Steve, one has to contend with the conflict between encouragement and dictate.
I favor the former but sternly oppose the latter which limits free choice, civil liberties, and human rights. A good example of a compromise is allowing smoking outdoors but not indoors, works a lot better than Prohibition did!
As for public schools, being public, I guess the owners, the state, can decide on how to run them. Another good reason to limit government.
The Captain
You might remember when airlines had smoking and non smoking sections. On a flight, after I quit smoking, I was assigned a seat in the rearmost non smoking row. When smokers lit up behind me it got so bad I had to ask a flight attendant to find me another seat, She did.
The Captain
Hereâs a suggestionâŚcheck out this article (and a few of the others on the site) and do what this cardiologist suggested to a statin hesitant patient.
Anthony Pearson is a low carb friendly cardiologist Iâve followed for years and I think itâs from a mention on his site that I began subscribing to Peter Attiaâs podcast. Anyways, Iâve done a lot of listening to and studying on cardiovascular physiology and more recently pathology and come to realise itâs a complicated topicâŚcomplicated even more for me by the fact that Iâve discovered that I have ASCVD.
Back storyâŚnever been overweight. Not one single day. Currently toggling around 130lbs at 5â6"âŚthe heaviest Iâve been since pregnancy when I topped the scales at a whopping 140lbs!!! Non smoker/never smoker. First time I heard âborderline high cholesterolâ as it pertained to me was back in the mid aughts after I sold my practice and altered my life insurance. My PCP did a lipid panel plus circulating insulin and the concensus seemed to be with my excellent lifestyle, blood work and insulin sensitivity, that âmildly elevated LDLâ and HDL in the high 80s that âborderline high cholesterolâ were only actuarial figures and thereâs no reason to treat numbers. My risk of future events was deemed low. Same ever since.
Always had that âmildly elevatedâ LDL as an itch I could never scratch but like a good many around me fell for the bamboozle that ASCVD is a lifestyle induced thingâŚlittle realising the bamboozle is just that. I started reading much more âŚespecially on the atherogenicity of Apo-B lipoprotein which hadnât been measured in me at the time ⌠and plenty more on the significance of CAC scores (any non zero score indicates evidence of disease) I decided to ask these extra tests just to reassure myself that advice Iâd received thus far was correct.
Turned out it wasnât. By a long way.
In your shoes, if you have doubts about your physicianâs advice but still intend to return, do what I (and Anthony Pearsonâs patient did) and get a CAC scanâŚbuy one for your partner as a Christmas gift too. One of you might be able to say âTold you so!â
P.S. I seriously wish Iâd had a physician with a thing about statinsâŚstarting from an age when statins werenât even available.
P.P.S. Another reason Iâm envious of the lipid management advice youâve been given is that apparently ASCVD is still perceived to be a more a manâs disease. Although, no one has ever added that as a mitigating factor, and for most of the time of what Iâll call The Big Bamboozle Iâve been post-menopausal I canât get the idea out of my head (cardiologist agrees that might be a factorâŚincluding an explanation as to why my new female PCP was a)so surprised at my level of disease (having ZERO symptoms doesnât count) a b) so wimpy in her initial response. In that contextâŚ
https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.116.307547
In theory, I agree with you, but in practice, the social engineering power of advertising is well documented, so there is a large thumb on the âindependence of actionâ scale. I could see allowing freedom of action if all advertising of a dangerous product is forbidden (as they have done with TV ads for cigarettes).
As you pointed out, there used to be smoking sections in airplanes, theatres, etc. and it was normal to see people taking elevators and walking through stores while smoking. While some might rage against the ânannyâ government, it seems to have attenuated the number of smokers.
I remember when Mayor Mike Bloomberg raised the taxes on cigarettes in NYC and the price of a pack went from about $4 to about $14. I was a smoker back then and it did change the number I smoked per day.
Jeff
Jeff, perfect is the enemy of good. Smoking was restricted (good enough) and it worked. Alcohol was banned (perfect) and it failed miserably.
The Captain
Yes, a similar thing happened to me, but it was outdoors: I was at an al fresco restaurant and two tables over (about 20 ft away), a couple people were smoking. The cloud wafted over to my table and it was as if they were sitting right beside me. Like you, I asked to be seated at another table more distant and, fortunately, there was one available.
Pete
Removing the pop vending machines from school premises is an excellent idea. Itâs so NON-INTRUSIVE that even the most diehard libertarians should support it. This would NOT turn the teachers into the High Fructose Corn Syrup Police or the Aspartame Police. Students who really, really want to drink pop at school would still have the right to bring it in from outside. However, this would result in less pop consumption, because drinking it would require bringing it in the first place. Some students would be too forgetful, and others would prefer to save bag space/weight for something else.
One underappreciated event was publication of studies linking lung cancer and cigarette smoking in the 1950s. The Doll and Hill British Doctors Study is what springs to my mind because it had an impact on my younger years (not least it exposed me early onâŚalong with the second hand smoke ⌠to silly justifications folk use to ignore good advice)
Not that it led to an immediate precipitate drop and plenty of folk continued (obviously)but it certainly influenced the thinking that smokers and random smoking were less acceptable socially. By my mid to late teens (late 1960s) very few of my classmates smoked whereas I suspect the non smokers wouldâve been in the minority a decade earlier.
In the late 90s, I attended a Wendyâs shareholder meeting in Columbus.
During the Q&A session, one woman stood up and asked for smoking to be banned in the restaurants, as she didnât like taking her kids in when the place was full of smoke. (Wendyâs stores are fairly small, so impossible to effectively isolate the smoking section.) The CEO at the time, Gordon Teter, thundered that he wasnât going to offend customers by not letting them smoke.
So, one personâs reasonable compromise is anotherâs unpardonable infringement of their âfreeedomâ.
Teter died maybe a year later, at 56. His predecessor, Jim Near, died of a massive heart attack at 58. When I was at the meeting, Dave Thomas was recovering from a quadruple bypass. Said he felt fine, but walked across the stage like he was 112 years old.
Steve
Which reasonable compromise?
During the Q&A session, one woman stood up and asked for smoking to be banned in the restaurants, as she didnât like taking her kids in when the place was full of smoke.
Requesting a ban is not a âreasonable compromise.â
The Captain
You proposed smoking outside, not smoking inside. She proposed not smoking inside. Teter was for smoking absolutism.
Steve
Thanks for posting an article that lead to a very interesting thread.
So to add more opacity to any confusion on lipids (mine at least)âŚonce again living up to my quote on my old TMF profile (âThe more I learn, the less I seem to knowâ)âŚ
This morningâs podcast accompanying my Z2/MAF/low lactate/ASCVD remediation treadmill work (running slow to run fasterâŚArthur Lydiard would be proud) was an interview with a young Canadian researcher whose field is all things Lp(a).
This apparently is a biomarker for an inheritable genetic polymorphism in the familial hypocholesteroleamia group. This is the really problematic part of my personal lipid profile and is one of the two that had never been measured in all the time Iâve been reassured that my slightly elevated LDL was countered by my high HDL and RLQ. Who knew??
Apologies if I havenât circumvented the paywallâŚbut, at least, not as irritating as WSJ and NYT etc.