Terminal cancer as cash cow

The real solution though are food purity laws. There are foods in convenience stores and some restaurants that cost the rest of society in the wake of their destruction. In other words the slimy operators do not pick up the cost which is a massive negative externality.

That is until you do the math and discover the healthier people live longer and cost society even more than the person who dies young.

<A few days ago, I wandered through a nearby mall and commented to my wife that every single person we passed was somewhere between fat and morbidly obese. >

https://www.cdc.gov/obesity/data/adult.html

From 1999–2000 through 2017–March 2020, US obesity prevalence increased from 30.5% to 41.9%. During the same time, the prevalence of severe obesity increased from 4.7% to 9.2%.

Your mall sample was self-selected. The people who were languidly strolling through the mall weren’t the same sample set as the ones who were at the gym or walking/ running outside. A few of the regulars at the YMCA gym are obese, but much less than the general population.

It’s shocking that 40% of adults are obese and 10% are morbidly obese – a condition that was so unusual in earlier decades that the circus had a “fat lady” in their freak sideshow that wasn’t much different than we frequently see everywhere today.

https://www.loc.gov/resource/highsm.40138/

Wendy

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Fat shaming does not work at all well for most people. It is more of the knee jerk fantasy that everything comes down to individual choice when the evidence is overwhelming that most individuals, beginning as babies and continuing through life, are guided and directed primarily by the culture and situation around them.

Obesity starts in the womb.

Forget fat shaming and focus on overcoming our idiot corrupt subsidization of dangerous foods over FOOD (a very crude summary of complex stuff that needs to be done).

An almost always useful step for an individual or family seeking to overcome obesity is to hang out with people who are not obese as much as possible, in those places and doing those things that healthy people do. Going to fat farms and lose fat meetings might very well reinforce obesity.

Tax sugar, trans-fats, and etc., as if they were tobacco and for the same reason – for the good of society but more simply to recover the social costs that such bad stuff does to people’s health that we all pay for.

david fb

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Fat shaming does not work at all well for most people.

Obesity starts in the womb.

The womb is a good place to start, the mother’s words in the open environment are next.

For each child decades ago that got fat there were the other children that were told for centuries, “if you eat too much you will get fat”. Many of them, a very high percentage, respected that in full.

Today how many people at the dinner table tell a young child if you eat too much you will get fat? Of course that fat shaming worked well for centuries.

The problem were the tinkering wannabee scientists trying to specify which food component would make you fat. Instead of how much will make you fat by eating too many calories. The messing around with limiting carbs or fat has taken society way off track. Carbs and fat are okay with protein when there is moderation. The message of moderation was lost.

The full truth anyone overweight feels bad about it. I do not give a fig if they deny that. No one really shames them. No one really has to. And the battle against shame is because it is an internal reality that of course matters more than any external reality.

“fat-shaming”

There is more of me to love!!! LOL

The Captain

There is more of me to love!!! LOL

The Captain


I am pretty sure you wont get a promotion. LOL

And it was our dear government that would never lead us astray, that really pushed the stop-eating-fat crusade and told us to stuff ourselves with carbs instead

Except it didn’t. Folk really need to give themselves more credit for any craptaculous eating habits they acquired when they heard the low fat message. As much as it’s very trendy to blame the obesity epidemic on some outside entity…government, food industry, Ancel Keys etc… there’s a lot of False Memory Syndrome floating around on this issue.

I’m willing to suggest that back in the late 1970s and 80s…or even earlier…very few folk who were eating their way to obesity and its consequences gave very much thought to every morsel that entered their mouth or wondering if their diet was in accordance with the principles of the food pyramid. Heck, if familiar with it at all, it was the cartoon version found on the back of cereal boxes or SnackWell cookie packs.

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rec to veeEnn for False Memory Syndrome floating around on this issue.

I agree.

And I also think the “dietary science” during most of my life, from the 60’s into the 10’s was lazy, delusional, amd worst of all dominated by models based on feeds for livestock rather than humans. It was quietly yet thoroughly corrupted by research money and other incentives provided by massive carbo merchants from Archer Daniel Midland to Monsanto to General Mills.

I was wonderfully lucky to grow up in a family dominated by homecooked meals, mostly freshly made salads and fresh vegetables served with small portions of intensely flavored meat and fish dishes, and old style Californio-Mexican cuisine (NOT TexMex but e.g. https://www.elcholo.com/menu.html), no sugar or bread on the table, and an attitude that was highly suspicious of anything my great grandmas did not eat (my little sister on opening her first TV dinner “Well, barf!”).

david fb

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It is more of the knee jerk fantasy that everything comes down to individual choice when the evidence is overwhelming that most individuals, beginning as babies and continuing through life, are guided and directed primarily by the culture and situation around them.

It does no good to tell people they have no control over their weight/life style. It is also a false narrative. Genetics is rarely destiny and culture can be overcome.

I am sadly old enough to remember that the nutritional culture for the average American in the 1960s and 1970s was terrible. This was the era of Wonder bread, TV dinners, canned vegetables, even canned spaghetti. Yet obesity rates then were far lower than today. The genetics then isn’t much different than today and the nutritional culture in the 1960s was much worse. We Americans are fatter than before because we Americans are more spoiled than before. We eat more and exercise less. We spend more time snacking and sitting.

Even simple things like routinely walking around the block immediately after dinner and parking far away from the restaurant can make a significant health difference.

https://www.healthline.com/nutrition/walking-after-eating

My wife is a doctor and she routinely urges her overweight patients to walk after dinner. She is amazed by how psychologically difficult this is for people who only want to head to their LazyBoy and remote control.

“We have met the enemy and he is us”—Pogo

It is time to can the excuses and start holding ourselves accountable for our problems.

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My mother died of gall bladder cancer at the age of 82. When she got her diagnosis, we went to the oncologist in Orange County. Probably a 8 story building with a wig store on the bottom. There were people in there that looked like the walking dead.

They had their own pharmacy and sold their own drugs. I asked how long the chemo would prolong my mother’s life. 3 months, maybe on a 9 to 12 month timeline. At the point she got sick, she was active, mowed her own substantial lawn. Very self-sufficient. If she took chemo, she would get nauseaous, need to stay out of the sun, etc. I called a palliative provider and spoke to a nurse. Asked her about the situation. She spoke in yes and no answers, haltingly when i asked her direct questions. Would chemo help my mom or make her life more difficult. Difficult.

Mom and I had a talk. What did she want? she wanted to keep doing what she was doing so that’s what we did. She kept active, doing all her usual things up to the last three weeks.

I told the doctor our decision. He left a voicemail saying he was disappointed in our decision, but people think, well they’re old so why try.

What s self-interested ass. And all Mom’s other doctors ordered medications, for depression, which we decided against. Breast x-rays-for a terminal patient. They all acted like their 15 mins with my mom entitled them to make life altering decisions and bristled when questioned.

Be your own advocate and an advocate for those you love. Doctors: Ka-Ching for everything they do so what do you thing they advocate for?

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There was a study done only a few years ago about what a doctor does when handed a terminal diagnosis in their own case. Most go home to die with no care.

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Mom and I had a talk. What did she want? she wanted to keep doing what she was doing so that’s what we did. She kept active, doing all her usual things up to the last three weeks.

Part of my Mom’s last will and testament, “I want to die at home.” I didn’t find this out until after she died but I knew her well enough that I carried out her wishes.

I told the doctor our decision. He left a voicemail saying he was disappointed in our decision,

Stupid, arrogant doctor!

I had a similar discussion with our doctor after he said he needed to take my mother to the hospital to examine her properly. I asked him, “If you take my mother to the hospital, will you cure her?” He replied “I can’t promise that.” So I declined. Later we had another conversation:

Denny: “Doctor, what do you think about my decision?”

Dr: “Medically it’s the wrong decision but humanly, it’s probably the right one.”

I was next to Mom as she quietly left this earth the following day, her last wish fulfilled.

The Captain
My Mom was quite a lady, she survived two world wars and three husbands!

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There was a study done only a few years ago about what a doctor does when handed a terminal diagnosis in their own case. Most go home to die with no care

Do you recall which journal this study was published in…because I’m willing to bet they don’t. Maybe more accepting of a diagnosis with poor prognosis, certainly less likely to threaten law suits or worse against their care team to demand futile interventions and possibly less likely to be duped by “alternative” practitioners promising miraculous cures with all manner of WOO! from homeopathy to cottage cheese enemas (Old Lags from the H&N board will know what I mean) Going home to die with no care is an unlikely scenario.

Just like with everyone else, a “terminal diagnosis” can be handed out at any age and stage of life/career. Over the past few decades, friends and colleagues of my husband and I have gone through this and made a choice to follow the sort of aggressive, misery inducing therapy I wouldn’t even entertain. Usually for the practical purpose of gaining just a bit more time to be able to put family affairs in order, see teenage offspring graduate college or their first child/grandchild born etc etc…and every once in a while lived for much longer than ever anticipated.

I bet this study was hugely flawed and full of confirmation bias on the part of the authors.

My wife is a doctor and she routinely urges her patients to walk after dinner. She is amazed at how difficult this is for people who only want to head to their LazyBoy and remote control

Husband and I were discussing this very topic on our early morning walk the other day…as in how long term overweight patients/clients seem not to realise just what us “naturally lean” folk do to actually be naturally lean.

There’s a huge advantage in never having been fat. Quite apart from all the metabolic and hormonal drivers to overeating that comes with excess adiposity (the physiology) the things that lean folk do that’s so different…controlling energy intake (whether you want to or not), and exercising appropriately (again, whether you want to or not)…are such longstanding habits that they’ve become well…habits

My stable weight range (of about 128-132lbs on a 5’6" fairly muscular frame) is achieved by, I’m guesstimating, a daily energy intake of around 2000-2200Cals, give or take with an energy output that matches it. This doesn’t allow for many desserts, glasses of wine or much time on the tuchis.

I’m in Emeritus mode now, but back when I was teaching group exercise classes it wasn’t uncommon for class members to quiz me on tips for staying in my sort of shape…looking for the illusive secret, I guess. Almost invariably when I’d go to the trouble of outlining my eating habits and training strategies (in addition to my upwards of 5 classes per week of SPIN, group strength with the occasional boot camp thrown in) complete with spread sheets and data from my current wearable, their reactions would range from disbelief to resentment.

“Well, no wonder you’re so skinny if you do all that”…for all the world as if I was somehow cheating.

“Well, if I ate like that, I’d be skinny”…well, yes…isn’t that the point?

Every once in a while the very same convo would nudge someone in the direction of behaviour change.

Like I always say…weight management is as least as much psychology as physiology

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Do you recall which journal this study was published in…

It was a Stanford study: “Most physicians would choose a “no-code” status for themselves if they were terminally ill, but would tend to pursue aggressive treatment for patients facing a similar prognosis” https://med.stanford.edu/news/all-news/2014/05/most-physicia….

Here is the article in the well-respected journal PLOS One 2014: https://journals.plos.org/plosone/article?id=10.1371/journal…

Conclusion of paper: “Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.”

It wouldn’t surprise me if fear of malpractice allegations plays a role. Much easier to justify doing everything one can to a grieving relative.

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Conclusion of paper: “Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.”

My Mom’s doctor had the answer, two different magisteria, Medicine vs. Humanities, two different courses of action. The question then shift to, “Who has the right to decide?”

The Captain

Good find, btresist…if only to illustrate that different folk, with different experiences can read/hear the same message and come to a different conclusion.

Assuming this is the study mentioned upstream, I don’t think it actually supports the statement that physicians are more likely to go home to die without care when receiving a diagnosis with poor prognosis.

First off, from the abstract you linked to, this was an advance directive simulation right? Totally hypothetical in healthy (as far as they know) individuals. As in a group of subspecialists filled out a questionnaire that asked them to imagine what they’d want if they were in need of resuscitation…that is usually taken to mean on the brink of death such that you’d be a corpse without intervention.

That’s very different from, say, getting a diagnosis of a primary CNS lymphoma that’s pretty extensive because of late diagnosis and the treatment is somewhat experimental, will cause you to lose your hair and feel absolutely lousy during its course. Let’s call this patient Marianne (for human interest in anecdata)…who, while actually having an advance directive/DNR in place, still opted for this hugely expensive, shot in the dark treatment. Which worked…6 years ago.

As mentioned way upstream…everyone wants to go to Heaven, but not right now.

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"I am sadly old enough to remember that the nutritional culture for the average American in the 1960s and 1970s was terrible. This was the era of Wonder bread, TV dinners, canned vegetables, even canned spaghetti. Yet obesity rates then were far lower than today. The genetics then isn’t much different than today and the nutritional culture in the 1960s was much worse. We Americans are fatter than before because we Americans are more spoiled than before. We eat more and exercise less. We spend more time snacking and sitting.

Even simple things like routinely walking around the block immediately after dinner and parking far away from the restaurant can make a significant health difference."


In the 1960s, you had ‘in season’ veggies and fruits. Otherwise it was canned veggies for 70% of the year, and fruit in sugary sauce out of a can. You ‘could’ still eat a decent diet if you wished. We always had a family sit down dinner. At least one veggie on the plate along with potatoes and small portions of meat. As a family we ate out about ONCE A YEAR, other than maybe a few times ‘on vacation’ where we went tent camping.

There were five TV channels in the NYC area. In many areas of the country - from 1 to 3 TV channels. Not much for kids in the evening other than network news.

Then along came frozen veggies - much better and not full of sodium in cans.

Yech! TV dinners.

Of course, the big ads on TV were for ‘breakfast cereals’ full of sugar… and snack foods and candy bars.

Never had a pizza till I went off to college in mid 60s.

Yet, I’d rather spend my 10 or 20c allowance on buying a balsa rubber band powered plane kit, or plastic model plane to put together than a candy bar or can of ‘soda’. or bottle of soda back then. that was a ‘treat’. (yeah, we had lots of Kool-Aid a cookouts during the summer. Hot dogs for the kids. Hamburgers for the adults. Sliced tomato.

Now? Average Family probably gets 5 take out meals a week. Pizza galore!

Anyone ever have family sit downs?

200 channels on the TV. Always ‘something’ to watch or re-watch.

Big Gulp 7-11 drinks, 32 oz of 800 Calorie Cokes or Pepsi!

Only 99 cents!

All you can eat buffets!

Yeah, welcome to the fat era of the 21st century.

t.

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“If she took chemo, she would get nauseous, need to stay out of the sun, etc. I called a palliative provider and spoke to a nurse. Asked her about the situation. She spoke in yes and no answers, haltingly when i asked her direct questions. Would chemo help my mom or make her life more difficult. Difficult.”


My BIL was diagnosed with State 4 pancreatic cancer in Dec at age 69. Decided to do ‘everything’ possible. Had operation. Spent the next 9 months in/out of hospitals, radiation treatment, chemo. He was ‘sick’ 99% of the time for the next 9 months. Essentially bed ridden or feeling rotten not able to do much. Could not keep food down. Every second or third week emergency trip to hospital, in between scheduled treatments. Yeah, he had 9 months of ‘life’ but it was miserable. He was ‘kept alive’ but barely.

Unfortunately, for pancreatic cancer, it’s often caught only late - at the Stage 4 level - when it’s already begun to spread everywhere. No symptoms till it’s already ‘too late’ .

t.

"Conclusion of paper: “Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life.”

Depends upon the cancer type. Some are quite successfully treated. Breast cancer? decent survival rate. Lung cancer? Good outcome if caught early.

Others like pancreatic cancer caught at Stage IV have short outcomes, require intensive operation, radiation, chemo - and often the cancer has spread so far - you’re a goner. Less than 5% five year survival and most of those are ‘caught early’ before Stage IV is reached.

t

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