Early Retirement Extreme Forums

https://www.amazon.com/dp/0807022004/ gives a more nuanced framework than the simple NNH and NNT numbers discussed here: https://earlyretirementextreme.com/my-h ... -care.html

For example, NNH and NNT is better displayed as a graph between mild and severe cases than thinking of the entire range at once. Indeed, grouping mild and severe cases together in one big bucket can really skew the numbers and the conclusions/recommended strategies that are derived from them.

Cheers, that's what I learned during medical statistics! Proactive testing is a bad idea. It's easy to see that if you test yourself for 10,000 diseases you'll be diagnosed with at least a hundred and the medicine alone will be more than you can stomach.

One example I remember was breast cancer. If a country implements population wide screening it finds more cases. More people are declared healed and the screening is seen as a success. However, the death rate shows more women die in the group that is being tested. Many have been treated for a disease that was never going to bother them, and some of them die. Statistically a breast cancer test has a lower NNT than NNH. The professor said that in a rational world these tests would be discouraged.

I only read the little summary of the book. I agree in part with what seems to be the premise. For most of us when you go in for routine annual blood work, there's a pill matched to every test. And I think it's fair to say that some of the most widely prescribed drugs, like statins and hypertension meds, are over-prescribed. Where there's no pill, tests are not done routinely. The mind boggling one that seems to be atop that list is fasting insulin. It's of course the flip side to fasting glucose. The insulin test can point to the beginning of chronic diseases (type 2 diabetes, CVD, dementia, many cancers, etc.) years or even decades before they display obvious symptoms that would trigger a diagnosis. But there's no pill or injection to lower insulin the way there is for glucose, so people go along ignorant and happy (often fat too) until, "Hey look, you have Type 2 diabetes [or other branch on the chronic disease tree], here's some pills, and when those don't work any more we have injections!"

I think the biggest issue is that so much of what ails so many people is best treated with self-discipline in their lifestyle. Unfortunately one has to go out of their way to find trustworthy sources for information. I get about 120-140 tests per year done now, and my only prescription is for a "rescue inhaler" for seasonal environmental allergies. Ironically, since I began advocating for my own health, I haven't needed it, but I still keep it current because, well, asthma sucks. So my personal 'solution' is I'll take about any test without having a symptom that would call for it under standards of care, but I won't blindly follow up on any findings just because there happens to be a pill for that. But it's a lot of work--equivalent to a part time job.

Also unfortunately, I don't think any form of central planning will lead to a good solution, especially if the thought is to curb or eliminate early detection. It's not really the screening that's the problem most of the time, it's what happens after the screening.

I have not read the book, so I do not know if it is mentioned, but one of the things that they never seem to take into consideration is the psychological effects of false positives and incorrect blood test. Never have I experienced such a degree of simultaneous relief and fury as I did with this. Whoops --- so sorry about that--- the first test was incorrect--- lucky for you! It happens frequently and makes me long for the day when AI will keep the results from you until there is some medical benefit to you knowing about the existence of an actual condition.

I'm interested in reading the book. But since discussion already deviated to personnal opinions about the topic, I will also give my two cents.
My impression is that doctor are like any person in charge, they fear very much to take an other decision than what other person with similar responsability is doing (like politicans during covid, or pension fund manager).
At a societal level, it is solved by not judging people following the herd more mildly than outsider. I dont know if this will ever happen. Maybe ai will be able to discharge people of their responsability and be better than what herd behaviour we have now?
At a personal level for this particular realm, it is solved by telling your doctor very clearly of the adverse effect experienced since taking the extrapill, compared to the absence of effect from the slightly out of norm metric experienced until now.
Also, I know several people that refused cancer treatment until to late and died, due to lack of trust in medicine, and people that went full nuclear on their early diagnosed cancer and healed from it.
So i don't know what effect this kind of book will have on the general public.

The problem with many pills is that the potential problem that they're treating is in the future. For example, these days I monitor people's blood thinner use and advise on their dosage (medication like warfarin needs dose adjustments regularly). Many of them take those blood thinners because their heart rhythm is irregular - specifically they have atrial fibrillation (AF). Many of them don't have any symptoms from the AF (although yes, some can experience symptoms from the irregular heart beat and cardiologists have treatments and medications for that). But a blood clot can develop in the heart when the blood flow is irregular like with AF, and then parts of this blood clot can break off and travel to the brain and cause a stroke. So we advice that people with chronic AF take blood thinners to develop those clots from forming and the strokes from occurring. The chance of a stroke for people with chronic AF is about 1-2% per year when not taking blood thinner medication. But a stroke is a bad thing, and people often have AF for decades.
But this means that you give a blood thinner - with potential side effects and risks - to people who have never experienced any symptoms and who will never know whether for them personally it will prevent a major medical issue.
It's odd working with chances. (ha). I think most people (including me) are pretty bad at truly understanding what a chance means.

IlliniDave wrote:But it's a lot of work--equivalent to a part time job.

Is it worth the time? I suppose for many/most INTJ's it would be since "Health" is rated their #1 value (#2 Home and Family, #3 Achievement, #4 Autonomy, #5 Financial Security) I question how much time/effort/attention an XNTP like me, whose value structure is more likely to be (#1 Autonomy, #2 Home and Family, #3 Achievement, #4 Health, #5 Financial Security.), would be willing to spend?

I recently starting reading Sarah Wilson, an Australian celebrity and climate activist, who wrote a well-received book on eliminating sugar from her diet a number of years ago. She has recently done a bit of an 180, after spending the last several years engaged in planetary collapse research:

Going from diet to mental health to climate and collapse “makes sense” to Wilson, because she feels she has always delved into spaces that hadn’t been properly investigated, which at the time included the sugar industry. Now, though, she regards her stint as an accidental wellness hero with a shrug.

“I did it and I wanted to get out, so that’s why I sold it and gave all the money away: I didn’t want to keep doing it,” she says. “That’s not my thing. I don’t like making money.”

And she’s not fond of where wellness culture has gone since her departure.

“It’s narcissism,” she says with the roll of an eye. “Worrying about your gut biome when the world’s burning is too indulgent … I think it’s particularly rampant in Australia, where the opulence is such that that’s what people now spend their time doing.”

I don't necessarily agree with her, because I think spending attention on either end of the complexity spectrum, your own microbiome to planetary collapse, can either be entirely appropriate or more towards a distraction, especially if you consider the many middle of the spectrum complexities such as current political situation in the U.S. or the dynamical interdependent systems which compose every "Home and Family" which is #1 valued by every MBTI type besides INTJ and INTP My point here, which is entirely off-topic (apologies), is that once one has gained a perspective inclusive of systems complexity, it becomes entirely possible to devote every available hour made available by one's retirement or semi-retirement to any one of these realms of value.

7Wannabe5 wrote: ↑

Tue May 27, 2025 10:17 am

Is it worth the time? I suppose for many/most INTJ's it would be since "Health" is rated their #1 value (#2 Home and Family, #3 Achievement, #4 Autonomy, #5 Financial Security) I question how much time/effort/attention an XNTP like me, whose value structure is more likely to be (#1 Autonomy, #2 Home and Family, #3 Achievement, #4 Health, #5 Financial Security.), would be willing to spend?

Keep in mind that that survey may be more reflective of US culture in the mid 90s (where the numbers were sampled) than any causative relation between temperament and priority of values. IOW, it's sampled on a huge background of what was then predominantly SD:blue and SD:orange... in the US ... in the 1990s---likely reflecting the cultural composition during the survey-takers' formative years of a few decades earlier still. Subtracting that average from a specific temperament will say more about what is specific to the temperament ("health") as opposed to what is just in waters of culture ("family", "financial security").

I would bet the sample population was expanded to other parts of the world AND the choices were expanded to include a somewhat fuller value spectrum (e.g. add in "change", "duty", "impact", "harmony", "happiness", "knowledge", "loyalty", "respect", "tradition",...) you'd see the value preferences from this 30yo survey change.

As for the OP book: Yes, it discusses all the points made above in great detail including asymmetric career risk for providers, the risk of anxiety and the diseases that could follow from that, as well as several more points. In my opinion, the book is worth reading even for those who aren't really interested in their health. However, for those who are, it's especially worth reading. It's also written to the intelligent layman (with numbers and graphs) rather than the typical obnoxious way with narrative examples of patients and travels to visit random experts.

jacob wrote:Keep in mind that that survey may be more reflective of US culture in the mid 90s (where the numbers were sampled) than any causative relation between temperament and priority of values.

Yes, I had the same thought. Type and SD Level are both likely to contribute to stated values. It also may be the case that within a given context, some types are more likely to be moving ahead of the SD curve. There's a certain predictability to what we become interested in when we do. For example, not yet affluent Moderns will be more interested in Wealth and already affluent Moderns will become more interested in Health, with a transition from Physical Health to Mental Health and Environmental Health most likely at juncture with Level Green/Post-Modern. Trusting in experts and/or test results would also likely be maximized mid-Modern, with reasons one might be more likely not to trust being reflective of other levels, but also likely reflective of Type. For example, if I communicated that I don't trust Pharmaceutical Companies, "because will do anything to turn a profit" and my solution was to "hack my own treatment", then that would be reflective of Level Green disdain for money-grubbing at Level Orange combined with XNTP type highly valuing Autonomy. OTOH, a belief that "clean living" can be substituted for any/all forms of medical treatment may be reflective of regression to Purity Law/Ethic at Level Blue and/or a high degree of Conscientiousness trait associated with Type, etc. etc.

7Wannabe5 wrote: ↑

Tue May 27, 2025 10:17 am

I recently starting reading Sarah Wilson, an Australian celebrity and climate activist, who wrote a well-received book on eliminating sugar from her diet a number of years ago.

Which book is that? As far as I know sugar is quite natural. Oranges contain a lot of it, as I learned when I tried to diet by drinking orange juice in the morning

Now if you put a pile of sugar next to an ant hill, the ants become fat and unhealthy. That is not unlike what supermarkets have done with humans. It seems to me the problem is lack of moderation, rather than sugar itself.

@delay:

I'm not reading her older book on quitting sugar. I am reading her books on resource conservation, global collapse, and reconnecting with nature. The first is entitled "This Wild and Precious Life: The Path Back to Connection in a Fractured World' and the newest is "This is Precious" which is only available in substack serialization.

https://sarahwilson.substack.com/p/table-of-contents

I found her by way of Planet: Critical podcast with Rachel Donald. It seems like collapse/resource depletion may have finally found some effective popularizers. At least in the sense that I believe they would play well with those on the brink of being convinced in my social circle.



END OFF-TOPIC DISTRACTION

7Wannabe5 wrote: ↑

Tue May 27, 2025 10:17 am

Is it worth the time? I suppose for many/most INTJ's it would be since "Health" is rated their #1 value (#2 Home and Family, #3 Achievement, #4 Autonomy, #5 Financial Security) I question how much time/effort/attention an XNTP like me, whose value structure is more likely to be (#1 Autonomy, #2 Home and Family, #3 Achievement, #4 Health, #5 Financial Security.), would be willing to spend?

I recently starting reading Sarah Wilson, an Australian celebrity and climate activist, who wrote a well-received book on eliminating sugar from her diet a number of years ago. She has recently done a bit of an 180, after spending the last several years engaged in planetary collapse research:



I don't necessarily agree with her, because I think spending attention on either end of the complexity spectrum, your own microbiome to planetary collapse, can either be entirely appropriate or more towards a distraction, especially if you consider the many middle of the spectrum complexities such as current political situation in the U.S. or the dynamical interdependent systems which compose every "Home and Family" which is #1 valued by every MBTI type besides INTJ and INTP My point here, which is entirely off-topic (apologies), is that once one has gained a perspective inclusive of systems complexity, it becomes entirely possible to devote every available hour made available by one's retirement or semi-retirement to any one of these realms of value.

Absolutely it's worth it. I want to see my grandson, who was valedictorian on his kindergarten class, graduate from college. No chance I'm going to get caught up in hysteria over doomsday prophesies and trash the body I've been given as some form of human sacrifice. Psychoanalyze me any way you want, but that's how I'm going to roll.

IlliniDave wrote: ↑

Tue May 27, 2025 4:48 pm

valedictorian on his kindergarten class

TIL. Over here, we don't even have valedictorians in College.

zbigi wrote: ↑

Wed May 28, 2025 2:27 am

TIL. Over here, we don't even have valedictorians in College.

I thought it was hilarious they even named one for a kindergarten class--first I'd ever heard of that. His mother was surprised too. His teacher mentioned it to her a couple weeks prior, but she thought it just the teacher saying he'd done well. But to her surprise he got an award for it at a little parents' open house day that sort of served as a graduation ceremony they had near the end of the year.

IlliniDave wrote: ↑

Tue May 27, 2025 4:48 pm

I want to see my grandson, who was valedictorian on his kindergarten class

Good for him. I couldn't focus on that scribble between the lines shit in a room full of girls, teacher included.

IlliniDave wrote:No chance I'm going to get caught up in hysteria over doomsday prophesies and trash the body I've been given as some form of human sacrifice.

Due to suffering from Crohn's Disease, I've gained a greater awareness of the fact that the human body is a complicated torus. So, the micro-organisms in our gut aren't really living in us, but on us. IOW, they actually are a part of the greater environment that might spread out to the unwanted mold in your Home/Zone 0 basement, the desired herb spiral flourishing in the Zone 1 microbiome created by a south-facing masonry wall, the economically desired/ ecologically undesired Zone 3 human-managed effluent from the Peloton factory on more distant river, etc. etc.

Arguments have been made that the plight of the planet has been "over-diagnosed." For example, some have suggested that the planetary overshoot number used to calculate 1 Ecological Jacob is not entirely reliable. The more we look for problems, the more we are likely to find. Just as with running metric-based tests on the complexity of any given human body. I tend towards believing that the overall evidence indicates that the situation is towards critical, but MMV.

Will reading an article about declining insect populations in the Amazon at bedtime be reflected in one's sleep score the next day? Dunno, but easy enough to test. Will one's sleep score be reflected in declining insect populations in the Amazon? Dunno, although that does seem to be what Sarah Wilson is implying with her comment above. IMO, if one buys the notion that approximately 1 Jacob/year spending is roughly equivalent to "do no harm" in terms of trashing the greater environment, I would go so far as to suggest that it might be "best" to spend the entire amount on one's personal health and associated micro-eco-system, but I am more likely to err on the side of musical theater tickets and hard candy. IOW, in term's of my primary focus of navel-gazing/psycho-analysis, it's rather remarkable how resistant I am to adopting the value's system of the median Type 5, no matter my claim to "wannabe."

There's a concept in economics called 'existence value' that one can derive utility from knowing say that the Dwarf Lemur* population is no longer extinct but now rediscovered in Madagascar.

*No relation to our Lemur.

@chenda:

Yes, but there is also an objective value to the biocomplexity signaled by species diversity. We are already so close to living on a planet where every living thing is dependent on Field Corn 2.

7Wannabe5 wrote: ↑

Wed May 28, 2025 6:34 am

...

Lots of interesting stuff there. The gut and oral microbiomes do live outside us as we are indeed tubes (or at least they should stay outside us--it's very bad news when they don't). Yet increasingly those hitchhikers are being identified as very deeply integrated into nearly every physiological function imaginable, including being a contributor to healthy functioning thereof. It's a bit of a quibble, but every organ in the body has it's own microbiome that is inside us, if you count "inside" as existing somewhere between the skin and gut lining. I'm not sure I follow where the rest of that paragraph goes, but I would tend to agree it's a case of false duality to see distinct demarcation between ourselves and the environment.

Much like the plight of the typical western human that I'd argue is simultaneously overdiagnosed and underdiagnosed as a function of what Medicine 2.0 can effectively (or in some cases profitably) address, I think the plight of the planet is simultaneously over- and underdiagnosed, though I'm less sure what that's a function of. By plight of the planet I mean more the current ecosystem writ large than the fate of the rock orbiting the sun. My amateur belief is that the biggest clear-and-present threat to human thriving is the widescale disruption or destruction of microbial ecosystems, through chemical-heavy monocrop agriculture and the various assaults we subject our own microbiomes to. At least those are the ones that seem to affect us most directly. That's not to say things like polluting water are insignificant. A good chunk of the "part-time job" for me is reasearching and procuring as many products of chemical-free regenerative agriculture as I can get my hands on, hopefully increasing their future financial viability and demonstrating the existence of a market for it. And that also looks out for the tiny portion of the ecology that I take around on my walks. Like it or not, I'm part of nature too, and the ecology.

I probably spend upwards of 1J per year simply directing food dollars towards the conscientious agricultural producers versus what I tend to consider either the ignorant or unethical ones. By the sustainability calculus that defines a jacob to start with, I'm a very bad actor. But I do think there should be offsets for directing resources in ways that support a movement towards more benign ecological stewardship outside the framework of an energy problem.

I get that there's more to life than a nerdy pursuit of optimizing physiology. And that most people don't have the time/energy equivalent for addition of part time job to chaperone the healthcare system and become the chief medical officer of Themselves Inc. That I can do that is part of the optionality that fatFIRE brings. Going back to the OP, it's really an unfortunate situation the typical person who understandably trusts the establishment when it comes to their healthcare. In some realms they get very good care, but in others they're apt to be misguided. But that's not a reason to stop living and enjoy the theater.