7 ms·

Your health is ultimately your own responsibility - it's your body. You have free will, and your appetite for risk is yours alone. You can choose to ignore expe

Your health is ultimately your own responsibility - it's your body. You have free will, and your appetite for risk is yours alone. You can choose to ignore expert advice and refuse to wear a seatbelt, skip your rehabilitation exercises, invest all-in on crypto, or smoke cigarettes. None of this responsibility should fall on the expert if they communicated the risks clearly.

kelseyfrog 10mo ago
What if you have an intrinsically lower ability to perform temporal discounting?
- nradov 10mo ago
  Is that really something intrinsic and fixed or can you improve it over time with deliberate effort?
  - kelseyfrog 10mo ago
    Open to evidence either way. I haven't seen people improve it even with what seems to be terrible negative consequences associated with poor temporal discounting ability, but I'd love to read differing perspectives.
    - btilly 10mo ago
      Research on heritability have found that the amount of temporal discounting we do is moderately heritable. With twin studies ranging from 30-60% of our natural variability explained by genes. This strongly suggests that genetics definitely slips a thumb on the scale, but ultimately we are able to also impact our personal behavior. More importantly, research such as https://pubmed.ncbi.nlm.nih.gov/31270766/ https://pubmed.ncbi.nlm.nih.gov/31270766/ shows that there are techniques (such as mindfulness practices) that have been demonstrated to improve our abilities in practice. I have personally seen these have an impact. Of course if you have a condition such as severe ADHD, you might not be able to reach the same level as is possible for someone with good genetics. But you still have the ability to move the needle. If you have a condition such as traumatic brain injury, even your ability to move the needle may be lacking. But most of us should be able to make a positive change.
      - Filligree 10mo ago
        > This strongly suggests that genetics definitely slips a thumb on the scale, but ultimately we are able to also impact our personal behavior. If it's 30-60% heritable, that leaves 70-40% to split between personal decisions and environment. It does not guarantee that personal decisions matter much at all...
        btilly 10mo ago
        That is why I said "strongly suggests" instead of "guarantees". And then further followed up with a link to research showing that it is, in fact, possible to change. With advice on how to change it.
        kelseyfrog 10mo ago
        What would be the upper bound of the effect of heritability where responsibility is no longer assumed?
getnormality 10mo ago
What you're communicating here, perhaps unintentionally, is that what matters is not results, but blame. If the doctor said what to do but the patient didn't do it, all that matters is the patient is to blame. You've communicated that by ignoring or dismissing the question of whether better outcomes are possible through other means than demanding that everyone follow doctors' orders and blaming them if they don't. "Who cares if better outcomes are possible, so long as blame is in the right place"? Is that how we want to approach this?
- recursive 10mo ago
  It's hard to help someone that doesn't want to be helped.
  - getnormality 10mo ago
    Struggling to change is different from not wanting to change. People seem to have trouble with basic distinctions like this when they're heavy into moralizing failure to change.
    - wjnc 10mo ago
      Profound point. My mother struggled with alcoholism and ultimately succumbed to that disease. In philosophy of mind they use “akrasia” and “akratic thinking” for acting against ones better judgement. It helped me somewhat getting to understand what my mother was going through at that time. She wanted to change, tried a many multiple of times and it failed. Fault, guilt, blame are useless concepts to use on the Other. And only in moderation should they be applied to the Self. There deep disconnects between what we think, know and do.
    - Terr_ 10mo ago
      I find it helps to explicitly abandon the expectation that each person has a unitary and consistent will. Bob the gambler wants to quit and wants to wager, sometimes sequentially and sometimes simultaneously. The question isn't whether the whole Bob "means it", but which version of Bob we want to ally-with to war against the other, and what conditions or limitations we put on that assistance.
btilly 10mo ago
If my health is my responsibility, then shouldn't the treatment that I receive be to the standard that I request? In 2015, https://pubmed.ncbi.nlm.nih.gov/26551272/ https://pubmed.ncbi.nlm.nih.gov/26551272/ showed that medicating all of the way to normal works out better than medicating down to stage 1 hypertension, then insisting on diet and exercise. And yet my request in 2018 to be medicated down to normal blood pressure was refused, because the professional guidelines followed by the experts was to only medicate down to stage 1 hypertension, then get the patient to engage with diet and exercise. The expert standard of care was literally the opposite of what research had shown that they should do. I agree that experts should not be accountable for my laziness. But can you agree that experts should be accountable for following standard of care guidelines that are in direct conflict with medical research? And (as in my case) refusing the patient's request to be treated in a way that is consistent with what medical research says is optimal?
- mrlongroots 10mo ago
  Maybe 80-90% of people should take doctors at face value, but it is easy and only getting easier to at least access the knowledge to better advocate for your own healthcare (thanks to LLMs), with better outcomes. Of course, this requires doctors that respect your ability to provide useful inputs, which in your case did not happen. My advice would be to "shop around" for doctors, establish a relationship where you demonstrate openness to what they say, try not to step on their toes unnecessarily, but also provide your own data and arguments. Some of the most "life-changing" interventions in terms of my own healthcare have been due to my own initiative and stubbornness, but I have doctors who humor me and respect my inputs. Credentials/vibes help here I think: in my case "the PhD student from the brand name school across the street who shows up with plots and regressions" is probably a soft signal that indicates that I mean business.
- gropo 10mo ago
  You should have bought some illegal street diet and exercise or cholesterol meds or whatever.
- ac29 10mo ago
  > In 2015, https://pubmed.ncbi.nlm.nih.gov/26551272/ https://pubmed.ncbi.nlm.nih.gov/26551272/ showed that medicating all of the way to normal works out better than medicating down to stage 1 hypertension Thanks for posting this. While I would generally advise a healthy dose of skepticism for any individual study, this one was very large and seems to be both well designed and executed. While there was a (statistically) significant increase in side effects with more intensive treatments, only about 1% more patients had adverse effects versus the standard treatment group, which seems like a very reasonable risk given the improved outcomes. I've been trying to get my blood pressure under control recently and was thinking getting down to 12x/8x was good enough, but this has me rethinking that.

kelseyfrog 10mo ago

What if you have an intrinsically lower ability to perform temporal discounting?

nradov 10mo ago
Is that really something intrinsic and fixed or can you improve it over time with deliberate effort?
- kelseyfrog 10mo ago
  Open to evidence either way. I haven't seen people improve it even with what seems to be terrible negative consequences associated with poor temporal discounting ability, but I'd love to read differing perspectives.
  - btilly 10mo ago
    Research on heritability have found that the amount of temporal discounting we do is moderately heritable. With twin studies ranging from 30-60% of our natural variability explained by genes. This strongly suggests that genetics definitely slips a thumb on the scale, but ultimately we are able to also impact our personal behavior. More importantly, research such as https://pubmed.ncbi.nlm.nih.gov/31270766/ https://pubmed.ncbi.nlm.nih.gov/31270766/ shows that there are techniques (such as mindfulness practices) that have been demonstrated to improve our abilities in practice. I have personally seen these have an impact. Of course if you have a condition such as severe ADHD, you might not be able to reach the same level as is possible for someone with good genetics. But you still have the ability to move the needle. If you have a condition such as traumatic brain injury, even your ability to move the needle may be lacking. But most of us should be able to make a positive change.
    - Filligree 10mo ago
      > This strongly suggests that genetics definitely slips a thumb on the scale, but ultimately we are able to also impact our personal behavior. If it's 30-60% heritable, that leaves 70-40% to split between personal decisions and environment. It does not guarantee that personal decisions matter much at all...
      - btilly 10mo ago
        That is why I said "strongly suggests" instead of "guarantees". And then further followed up with a link to research showing that it is, in fact, possible to change. With advice on how to change it.
        kelseyfrog 10mo ago
        What would be the upper bound of the effect of heritability where responsibility is no longer assumed?

getnormality 10mo ago

What you're communicating here, perhaps unintentionally, is that what matters is not results, but blame. If the doctor said what to do but the patient didn't do it, all that matters is the patient is to blame. You've communicated that by ignoring or dismissing the question of whether better outcomes are possible through other means than demanding that everyone follow doctors' orders and blaming them if they don't. "Who cares if better outcomes are possible, so long as blame is in the right place"? Is that how we want to approach this?

recursive 10mo ago
It's hard to help someone that doesn't want to be helped.
- getnormality 10mo ago
  Struggling to change is different from not wanting to change. People seem to have trouble with basic distinctions like this when they're heavy into moralizing failure to change.
  - wjnc 10mo ago
    Profound point. My mother struggled with alcoholism and ultimately succumbed to that disease. In philosophy of mind they use “akrasia” and “akratic thinking” for acting against ones better judgement. It helped me somewhat getting to understand what my mother was going through at that time. She wanted to change, tried a many multiple of times and it failed. Fault, guilt, blame are useless concepts to use on the Other. And only in moderation should they be applied to the Self. There deep disconnects between what we think, know and do.
  - Terr_ 10mo ago
    I find it helps to explicitly abandon the expectation that each person has a unitary and consistent will. Bob the gambler wants to quit and wants to wager, sometimes sequentially and sometimes simultaneously. The question isn't whether the whole Bob "means it", but which version of Bob we want to ally-with to war against the other, and what conditions or limitations we put on that assistance.

btilly 10mo ago

If my health is my responsibility, then shouldn't the treatment that I receive be to the standard that I request? In 2015, https://pubmed.ncbi.nlm.nih.gov/26551272/ https://pubmed.ncbi.nlm.nih.gov/26551272/ showed that medicating all of the way to normal works out better than medicating down to stage 1 hypertension, then insisting on diet and exercise. And yet my request in 2018 to be medicated down to normal blood pressure was refused, because the professional guidelines followed by the experts was to only medicate down to stage 1 hypertension, then get the patient to engage with diet and exercise. The expert standard of care was literally the opposite of what research had shown that they should do. I agree that experts should not be accountable for my laziness. But can you agree that experts should be accountable for following standard of care guidelines that are in direct conflict with medical research? And (as in my case) refusing the patient's request to be treated in a way that is consistent with what medical research says is optimal?

mrlongroots 10mo ago
Maybe 80-90% of people should take doctors at face value, but it is easy and only getting easier to at least access the knowledge to better advocate for your own healthcare (thanks to LLMs), with better outcomes. Of course, this requires doctors that respect your ability to provide useful inputs, which in your case did not happen. My advice would be to "shop around" for doctors, establish a relationship where you demonstrate openness to what they say, try not to step on their toes unnecessarily, but also provide your own data and arguments. Some of the most "life-changing" interventions in terms of my own healthcare have been due to my own initiative and stubbornness, but I have doctors who humor me and respect my inputs. Credentials/vibes help here I think: in my case "the PhD student from the brand name school across the street who shows up with plots and regressions" is probably a soft signal that indicates that I mean business.
gropo 10mo ago
You should have bought some illegal street diet and exercise or cholesterol meds or whatever.
ac29 10mo ago
> In 2015, https://pubmed.ncbi.nlm.nih.gov/26551272/ https://pubmed.ncbi.nlm.nih.gov/26551272/ showed that medicating all of the way to normal works out better than medicating down to stage 1 hypertension Thanks for posting this. While I would generally advise a healthy dose of skepticism for any individual study, this one was very large and seems to be both well designed and executed. While there was a (statistically) significant increase in side effects with more intensive treatments, only about 1% more patients had adverse effects versus the standard treatment group, which seems like a very reasonable risk given the improved outcomes. I've been trying to get my blood pressure under control recently and was thinking getting down to 12x/8x was good enough, but this has me rethinking that.