[epistemic status: i have formal education in nutrition, and this is remembered impressions i got from professors/experts, but may not be correct, and is almost certainly simplified and lacking in nuance]
In our parents' generation, boiling or steaming was considered the most healthy way to prepare vegetables: fat and salt were the enemy, and especially steaming left the vitamins in (rather than allowing water soluable ones to leach into the cooking water).
Our parents cooked vegetables in this way because they learned it was the healthiest and they wanted us to be healthy.
Nowadays the nutrition Powers That Be have acknowledged that yes, steamed broccoli is a little healthier than roasted broccoli or broccoli sauteed in garlic oil, but steamed broccoli only tastes okay while roasted broccoli and sauteed broccoli are both damn delicious (epistemic status: broccoli is my favourite vegetable). The wisdom from on high is now that vegetables should be cooked in appealing ways, and the small loss in nutrients is nothing compared with the large gain in flavour which encourages people to eat vegetables which then means that people are less likely to eat e.g. big macs and tater tots.
I think as well as what others have said, an ethical consideration with placebos is that they are treating someone with something that they know doesn't work. Like, basically, on some level, it's ethically dubious to make you go to all the effort you outlined, interact with medical staff, receive an actual injection, etc, and deliberately not treat you. That's why many many trials have "stopping rules", where if it turns out the treatment is working really well, the placebo group gets it, too.
My impression is that my period symptoms are maybe in the top half of severity, but not the top quartile?
Don't compare yourself to others. It's a very common problem that apparently women especially have. You have symptoms that are distressing to you and are more than you want to experience AND THAT IS ENOUGH.
FWIW, I would definitely say based on your description you would be in the most severe 5-10% given when I am bitching about periods with friends who menstruate none of them talk about being out of action for 4 hours a month.
It took me like 3 doctors before one of them suggested the medications I'm trying now, and that was a doctor at a sexual health centre. This included one doctor who, when he saw I had low iron and I told him it was probably my frequent, long, heavy periods gave me a PPI (in case I had some stomach issue stopping iron absorption - because when he asked me if I had heartburn I said once every 2 or 3 months after eating like crap I have a little bit that an antacid fixes immediately), an endoscopy (in case I had, idk, a digestive issue? this required sedation, fasting, and a day off work so wasn't exactly Fun), and finally said it probably was my period and I should probably go on a different BC (so I'd resigned myself to trying an IUD, which is its own kind of pain, and if I'd had the sexual side effects I attribute to my last IUD again I'd have to have it removed after only a month or two so FUN).
So I went to the sexual health centre to discuss options for other BC (since I was also considering the shot) and she was like "you could try this medicine?" and I was confused because the medicine while not free was cheap enough (about AU$30 per cycle, or less than an hour's pre-tax wage for me). I went back to my original doctor to refill the prescription and asked why he didn't recommend it to me and he said kind of dismissively "it doesn't always work" and after that I read research on it and apparently it works 30% of the time which for me is, you know, A PRETTY GOOD SHOT.
So yeah, I don't know how firm or insistent you've been with doctors, or how accessible doctors are in your country, but being very firm ("these cramps are no good and I need to do something about them! Is there something we could try?") might help? Is going on a hormonal BC an option for you - I can't have estrogen but if I could it would just be a case of taking "the pill" without the placebo weeks which would stop my period altogether.
But yeah, I'd take my previous long periods over a 4 hour debilitating cramp with a regular, say 3 day period, so I'd encourage you to keep asking doctors as those cramps sound so intense.
I'm one of the many women who can't take estrogen due to a history of migraines. It makes things... interesting.
I use nexplanon, which gives me extremely long, heavy periods (and I am not joking: three 5-10 day periods in a row with 3 days in between) but I had a bad experience with an IUD, am bad at taking pills and the mini-pill is extremely sensitive to timing, and will probably have children within 2 years so the jab is not for me.
So what I've been experimenting with is two medications my doctor has given me to stop my period (only one at a time): Ponstan and Tranexamic acid. Still not sure which works better but they each seem to be pretty good at lightening and probably also shortening things. I am not sure how they'd help your dysmenorrhea though because of yours only being the first four hours, and you take the medication once bleeding starts.
FWIW I haven't noticed productivity issues one way or the other. How do people notice this sort of thing? Like, was it obvious, or did you chart productivity vs period somehow and saw the trend?
Setting aside the absolutely horrific ethical problems with experimenting on imprisoned people, imprisoned people do have access to commissary, would have access to special meals for religious or cultural reasons, and are likely to exchange food amongst themselves.
And as said in the other reply, coma patients are fed through tubes and don't do things like exercise, so you wouldn't be able to determine the effect of protein intake on muscle growth or whatever, and they also have whatever condition put them in a coma in the first place, and I believe long term comas are rare. Oh, and no informed consent, because they're in a coma.
I'm studying nutrition at a tertiary level for pretty much this exact reason and what it has taught me from speaking to dietitians who teach my course and from doing the course is:
a. Advice for the average person with a typical western diet boils down to "would it kill you to eat a damn vegetable?"
b. There's a lot of organic chemistry that despite me being 3 years into a 4 year degree hasn't paid off (I am doing the degree that feeds into a masters of dietetics, so I'm sure that's where it was going to pay off. Alas, I'm not going to do that masters any time soon because my government engineering job 8 years in pays more than and end of career dietitian despite the higher level of education, and the masters would require me to work 9-5 for 6 months for free)
But most importantly, and most relevantly for the lesswrong sort of person, is that it is basically impossible to study diets in anything resembling double blind randomised placebo controlled. Diets are strongly linked to culture and personality and strongly influenced by those around you and virtually impossible to double blind. Like, imagine you wanted to study whether eating red meat is good for your health. Imagine getting 10,000 people and randomising them into three groups (high red meat, moderate red meat, no red meat). Would a steer farmer from Texas really stop eating red meat just because he was randomised into the no group? Would I, a vegan for 5 years, start eating 4 serves of red meat because I was randomised into the high group? (no, but I wouldn't sign up for the study for this reason, which is a confounder because people like me then wouldn't sign up). And if the Texan did stop eating red meat, would he keep it up for 20 years? Would someone randomised into the high group who got diagnosed with heart disease and was told by their doctor to cut down on red meat ignore the advice because of the study?
It's that problem but writ large that makes decent dietary research hard to do. You'll notice a lot of studies are done over 1-3 months, because that's a reasonable amount of time to be able to provide three pre-packaged meals to your participants that you can control exactly (though those participants are probably going to eat other things: who goes to a birthday party without eating cake, for example?).
So then we have to do animal studies, and our ancestral diet is very different from say a mouse or even a chimp, and is maybe not even what is best for us.
Also, something that isn't really emphasised in this sort of discussion is the cultural value of food. Sitting and sharing meals with people is good for our mental wellbeing.
I think some people also stick on "are eggs good or bad for you? is red meat healthy? are tomatoes good?" when this is kinda missing the point. No one thing should be such a big part of your diet that this information is gamebreaking. And I think everyone knows that vegetables are healthy and hamburgers aren't.
So, where does that leave us?
Fortunately, pretty much every country in the world has a team of dietitians who come together to make a guide for how to eat healthfully. I'm Australian so the Australian guide to healthy eating ( https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating ) and the associated material on the website is what I'm most familiar with. It boils down to eating a lot of vegetables (50% of your plate!), a moderate amount of grains, a small amount of lean protein, and eating fruit and calcium-rich foods. But the website has a lot of information on it in a very accessible format and I'd recommend it as a good starting point.
Hey OP -
Just want to say thank you for this post. This along with the failure of the rationalist community to buy bitcoin led to me betting $150 AUD on Biden, and Sportsbet Australia called the election for him already (no, I don't understand why either - I guess the publicity), so I got $235 in my bank account now (win: $85 AUD).
I would not have done this without your post.
To be honest, I don't care how things will go in the future: at the moment, I'm paying, now, to not experience ads, and I'm hoping that my purchasing decisions in this vein will encourage the sort of behaviour I want. If hosts start incorporating ads into their patron podcasts they'll lose my $5/mo and receive a polite but firm note explaining why.
It bothers me on a fundamental level that we've been conditioned to accept ads as "the price of the internet": I want to pay $5 for an app with no ads/IAP, not be advertised to forever. I want to pay $5 a month to listen to a podcast without ads, not have my precious time taken up with podcast hosts (aka People I Trust) telling me about how much they love whichever meal box kit is paying them this year.
I put my money where my mouth is, btw: I support ad-free podcasts, or podcasts with unlockable ad-free versions, on Patreon (as ad-free is becoming a more common perk, it's beginning to get expensive, but podcast-listening is my main hobby). I messaged one small podcaster about why she didn't have ad-free versions of her podcast as a patreon perk and she said the reason for it was because her advertisers have a clause stating that there must be no ad-free versions, because apparently the more devoted listeners (the ones who trust the podcasters the most) are their preferred target market.
I also emailed a podcaster I listen to when her podcast ran an ad for a 'product' I knew she wouldn't support if she knew some easily googleable backstory, and she emailed me back, pulled the ad, and said that she hadn't used the product and so didn't know that the product was counteractive to her 'brand'. Obviously, you know a lot of these endorsements are fake, but I find podcasts especially insidious as the podcaster-listener relationship is surprisingly intimate.
So yeah, I completely agree with you. I'm voting with my dollar, to try and make the "paid" business model more sustainable for internet services. Thanks for an enlightening post!