> What UK Biobank is revealing, scan by scan and layer by layer, is that disease doesn’t arrive out of nowhere. It accumulates quietly, shaped by genes, environment, and habits.
I think that is already known for a while. It's called functional reserve, and was a big topic in HIV patients (and then again for SARS-CoV-2).
Like people with higher cognitive capabilities will be protected by those a bit longer before onset of HIV-associated neurocognitive disorder (or even dementia).
Same for kidneys: They have a functional reserve that you are born with gets used up during life, until it is gone. Acute kidney disease treatment is aimed at preserving whatever little function is left.
I am a 61 year old guy. I've never been overweight, never smoked, I've never been drunk and drink only infrequently, and have been fitter than average ... sometimes very fit. A few years ago I decided to make an undirected kidney donation. I thought I'd be a slam dunk. Everything was great, except my eGFR (estimate granular filtration rate) was 73, and for many people it is more like 110, which disqualified me, as after donating my number would get cut in half, putting me at some risk.
So I pulled up blood work results going back 15 years that I had records for and found that 73 was my high score! It typically was mid 60s, with a low of 61. I have no idea why it is so low. Anyway, this is the reason I'm relating this story. It seems odd that my kidney function has gone up. It wasn't just a fluke -- I've had bloodwork done at least five times since then and I'm always in the mid 70s now.
eGFR is an indirect measurement of kidney function. It can be slightly lower in some people with normal kidney function for various reasons.
There are additional kidney function tests that would be used for a more complete picture of kidney function if it was suspected that you had a kidney condition. There are more direct GFR tests, minus the ‘e’ prefix which means estimated. However, a better blood test that is more accessible would be Cystatin C. Worth getting one of those as a baseline at some point.
In the content of donation, though, it’s not worth risking it. It’s best to play it safe. If you happened to have been inspired by the kidney donation story and blog that circulated in rationalist communities, it’s also worth noting that it was not a great source of information about the relative risks of the procedure, despite being presented as comprehensive and well researched.
The first time I tried a community donation, they didn't do that. But a couple years later one of my brothers needed a kidney, so I got tested again. Again, my eGFR was low 70s, and so they did the Cystatin C test. I scored 1.00 (ref range 0.52-1.23mg/mL) which they mapped to an eGFR of 78, and I was rejected.
None of my other siblings were a good enough match, so one of my sisters donated hers (IIRC, her eGFR was low 90s) as part of a chain. That was more than two years ago and my sister is feeling fine. My brother is no longer on dialysis, though he didn't experience one of those feel-good stories where he got his kidney and he suddenly felt amazing, unfortunately.
[EDIT] I forgot to address the last part of your comment. A few years back an email acquaintance of many years mentioned that he is on dialysis. Although he is in Germany, I said if he can't find a donor, I'd be willing to fly there to donate directly if I matched or to be part of a chain. He is in Germany and his response surprised me: thank you very much, but he said living donations were not allowed (at least from non-relatives). Maybe things have changed, this was back in 2016.
"But there are some reasons that make this solution unlikely. At first I am very sure that this kind of donor isn't allowed in germany. We have strong ethic rules regarding donation by living people because of the bad experiences with commercial organ deals."
Still the idea sat with me. I have donated many gallons of blood and 25 years ago signed up for "be the match" marrow donation that never came to anything, though every few years they send a confirmation letter to make sure my address is still valid. It most charity donations I can write a check and there is a diffuse sense that maybe I incrementally did some good, but giving a kidney has a high probability to make one person's life dramatically better. So that was my motivation.
I suspect that my kidney function was negatively affected by a reaction to the contrast used in some medical imaging I had a few years ago. Unfortunately, lack of access to healthcare means I've never been able confirm it. I just know that, before that episode, I was noted for my ability to hold my alcohol; after, no more, and I've had to be careful about taking certain kinds of OTC medication because I can feel it affecting me similarly.
Wouldn't be surprised if there was some source of hidden damage like that.
I previously looked at eGFR numbers and they seem very ballpark-ish and prone to fluctuation, as their name implies. My understanding is that they are used to detect acute cases, rather than to give a real measurement of your kidneys if you’re well.
I’m working with doctors at the moment in a similar area. eGFR is well-known to decline at approx 1 point per year after age 30. You’re fine.
Here’s just one source:
“After the age of 30 years, glomerular filtration rate (GFR) progressively declines at an average rate of 8 mL/min/1.73 m² per decade.4”
It would be interesting what this functional reserve is, right? The microbiome perhaps, or intracellular minerals? Some other thing we haven’t even identified?
> It would be interesting what this functional reserve is, right?
It is most likely not a single thing.
Looking for "the functional reserve" is like looking for which part of an airplane is the "multiple redundancy". Or which line of code is the "fault tolerance" in google's code base. It is not a single part, it is all the parts working together.
Just looking at the kidney example (which is not the only kind of function we can describe having functional reserve.) functional reserve is that there are two kidneys, and each kidney have multiple renal pyramids, and if this or that part of the kidney functions worse other parts compensate and will work overtime.
Depletion of functional reserve is not something literally running out (like a fuel tank running empty), it is more like a marauding gang shooting computers in a cloud data center. Sure initially all works as it used to, because the system identifies the damaged components and routes the processing to other ones. But if they keep it up they will damage enough that the data center will keel over and can't do what it could do before.
(No, I'm not saying that a human body is literally a data center, or literally an airplane. What I'm saying is that all three shares the common theme that some process is maintained in the presence of faults.)
In case of kidneys, my understanding is that only a certain subset of glomerular cells are actively filtrating blood at any given point. The other cells form the functional reserve, and start to become active once the other cells age out, or are disrupted due to an event (like poisoning, such as mycotoxin damage from eating moldy food). Once the functional reserve is exhausted however, no new cells can become active and you are left with whatever dwindling GFR you have, until you get a transplant.
With the vascular system you have example arterial elasticity which is an important measure of vascular health. When your blood vessels become less elastic it does not immediately cause symptoms, but it increases the risk of heart disease and stroke. This is also why periodontitis and gum disease is a predictor for vascular diseases: Bacteria enter the bloodstream through inflamed oral mucosa and form plaques along the blood vessels.
>"This is also why periodontitis and gum disease is a predictor for vascular diseases: Bacteria enter the bloodstream through inflamed oral mucosa and form plaques along the blood vessels."
And yet in the year 2025 dental care is globally treated as seperate from other healthcare, a strange historical artifact that clings on.
Story from the US: had an awful tooth infection (from a known dead tooth) that I tried to ride out, half my face was swollen up, even my eye looked half shut. Well after a day of this I couldn't take the pain. Called my doctor "we don't pull teeth, you have to call a dentist." So I called a dozen dentist and was told either "we aren't taking new patients" or "we can't get you in for 6 months".
I ended up just driving to a dentist and saying "look at my fucking face! Pull this fucking tooth out!" Finally a dentist was able to spare 30 seconds to yank it. Bill was something like $750.
I got a doctor to pull an internal tooth that had formed a cyst around it, a maxillofacial surgeon.
The dentist quoted $1300 but said insurance wouldn’t cover it, it’d be out of pocket. The surgeon did it (I was awake with local anesthesia) for $300 but insurance paid an additional $4000.
Before all this, A PE owned dentist office (the one that didn’t have the six month wait) had told me two years before that the pain I was experiencing was because I had periodontal disease and that I just needed to get a periodontal cleaning (which cost $750 and didn’t help at all, also conveniently not done by a dentist but a dental hygienist). This turned out to be very dangerous because the cyst was pushing and wearing away at my nose bone, and if I’d waited any longer my nose may have sunk into my face.
It’s definitely maddening the hoops one has to go through to get proper dental care in the US.
Regardless of the financial and administrative issues, dentistry is still far more an art than a science. Go to 10 different dentists for any serious condition and you'll likely receive 10 different treatment plans. In most cases they're making good faith recommendations but there's a huge amount of subjectivity and personal bias involved.
Physicians have recently started embracing evidence-based medicine with documented best practice treatment guidelines so hopefully a similar cultural change will come to dentistry in time.
And you couldn’t just board a plane to Mexico or anywhere down south and get the job done for half the price including said flight? People keep complaining but don’t realize that no place is perfect in this world.
Some places are significantly worse than all others in the same wealth class though.
Somebody further up quoted such insane numbers - $750 for a proper periodontal cleaning? That's usually ~50 to 80€ in Germany. For a _full_ self payer.
Those prices and the health system creating them are utter insanity.
Why though? You demand a service that you can get cheaper abroad. You can’t change the health system but you can travel to a socially developed country that hasn’t yet fallen victim of corruption
Functional reserve means you are completely well but the start of the disease is coming closer as the former is depleting.
Another case is when disease starts subtly and slowly _with_ initial symptoms that are otherwise not debilitating. Eg Alzheimer's starting decades ago by being forgetful.
I have no idea which one the post is reffering to.
In biomed sciences we rarely refer to the huge amount of resiliency of living organisms. They are so robust, stable and self healing that it would need a fleet of human made machines to cover the basic difficulties.
It’s interesting they make no mention of trying to understand the body’s ability to self-defend and self-heal. That is, it’s possible to get X (e.g., cancer) and the immune system wins the fight (before it’s even detected).
In theory it’s possible the best early treatment is no treatment at all; that there might be such a thing as too-early detection.
This is a well known phenomenon in medicine. It is always carefully considered when making public health decisions regarding e.g. screening programs and intervention best practices.
For example, a PSA test is useful to detect cancer of the prostate, if a male patient has urination problems. But doing general screening for high PSA values in middle aged men is not considered a good idea, because there are too many false positives and it would likely lead to many unnecessary invasive interventions.
It's also why "early detection leads to longer survival" claims in cancer patients has to be treated with quite some care.
Two people develop a fatal cancer at T0. One is diagnosed at T1, the other at T2, both die at T3.
It looks like the first person survived longer with cancer than the second, but they didn't: the interventions had no effect, it's just a statistical artifact.
This is by no means always the case - earlier detected cancer is more treatable - but it still needs to be controlled for.
And of course there’s always a riff on the placebo effect even when the intervention isn’t sugar pills. That is, success gets attributed to the approved intervention, but at the nuts & bolts level it had little or no effect. The body cured itself but the treatment gets the credit.
Have a friend working as urology surgeon - basically all men get prostate cancer, its just a function of time (unless you die young). Most of them is benign, or cause few issues and are often let alone.
If you would run scans on all males above say 45 there would be endless stream of operations happening, all of which would lower quality of life for everybody, and sometimes shorten their lives a bit or a bit more. Any public healthcare system would be brought to the edge of collapse by just this since surgeries are supremely expensive everywhere, that's not just US invention.
Yo, personal experience. I'll be undergoing a second test soon, as a precaution, but the first showed me at "acceptable risk level but cancer is still present".
My urologist carefully assured me ahead of the test that I "do have cancer, as all men my age do", and clarified the difference between "have" and "might well die of".
True for many things. You can have the HIV virus in your blood, and successfully fight it off, preventing infection. Your immune system will remember, and thereafter show markers that are indicate "possibly infected" - but you will not be CURRENTLY infected.
Number of studies are meaningless by itself, and an intellectually rigorous scientist wouldn't use that as a metric. We've known for decades that any serious infection can have long lasting effects for some patients. There's nothing special about SARS-CoV-2.
What's unsupported? What I stated is common knowledge in the medical community. Anyone unaware of this hasn't been paying attention for the past 40 years.
usually (at least since Ol' Russel) there's no real need to prove that space is quite rare when it comes to teapots
so far there was absolutely no scientifically "woah" thing about SARS-CoV-2, it fits "neatly" into an acute respiratory virus hole (we know of a lot of coronaviruses and influenzaviruses), we even had a lab set up to research zoonotic viruses ... instead of telling idiots to stop running the patient zero lottery on that fucking market.
To me, this is the strongest argument for a centralised health system, such as the UK NHS.
When you have one organisation responsible for health as a whole rather than just treatment, you can make better decisions. The usual example I give is that it's cheaper to give out the contraceptive pill than deal with pregnancies, but the same thinking applies to broader disease and health.
This holds true for many things. It’s easier to stay in shape and maintain a healthy weight than it is to recover from getting out of shape or overweight. The longer someone spends out of shape or overweight, the harder it becomes to escape the cycle. There’s no better time to start than now.
As for preventative medical treatment: This one is a difficult topic. There’s a popular misconception that getting a lot of different blood tests and imaging scans is a good idea to identify conditions early, but most people don’t understand that these tests (including imagine) are prone to a lot of false positives. Excessive testing has been shown time and time again to lead to unnecessary interventions, leading to worse outcomes on average. A number of previously routine medical tests are now not recommended until later age or until other symptoms appear because routine testing was producing too many unnecessary interventions, producing a net negative benefit.
It’s a hard concept to wrap our heads around when we’re so attached to the idea that more testing means better information. It’s a huge problem in the alternative medicine community where podcast grifters will encourage people to get various tests like organic acid tests or various “levels” testing, then prescribe complex treatment programs with dozens of supplements. The people chasing these tests then throw themselves far out of balance with excess supplements while sinking thousands of dollars into repeat testing
He’s better than most, in that he puts disclaimers on things that aren’t rigorously proven. That said, he talks a lot in that book about things that aren’t actionable, even if they were rigorously proven - such as the coronary calcium scan.
If you get a high score on that test, what are you going to do? Eat better, lose weight and exercise. So skip the test and just do that instead.
A high coronary calcium score factors into the decision about whether to apply more aggressive pharmacologic interventions. Those have risks and side effects so unlike the lifestyle factors you mentioned they aren't appropriate for everyone.
I didn’t say the tests have no use, but trust me: if you’re otherwise well and don’t have symptoms, nobody is making aggressive pharmacological interventions based on the calcium scan.
I am aware that is the current standard clinical practice. Dr. Attia's argument is that we could cut death rates in such patients by starting aggressive pharmacological intervention much earlier in the disease progression. From a physiological perspective that makes some sense, although there haven't been any studies to show whether that cuts all-cause mortality.
Yeah, I get it. I read the book. I think his argument is wrong.
The point I am making is that for the “worried well” (aka “longevity enthusiasts”) you aren’t going to do anything differently based on the result. It's largely a waste of money for the sake of people who want to feel like they're Doing Something (tm).
If you really think about it, you're talking about the extremely marginal case where a) the patient had no prior symptom of an illness; b) the calcium scan is so bad that you'd put the person on a medication to manage a hypothetical future problem; and c) you weren't going to do it anyway based on other tests.
The three things together are vanishingly unlikely. The better argument, mayyyyybe, is that maybe the test is one of those things that motivates a certain type of person (again, the "longevity enthusiast") to do something they otherwise wouldn't do, but that kind of person seems like...the kind of person who wants to do things. So what is the goal?
See also: Vo2max, DEXA scans, and most of the other tests mentioned in the book. Great for nerding out on metrics, but...you aren't going to do anything you weren't already doing if you're the type of person to be getting the test in the first place.
I'm not sure I disagree with your general argument but it's worth noting that aerobic sport forums are replete with examples of people who were considered extremely fit, right up until the moment they were in an ambulance due to an undetected issue that could have been anticipated with a scan.
Testing in general gets out of control but we as a medical community also have a problem I think of not identifying certain problems until it's too late. Some preventative testing could be done more, some less.
> aerobic sport forums are replete with examples of people who were considered extremely fit, right up until the moment they were in an ambulance due to an undetected issue that could have been anticipated with a scan.
The primary lesson from this is to ignore stories you read in aerobic sport forums.
This kind of (usually apocryphal) tale is an example of the turtles, rabbits and birds allegory [1]. Testing is like a fence around a farmer's field -- it may catch rabbits, but it's useless for turtles (who will be caught, but move too slowly to matter) and birds (since you can't catch them with a fence). The "super fit person who randomly drops dead" is the very definition of a "bird" -- even if you assume the test is sensitive enough to catch the rare thing before it happens (usually not), you have the dual problems of timing (i.e. are you going to test daily?) and false positives for whatever rate of testing you do choose.
In real life, almost nobody has an illness that moves so quickly that it requires special screening, but so slowly that it can be stopped, or at least, that has a positive risk/reward ratio for the testing required to detect it. It's the fundamental problem of medical testing, and even most of the recommended tests have a very small expected benefit.
This sounds like an example of a fault in how to take action based on results vice a fault in getting too much data. Perhaps the conclusion you state about the better approach being to forego tests is true. For example, if emotional and legal factors prevent patients and providers from acting rationally here. Optimistically, we can do better.
The ACA made this standard. It’s been like this for a long time.
When we were hiring a lot of people out of college, I spent way more time than I expected teaching them about how healthcare works and how to find their own information. We found that a lot of them would build their idea about how health insurance works from years of reading Reddit posts: They thought visiting the doctor was always going to be a $1000 bill or a single accident was going to medically bankrupt them, because those are the stories they saw on Reddit. I would explain things like the free annual physical and many just wouldn’t believe me. It’s really tough to cut through the confusion out there.
I would argue this has severe caveats. I knew a girl in college who was billed over 400$ to test for PCOS, which is one of those diseases that 1) affects just women 2) is underdiagnosed but has severe systemic effects like facial hair growth, diabetes and obesity...
But if they do anything other than extremely basic tests, like blood pressure at the "free annual physical" you will be billed, ridiculous amounts you have no way of knowing in advance.
During these "free" preventative checkups, if your doctor asks if you have any other medical issues to discuss, having an answer other than "no" can change the visit from a free preventative visit into a standard non-free office visit.
These are items you receive along with your insurance.
They are not insurable events and they are not “covered” like an insurable event.
Predictable, regularly occurring events cannot be covered by insurance by definition. You can’t adjust it, you can’t assemble a risk pool, etc.
We use the word “insurance” to mean “nice things that I like” but I think we’d have more enthusiasm for socialized medicine if we knew how much of “insurance” was nothing of the sort.
That's not quite correct. Many patients forgo preventive screening procedures even when they're free (to the patient). Medical insurer actuaries are aware of this and price policies accordingly.
So exercise, eating healthy, fasting, brushing/flossing teeth, consistent sleep schedule, daily sun exposure, good relationships, and stress management all depend on a health insurance plan?
You certainly need to "pay" for those yourself, insurance or not (I guess that's probably your point). Going for a run doesn't go on any billing schedule or contribute to GDP, it's all self-funded from your own personal resources of time and energy.
Sam Vimes 'Boots' Theory of Socio-Economic Unfairness
>The reason that the rich were so rich, Vimes reasoned, was because they managed to spend less money.
>Take boots, for example. He earned thirty-eight dollars a month plus allowances. A really good pair of leather boots cost fifty dollars. But an affordable pair of boots, which were sort of OK for a season or two and then leaked like hell when the cardboard gave out, cost about ten dollars. Those were the kind of boots Vimes always bought, and wore until the soles were so thin that he could tell where he was in Ankh-Morpork on a foggy night by the feel of the cobbles.
>But the thing was that good boots lasted for years and years. A man who could afford fifty dollars had a pair of boots that’d still be keeping his feet dry in ten years’ time, while the poor man who could only afford cheap boots would have spent a hundred dollars on boots in the same time and would still have wet feet.
What the heck does the price of boots have to do with any of this? All footwear eventually wears out, and if you're talking about athletic shoes the more expensive ones are often less durable (they can improve performance a little).
Sheesh, it's an analogy. If you can spend afford to spend a little more money now (on preventative care) it can help being ruined later.
Fpr example, paying for a diabetic's insulin/blood sugar testing vs. amputating a limb, with the bonus of a working individual now likely ending up on disability
This assertion is extremely privileged and I heartily disagree with it
Even if we're just going to say "diet and exercise" it is a privilege to not live in a food desert and have sidewalks. If we are to mention the free yearly physical it's a privilege to have a doctor nearby and be able to get the time off work
So no, I don't think I am the one missing the point
I would assert that nearly anyone can find a place to walk, or climb stairs, even if it's while they eat or work. Healthy food may be harder to come by for some, either because of expense or lack of availability. But again, fasting is a great protection against so many modern eating related problems, like type 2 diabetes and heart disease. The point is that nearly everyone can improve their preventative standing, even the less fortunate.
It baffles me that an offhand example not applying 100% of the time is used to dismiss the broader point as invalid and/or ridiculous. Though I now notice that even the original point with shoes was treated the same way: "in this single pedantic example with running shoes the situation doesn't hold, therefore I reject the entire idea as invalid"
No one is saying "all medical issues are more expensive if you're poor" or "it's impossible to be healthier if you're poor." All of that is fantastic, but it in no way disproves the catch-22 that it isoften more expensive to be poor, in many ways, including medicine. Particularly in the US with its clusterfuck confusopoly of copayments, coinsurance, deductibles, and so on, so the mere act of going to any doctor is a gamble
I think you may be missing the point: preventative treatment is typically much less expensive, for instance behaviour and dietary changes do not require drugs at all and avoiding some conditions can be helped by drugs which have long since come off patents.
But even with your point, all insurance companies I've ever had cover with in the UK have had some element of support for preventing illness (periodic assessments, support material and trackers) and, at least with people covered under company schemes, they clearly have an incentive to offer more if you are at risk of becoming affected by a preventable illness.
And yet not a single doctor in the United States will permit you to care about early signals, preventative medicine, or routine deep dive bloodwork, in order to stave off those diseases. Anyone who's on top of this is paying fully out of pocket for individual tests, screenings, medicines. Manageable for some, unattainable for most.
My ex girlfriend was a doctor and we talked about this once. The gist of it that I got was that excessive early tests have a lot of risk factors that come along with them, because tests themselves being harmful (CT scans cause something like 5% of all cancers), and because false positives lead to unnecessary treatments, surgeries, medications, etc which can cause real harm. Basically, if the expected harm from the proactive testing is greater than the expected harm it would mitigate, you don't do it.
Huh? Plenty of doctors out there cater to the "worried well" and will order any blood work you want or spend a lot of time with you on preventive care. But of course most health insurance plans won't pay for that. In most cases it's a total waste and doesn't significantly improve patient outcomes.
> I wonder if, in parts, the effects of the so called "mild covid" and "long covid" […] are nothing but psychological. There seems to be quite a cloud of uncertainty around the vast array of reported possible symptoms.
Uncertainty does not imply psychological. It’s like saying ”our users report a lot of different bugs that we can’t reproduce, they must be all imagined”, except the body is OOMs more complex than even the most carelessly developed enterprise application. There is uncertainty in every part of medicine, all the time. That’s why it takes time and is difficult (often too difficult) to root cause everything that happens.
If you have a novel pathogen with neurological effects (see olfactory impacts - people literally losing their sense of smell), it would be my first guess of mysterious symptoms rather than.. checks notes the war in Ukraine? Honestly I’m not sure how to connect your first sentence to the next.
Doctors have a habit of blowing off unknowns as "it's all in your head" (as if that somehow makes it out of their jurisdiction). There used to be a diagnosis of "female hysteria." After the invention of the MRI doctors were able to see the physical damage caused by the disease and they renamed it multiple sclerosis.
Absolutely. Academics in particular are hyper averse to saying ”we don’t know yet”. They’d much rather establish an unfalsifiable narrative which can mislead and cause damage for decades, until it can be properly reversed. Archeology is perhaps the best field at turning random early speculations into entrenched dogma. But it happens in all fields.
Me neither, but there is a theory that Putin grew increasingly disconnected from reality when isolating himself from a potential Covid infection, and that this might have contributed to his decision to go all in.
Should this be the truth, there would be an actual connection between the virus and the war.
No, but loss of smell is indeed a (very well documented) ”mystery effect” of neurological damage, so it’s not a regular ”flu” by any means. It’s closest relative is SARS1 and that’s also vastly different from flu. There are always psychosomatic or ”mystery” effects even with something clear cut like breaking a bone. Noisy data is the first thing you have to accept dealing with these complex systems. If you see a giant cloud of black smoke, it’s a good idea to assume there’s fire and invalidate it later, should it turn out to be something else.
As someone who has seen multiple people close to me, including my wife, struggle with long covid, I can tell you the answer is simply no. Anecdotal, yes, but this shouldn't be an argument.
We are several years in now. These statements are actually pretty hurtful for people who have been through a lot. It's like saying you could beat cancer if you only wanted to, or if you didn't think all those negatives thoughts, you wouldn't be so ill now.
Not only is it suggesting that this misery is in some way 'your own fault', but it also implies that it isn't real, or serious, at least not in the same way other diseases are.
And yes, psychological problems are real too, indeed. But it is not the same. The origin narrative around a disease does in fact matter for people trying to cope with it, and how others see you, for insurance, for politics and medical care. Please be more respectful about it.
This sounds like "you shouldn't suggest that long COVID is psychosomatic because doing so makes me or others feel bad" to me. Which part of what you're saying am I misunderstanding?
It's insane how some people seek to blame a few pieces of RNA rather than the virus eating your arteries to reproduce. Medicine should of course be checked for safety but we're way past that. Of course people getting sick from vaccines deserve recognition and help but long covid patients just as much.
There is growing evidence that long covid is actually CIRS (toxic mold usually from living in water damaged buildings) triggered by covid. Only 25% of people have the genes for CIRS, but then it takes exposure and a immune shock to get your systems out of whack (lyme, covid, etc.) The vast array of symptoms come from the mycotoxins becoming present in every part of your body and affecting all your systems, especially your gut biome.
Source: I have it and am on the long road to recovery. Before I moved out of my house this spring, I could have days with several migraine level headaches and where my vision was so messed up I could barely see 10 feet. I don't have bad days like that anymore since I moved to my sisters. (I have lots of other symptoms too, this is just a sample.)
I would reframe this and ask whether psychiatrists should be spending a lot more time understanding the patient’s immune system history and other factors. Brain fogs and other symptoms are understood by many patients to be modulated by other health processes, and physical fitness is considered a treatment by some practitioners, yet psychiatry is recovering from a legacy of medical dogma in which the brain and the immune system are completely separate, due to the idea of the blood-brain barrier. I would recommend to look more comprehensively at patients’ clinically relevant information, which I believe would produce deeper, systems-level understanding and treatments in more than enough cases to be worthwhile.
The very fact that you are hypothesizing about my intentions is, in fact, an act of asking questions on its own.
You are worried that I might be suggesting some form of conspiracy, but these worries are all in your head.
There is uncertainty about the effects post acquiring a covid flu. If there weren't, the article wouldn't mention the efforts in trying to figure out what these symptoms and causes are. I'm sure they are also "asking questions".
Instead of criticizing me, perhaps you could try to put your guard down and try to investigate if other more reputable sources asked the same questions as I did:
I haven't read those papers, and I'm not qualified to discuss them in depth. However, they indicate that my assessment of the situation is not as outlandish as you suggest.
> You are worried that I might be suggesting some form of conspiracy, but these worries are all in your head.
Because you communicate them. Combining unrelated information without any reasoning, backup, or even a link is a bizarre style. You go from wars, AI and lack of information about long covid to ignoring all physical markers.
And that doesn't take away that you argue in the same style as the people who argue that illnesses can be overcome mentally. Cancer originates between your ears; if you get it, it's your fault. Suggesting long covid is the same, places you square in that group.
> Instead of criticizing me, perhaps you could try to put your guard down and try to investigate if other more reputable sources asked the same questions as I did:
Fortunately, I am qualified for psych research, and if you would just open them, you'd see that those papers do not suggest a psychological cause for long covid. People are anxious, health staff is under pressure, those with long covid need psychological support, because it's hard to cope with, there's neurological damage, and there's some speculation about long-term effects on the population. There are obviously way too many papers to even scan.
You also did a wrong search, because "effects" are not what you're suggesting.
> Combining unrelated information without any reasoning
I estabilished a loose correlation that does not imply cause (they all happened roughly at the same time).
It seems you assumed what I was thinking by the writing style. A common mistake.
> Fortunately, I am qualified for psych research
Congratulations.
> People are anxious, health staff is under pressure, those with long covid need psychological support
Can you elaborate on the reasons why people are anxious and health staff is under pressure? I agree with it, but I want to understand why you think that is.
For most people Ukraine and Gaza are just very remote worries, unless of course they're related to people there or close to the conflicts.
AI might be real stressor for those losing their job, or bad for those using it as a virtual love interest or therapist, but it's mostly a remote worry for most too.
Of the three, only the covid flu could have real mild/long effects. But if you want to seek other psychological factors, iflation, the job market, the loneliness epidemic, and other such things are much more likely ones...
>>There seems to be quite a cloud of uncertainty around the vast array of reported possible symptoms.
Just because it is a "cloud of uncertainty" to you does not mean it is to people actually studying the phenomenon.
Multiple studies are already identifying scores of biomarkers correlated with Long COVID, e.g., "Identified from 28 studies and representing six biological classifications, 113 biomarkers were significantly associated with long COVID"[0]. The same type of phenomenon happened with Chronic Fatigue Syndrome, now identified as "Myalgic encephalomyelitis" where patients were long disregarded as simply having psychological problems, and the same with many auto-immune disorders. These can all be discovered with a sub-30second DDG search.
Yes, the democracies of the world are under assault from right-wing or authoritarian movements and this is dramatically increasing uncertainty, worry, and indeed harm for everyone. But before you start dismissing disease processes as caused by social psychologies and causing more harm to those already suffering, perhaps search for more concrete causes first.
It seems you misread my comment profoundly. I never dismissed any actual biological causes.
It's ok, lots of people do this mistake. A more critical look would notice that I was only questioning aspects of the phenomena that are currently unexplained. In the long run, your pick for how to respond would sound rushed and desperate.
>>I was only questioning aspects of the phenomena that are currently unexplained
Right. The "God In The Gaps". Again. The refuge of those who lack an actual explanation. If that is what you meant, you should have explicitly stated it instead of requiring everyone to take "A more critical look [to] notice"
As I said before, there IS definitely a phenomena as the free world is under attack. But trying to bootstrap that into something much larger doesn't cut it. You protest too much; you'd have been better off just taking the lesson by itself. We all make errors
"'God of the gaps' is a theological concept that emerged in the 19th century, and revolves around the idea that gaps in scientific understanding are regarded as indications of the existence of God."[0]
In this case, the analogy I'm making was to illustrate how you were trying to re-fit your original comment into the gaps in knowledge about the clusters of symptoms.
Unsolicited advice worth less than you paid for it: It was not an awful initial concept, but it was neither well thought-through nor well-presented. We all make mistakes like that, just posting an initial thought, but as you can see, that occasionally goes awry, and in those cases it's best to just take the L and move on. Be well
> It was not an awful initial concept, but it was neither well thought-through nor well-presented.
I am looking forward to discussing such matters with people that are less compelled to observe style before content.
I don't have the time or the luxury to wear fancy clothes, that's why I'm here on hacker news, which is supposed to be a place that does not require them.
Personally, I don't find it helpful to post paywalled content here, at least without a summary.
Other than that I'm here to for the kind of nerdy tech stuff that normally doesn't appear on NYT, Bloomberg etc which are designed to service adtech more than illuminate its consumers. I do consume their content, especially the latter but to me posting that stuff here feels like coming to a small downtown art gallery to discuss a prime time tv show like Big Brother or Friends reruns
> What UK Biobank is revealing, scan by scan and layer by layer, is that disease doesn’t arrive out of nowhere. It accumulates quietly, shaped by genes, environment, and habits.
I think that is already known for a while. It's called functional reserve, and was a big topic in HIV patients (and then again for SARS-CoV-2).
Like people with higher cognitive capabilities will be protected by those a bit longer before onset of HIV-associated neurocognitive disorder (or even dementia).
Same for kidneys: They have a functional reserve that you are born with gets used up during life, until it is gone. Acute kidney disease treatment is aimed at preserving whatever little function is left.
I am a 61 year old guy. I've never been overweight, never smoked, I've never been drunk and drink only infrequently, and have been fitter than average ... sometimes very fit. A few years ago I decided to make an undirected kidney donation. I thought I'd be a slam dunk. Everything was great, except my eGFR (estimate granular filtration rate) was 73, and for many people it is more like 110, which disqualified me, as after donating my number would get cut in half, putting me at some risk.
So I pulled up blood work results going back 15 years that I had records for and found that 73 was my high score! It typically was mid 60s, with a low of 61. I have no idea why it is so low. Anyway, this is the reason I'm relating this story. It seems odd that my kidney function has gone up. It wasn't just a fluke -- I've had bloodwork done at least five times since then and I'm always in the mid 70s now.
eGFR is an indirect measurement of kidney function. It can be slightly lower in some people with normal kidney function for various reasons.
There are additional kidney function tests that would be used for a more complete picture of kidney function if it was suspected that you had a kidney condition. There are more direct GFR tests, minus the ‘e’ prefix which means estimated. However, a better blood test that is more accessible would be Cystatin C. Worth getting one of those as a baseline at some point.
In the content of donation, though, it’s not worth risking it. It’s best to play it safe. If you happened to have been inspired by the kidney donation story and blog that circulated in rationalist communities, it’s also worth noting that it was not a great source of information about the relative risks of the procedure, despite being presented as comprehensive and well researched.
The first time I tried a community donation, they didn't do that. But a couple years later one of my brothers needed a kidney, so I got tested again. Again, my eGFR was low 70s, and so they did the Cystatin C test. I scored 1.00 (ref range 0.52-1.23mg/mL) which they mapped to an eGFR of 78, and I was rejected.
None of my other siblings were a good enough match, so one of my sisters donated hers (IIRC, her eGFR was low 90s) as part of a chain. That was more than two years ago and my sister is feeling fine. My brother is no longer on dialysis, though he didn't experience one of those feel-good stories where he got his kidney and he suddenly felt amazing, unfortunately.
[EDIT] I forgot to address the last part of your comment. A few years back an email acquaintance of many years mentioned that he is on dialysis. Although he is in Germany, I said if he can't find a donor, I'd be willing to fly there to donate directly if I matched or to be part of a chain. He is in Germany and his response surprised me: thank you very much, but he said living donations were not allowed (at least from non-relatives). Maybe things have changed, this was back in 2016.
"But there are some reasons that make this solution unlikely. At first I am very sure that this kind of donor isn't allowed in germany. We have strong ethic rules regarding donation by living people because of the bad experiences with commercial organ deals."
Still the idea sat with me. I have donated many gallons of blood and 25 years ago signed up for "be the match" marrow donation that never came to anything, though every few years they send a confirmation letter to make sure my address is still valid. It most charity donations I can write a check and there is a diffuse sense that maybe I incrementally did some good, but giving a kidney has a high probability to make one person's life dramatically better. So that was my motivation.
What did Scott leave out from the post(s)?
https://www.astralcodexten.com/p/my-left-kidney
https://www.astralcodexten.com/p/highlights-from-the-comment...
I suspect that my kidney function was negatively affected by a reaction to the contrast used in some medical imaging I had a few years ago. Unfortunately, lack of access to healthcare means I've never been able confirm it. I just know that, before that episode, I was noted for my ability to hold my alcohol; after, no more, and I've had to be careful about taking certain kinds of OTC medication because I can feel it affecting me similarly.
Wouldn't be surprised if there was some source of hidden damage like that.
I previously looked at eGFR numbers and they seem very ballpark-ish and prone to fluctuation, as their name implies. My understanding is that they are used to detect acute cases, rather than to give a real measurement of your kidneys if you’re well.
I’m working with doctors at the moment in a similar area. eGFR is well-known to decline at approx 1 point per year after age 30. You’re fine.
Here’s just one source: “After the age of 30 years, glomerular filtration rate (GFR) progressively declines at an average rate of 8 mL/min/1.73 m² per decade.4”
https://www.racgp.org.au/afp/2012/december/ckd-in-the-elderl...
Mine was low, but it's probably because I was taking creatine. Do you happen to take creatine?
It's inverse of how much is your blood creatinine level, and creatine increased that.
I am early 30s, and my eGFR was below 60 due to creatine (at least I think it was creatine).
Nope, no creatine.
Maybe you lost weight or changed some aspects of your diet after 50?
Your diet is less salty maybe?
Glomerular not granular
Thanks for the correction ... I should have looked that up instead of going by memory.
It would be interesting what this functional reserve is, right? The microbiome perhaps, or intracellular minerals? Some other thing we haven’t even identified?
> It would be interesting what this functional reserve is, right?
It is most likely not a single thing.
Looking for "the functional reserve" is like looking for which part of an airplane is the "multiple redundancy". Or which line of code is the "fault tolerance" in google's code base. It is not a single part, it is all the parts working together.
Just looking at the kidney example (which is not the only kind of function we can describe having functional reserve.) functional reserve is that there are two kidneys, and each kidney have multiple renal pyramids, and if this or that part of the kidney functions worse other parts compensate and will work overtime.
Depletion of functional reserve is not something literally running out (like a fuel tank running empty), it is more like a marauding gang shooting computers in a cloud data center. Sure initially all works as it used to, because the system identifies the damaged components and routes the processing to other ones. But if they keep it up they will damage enough that the data center will keel over and can't do what it could do before.
(No, I'm not saying that a human body is literally a data center, or literally an airplane. What I'm saying is that all three shares the common theme that some process is maintained in the presence of faults.)
In case of kidneys, my understanding is that only a certain subset of glomerular cells are actively filtrating blood at any given point. The other cells form the functional reserve, and start to become active once the other cells age out, or are disrupted due to an event (like poisoning, such as mycotoxin damage from eating moldy food). Once the functional reserve is exhausted however, no new cells can become active and you are left with whatever dwindling GFR you have, until you get a transplant.
With the vascular system you have example arterial elasticity which is an important measure of vascular health. When your blood vessels become less elastic it does not immediately cause symptoms, but it increases the risk of heart disease and stroke. This is also why periodontitis and gum disease is a predictor for vascular diseases: Bacteria enter the bloodstream through inflamed oral mucosa and form plaques along the blood vessels.
>"This is also why periodontitis and gum disease is a predictor for vascular diseases: Bacteria enter the bloodstream through inflamed oral mucosa and form plaques along the blood vessels."
And yet in the year 2025 dental care is globally treated as seperate from other healthcare, a strange historical artifact that clings on.
Story from the US: had an awful tooth infection (from a known dead tooth) that I tried to ride out, half my face was swollen up, even my eye looked half shut. Well after a day of this I couldn't take the pain. Called my doctor "we don't pull teeth, you have to call a dentist." So I called a dozen dentist and was told either "we aren't taking new patients" or "we can't get you in for 6 months".
I ended up just driving to a dentist and saying "look at my fucking face! Pull this fucking tooth out!" Finally a dentist was able to spare 30 seconds to yank it. Bill was something like $750.
The US is a dystopian hellhole.
I got a doctor to pull an internal tooth that had formed a cyst around it, a maxillofacial surgeon.
The dentist quoted $1300 but said insurance wouldn’t cover it, it’d be out of pocket. The surgeon did it (I was awake with local anesthesia) for $300 but insurance paid an additional $4000.
Before all this, A PE owned dentist office (the one that didn’t have the six month wait) had told me two years before that the pain I was experiencing was because I had periodontal disease and that I just needed to get a periodontal cleaning (which cost $750 and didn’t help at all, also conveniently not done by a dentist but a dental hygienist). This turned out to be very dangerous because the cyst was pushing and wearing away at my nose bone, and if I’d waited any longer my nose may have sunk into my face.
It’s definitely maddening the hoops one has to go through to get proper dental care in the US.
Regardless of the financial and administrative issues, dentistry is still far more an art than a science. Go to 10 different dentists for any serious condition and you'll likely receive 10 different treatment plans. In most cases they're making good faith recommendations but there's a huge amount of subjectivity and personal bias involved.
Physicians have recently started embracing evidence-based medicine with documented best practice treatment guidelines so hopefully a similar cultural change will come to dentistry in time.
And you couldn’t just board a plane to Mexico or anywhere down south and get the job done for half the price including said flight? People keep complaining but don’t realize that no place is perfect in this world.
Some places are significantly worse than all others in the same wealth class though.
Somebody further up quoted such insane numbers - $750 for a proper periodontal cleaning? That's usually ~50 to 80€ in Germany. For a _full_ self payer.
Those prices and the health system creating them are utter insanity.
What an asinine response.
Seriously. "Just"
Why though? You demand a service that you can get cheaper abroad. You can’t change the health system but you can travel to a socially developed country that hasn’t yet fallen victim of corruption
A same day flight to Mexico is $1000 where I live. Other countries seem to have figured out healthcare. The US can too.
It might be able to, but only after passing legislation to control guns and protect school children from being victims of daily school shootings
Functional reserve means you are completely well but the start of the disease is coming closer as the former is depleting.
Another case is when disease starts subtly and slowly _with_ initial symptoms that are otherwise not debilitating. Eg Alzheimer's starting decades ago by being forgetful.
I have no idea which one the post is reffering to.
Thankfully biology has redundancy, so a single cosmic bit flip does not send humans into a BSOD.
In biomed sciences we rarely refer to the huge amount of resiliency of living organisms. They are so robust, stable and self healing that it would need a fleet of human made machines to cover the basic difficulties.
A very elderly doctor referred to "cognitive reserve", lamenting hen had more of it when younger.
It’s interesting they make no mention of trying to understand the body’s ability to self-defend and self-heal. That is, it’s possible to get X (e.g., cancer) and the immune system wins the fight (before it’s even detected).
In theory it’s possible the best early treatment is no treatment at all; that there might be such a thing as too-early detection.
This is a well known phenomenon in medicine. It is always carefully considered when making public health decisions regarding e.g. screening programs and intervention best practices.
For example, a PSA test is useful to detect cancer of the prostate, if a male patient has urination problems. But doing general screening for high PSA values in middle aged men is not considered a good idea, because there are too many false positives and it would likely lead to many unnecessary invasive interventions.
It's also why "early detection leads to longer survival" claims in cancer patients has to be treated with quite some care.
Two people develop a fatal cancer at T0. One is diagnosed at T1, the other at T2, both die at T3.
It looks like the first person survived longer with cancer than the second, but they didn't: the interventions had no effect, it's just a statistical artifact.
This is by no means always the case - earlier detected cancer is more treatable - but it still needs to be controlled for.
And of course there’s always a riff on the placebo effect even when the intervention isn’t sugar pills. That is, success gets attributed to the approved intervention, but at the nuts & bolts level it had little or no effect. The body cured itself but the treatment gets the credit.
Have a friend working as urology surgeon - basically all men get prostate cancer, its just a function of time (unless you die young). Most of them is benign, or cause few issues and are often let alone.
If you would run scans on all males above say 45 there would be endless stream of operations happening, all of which would lower quality of life for everybody, and sometimes shorten their lives a bit or a bit more. Any public healthcare system would be brought to the edge of collapse by just this since surgeries are supremely expensive everywhere, that's not just US invention.
Yo, personal experience. I'll be undergoing a second test soon, as a precaution, but the first showed me at "acceptable risk level but cancer is still present".
My urologist carefully assured me ahead of the test that I "do have cancer, as all men my age do", and clarified the difference between "have" and "might well die of".
for anyone else wondering:
https://cdn.mdedge.com/files/s3fs-public/fedprac/images/fed0...
~0.7% at 49 years, 45.5% at 70 years, looks like a logarithmic growth curve
True for many things. You can have the HIV virus in your blood, and successfully fight it off, preventing infection. Your immune system will remember, and thereafter show markers that are indicate "possibly infected" - but you will not be CURRENTLY infected.
Dr Sean Mullen on Twitter "there are now over 500,000 studies on the consequences of SARS-CoV-2 infection" - https://x.com/drseanmullen/status/1924960793264525772 *IF* that's true - yeesh!
Number of studies are meaningless by itself, and an intellectually rigorous scientist wouldn't use that as a metric. We've known for decades that any serious infection can have long lasting effects for some patients. There's nothing special about SARS-CoV-2.
you can't criticize someone for poor reasoning while simultaneously making unsupported claims yourself
What's unsupported? What I stated is common knowledge in the medical community. Anyone unaware of this hasn't been paying attention for the past 40 years.
I suppose the no special sauce is the unsupported claim, not that I disagree
usually (at least since Ol' Russel) there's no real need to prove that space is quite rare when it comes to teapots
so far there was absolutely no scientifically "woah" thing about SARS-CoV-2, it fits "neatly" into an acute respiratory virus hole (we know of a lot of coronaviruses and influenzaviruses), we even had a lab set up to research zoonotic viruses ... instead of telling idiots to stop running the patient zero lottery on that fucking market.
Preventative treatment for disease is ten, hundred, thousand times cheaper than treatment ex post facto.
To me, this is the strongest argument for a centralised health system, such as the UK NHS.
When you have one organisation responsible for health as a whole rather than just treatment, you can make better decisions. The usual example I give is that it's cheaper to give out the contraceptive pill than deal with pregnancies, but the same thinking applies to broader disease and health.
This holds true for many things. It’s easier to stay in shape and maintain a healthy weight than it is to recover from getting out of shape or overweight. The longer someone spends out of shape or overweight, the harder it becomes to escape the cycle. There’s no better time to start than now.
As for preventative medical treatment: This one is a difficult topic. There’s a popular misconception that getting a lot of different blood tests and imaging scans is a good idea to identify conditions early, but most people don’t understand that these tests (including imagine) are prone to a lot of false positives. Excessive testing has been shown time and time again to lead to unnecessary interventions, leading to worse outcomes on average. A number of previously routine medical tests are now not recommended until later age or until other symptoms appear because routine testing was producing too many unnecessary interventions, producing a net negative benefit.
It’s a hard concept to wrap our heads around when we’re so attached to the idea that more testing means better information. It’s a huge problem in the alternative medicine community where podcast grifters will encourage people to get various tests like organic acid tests or various “levels” testing, then prescribe complex treatment programs with dozens of supplements. The people chasing these tests then throw themselves far out of balance with excess supplements while sinking thousands of dollars into repeat testing
Any opinion on Outlive: The Science and Art of Longevity by Peter Attia? He seems fairly fact-based, but does recommend several diagnostics.
He’s better than most, in that he puts disclaimers on things that aren’t rigorously proven. That said, he talks a lot in that book about things that aren’t actionable, even if they were rigorously proven - such as the coronary calcium scan.
If you get a high score on that test, what are you going to do? Eat better, lose weight and exercise. So skip the test and just do that instead.
A high coronary calcium score factors into the decision about whether to apply more aggressive pharmacologic interventions. Those have risks and side effects so unlike the lifestyle factors you mentioned they aren't appropriate for everyone.
I didn’t say the tests have no use, but trust me: if you’re otherwise well and don’t have symptoms, nobody is making aggressive pharmacological interventions based on the calcium scan.
This is why, historically, they were rarely used.
I am aware that is the current standard clinical practice. Dr. Attia's argument is that we could cut death rates in such patients by starting aggressive pharmacological intervention much earlier in the disease progression. From a physiological perspective that makes some sense, although there haven't been any studies to show whether that cuts all-cause mortality.
Yeah, I get it. I read the book. I think his argument is wrong.
The point I am making is that for the “worried well” (aka “longevity enthusiasts”) you aren’t going to do anything differently based on the result. It's largely a waste of money for the sake of people who want to feel like they're Doing Something (tm).
If you really think about it, you're talking about the extremely marginal case where a) the patient had no prior symptom of an illness; b) the calcium scan is so bad that you'd put the person on a medication to manage a hypothetical future problem; and c) you weren't going to do it anyway based on other tests.
The three things together are vanishingly unlikely. The better argument, mayyyyybe, is that maybe the test is one of those things that motivates a certain type of person (again, the "longevity enthusiast") to do something they otherwise wouldn't do, but that kind of person seems like...the kind of person who wants to do things. So what is the goal?
See also: Vo2max, DEXA scans, and most of the other tests mentioned in the book. Great for nerding out on metrics, but...you aren't going to do anything you weren't already doing if you're the type of person to be getting the test in the first place.
I'm not sure I disagree with your general argument but it's worth noting that aerobic sport forums are replete with examples of people who were considered extremely fit, right up until the moment they were in an ambulance due to an undetected issue that could have been anticipated with a scan.
Testing in general gets out of control but we as a medical community also have a problem I think of not identifying certain problems until it's too late. Some preventative testing could be done more, some less.
> aerobic sport forums are replete with examples of people who were considered extremely fit, right up until the moment they were in an ambulance due to an undetected issue that could have been anticipated with a scan.
The primary lesson from this is to ignore stories you read in aerobic sport forums.
This kind of (usually apocryphal) tale is an example of the turtles, rabbits and birds allegory [1]. Testing is like a fence around a farmer's field -- it may catch rabbits, but it's useless for turtles (who will be caught, but move too slowly to matter) and birds (since you can't catch them with a fence). The "super fit person who randomly drops dead" is the very definition of a "bird" -- even if you assume the test is sensitive enough to catch the rare thing before it happens (usually not), you have the dual problems of timing (i.e. are you going to test daily?) and false positives for whatever rate of testing you do choose.
In real life, almost nobody has an illness that moves so quickly that it requires special screening, but so slowly that it can be stopped, or at least, that has a positive risk/reward ratio for the testing required to detect it. It's the fundamental problem of medical testing, and even most of the recommended tests have a very small expected benefit.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC4865494/
Chapter-level summary: https://www.booksummary.pro/Outlive_summary.html
This sounds like an example of a fault in how to take action based on results vice a fault in getting too much data. Perhaps the conclusion you state about the better approach being to forego tests is true. For example, if emotional and legal factors prevent patients and providers from acting rationally here. Optimistically, we can do better.
Only if you have an excellent health insurance plan. Otherwise, preventive treatment costs you money, while curative treatment is paid for you.
Sounds like a misguided incentive ...
My insurance covers annual bloodwork/physicals as well as immunizations. I am pretty sure most health insurance policies do.
The ACA made this standard. It’s been like this for a long time.
When we were hiring a lot of people out of college, I spent way more time than I expected teaching them about how healthcare works and how to find their own information. We found that a lot of them would build their idea about how health insurance works from years of reading Reddit posts: They thought visiting the doctor was always going to be a $1000 bill or a single accident was going to medically bankrupt them, because those are the stories they saw on Reddit. I would explain things like the free annual physical and many just wouldn’t believe me. It’s really tough to cut through the confusion out there.
I would argue this has severe caveats. I knew a girl in college who was billed over 400$ to test for PCOS, which is one of those diseases that 1) affects just women 2) is underdiagnosed but has severe systemic effects like facial hair growth, diabetes and obesity...
But if they do anything other than extremely basic tests, like blood pressure at the "free annual physical" you will be billed, ridiculous amounts you have no way of knowing in advance.
During these "free" preventative checkups, if your doctor asks if you have any other medical issues to discuss, having an answer other than "no" can change the visit from a free preventative visit into a standard non-free office visit.
An important nit I need to pick…
These are items you receive along with your insurance.
They are not insurable events and they are not “covered” like an insurable event.
Predictable, regularly occurring events cannot be covered by insurance by definition. You can’t adjust it, you can’t assemble a risk pool, etc.
We use the word “insurance” to mean “nice things that I like” but I think we’d have more enthusiasm for socialized medicine if we knew how much of “insurance” was nothing of the sort.
That's not quite correct. Many patients forgo preventive screening procedures even when they're free (to the patient). Medical insurer actuaries are aware of this and price policies accordingly.
So exercise, eating healthy, fasting, brushing/flossing teeth, consistent sleep schedule, daily sun exposure, good relationships, and stress management all depend on a health insurance plan?
You certainly need to "pay" for those yourself, insurance or not (I guess that's probably your point). Going for a run doesn't go on any billing schedule or contribute to GDP, it's all self-funded from your own personal resources of time and energy.
We pay either way. Pay to stay healthy or pay to stop being sick.
You only get so many chances to be sick before you can't come back from one, or it alters your life so severely you'd wish you were dead anyways.
I'll opt for paying to stay healthy.
Sam Vimes 'Boots' Theory of Socio-Economic Unfairness
>The reason that the rich were so rich, Vimes reasoned, was because they managed to spend less money.
>Take boots, for example. He earned thirty-eight dollars a month plus allowances. A really good pair of leather boots cost fifty dollars. But an affordable pair of boots, which were sort of OK for a season or two and then leaked like hell when the cardboard gave out, cost about ten dollars. Those were the kind of boots Vimes always bought, and wore until the soles were so thin that he could tell where he was in Ankh-Morpork on a foggy night by the feel of the cobbles.
>But the thing was that good boots lasted for years and years. A man who could afford fifty dollars had a pair of boots that’d still be keeping his feet dry in ten years’ time, while the poor man who could only afford cheap boots would have spent a hundred dollars on boots in the same time and would still have wet feet.
What the heck does the price of boots have to do with any of this? All footwear eventually wears out, and if you're talking about athletic shoes the more expensive ones are often less durable (they can improve performance a little).
Sheesh, it's an analogy. If you can spend afford to spend a little more money now (on preventative care) it can help being ruined later.
Fpr example, paying for a diabetic's insulin/blood sugar testing vs. amputating a limb, with the bonus of a working individual now likely ending up on disability
Interestingly, you prevent diabetes by abstaining from buying/eating food. Fasting is an amazing thing for the body, and it's completely free.
That's awesome, let's get the message out to the 2 million people in the US with Type 1 diabetes straightaway!
That's a bad analogy and poor example. Preventing type-2 diabetes (the vast majority of cases) is literally free.
Anything to miss the point, eh?
The point being, "an ounce of prevention is worth a pound of cure" - if you can afford it
You're really missing the point. Anyone can afford the most effective types of prevention.
This assertion is extremely privileged and I heartily disagree with it
Even if we're just going to say "diet and exercise" it is a privilege to not live in a food desert and have sidewalks. If we are to mention the free yearly physical it's a privilege to have a doctor nearby and be able to get the time off work
So no, I don't think I am the one missing the point
I would assert that nearly anyone can find a place to walk, or climb stairs, even if it's while they eat or work. Healthy food may be harder to come by for some, either because of expense or lack of availability. But again, fasting is a great protection against so many modern eating related problems, like type 2 diabetes and heart disease. The point is that nearly everyone can improve their preventative standing, even the less fortunate.
It baffles me that an offhand example not applying 100% of the time is used to dismiss the broader point as invalid and/or ridiculous. Though I now notice that even the original point with shoes was treated the same way: "in this single pedantic example with running shoes the situation doesn't hold, therefore I reject the entire idea as invalid"
No one is saying "all medical issues are more expensive if you're poor" or "it's impossible to be healthier if you're poor." All of that is fantastic, but it in no way disproves the catch-22 that it is often more expensive to be poor, in many ways, including medicine. Particularly in the US with its clusterfuck confusopoly of copayments, coinsurance, deductibles, and so on, so the mere act of going to any doctor is a gamble
What a bizarre way of looking at the basic maintenance necessary to keep your body working.
Not wrong tho. If there were no costs then surely everyone would do it.
I think you may be missing the point: preventative treatment is typically much less expensive, for instance behaviour and dietary changes do not require drugs at all and avoiding some conditions can be helped by drugs which have long since come off patents.
But even with your point, all insurance companies I've ever had cover with in the UK have had some element of support for preventing illness (periodic assessments, support material and trackers) and, at least with people covered under company schemes, they clearly have an incentive to offer more if you are at risk of becoming affected by a preventable illness.
Actually the conversion rate is 1 oz prevention = 1 lb cure. 1/16
If you’re looking for the archive link in the comments like I was, it’s at the top underneath the original link.
thats a cool study.
there should be more like it. (thanks for the archive link btw!)
And yet not a single doctor in the United States will permit you to care about early signals, preventative medicine, or routine deep dive bloodwork, in order to stave off those diseases. Anyone who's on top of this is paying fully out of pocket for individual tests, screenings, medicines. Manageable for some, unattainable for most.
My ex girlfriend was a doctor and we talked about this once. The gist of it that I got was that excessive early tests have a lot of risk factors that come along with them, because tests themselves being harmful (CT scans cause something like 5% of all cancers), and because false positives lead to unnecessary treatments, surgeries, medications, etc which can cause real harm. Basically, if the expected harm from the proactive testing is greater than the expected harm it would mitigate, you don't do it.
I had not heard the "CT scans cause 5% of cancers [in the US]" stat before, it makes for interesting reading. That's incredibly high!
Huh? Plenty of doctors out there cater to the "worried well" and will order any blood work you want or spend a lot of time with you on preventive care. But of course most health insurance plans won't pay for that. In most cases it's a total waste and doesn't significantly improve patient outcomes.
Great study
https://archive.ph/20250718060542/https://www.bloomberg.com/...
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> I wonder if, in parts, the effects of the so called "mild covid" and "long covid" […] are nothing but psychological. There seems to be quite a cloud of uncertainty around the vast array of reported possible symptoms.
Uncertainty does not imply psychological. It’s like saying ”our users report a lot of different bugs that we can’t reproduce, they must be all imagined”, except the body is OOMs more complex than even the most carelessly developed enterprise application. There is uncertainty in every part of medicine, all the time. That’s why it takes time and is difficult (often too difficult) to root cause everything that happens.
If you have a novel pathogen with neurological effects (see olfactory impacts - people literally losing their sense of smell), it would be my first guess of mysterious symptoms rather than.. checks notes the war in Ukraine? Honestly I’m not sure how to connect your first sentence to the next.
Doctors have a habit of blowing off unknowns as "it's all in your head" (as if that somehow makes it out of their jurisdiction). There used to be a diagnosis of "female hysteria." After the invention of the MRI doctors were able to see the physical damage caused by the disease and they renamed it multiple sclerosis.
Absolutely. Academics in particular are hyper averse to saying ”we don’t know yet”. They’d much rather establish an unfalsifiable narrative which can mislead and cause damage for decades, until it can be properly reversed. Archeology is perhaps the best field at turning random early speculations into entrenched dogma. But it happens in all fields.
Me neither, but there is a theory that Putin grew increasingly disconnected from reality when isolating himself from a potential Covid infection, and that this might have contributed to his decision to go all in.
Should this be the truth, there would be an actual connection between the virus and the war.
That's very original but not the kind of thing I proposed.
I am sure there are many ways one could be disconnected from reality.
Ironically.
Do you think I was talking about the sense of smell?
No, but loss of smell is indeed a (very well documented) ”mystery effect” of neurological damage, so it’s not a regular ”flu” by any means. It’s closest relative is SARS1 and that’s also vastly different from flu. There are always psychosomatic or ”mystery” effects even with something clear cut like breaking a bone. Noisy data is the first thing you have to accept dealing with these complex systems. If you see a giant cloud of black smoke, it’s a good idea to assume there’s fire and invalidate it later, should it turn out to be something else.
Do you believe the terms "neurological" and "psychological" are interchangeable?
The Gaza conflict has been running since before 1948 at various levels of intensity, and the Ukraine conflict since 2012.
It's possible that social media is making people ill, but long COVID is very real and very different.
As someone who has seen multiple people close to me, including my wife, struggle with long covid, I can tell you the answer is simply no. Anecdotal, yes, but this shouldn't be an argument.
We are several years in now. These statements are actually pretty hurtful for people who have been through a lot. It's like saying you could beat cancer if you only wanted to, or if you didn't think all those negatives thoughts, you wouldn't be so ill now.
Not only is it suggesting that this misery is in some way 'your own fault', but it also implies that it isn't real, or serious, at least not in the same way other diseases are.
And yes, psychological problems are real too, indeed. But it is not the same. The origin narrative around a disease does in fact matter for people trying to cope with it, and how others see you, for insurance, for politics and medical care. Please be more respectful about it.
This sounds like "you shouldn't suggest that long COVID is psychosomatic because doing so makes me or others feel bad" to me. Which part of what you're saying am I misunderstanding?
Perhaps you are right. I took the vaccines and was pretty lucky to not suffer any major consequences.
What I said could be read as offensive and some kind of "your own fault" to laymen. However, that is not the idea.
I have psychological issues of my own and I completely understand when someone tries to say "it's all my own fault", so I'm empathetic to your critic.
> I took the vaccines and was pretty lucky to not suffer any major consequences.
Lucky as in 999,990 chances on one million of being safe (myocarditis, see: https://labeling.pfizer.com/showlabeling.aspx?id=19542&forma... ). Long covid is a multi-percent risk by comparison, extremely larger.
It's insane how some people seek to blame a few pieces of RNA rather than the virus eating your arteries to reproduce. Medicine should of course be checked for safety but we're way past that. Of course people getting sick from vaccines deserve recognition and help but long covid patients just as much.
I took the vaccines because I trust them.
I'm talking about not suffering consequences of the virus because I decided to receive some immunization.
However, I was skeptical about mixing different vaccine types, so I took only one kind of it.
There is growing evidence that long covid is actually CIRS (toxic mold usually from living in water damaged buildings) triggered by covid. Only 25% of people have the genes for CIRS, but then it takes exposure and a immune shock to get your systems out of whack (lyme, covid, etc.) The vast array of symptoms come from the mycotoxins becoming present in every part of your body and affecting all your systems, especially your gut biome.
Source: I have it and am on the long road to recovery. Before I moved out of my house this spring, I could have days with several migraine level headaches and where my vision was so messed up I could barely see 10 feet. I don't have bad days like that anymore since I moved to my sisters. (I have lots of other symptoms too, this is just a sample.)
I would reframe this and ask whether psychiatrists should be spending a lot more time understanding the patient’s immune system history and other factors. Brain fogs and other symptoms are understood by many patients to be modulated by other health processes, and physical fitness is considered a treatment by some practitioners, yet psychiatry is recovering from a legacy of medical dogma in which the brain and the immune system are completely separate, due to the idea of the blood-brain barrier. I would recommend to look more comprehensively at patients’ clinically relevant information, which I believe would produce deeper, systems-level understanding and treatments in more than enough cases to be worthwhile.
The "between-the-ears" brigade is at it again. Just asking questions.
The very fact that you are hypothesizing about my intentions is, in fact, an act of asking questions on its own.
You are worried that I might be suggesting some form of conspiracy, but these worries are all in your head.
There is uncertainty about the effects post acquiring a covid flu. If there weren't, the article wouldn't mention the efforts in trying to figure out what these symptoms and causes are. I'm sure they are also "asking questions".
Instead of criticizing me, perhaps you could try to put your guard down and try to investigate if other more reputable sources asked the same questions as I did:
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=psyc...
I haven't read those papers, and I'm not qualified to discuss them in depth. However, they indicate that my assessment of the situation is not as outlandish as you suggest.
> You are worried that I might be suggesting some form of conspiracy, but these worries are all in your head.
Because you communicate them. Combining unrelated information without any reasoning, backup, or even a link is a bizarre style. You go from wars, AI and lack of information about long covid to ignoring all physical markers.
And that doesn't take away that you argue in the same style as the people who argue that illnesses can be overcome mentally. Cancer originates between your ears; if you get it, it's your fault. Suggesting long covid is the same, places you square in that group.
> Instead of criticizing me, perhaps you could try to put your guard down and try to investigate if other more reputable sources asked the same questions as I did:
Fortunately, I am qualified for psych research, and if you would just open them, you'd see that those papers do not suggest a psychological cause for long covid. People are anxious, health staff is under pressure, those with long covid need psychological support, because it's hard to cope with, there's neurological damage, and there's some speculation about long-term effects on the population. There are obviously way too many papers to even scan.
You also did a wrong search, because "effects" are not what you're suggesting.
> Combining unrelated information without any reasoning
I estabilished a loose correlation that does not imply cause (they all happened roughly at the same time).
It seems you assumed what I was thinking by the writing style. A common mistake.
> Fortunately, I am qualified for psych research
Congratulations.
> People are anxious, health staff is under pressure, those with long covid need psychological support
Can you elaborate on the reasons why people are anxious and health staff is under pressure? I agree with it, but I want to understand why you think that is.
For most people Ukraine and Gaza are just very remote worries, unless of course they're related to people there or close to the conflicts.
AI might be real stressor for those losing their job, or bad for those using it as a virtual love interest or therapist, but it's mostly a remote worry for most too.
Of the three, only the covid flu could have real mild/long effects. But if you want to seek other psychological factors, iflation, the job market, the loneliness epidemic, and other such things are much more likely ones...
>>There seems to be quite a cloud of uncertainty around the vast array of reported possible symptoms.
Just because it is a "cloud of uncertainty" to you does not mean it is to people actually studying the phenomenon.
Multiple studies are already identifying scores of biomarkers correlated with Long COVID, e.g., "Identified from 28 studies and representing six biological classifications, 113 biomarkers were significantly associated with long COVID"[0]. The same type of phenomenon happened with Chronic Fatigue Syndrome, now identified as "Myalgic encephalomyelitis" where patients were long disregarded as simply having psychological problems, and the same with many auto-immune disorders. These can all be discovered with a sub-30second DDG search.
Yes, the democracies of the world are under assault from right-wing or authoritarian movements and this is dramatically increasing uncertainty, worry, and indeed harm for everyone. But before you start dismissing disease processes as caused by social psychologies and causing more harm to those already suffering, perhaps search for more concrete causes first.
[0] https://pubmed.ncbi.nlm.nih.gov/36744129/
It seems you misread my comment profoundly. I never dismissed any actual biological causes.
It's ok, lots of people do this mistake. A more critical look would notice that I was only questioning aspects of the phenomena that are currently unexplained. In the long run, your pick for how to respond would sound rushed and desperate.
>>I was only questioning aspects of the phenomena that are currently unexplained
Right. The "God In The Gaps". Again. The refuge of those who lack an actual explanation. If that is what you meant, you should have explicitly stated it instead of requiring everyone to take "A more critical look [to] notice"
As I said before, there IS definitely a phenomena as the free world is under attack. But trying to bootstrap that into something much larger doesn't cut it. You protest too much; you'd have been better off just taking the lesson by itself. We all make errors
I don't quite understand your point. What is this "God In The Gaps" thing you mention?
"'God of the gaps' is a theological concept that emerged in the 19th century, and revolves around the idea that gaps in scientific understanding are regarded as indications of the existence of God."[0]
In this case, the analogy I'm making was to illustrate how you were trying to re-fit your original comment into the gaps in knowledge about the clusters of symptoms.
Unsolicited advice worth less than you paid for it: It was not an awful initial concept, but it was neither well thought-through nor well-presented. We all make mistakes like that, just posting an initial thought, but as you can see, that occasionally goes awry, and in those cases it's best to just take the L and move on. Be well
[0] https://en.wikipedia.org/wiki/God_of_the_gaps
> It was not an awful initial concept, but it was neither well thought-through nor well-presented.
I am looking forward to discussing such matters with people that are less compelled to observe style before content.
I don't have the time or the luxury to wear fancy clothes, that's why I'm here on hacker news, which is supposed to be a place that does not require them.
I do understand where you're coming from though.
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Personally, I don't find it helpful to post paywalled content here, at least without a summary. Other than that I'm here to for the kind of nerdy tech stuff that normally doesn't appear on NYT, Bloomberg etc which are designed to service adtech more than illuminate its consumers. I do consume their content, especially the latter but to me posting that stuff here feels like coming to a small downtown art gallery to discuss a prime time tv show like Big Brother or Friends reruns