MAID now is already 5% of all deaths in Canada
Another way of looking at this number: 94% of deaths in Canada are nonconsensual. (Around 1% of deaths are non-medically-assisted suicides.)
2Wait, do I understand it correctly that when people say "science has proved that even small amounts of alcohol are harmful", the actual scientific definition of "small amounts" is "one drink every day"?
To me that sounds a surprisingly lot for a "small amount", and I am in Eastern Europe. The idea that the recommended amount is two drinks a day is something I would expect in Russia, not in USA.
A new major study finds that alcohol causes cancer, so government worked to bury the study. Time and time again we get presented with the fact that small amounts of drinking correlate with improved health in various ways, fooling many into thinking a little alcohol is healthy.
That seems a pretty uncritical way to frame the issue.
It turns out when you put a few people who believe that nutritional research with it's correlational observational studies is crap into leadership positions, they don't take that kind of nutritional research very seriously. MAHA was never about trusting the existing nutrition researchers, so this should not be surprising.
If you do report on the issue, I think it would make sense to focus on the actual merits of a policy choice instead of just "Trump administration doesn't like the status quo that nutritional experts propagate - Nutritional experts are so worthy of respect that disrespecting them is bad".
Some amazing things are going on, not all of which involve mRNA, although please please those of you with the ability to do so, do your part to ensure that stays funded, either via investment or grants.
As for mRNA, please do what you can to help save it, so we can keep getting more headlines like ‘a new cancer vaccine just wiped out tumors’ even if it is sufficiently early that the sentence this time inevitably concludes ‘IN MICE.’
Heart Disease
Wait, what, you’re saying we might soon ‘mostly defeat’ heart disease?
I wouldn’t go that far. Even if these trials are successful, it seems unlikely we’re talking about ‘mostly defeat,’ although we could plausibly be at ‘greatly reduce.’ Which could still be worth several years of life expectancy across the board. If we could also similarly help with other major causes of death and aging, you’d see compounding gains, but without that aging still catches up with everyone.
Unfortunately, America under the current administration is making deep cuts in basic research funding that leads to advances like this. Hopefully AI can make up for that.
Alcohol
A new major study finds that alcohol causes cancer, so government worked to bury the study. Time and time again we get presented with the fact that small amounts of drinking correlate with improved health in various ways, fooling many into thinking a little alcohol is healthy.
As opposed to the reality, which is that alcohol is bad for you no matter what, but that inability to drink is highly correlated with alcoholism and other traits that go along with poor health, whereas ability to drink only in moderation is a good sign.
So drinking in moderation, which is only a small amount bad for your health, is still a good sign for your health if you are drinking in moderation. Whereas heavier drinking consistently looks bad, perhaps even worse than it is.
Trump himself is not fooled, and does not drink at all, as he has seen the dangers of alcoholism in his own family. A wise choice.
A 4% chance of dying on average 15 years earlier is a big deal.
This is not the first time a Trump administration defied the data on this.
Legal Reforms
Montana passes SB 535 with broad bipartisan backing, further expands its ‘right to try’ rules, with a license path for experimental treatment centers to administer any drug that got through Phase I trials, to anyone who wants it. This is The Way.
Alex Tabarrok is correct that we could greatly improve healthcare if we allowed telemedicine across state lines. As long as a doctor is licensed where the doctor is physically located, it shouldn’t matter where the patient is located. The best part is that this could be done with an admin rules change of two words.
A call to make statins be sold over the counter (OTC). This seems obviously correct, even if you are highly skeptical that the correlations cited here imply causation, or that they imply that intervening via statin cause this causation without important side effects. That’s a decision people can make for themselves at this point. But then a whole host of things should be OTC at this point that aren’t.
Embryo Selection and Gene Editing
A new embryo selection company, Herasight has launched that is allowing users to select for IQ. They claim that with as few as 10 embryos you can already go from an expected IQ of 100 to a new average of 107. Or you can do things like go from 45% chance of Type 2 Diabetes to 25%.
In practice what happens is you get your 5, 10 or 20 embryos, they profile each one, and you are choosing based on a variety of traits. What do you actually care about most? You are about to find out.
I agree that this technology is coming. I agree it will matter to people. And why shouldn’t it matter, at least from a selfish point of view? It also might be a better way to select for other good things than you might think, as in general health and other positive traits are correlated with beauty. I do not think it will be anything like ‘this overrides everything else.’
Even the graceful failure mode for things like this is a really big deal.
I mean that sounds pretty great? You got your choice of gender and a couple of IQ points, while presumably also dodging a variety of potential genetic disorders. That’s a pretty good haul.
What you actually get is not maximizing on one to two traits, although you do have that option. What you get is to do a general maximization over many traits. That is a lot more valuable if you are making reasonable decisions.
Mason is however making the very important point that if you want to use IVF and have confidence it will work at all, let alone confidence it will give you selection, you need to do it early. The younger you are, the better all of this will on average go, until such time as we figure out how to generate new eggs (which is plausibly only a few years away).
As Gene Smith points out in this thread, academics are super against all of this.
He also reminds us that we are spending all our gene editing resources on rare diseases where we can stick the government gigantic bills and the ‘ethicists’ stop trying to ban you from helping, whereas the places where most of the value lies are complete ignored, even by people who would directly benefit.
I mean, it’s not that simple, of course it is not that simple, but it is a little bit that simple?
If you have the option to use the technology we do have, it seems crazy not to use it. Noor Siddiqui is being too righteous and superior about it even for me here, but if it really does cost as little as $2,500 to get selection over potential embryos, that is a better deal than essentially any remotely optional interventions you have access to after birth. The replies to such proposals are full of people saying how horrible all this is and having instinctual disgust and purity reactions, and calling everyone involved and the proposal itself various names, all of it patently absurd without any actual justifications.
I do strongly agree with Vitalik Buterin that while we should be very much in favor of embryo selection and most of the attacks on it are deranged, it is counterproductive and wrong to strike back by saying that since it condemns your children to be worse off that not using selection is unethical.
We’ve been over this one many times. If that which is not forbidden is compulsory, then that which I do not want to be compulsory must be forbidden.
GLP-1s Work
Oh no, all these GLP-1 drugs are going to prevent people from dying, and that could have a negative impact on pensions?
Eliezer does a survey, finds ~80% of those who tried GLP-1 drugs report it helped lots versus those that didn’t, roughly confirming industry claims. That’s a fantastic success rate.
Now we are potentially seeing Eli Lily have a pill that’s ~55% as effective as Ozempic in phase-3 trials, their stock was up 14% on the news. They also have Retatrutide coming in a year or two, which is claimed to be a more effective GLP-1 drug that also causes less muscle loss.
These marginal improvements make a huge practical difference. GLP-1s are now a lot like AI, in that we keep getting better versions and people’s impressions don’t update.
Unfortunately, it’s not always easy to get a line on the necessary supply.
There were official shortages of GLP-1 drugs, which allowed compounders to make and sell those drugs cheaply, on the order of $300/month, in essentially unlimited quantities. Alas, there is now no longer an official shortage, so the price is shooting back up again (~$1k/month) and supply is harder to find. We really should find a way to buy out those patents and make these drugs available for low prices (ideally for free, with at most a minimal consultation) for whoever wants them.
Is it possible that if you combine a GLP-1 with anabolic agent Bimagrumab, you can lose fat without losing muscle? Eli Lily is in phase 2b of trying to find out.
What we don’t know works with GLP-1s is microdosing.
As usual this as worded confuses lack of formalized data and evidence for a lack of data and evidence. These are not the same thing. It is an entirely sensible strategy to experiment with different doses and to choose, with a drug that has big benefits, but also downsides, and is clearly safe. Self-experimentation can provide highly useful data and evidence, and clearly different people respond differently in terms of benefits and side effects at different doses.
The marketing involving microdosing does sound not great, especially its claims of other vague and hard to measure benefits.
There Is No Catch Other Than Availability And Price
There are still some potential safety issues where it would be good to have more confidence, I agree that we are not treating checking for such possibilities as seriously as we should given how many people are on these drugs. But also given how many people are on these drugs (about 6% of Americans right now), and how much many people are inherently suspicious that there is a catch, and how long people have been taking them for (including previously for diabetes) I am confident that if there was a showstopper problem it would have been found by now.
People instinctively think there must be a catch to GLP-1s. But for people in most circumstances there mostly isn’t one, at least not one of magnitude similar to the benefits, other than that for some people it doesn’t work?
Of course, here I am saying that and then not taking them, but I am a bizarro case where I was able to get to my target through sheer willpower, and I have decades of experience dealing with essentially permanent hunger. That almost never works.
Andrew Rettek reports from a week discussing diet, exercise and GLP-1s at LessOnline and Manifest. Lots of people wanted to exercise, but felt they needed ‘demystifying’ of the gym and the general procedures involved. I very much feel this. Our on ramps suck, and mostly amount to ‘find a source and trust it.’ Which is way better than not exercising but doesn’t fill one with confidence or motivation – I’m spending a substantial portion of my time and willpower and energy on this, and different implementations differ a lot. Whereas for diet, Andrew observed people mostly weren’t interested, my guess is because they’ve already heard so many contradictory things.
The Societal Impact of GLP-1s
GLP-1s served as a large scale experiment in drug compounding, and in sidestepping the FDA’s various usual regulatory requirements. The results were amazingly great, everything went smoothly. This is even more evidence for FDA Delenda Est, while noting that ‘fire a bunch of people at the FDA’ makes things worse rather than better. Removing requirements is good, but if there are going to be requirements it is necessary to be able to handle the paperwork and meetings promptly.
Going forward, the bigger question is: What happens if this actually works?
At what point do we start to think of weight loss as fully treatable?
Not every case can be treated, since we have a non-response problem, and some people will run into side effects or risk factors. But a large majority of people with a problem still haven’t attempted treatment. Most of them should try. If you were already going to lose the weight on your own, you could do it easier with help?
What about the equilibrium, signaling and status arguments? That if we allow people to lose weight without willpower or personal virtue then that will make the signals harder to read and be Just Awful? Yeah, I don’t care.
I’m Not a Yo-Yo
Cremieux claims that it is a myth that yo-yo weight loss reduces muscle mass and makes you fatter. Andrew Rettek responds that the studies claiming to bust this were on wrestlers, which doesn’t apply to normal people, and I buy his explanation of the mechanism here, which is:
There are also other exercise methods. The point is clear.
Back Problems Are An Underrated Reason To Lose Weight
Weight loss helps resolve back problems and otherwise make things hurt less. Few appreciate how big a deal this is. This was a big game changer for me on its own.
No One Knows Much About Nutrition
That is, no one knows much about how to do it right.
We do know many ways in which one can do it wrong.
Cremieux points out that in general ‘nutrition beliefs are just-so stories.’
If there were two concrete specific things I would have said I was confident about, one of them would have been ‘vegetables mostly good’ and the other would be ‘sugar bad.’ I don’t think it’s bad enough to stop me all that much on either front, but I do buy that sugar is bad on the margin.
And yet when Americans cut sugar consumption (modestly by ~10%, note the y-axis) the obesity rate still mostly kept moving up.
He blames this mess on selection. Once sugar got blamed, choosing to consume more sugar became correlated with other health decisions, some of which matter. The associations between sugar and health only show up, he claims, after 2012. And he says this generalizes – certain people eat certain diets. He finishes with a survey of some of the other problems.
I am inclined to be kinder, and see the epistemic problems here as actually super hard. Nutrition is remarkably different for different people, doing proper studies on humans is extremely hard, there are distinct effects for short, medium and long terms, a lot of this is about how you psychologically respond, lots of details matter and are hard to measure and can be changed without you realizing, and so on.
As far as anyone can tell Aspartame, a zero calorie sweetener, seems benign. I agree that this is great news so long as no one forces anyone to use it. I think the people this most annoys are people who believe that it is not as good an experience as sugar, and don’t want their sugar taken away, either legally or by those ‘worried about their health.’ Also, since no one knows anything about nutrition, I wouldn’t assume that there isn’t a catch.
Ketogenic Diets Can Go Very Wrong
From what I’ve seen, they go wrong enough often enough that starting to mess with them probably doesn’t make sense if you aren’t already messing with them.
Do ketogenic diets dramatically raise risk of stroke and heart attack?
The graphs show dramatically accelerated PAV (Percent Atheroma Volume) and NCPV (Non-Calcified Plaque Volume) in those on Keto diets.
As always, beware conclusions from intermediate endpoints, and also different people often have very different reactions and averages can be misleading. But I agree this does not look good.
I don’t think we have enough evidence here to draw that conclusion either?
Here’s a counterargument from someone thoughtful and sympathetic to Keto:
Nathan Cofnas defends Keto on multiple fronts while also offering warnings.
I find these defenses:
For keto to make sense, even if you mostly buy the counterarguments, given the risks involved (over a range of possible worlds):
And that’s if you buy the counterarguments.
In practice, even if you think this is right for you to try, I’m willing to go ahead and say that on average you are wrong about that.
Weight Loss The Hard Way
Congratulations to Allyson Taft on her transformation, including losing 120+ pounds in just under a year by walking a lot, drinking a lot of water and tracking calories.
Not everyone can do this. Not everyone should attempt this. And most people in the position to need to do it should probably take GLP-1s.
It was still very nice to see a clear example of someone pulling off the pure willpower route who wasn’t me. And it sounds like she didn’t even use GLP-1s.
We Ask Far Too Much Of Satiety
One thing I would push back on very hard is the idea that there is something perverse and modern about the fact that if we eat until we feel satiated with reasonable access to a variety of foods then we will gain weight:
I’m not saying that staying thin did not get harder on many fronts, and it is entirely possible that there are other things making things harder on top of that, but the idea that in the past eating as much as you wanted of what you wanted wouldn’t have made you fat is Obvious Nonsense. Rich people from the past who could eat as much as they wanted, and didn’t care, totally got fat. Sure, people mostly stayed thin, but largely out of lack of opportunity.
Needing to control yourself to stay thin does not mean that your satiety is broken. You’re asking way too much of satiety. You’re asking it to give you the right highly calibrated signal in a radically different world than the one it was trained for.
This doesn’t require toxins or any particular villain beyond widespread variety and caloric availability, including many calorically dense foods, and greatly increased food variety and quality, and various cultural expectations of eating frequently. It is enough, and regardless of the original cause life is not fair.
My answer is simple, and similar to Cremieux’s in the thread, that there was never really any robust natural ‘balance.’
For full disclosure, I say this as someone whose satiety has always been utterly broken to the point of uselessness. If left to my own devices I would put on insane amounts of weight very quickly. I might double my caloric intake. That’s what actually broken looks like. But don’t ask an evolutionary mechanism to give the right answer in a radically changed world, and don’t call it ‘broken’ when you have to adapt.
Yes, until recently that meant you had to work for it. That’s one option. The other? Good news, now we have Ozempic and other GLP-1s.
Supplements
Unfortunately there are what the economists call ‘long and variable lags’ in vitamin impact, both positive and negative. Even if it originally helped or hurt in a day, it might take a while for a supplement to wear off. Others only work via accumulation over time, or work on things other than observable mood.
Experimental design here is very hard. I would not want to maximize purely on the basis of how I feel within 24 hours.
Also, for various reasons, you cannot by default confidently equate any given pill with other pills from another source that claim to deliver the same dose of the same vitamin.
If I was going to run such tests, as much I would like to randomize every day, I would at minimum want to wait three or so days between swaps, and I would limit the multiple hypothesis testing. The data is going to be super noisy at best.
A Cure For Some Depression
A story worth sharing.
Assisted Suicide
As in, MAID now is already 5% of all deaths in Canada and is about to be available for mental conditions and parliament wants to grant access to minors, and I see a bunch of claims about it being aggressively pushed onto people in various ways. One wonders where this stops, once it starts. If it stops.
Former Quebec officials suggest that best “solution” for intellectually disabled woman without adequate support might be death. Which might be true, but wowie. This highlights where things might be going. Do you trust the state to not push such solutions on people who are financial burdens? To not cut off aid to them as part of an attempt to force such choices upon them? I notice my answer is very much no.
Bioethics Delenda Est
A lot of ‘ethics’ people think the only ethical thing for you to do is hurry up and die.
As in, you are trying to solve people’s health problems, but this might also cure aging, And That’s Terrible.
Once again: Bioethicists know nothing of ethics. This is them answering:
Here’s a bioethicist giving a Ted talk advocating that humans be ‘engineered’ to be, no not more intelligent or healthy or happy but (checks notes) intolerant to meat, at the same time that other ‘ethicists’ are screaming about how awful it is we might do embryo selection on positive traits.
And 41% stand ready here to outright deny physical reality.
How exactly would we design society such that it is not a disadvantage to be blind?
If I was blind and I heard people were claiming this, I’d be pretty pissed off at them.
Do you think, by answering that way, you are helping anyone?
Ignorance Can Be Bliss
Learning about your HIV status, when treatment is not available, dramatically reduces long term survival rates. Some of this is people adjusting rationally to the news, and engaging in generally riskier (to themselves) behaviors and having higher discount rates. Some of it is despair or overreaction. However it isn’t really an option not to tell them or not run the tests, for obvious reasons.
Here in New York they take every opportunity to push you to get tested for HIV, even when there is no reason to do that, as I found out on a recent hospital visit (it was an infection, I am 100% fine now, don’t worry).
Living Forever In Your Apartment
I do see hope that some people might live to 150 this century, or even that some people alive today might live far longer than that. It will not happen because ‘organs can be replaced endlessly’ because that does not reverse aging, so the rate of new problems will keep doubling roughly every seven years, but we have other options.
Also, yeah, thinking ‘at 70 you’re still a child’ is both obviously false and reflective of the geriatric ruling class that is doing so much damage. Until your anti-aging technology gets a lot better no one 70+ should be in high office.
In Other Health News
In response to RFK’s War on Vaccinations and as Florida repeals all vaccine requirements, there are now two state coalitions trying to defend our health. California, Oregon, Washington and Hawaii are going to form one set of recommendations. New York, Massachusetts, Connecticut, Delaware, Pennsylvania and Rhode Island will form another, likely with New Jersey, Vermont and Maine.
Freezing sperm young, if you can spare a little cash to do it, is a pretty great deal. Even if everything keeps working fine you cut down on mutation load a lot, and if something does go wrong you’re going to be very happy about it. It’s a lot of optionality and insurance at a remarkably cheap price, even if you factor in the chance that in the long term we’ll have other tech that renders it unnecessary.
This could end up being a big one: Germany’s national academy of sciences correctly urges that we treat aging like a disease. If we can get momentum behind this, it will supercharge progress towards the (non-AI) thing that is actually killing most of us.
New study claims living near (within 1-3 miles of) a golf course doubles risk of Parkinson’s Disease, which is presumed to be due to pesticides.
Ross Rheingans-Yoo is doing a video podcast series on why our drug development process is so broken and expensive.
Scott Adams has prostate cancer, we wish him well, thread has illustrations of exactly how unhinged a certain type of thinking got and how wide a set of medical topics. Luckily he himself has realized the mistake and although the odds are against him he now appears to be setting aside the quacks and getting real treatment.
A new claim from a randomized trial that getting immunotherapy in the morning has a doubled survival rate versus getting it in the evening, Abhishaike Mahajan speculates potential reasons why.
A potentially serious incentive problem: If CRISPR treatments can permanently cure conditions, insurance companies have no reason to value a permanent solution more than a temporary one, so the whole system will underinvest in such treatments. Ultimately it should be fine, since at most this is a limited cost factor and thus not enough distortion to stop this from happening, and AI should improve development costs enough to compensate.
They did finally run a decade-long study of GMOs in monkeys, and of course they found zero adverse effects on any measured health indicator.