"NHS on its knees"

Investment Analysis Clubs Macro Economic Trends and Risks
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Welcome to the new America where basing opinion on data is too inconvenient. Not sure what you think my POV is. I favor single payer health provider systems but also believe some single-payer systems work better than others. In this specific example it appears that the Japanese system works better than the British one even with the same number of doctors per capita.

I think it is worth asking why that is even if one has to look at a graph or two.

My bias is that it is mostly because the average Japanese lifestyle is substantially healthier than that of the UK, particularly with respect to obesity. This means that on average, Japanese doctors have less to do per patient and so can more efficiently handle more patients.

Here is where I think we differ. You want to solve the British health care system by spending more money over a long period of time to expand the system so that it can adequately take care of the population. I instead want to motivate a healthier population so that the existing health care system is sufficient. I think my strategy will cost less money and be more effective. In fact, I think it is the only possible long-term solution.

This is because I think it is impossible for a nation that is simultaneously rapidly getting older AND becoming obese to have an effective and affordable health care system. It doesn’t matter what the system is, single payer or multi-payer, private or public. Given declining birth rates and longer life spans, if we don’t end the obesity epidemic soon all health systems will crash and burn.

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Err…no. i think you’re beating up on your Straw Man a bit too much here. I can’t think how you managed to infer I was attempting to solve the British health care system as opposed to pointing out that Steve’s time-line for underinvestment in the system was actually a bit shorter than in reality (did I mention that?) Also added something to the effect that the links you dumped initially…presumably to refute that idea?..bore little resemblance to anything historical or relevant.

Don’t get me wrong…it’s sort of interesting that the US had fewer physicians and hospital beds than Italy and other countries during the worst of the Covid epidemic but it doesn’t really help clarify or refute whether historical spending in the UK has been on point or no.

I agree with your Straw Man WRT the drain that obesity and other lifestyle diseases have on healthcare spending though…but then I guess I would say that not being fat etc.

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Here you go…here’s a nifty link dump that covers the time line before the ones you chose

Full disclosure I’m putting it here to bookmark it for myself as much as offering any particular insight. It’s an interesting read but even so doesn’t give much background to the birth and subsequent evolution of the service…or, come to that, whether spending has kept pace with demands appropriately.

The NHS’s formation was a monumental undertaking at the time, given that the UK was virtually bankrupt after 6 years of WWII hostilities accompanied, as it was, by other aspects of a fully comprehensive welfare state. One of the observations I’ve made over the years WRT spending…and raising my dad’s ire in the process…is that no one appeared to take into account how costs would rise with increasing expectations that accompanied improvements and advances that ongoing research brought along.

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This.

And, I would add nobody foresaw the industrialization of the health care process and the transition to the giant, Welchian-MBA managed systems that are now called healthcare.

:hiking_boot:
ralph

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Obesity per se is not the major health issue it’s commonly thought to be*. Now with the disclaimer that reading a few books doesn’t make me a doctor, I submit to you that many conventional beliefs MAY be wrong. Bad diet is major factor; some argue [saturated] fat not a major culprit, rather the worst damage is excessive refined sugar/corn syrup/simple carbs and trans fats/most vegetable oils (burnt by deep frying). Add lack of exercise and not enough sun (vitamin D) and you have a prescription for all manner of chronic illness.

*Did you know that those who are slightly overweight or even moderately obese actually have lower death rates than those with “normal” BMI? Death rate doesn’t exceed “normal” BMI until Obese II. Perversely, the underweight have greatest risk of death. The story for cholesterol is largely the same.

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Yes…or rather, I’m aware of claims to that “fact”. Something like was widely touted in the popular press a few years back following a review article in one of the journals. Pretty roundly debunked at the time at peer review primarily because it was a data trawl on mortality and BMI within a few weeks of death. It totally neglected cause of death and the fact that many of the diseases that kill people result in weight-loss…oftentimes dramatic weight-loss…immediately prior.

The story for cholesterol isn’t at all similar…except for the denialism aspect.

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One has to distinguish between primal cause and proximate cause.

Obesity is the proximate cause

Unhealthy diet and unhealthy lifestyles are the primal causes

The Captain

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Somewhere in the distribution curve of wt or obesity you have to find those skinny people who starve themselves.

It does not surprise me that people in the upper end of the normal range are healthier.

In the goid old days, farmers inherited decades of breeding experience with livestock. It comes as no surprise they preferred their children to marry people from “good families.”

That included their preference for big women with big bones. They could have many children and do more work.

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VeeEnn: I admit I haven’t checked the obesity data. I made that claim based upon Kendrick, Malcolm “Doctoring Data” (pp 118-121). Your skepticism is warranted; studies are twisted to taste to support desired claims. I confess I have not checked Kenricks’s sources but he clearly cites them. Kendrick in this book (and elsewhere, and other authors) examine the cholesterol/statin claims and pretty well demolish them. This one I do have a personal interest in, and I take a statin. And yes, I have checked some of “the literature.” Statins nearly always reduce cholesterol as promised. What’s much less widely discussed is the very slight reduction in circulatory issues and little to zero reduction in all-cause morbidity or mortality. This fact alone would seem to cast doubt on yet another popular medical “truth,” that saturated fat is a major cause of heart/circulatory disease. For those interested, google “Seven countries study” will open the door to the ancient fat debate.

I’m not sure what you mean by “denialism.” Do you mean a denier is someone who holds a view shown to be incorrect by established science? I’d agree with that definition. Or do you mean the term as it’s more commonly seen today, to dismiss a skeptic’s claim without considering his argument or evidence?

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Manifestly the former…with the caveat I’d say a view shown to be incorrect with available evidence. The Scientific Method allows for…nay, encourages… challenges to current hypotheses. The concept of “established science” is more a misunderstanding/misrepresentation by folk who probably don’t have the best take on what current data suggests. Obviously, this is more relevant to the biomedical sciences than the “hard” sciences. I think the recognition that the earth is round…or oblate spheroid-ish…could reliably called “established science”.

WRT folk who choose to ignore the preponderance of relevant and reproducible data in a given field…either through ignorance or what they call “outside the box” thinking…well I guess they might choose the title skeptic knowing it smacks a bit more of thoughtful analysis to a lay readership.

You maybe should read the actual studies that folk such as Malcolm Kendrick cite. A good many of these “mythbuster” type authors are only busting myths that they’ve created in order to appeal to a lay audience. It seems like you were misled by one statement…what about the rest?

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Further to my comment above, always read the primary document/original study if you can (assuming it’s not behind a paywall or…equally important…you have a fundamental understanding of how to read a scientific paper and the subject matter.itself) This applies whether you’re reading a gussied up press relase in the popular press or a mythbusting book.

This was brought home to me very clearly sometime in the early aughts (the need to understand the subject matter, that is) I’m a dentist by primary training (so actually do know a thing or 6.5 about nutrition and a fairly extensive acquaintance with “the literature”…historic as well as up to date stuff) Anyway, one particular Tuesday…the day that NYT’s Science supplement comes out…I was sitting with a bunch of colleagues at lunch and one piped up “How is it these reporters always get things wrong about dentistry?” after reading some article on the topic. I replied along the lines that maybe they get it wrong about other things too…but we just don’t know because we don’t know enough. We all thought about that for a bit and then decided that no…they just don’t bother with dentistry. Well, of course, over the next few weeks a number of topics came up that one or other of us did know enough about to see multiple examples were the science writer had got it wrong…volcanology, birding and exercise science (my other career)

See, sometimes your mythbuster doesn’t know enough to know they’re wrong…or, maybe even worse, do know enough but are taking a bet that their readership doesn’t.

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As a 40 year practitioner in the dark arts of journalism (everything from DJ to newsreader to news writer to magazine editor to newspaper columnist and eventually management over most of those domains in one way or another)… I will say this:

“Journalists” are generally “above average.” I say that because most of them can spell, use proper grammar (mostly), and in some manner communicate. That does not mean they are necessarily smart, although some are. I have known some who are not.

Now take the life of the average: one day interviewing people outside of WalMart to find what they think about, oh, inflation or chicken overcrowding, and the next day covering an airplane crash. Understand that you are not an expert in inflation, chicken overcrowding, or airline safety, but it is your job to try to bring information (hopefully facts, but not always) to other people who are going about their everyday humdrum lives, being plumbers, call center operators, or perhaps dentists :wink:

You are going to get things wrong. And in fact that will happen a reasonable percent of the time simply because you understood something wrong, don’t have the formal basis on which to judge competing claims, or you’re just trying to word salad a 2 minute piece for the six o’clock news because that’s what you were assigned to do that day by an editor who doesn’t care that you’re divorcing your husband.

At the larger operations you might get to specialize, i.e. “science writer” or “real estate writer” or whatever, but that does not confer magical powers on you either; hopefully it ups your qualifications to interpret many subjects in a narrower field, but not to be infallible.

Speaking of infallible, we have Elon Musk, Mark Zuckerberg, /insert any political leader here/, Sam Bankman Fried just this week in the area of “expert” who are apparently not, and history is replete with others who rose and fell just as hard, or were frauds, or whatever - and somehow we expect journalists to ferret this out and be right about it. I am more hopeful that they got the general gist of it in comprehensible fashion than they get every tiny detail right (simply because that is, as a practical matter, impossible.

Truth is I learn a lot from reading credible media, but I learn a lot on these boards reading, well, credible people. I also find ridiculous nonsense in the media (radio talk shows! Brexiteers! Sports!) just as I do here. Everybody gets to make their own critical decisions, journalists are merely the carriers of information to allow people to do it, and no, they don’t always get it right. I hope they’re about as good as their jobs as doctors, dentists, plumbers, but there are are fair number of those who are mildly or grossly incompetent, and I would submit that numbers are likely similar.

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Fat chance of that happening

Mike

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I hope they’re about as good as their jobs as doctors, dentists, plumbers, but there are are fair number of those who are mildly or grossly incompetent, and I would submit that numbers are likely similar.

Well, when it comes to particularly health and science writing, journalists can be excellent at their job…but they’re largely acting as little more than stenographers for PR departments at research institutions. Not many people know or accept this…even when given a heads-up.

See, if I were looking to get insight on, say, a latest film that was being released and looked to the NYT’s movie critic for a review (I’m not a film buff, BTW, so this is hypothetical) I would expect that critic to have seen the film in its entirety. I wouldn’t expect the review to be based solely on watching a two minute trailer. That’s how thinking goes, right. Similarly with cars…the auto correspondent should at least have driven around the block a couple of times.

This isn’t the case with health and science reporting. Quite the reverse. Science By Press Release is a longstanding problem (I was late-to-the-party way back in about 2003) and, in all fairness, the journalists don’t bear full responsibility. In the push for recognition and grant funding, researchers themselves are almost equally at fault and don’t seem to be at all circumspect when it comes to overselling their work…which they all surely must be aware is going to be presented to the public in the form of banner headlines announcing the latest new discovery that upsets “established science”. Oftentimes, a publication based on preliminary data that never gets reproduced or, worse yet…gets retracted.

P.S…here’s but one article on the topic that former regulars on the old H&N board have become very familiar with over the years…

It’s easy to dismiss this sort of thing if you don’t know or have confidence in one particular news outlet but, at the very least, it does a disservice to folk who are interested in a given topic and can in some cases become a big publc health problem (think Andrew Wakefield, Peter Duesberg etc)

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I don’t know how to give more than one rec for this

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Mike

Mike

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That may very well be, and I hope it is because I certainly don’t want fat people to die. But for the underlying topic of this thread—the quality of health care and its cost—your factoid supports my position. There is a wealth of evidence demonstrating being overweight significantly increases the likelihood of a number of chronic diseases, most notably diabetes and high blood pressure. The math now becomes obvious:

  1. Fat people are increasing relative to nonFat people.
  2. Fat people have a higher frequency of chronic diseases.
  3. Chronic diseases add significantly to health care costs.
  4. Fat people live as long as nonFat people.

Result: The demand for health care increases. Health costs rise or the quality of health care declines.

Sure, but I submit to you that most conventional beliefs are correct, and that is because beliefs are vetted by natural selection. Wrong beliefs, like all mushrooms are safe to eat, tend to get weeded out pretty quickly. Do a Google search on “obesity and health care costs” and see if you can find a study that shows no effect. It is a pretty well-supported conventional belief.

Preventing disease is almost alway better and cheaper for everyone concerned than treating disease (except of course for pharmaceutical companies). The best way to improve health care and reduce costs is to increase the overall health of the general population. The best way to do that is through economics, sticks and carrots. We already hold people who smoke and drink at least partly accountable through high tobacco and alcohol taxes. If you get a lot of traffic tickets, your car insurance goes up.

The precedence is there to hold those who choose to become obese more accountable for their role in increasing health care costs.

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Please pardon the late reply; I don’t check in often. I agree fully that ideally a person will check the primary sources. Continuing Kendrick as an example: I HAVE, in fact checked a few of his citations. In particular, the study (JUPITER) that was of a statin I was taking (rosuvastatin.) Guess what? The claims he makes are completely supported. This doesn’t mean, of course that having been validated on one claim, that all other claims should be accepted unchallenged. That goes for anything, or should. For the record, I’ve checked additional studies, meta-analyses, for statins, as well as for baby aspirin and hypertension medications and guess what? Even using the primary literature, these public health interventions really don’t do much (my opinion, of course). This isn’t some crackpot stuff I read on social media either – I did read it in a “dissident” book or site, but I did some background research and it turns out that the Emperor isn’t wearing a wonderful suit of clothes. He may not be stark naked, but metaphorically, he’s a hairy pot-bellied middle-aged man wearing a thong. Not pretty!

The broader problem is the demonstrable lies that are feed a gullible public by the media, the government, medicine, and darned near everybody. I’ll let you find your own examples but it isn’t hard. This is hardly a new problem, and it extends even to academia and medical journals and research.

Witness the continuing gaslighting and narrative shifting regarding the Covid-19 “vaccines”. On this, and other hot topics, the authorities would censor so-called “misinformation.” Musk’s Twitter disclosures show with what great effort the government did (and presumably, will in the future) continue to try to stymie discussion that doesn’t fit the desired narrative. This doesn’t mean that all dissent is worthy. Surely there will always be flat-earthers and such crackpots. But to suppress all dissent? That should tell us that something is very wrong.

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I’m in general agreement. What may be missing in your argument: Isn’t it possible that obesity is a symptom, not a cause, of other health issues? Kendrick in one of his books uses the example of “yellow fingers”: We know know that smoking “causes” (or more honestly “greatly increases risk of”) lung cancer. Many smokers have yellow fingers. Yet it would be logically incorrect to say that yellow fingers cause lung cancer. This example is of course ludicrous. It’s meant to be. But the lesson is that people, even professionals, are not immune to flawed thinking.

Relevant to obesity, my reading suggests it’s most likely caused by poor diet. Here we run into problems! Many authors make a case that even official diet advice may be wrong: e.g. too much sugar and simple carbs. There may be science supporting one view or another, but there’s another angle. At large scale there is almost always a political angle. Turns out that sugar, corn, etc. are big business and have enormous lobbying power in governments. This has been true for a very long time. More recently we have the “ecological” lobby that wants to reduce animal farming and such. Desire to get more money, protect existing markets and/or obtain more political power is almost always at root of such movements.

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There’s not even a doubt about this one anymore. It’s just being avoided for various social reasons (political, organizational, entrenchment, etc). The reason there is no doubt is:

  1. It is mostly a USA phenomenon.
  2. It almost perfectly correlates in time with the advent, and gradual growing acceptance, of the food pyramid.
  3. It is so widespread that it cannot be caused by anything “local”, has to be caused by some widespread phenomenon.
  4. Can’t be a virus or bacteria, because those don’t respect human created artificial borders.

Therefore, I firmly believe as fact that the primary cause of the obesity epidemic is the demonization of fat, and the minimization of proteins, which led to the heavy over-reliance on sugars, and other simple carbohydrates, to make food taste good so people will eat it. Furthermore, with time, an over-reliance on carbohydrates in ones diet, especially simple carbohydrates, very often leads to an overall overconsumption (because proteins and fats satisfy hunger more), which leads to obesity.

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In some people, like myself and many others I have talked with, simple carbs are even worse than calories in/calories out. They trigger an opioid like addiction, triggering an almost impossible to control urge to stuff carbs in your face, which honestly has nothing to do with hunger. This is a physical urge, not emotional, and happily one I have avoided over the twenty-five or so years I have been low carbing. Was truly amazing to find an eating style that worked for me without triggering cravings or feelings of deprivation, just satiety and control. At the same time it greatly reduced DH’s insulin needs, increasing his control over blood sugars. His body does not manufacture insulin, (type 1,) but is not insulin resistant, (type 2,) with weight never having been an issue.

Our bodies are complicated and not all the same.

IP

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