiences may be different.
        
           | colechristensen wrote:
           | Not always, if you've been close to someone who lived into
           | their 90s and were barely there for a decade due to mental
           | decline you wouldn't necessarily think it was the best way to
           | go. Rotting in a nursing home confused and suffering for a
           | couple of decades isn't luxury.
        
             | AdrianB1 wrote:
             | You are completely right. In the few cases of dementia I
             | know, people lived just a few weeks after they completely
             | lost memory and awareness, not long term.
        
               | lazyasciiart wrote:
               | Thats unusual, if I'm understanding your description
               | right. Severe dementia (requiring 24 hour
               | care/supervision) lasts a couple of years on average.
               | Even moderate dementia, the level at which people can
               | live in memory care units but have trouble communicating
               | and understanding their surroundings, can last ten years.
        
               | BeetleB wrote:
               | You were lucky. Some forms can last several years, and
               | those are not unusual.
        
               | nativecoinc wrote:
               | What the hell? A slow decline for years is not uncommon
               | at all. At first you know that you are going to forget
               | yourself and be completely helpless, and then you spend
               | years in that state.
        
         | usrusr wrote:
         | True. What prevents cancer death is wingsuit basejumping and
         | faster motorbikes. And war I guess, but that makes cancer death
         | look attractive (and when you're working too close to the radar
         | or DU ammunition is part of the equation, it can very well
         | _cause_ cancer death on top of all the  "prevention")
        
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