It is hard to understand the stupidity of this narcissism. Even if you can edit out the imperfections in your own body – perhaps downsizing your nose – you’re probably setting up your children to have to do the same (they’ll likely inherit the same “faults” you’ve spent so much money airbrushing out and feel pressure to do the same). So you end up almost imposing unnecessary surgery on your own children.
These are the very same people lecturing us about how they need to take more of money from ordinary working people to hand out to “more deserving” people who are the “victims” of life’s unfairnesses. While blowing fortunes on their vanity and not dipping into their own pockets (and often paying very little tax).
They truly are the Bourbons of the modern age.
Ignore these fools trying to tell you how you should look or behave. Just be yourself.
But what if being yourself is not good enough to get you a stunningly gorgeous trophy wife or a ripped, studly boy toy? It’s all about the sex, nothing more.
Vane, vane, vane
Nobody really gives a shit about you looking like a plastic action man figure, unnatural, super white teeth, skinny….it’s a fashion symbol of thinking you look good…..pride in vanity, history tells us this always goes on. Nobody cares apart from the clique that do it. Rich to poor, there are such cliques.
Won’t resolve your inner self issues, if you have them.
The biggest issue here is the gap between the rich and others, never in history has it been this wide and at some point the masses have to rebel. Laws, regulations, government policy all very very beneficial to take more from us peasants.
Work hard and you’ll hit a glass ceiling….in the past, physically you could take, now it’s shielded by a web of tech. Not to say its right to physically take but that was a means when the rich got too out of control- as mentioned in the article.
Unfortunately it’s not going to improve and the world’s assets will be sucked into the few and the ridiculous gluttony and waste will continue as others suffer.
Sermon over, I’m lucky that I’m at the glass ceiling and only significantly taxed for the privilege of working hard and having a bit of luck. I detest what’s happening and the lack of wealth distribution and advantageous acts of the few, who take take take.
I was astonished by the number of human barrels I saw in costco yesterday – and most of them have obviously picked up bad habits from the indigenous population. They’ll buy the daft jabs, and be surprised when they don’t work.
But what if being yourself is not good enough to get you a stunningly gorgeous trophy wife or a ripped, studly boy toy? It’s all about the sex, nothing more.
Vane, vane, vane
Nobody really gives a shit about you looking like a plastic action man figure, unnatural, super white teeth, skinny….it’s a fashion symbol of thinking you look good…..pride in vanity, history tells us this always goes on. Nobody cares apart from the clique that do it. Rich to poor, there are such cliques.
Won’t resolve your inner self issues, if you have them.
The biggest issue here is the gap between the rich and others, never in history has it been this wide and at some point the masses have to rebel. Laws, regulations, government policy all very very beneficial to take more from us peasants.
Work hard and you’ll hit a glass ceiling….in the past, physically you could take, now it’s shielded by a web of tech. Not to say its right to physically take but that was a means when the rich got too out of control- as mentioned in the article.
Unfortunately it’s not going to improve and the world’s assets will be sucked into the few and the ridiculous gluttony and waste will continue as others suffer.
Sermon over, I’m lucky that I’m at the glass ceiling and only significantly taxed for the privilege of working hard and having a bit of luck. I detest what’s happening and the lack of wealth distribution and advantageous acts of the few, who take take take.
I was astonished by the number of human barrels I saw in costco yesterday – and most of them have obviously picked up bad habits from the indigenous population. They’ll buy the daft jabs, and be surprised when they don’t work.
Peter B
1 year ago
It is hard to understand the stupidity of this narcissism. Even if you can edit out the imperfections in your own body – perhaps downsizing your nose – you’re probably setting up your children to have to do the same (they’ll likely inherit the same “faults” you’ve spent so much money airbrushing out and feel pressure to do the same). So you end up almost imposing unnecessary surgery on your own children.
These are the very same people lecturing us about how they need to take more of money from ordinary working people to hand out to “more deserving” people who are the “victims” of life’s unfairnesses. While blowing fortunes on their vanity and not dipping into their own pockets (and often paying very little tax).
They truly are the Bourbons of the modern age.
Ignore these fools trying to tell you how you should look or behave. Just be yourself.
Phillipa Fioretti
1 year ago
I feel a bit sorry for these poor people. All that money and yet so much fear. The joys of existence, simple and plain, swapped for an endless battle with the inevitable.
And how much more anguishing it’ll be for them, when the inevitable happens.
Phillipa Fioretti
1 year ago
I feel a bit sorry for these poor people. All that money and yet so much fear. The joys of existence, simple and plain, swapped for an endless battle with the inevitable.
Chris Twine
1 year ago
Momento Mori – don’t underestimate Mother Nature or Father Time – they’ll get you in the end. Remember the cadaver tombs of medieval England. Yes, you can delay the journey to compost but isn’t it better just to face up to it instead?
I liked your comment but let’s get our Latin right – it’s ‘memento mori’
Chris Twine
1 year ago
Momento Mori – don’t underestimate Mother Nature or Father Time – they’ll get you in the end. Remember the cadaver tombs of medieval England. Yes, you can delay the journey to compost but isn’t it better just to face up to it instead?
Nicky Samengo-Turner
1 year ago
When I gave up drinking, I lost 4 stone in about 5 months: My ” diet advisors” were jockeys, who live ” to the pound” as they are weighed sometimes 32 times a day when evening racing occurs.
I learned from their sage advice that the key to losing weight is to break the ” habit signal” between mind and stomach, and after only 3 days of 1 small meal a day, it starts to kick in. After that its about planning a weekly intake, and adjusting it upwards and downwards. 20 years on, it has worked for me!
I then proceeded to, in the following 4 years, break 8 ribs, sternum, 3 verterbrae, all my fingers and disclocate my jaw out hunting, proving that swapping an alcohol addiction for the ” buzz” of riding over hedges and fences, ” sans talent” , was just another addict proclivity… but at least I was thin!
I then proceeded to, in the following 4 years, break 8 ribs, sternum, 3 verterbrae, all my fingers and disclocate my jaw out hunting, proving that swapping an alcohol addiction for the ” buzz” of riding over hedges and fences, ” sans talent” , was just another addict proclivity… but at least I was thin!
When I gave up drinking, I lost 4 stone in about 5 months: My ” diet advisors” were jockeys, who live ” to the pound” as they are weighed sometimes 32 times a day when evening racing occurs.
I learned from their sage advice that the key to losing weight is to break the ” habit signal” between mind and stomach, and after only 3 days of 1 small meal a day, it starts to kick in. After that its about planning a weekly intake, and adjusting it upwards and downwards. 20 years on, it has worked for me!
Hendrik Mentz
1 year ago
Humanity’s biggest danger is at its moment of optimum possibility it opts for dumbing down, and superficiality.
Opting for? Then, as now, the ‘ridiculous’ creed of the Nazarene has irresistible power to deliver life and liberty.
Sadly, Rome opted largely for the creed. The Nazarene himself is never an instrument of the State…..
Opting for? Then, as now, the ‘ridiculous’ creed of the Nazarene has irresistible power to deliver life and liberty.
Sadly, Rome opted largely for the creed. The Nazarene himself is never an instrument of the State…..
Rather like the Classical Roman Empire opting for the ridiculous creed of the Nazarene, otherwise known as Christianity.
Hendrik Mentz
1 year ago
Humanity’s biggest danger is at its moment of optimum possibility it opts for dumbing down, and superficiality.
Last edited 1 year ago by Hendrik Mentz
Phillipa Fioretti
1 year ago
I feel a bit sorry for rich people if this is what they focus on all the time. Not much of a life, is it. All that money and they spend it on cosmetic drugs and procedures? Poor buggers.
Oh they do. More. But of course their “charity” means imposing their vision on the world – i.e. translating money into power ala Bill Gates. There’s only so much money one can consume, so the rest must feed the ego in other ways. Hard to avoid at a certain scale.
The “charitable” stuff often involves huge tax breaks in the US and is often done for financial reasons.
But not always. There is a real and strong tradition of philanthropy by billionaires going back at least to Andrew Carnegie (including building countless public libraries back in the UK).
Sorry, I don’t buy into the Bill Gates conspiracy theories. People’s motivations vary and are not always malign. We should not always assume the worst case.
It’s not that Gates is malign. But he’s a software guy through and through.
RNA, DNA. They’re biologic forms of software. The body can be happily reprogrammed. Hence mrna vaccines.
I didn’t use to until I saw him,Gates doing an interview. It was his facial movements. Smiling inappropriately at the wrong times. Answering too quick or far too slow. When someone says 15K children are going to die all the while self satisfied smiling it just comes across as wrong. If he is autistic or something he’s not doing that community any favours.
It’s not that Gates is malign. But he’s a software guy through and through.
RNA, DNA. They’re biologic forms of software. The body can be happily reprogrammed. Hence mrna vaccines.
I didn’t use to until I saw him,Gates doing an interview. It was his facial movements. Smiling inappropriately at the wrong times. Answering too quick or far too slow. When someone says 15K children are going to die all the while self satisfied smiling it just comes across as wrong. If he is autistic or something he’s not doing that community any favours.
The “charitable” stuff often involves huge tax breaks in the US and is often done for financial reasons.
But not always. There is a real and strong tradition of philanthropy by billionaires going back at least to Andrew Carnegie (including building countless public libraries back in the UK).
Sorry, I don’t buy into the Bill Gates conspiracy theories. People’s motivations vary and are not always malign. We should not always assume the worst case.
Oh they do. More. But of course their “charity” means imposing their vision on the world – i.e. translating money into power ala Bill Gates. There’s only so much money one can consume, so the rest must feed the ego in other ways. Hard to avoid at a certain scale.
All the while lecturing us about equity and inclusion. Now if they donated 10% of their wealth to charity, then I would think differently about them.
Phillipa Fioretti
1 year ago
I feel a bit sorry for rich people if this is what they focus on all the time. Not much of a life, is it. All that money and they spend it on cosmetic drugs and procedures? Poor buggers.
Chris Wheatley
1 year ago
Plus ça change, plus c’est la même chose. The rich always have and always will divorce themselves from reality – because they can. See Lineker’s recent comments.
The people who can afford to escape real life have to make their own reality.
The own reality would be ok in itself. Problematic are the gated communities (or own worlds) spreading along with it. Despite having a conservative liberal worldview, I conclude with Žižek among others that this is not a thing to wish for if one is interested in keeping civilization intact in some form.
Imho it is not about directly or indirectly controlling people. There are a lot of different ways to assess the problem of gated communities (both on the political and the cultural spectrum …). It would take it too far starting discussing them here, but I found it a pity that people seem to have problems imagining possible solutions that go beyond autocratic policies, although I understand the defensive reflex (and know it myself) just assuming something repressive…
Imho it is not about directly or indirectly controlling people. There are a lot of different ways to assess the problem of gated communities (both on the political and the cultural spectrum …). It would take it too far starting discussing them here, but I found it a pity that people seem to have problems imagining possible solutions that go beyond autocratic policies, although I understand the defensive reflex (and know it myself) just assuming something repressive…
The own reality would be ok in itself. Problematic are the gated communities (or own worlds) spreading along with it. Despite having a conservative liberal worldview, I conclude with Žižek among others that this is not a thing to wish for if one is interested in keeping civilization intact in some form.
Chris Wheatley
1 year ago
Plus ça change, plus c’est la même chose. The rich always have and always will divorce themselves from reality – because they can. See Lineker’s recent comments.
The people who can afford to escape real life have to make their own reality.
Last edited 1 year ago by Chris Wheatley
Emmanuel MARTIN
1 year ago
Progresss and technology DO trickle down
Almost every European enjoys access to a level of medication, nutrition and health resources that are inline with the best of the best available a century ago.
Put trickle down is a long process, and probably in 50y middle class people will routinlely get Ozempic like shape enhancing medication while the elite of the future will have brain transplant body rejuvenation
If we do not find other ways to deal with obesity in our societies, then yes, it will unfortunately become a normal thing at some distant point in time. But I also believe there will be a change in thinking on the way, just because it is already happening, that will counter the severity of the development towards the “just fix it with a pill” mentality.
What would drive this change in thinking? I can’t see it. The average person I know lives for treats. Almost all of these treats involve eating or drinking something:
Now I’ve been shopping I deserve a treat – a cup of tea and a chocolate biscuit, or,
I’ve had a hard week – let’s go out for a curry on Friday, or.. It’s John’s birthday tomorrow, let’s take him out for a meal. Etc, etc.
What else is there to look forward to?
It is indeed hard to see. But, hey, we are here talking about at least the possibilities of change.
If you look at it from a historical perspective, the mainstream mind set within a nation or a cultural sphere is constantly changing. I think we are heading forward towards a “dark age” (not in the sense of everything is bad, civilization going to collapse, worlds ending and so on…). Things will be confusing and changes more erratic and less streamlined than in the last maybe 200 years. Society won’t be the same in 50 years as it is now. I do not see the worth in fatalistic thinking regarding the future, regardless of being a rather pessimistic person myself.
Oh, there is so much to look forward to beside food and drink!!!! Gardening, enjoying the birds, butterflies, and flowers in your garden, cuddling with your cat, going for a walk with your dog, riding and caring for your horse. A kiss, a hug, holding hands, the sparkle in your partner’s eyes when they look at you, sex of course, painting, listening to music (be it at home, a concert or the symphony – all things I greatly look forward to), making music (this is what my husband looks forward to whenver he is away from his instruments), taking a bath, enjoying fragrances in all kinds of forms – flowers, herbs, fresh cut grass, essential oils. Colors – the blue of the sky, the orange red of a cardinal and the yellow of a goldfinch on my birdfeeder. The sound, scent and beauty of the ocean. Amazing architecture, gorgeous old buildings, the beautiful canopy of my neighborhood’s tree lined streets. And a million more things. I mean, there is SO MUCH to enjoy and look forward to!!!! Food & drink are pretty much at the bottom of my list.
Great reply,exactly my thoughts but I could never have found those great words to express it. Plant a garden,there’s always something to add anticipate
Great reply,exactly my thoughts but I could never have found those great words to express it. Plant a garden,there’s always something to add anticipate
It is indeed hard to see. But, hey, we are here talking about at least the possibilities of change.
If you look at it from a historical perspective, the mainstream mind set within a nation or a cultural sphere is constantly changing. I think we are heading forward towards a “dark age” (not in the sense of everything is bad, civilization going to collapse, worlds ending and so on…). Things will be confusing and changes more erratic and less streamlined than in the last maybe 200 years. Society won’t be the same in 50 years as it is now. I do not see the worth in fatalistic thinking regarding the future, regardless of being a rather pessimistic person myself.
Oh, there is so much to look forward to beside food and drink!!!! Gardening, enjoying the birds, butterflies, and flowers in your garden, cuddling with your cat, going for a walk with your dog, riding and caring for your horse. A kiss, a hug, holding hands, the sparkle in your partner’s eyes when they look at you, sex of course, painting, listening to music (be it at home, a concert or the symphony – all things I greatly look forward to), making music (this is what my husband looks forward to whenver he is away from his instruments), taking a bath, enjoying fragrances in all kinds of forms – flowers, herbs, fresh cut grass, essential oils. Colors – the blue of the sky, the orange red of a cardinal and the yellow of a goldfinch on my birdfeeder. The sound, scent and beauty of the ocean. Amazing architecture, gorgeous old buildings, the beautiful canopy of my neighborhood’s tree lined streets. And a million more things. I mean, there is SO MUCH to enjoy and look forward to!!!! Food & drink are pretty much at the bottom of my list.
What would drive this change in thinking? I can’t see it. The average person I know lives for treats. Almost all of these treats involve eating or drinking something:
Now I’ve been shopping I deserve a treat – a cup of tea and a chocolate biscuit, or,
I’ve had a hard week – let’s go out for a curry on Friday, or.. It’s John’s birthday tomorrow, let’s take him out for a meal. Etc, etc.
What else is there to look forward to?
Quite so. The same went for automobiles, fresh fruit, colored televisions, cell phones and world class health care. All were at one time only in the purview of the rich.
If we do not find other ways to deal with obesity in our societies, then yes, it will unfortunately become a normal thing at some distant point in time. But I also believe there will be a change in thinking on the way, just because it is already happening, that will counter the severity of the development towards the “just fix it with a pill” mentality.
Quite so. The same went for automobiles, fresh fruit, colored televisions, cell phones and world class health care. All were at one time only in the purview of the rich.
Progresss and technology DO trickle down
Almost every European enjoys access to a level of medication, nutrition and health resources that are inline with the best of the best available a century ago.
Put trickle down is a long process, and probably in 50y middle class people will routinlely get Ozempic like shape enhancing medication while the elite of the future will have brain transplant body rejuvenation
sal b dyer
1 year ago
Early follow up studies show people gain weight just as quickly after stopping Ozempic as after any other form of weight loss. It’s also suspected of causing Thyroid cancer in animals as well as being teratogenic. There are no free rides in this life.
Yes there are, working for the wretched British Civil Service for one.
sal b dyer
1 year ago
Early follow up studies show people gain weight just as quickly after stopping Ozempic as after any other form of weight loss. It’s also suspected of causing Thyroid cancer in animals as well as being teratogenic. There are no free rides in this life.
Phil Rees
1 year ago
There’s increasing confusion in unherd articles between UK and USA. On the day I received this one, NHS announced the drug will be available in UK on the NHS, and that rather negates the whole article!
Phil Rees
1 year ago
There’s increasing confusion in unherd articles between UK and USA. On the day I received this one, NHS announced the drug will be available in UK on the NHS, and that rather negates the whole article!
John Riordan
1 year ago
The supposition that no “trickle-down” effect will happen is not actually defended here beyond mere assertion. Mainly because as soon as anyone uses the phrase, they automatically place themselves into a logical cul-de-sac because there is not and never has been such a thing as “trickle-down” economics in the modern age.
The modern age has been characterised by mass prosperity, and that prosperity has been driven principally on how to deliver technological gains at a level of resource use that makes it possible for people on modest incomes to afford those gains themselves. There is no reason given in the above article as to why this same mechanism won’t apply in due course to the healthspan extension presently enjoyed only by wealthy people, and the reason is simply that as soon as it becomes technically efficient to produce the various drugs and treatments, the people who own the rights to them will find that they make more money selling millions of treatments for $1000 than they do selling a hundred treatments for a million each.
As to some of the other comments here which dismiss all this as mere vanity, no it isn’t, because what you look like is only part of the issue. The rest of it is about how much longer your life can be while remaining physically robust and vigorous, and wanting that period of your life to last as long as possible is entirely understandable and it’s no surprise that people will pay a lot of money for it if they can.
There is also, of course, possibly a huge economic benefit in making adults live longer by extending the middle part of their lives – when they can work – instead of extending the decrepit part of their lives at the end when they require the economic output of others to live. The possibilities here are actually rather amazing – doctors, lawyers, software programmers, artists, architects etc whose professional careers aren’t just 40 years long but, say, a whole century long. And it would solve the demographic challenge about how a shrinking working age population can support expanding legions of retired people who all want their pensions and healthcare – it would put that trend into reverse. Just a thought.
Last edited 1 year ago by John Riordan
John Riordan
1 year ago
The supposition that no “trickle-down” effect will happen is not actually defended here beyond mere assertion. Mainly because as soon as anyone uses the phrase, they automatically place themselves into a logical cul-de-sac because there is not and never has been such a thing as “trickle-down” economics in the modern age.
The modern age has been characterised by mass prosperity, and that prosperity has been driven principally on how to deliver technological gains at a level of resource use that makes it possible for people on modest incomes to afford those gains themselves. There is no reason given in the above article as to why this same mechanism won’t apply in due course to the healthspan extension presently enjoyed only by wealthy people, and the reason is simply that as soon as it becomes technically efficient to produce the various drugs and treatments, the people who own the rights to them will find that they make more money selling millions of treatments for $1000 than they do selling a hundred treatments for a million each.
As to some of the other comments here which dismiss all this as mere vanity, no it isn’t, because what you look like is only part of the issue. The rest of it is about how much longer your life can be while remaining physically robust and vigorous, and wanting that period of your life to last as long as possible is entirely understandable and it’s no surprise that people will pay a lot of money for it if they can.
There is also, of course, possibly a huge economic benefit in making adults live longer by extending the middle part of their lives – when they can work – instead of extending the decrepit part of their lives at the end when they require the economic output of others to live. The possibilities here are actually rather amazing – doctors, lawyers, software programmers, artists, architects etc whose professional careers aren’t just 40 years long but, say, a whole century long. And it would solve the demographic challenge about how a shrinking working age population can support expanding legions of retired people who all want their pensions and healthcare – it would put that trend into reverse. Just a thought.
Last edited 1 year ago by John Riordan
Cynthia W.
1 year ago
“They are selling you a picture of health that doubles as a picture of wealth” … that doubles as a picture of happiness. In many cases, the reality is the opposite.
Cynthia W.
1 year ago
“They are selling you a picture of health that doubles as a picture of wealth” … that doubles as a picture of happiness. In many cases, the reality is the opposite.
julianne kenny
1 year ago
The other side of this strive for immortality and endless youth is the drugging and chemical engineering by state heath entities -leading to obesity and diabetes etc. Anti depressants ,neuroleptics mood “enhancers” and more. A naturally thin youth can gain 50kg over two or three years medicated with these regularly prescribed drugs.Obesity by prescription. No counter measures to address it. That is why we see so many obese people – not due to diet greed but prescribed by health service professionals. Epidemic in the USA- reaching that point here.
julianne kenny
1 year ago
The other side of this strive for immortality and endless youth is the drugging and chemical engineering by state heath entities -leading to obesity and diabetes etc. Anti depressants ,neuroleptics mood “enhancers” and more. A naturally thin youth can gain 50kg over two or three years medicated with these regularly prescribed drugs.Obesity by prescription. No counter measures to address it. That is why we see so many obese people – not due to diet greed but prescribed by health service professionals. Epidemic in the USA- reaching that point here.
Allison Barrows
1 year ago
So Lizzo is “plus-sized” but Ann Coulter is “skeletal”? Lizzo is morbidly obese, but you didn’t describe her as whale-like. Why such an uneven use of adjectives?
The writer has to make sure he consistently signals his alignment with the left in order to avoid the outrage and ostracism mob from targeting him. This is what too much reliance on a tribalistic political alignment does, it leaves people obfuscating and unable to step beyond the collective narratives of their chosen tribe for fear that they will be rejected and forced to go grovelling to the dreaded others for support.
The writer has to make sure he consistently signals his alignment with the left in order to avoid the outrage and ostracism mob from targeting him. This is what too much reliance on a tribalistic political alignment does, it leaves people obfuscating and unable to step beyond the collective narratives of their chosen tribe for fear that they will be rejected and forced to go grovelling to the dreaded others for support.
What’s wrong with plain old ‘very fat’? When did we become so mealy-mouthed?
Allison Barrows
1 year ago
So Lizzo is “plus-sized” but Ann Coulter is “skeletal”? Lizzo is morbidly obese, but you didn’t describe her as whale-like. Why such an uneven use of adjectives?
Richard Craven
1 year ago
“For me, glorifying the “natural” in and of itself, then, is little better than writing some trite ode to manual labour.”
This stuff is all just rich people making rods for their own backs. I’ve never been tempted to take steroids, but just go to the gym because I like being quite fit and strong and want to enjoy my old age. And once upon a time I worked as a builder’s labourer and really liked it.
I’m in my mid 50s and have been going to the gym for over 30 years now. Gone are the days when I care what I look like in the mirror, but the benefits of simply remaining strong and fit are enough on their own to make it worth it.
I’m in my mid 50s and have been going to the gym for over 30 years now. Gone are the days when I care what I look like in the mirror, but the benefits of simply remaining strong and fit are enough on their own to make it worth it.
Richard Craven
1 year ago
“For me, glorifying the “natural” in and of itself, then, is little better than writing some trite ode to manual labour.”
This stuff is all just rich people making rods for their own backs. I’ve never been tempted to take steroids, but just go to the gym because I like being quite fit and strong and want to enjoy my old age. And once upon a time I worked as a builder’s labourer and really liked it.
Last edited 1 year ago by Richard Craven
Nils Espenlaub
1 year ago
Lately I have been contemplating here and there about the body cults of our time and their dynamics with class questions. This article helps with its insights of the pharma and medical industry.
Personally, I would like to add that as a former nurse I have solid knowledge about side effects and the problems connected with new treatments or alternative use of long known medication, and I’ve got around quite in my work life. In the places I worked in and patients I treated, both wealthy with private insurance (but seldom celebrities and 1% per centers of the wealthy classes), the work ethic has always been mainly conservative: Don’t use medication or treatment that aren’t really necessary for your overall health. Because of that, I think it is worth noting that despite the dystopic urgency conveyed in the article, the phenomena described are far away from being standard mindset and way to go neither among poor nor rich people.
Here in the UK doctors and nurses approve of statins because they have to. When confronted by a patient they have three choices:
1) Prescribe approved tablets – perhaps after routine blood tests. There are fixed rules about when to prescribe or not,
2) Send him/her up the line to a specialist,
3) Both of those.
Nowhere is the doctor allowed to use an independent answer because that could lead to litigation. Lifestyle advice is taboo as well.
Are statins good for your health? Only time can tell.
I had a check-up just a week ago. Everything was fine aside from a little high cholesterol. My physician didn’t even mention the option of taking statins (but we did talk about possible causes and measures against it). Another physician may have suggested it. In Switzerland there are guidelines but no fixed rules. Doctors should have their opinion and discuss it with their patients. Is that really not the standard in GB or are you exaggerating a bit maybe?
I don’t expect any big scandals in the future around statins, rather something like with antiplatelet drugs (like Aspirin Cardio). They were widely prescribed for a while to basically anyone with risk factors, the standard now is: When it is needed. No heavy damage but also not a high benefit was the conclusion made…
Further, there’s an awareness around polypharmacy nowadays. People are often taking too many pills. Nobody can possibly know all the interactions happening in those cocktails…
I am not exaggerating. I obviously can’t say that ALL doctors (100%) behave in the same way but most do. If you are intelligent, UnHerd subscribers maybe, you have knowledge and confidence so you might initiate a discussion about health. That, I think, is slightly different.
I can confirm that most doctors in England do conform to this model of prescribing statins. There is a standard NHS test which is supposed to provide your ‘risk score’ of heart disease due to excess cholesterol. For years I was marginally below the threshold and firmly refused when my doctor wanted to prescribe statins ‘just in case’. Then then threshold was lowered by 25% without explanation and so I was marginally above it.
Although the doctor insisted on prescribing statins I have never taken them. All the evidence suggests marginal benefits, but a high risk of unpleasant side effects. Some practitioners even dispute the link between high cholesterol and heart disease.
I think this is fairly standard across the UK for how GPs operate whether with statins or with other medications. The NHS guidance gives them very little leeway to use their own discretion, hence why I tend to go round and round in circles with mine.
It seems ridiculous to have highly intelligent individuals who spend years learning about medicine and the human body reduced to reading out what their computer tells them after they’ve inputted a series of symptoms, but that is apparently what they’ve been reduced to under the current NHS bureaucracy.
GPs, like hospital consultants, are categorised as ‘independent practitioners’. This means that they aren’t obliged to follow any fixed guidelines or protocols and may deviate from algorithms as much as they please if they consider it’s in the patient’s best interests.
There are 2 hefty provisos here: first, they must be able to justify what they have done; and secondly, if they are going to go ‘off piste’, it must be with the informed agreement of the patient. This takes more time.
Most doctors are motivated by what they feel is their patients’ best interests and guided by well-researched clinical guidelines. In over 20 years’ practice, I have only very rarely met a doctor who didn’t genuinely want to do the best for his or her patients. So they do follow guidelines, which nowadays are very evidence-based. (Note that the benefits of a guideline apply to to a population and may not apply to a particular individual. That’s where a really good doctor will feel it’s appropriate to do something else.)
Deviating from guidelines takes time and may involve professional risk; and doctors are by nature risk-averse. They also don’t have a lot of time. There aren’t enough doctors and their supporting and administrative infrastructure is generally poor in the NHS.
GPs are also motivated by centralist incentives, linking targets to funding. This is an example of top-down micromanagement from non-medical NHS senior managers who don’t like the idea of providing the resources and trusting what are generally well motivated professionals to do their job. Don’t blame GPs for following NHS central incentives, blame the Stalinist NHS for forcing often inappropriate targets onto them. A GP practice that ignores them will go bust.
So doctors do tend to follow the guidelines by default. They don’t do it because they’re lazy, greedy, stupid, ignorant or in the pay of Evil Big Pharma (if only…).
They do it because they don’t have much time, because the guidelines tend to work and are strongly evidence-based, and because going off-piste involves professional risk and doctors don’t like risk.
Thanks to all for taking the time to share the experiences with and opinions about the health care system of England. As a foreigner I read them with a keen interest.
Thanks to all for taking the time to share the experiences with and opinions about the health care system of England. As a foreigner I read them with a keen interest.
GPs, like hospital consultants, are categorised as ‘independent practitioners’. This means that they aren’t obliged to follow any fixed guidelines or protocols and may deviate from algorithms as much as they please if they consider it’s in the patient’s best interests.
There are 2 hefty provisos here: first, they must be able to justify what they have done; and secondly, if they are going to go ‘off piste’, it must be with the informed agreement of the patient. This takes more time.
Most doctors are motivated by what they feel is their patients’ best interests and guided by well-researched clinical guidelines. In over 20 years’ practice, I have only very rarely met a doctor who didn’t genuinely want to do the best for his or her patients. So they do follow guidelines, which nowadays are very evidence-based. (Note that the benefits of a guideline apply to to a population and may not apply to a particular individual. That’s where a really good doctor will feel it’s appropriate to do something else.)
Deviating from guidelines takes time and may involve professional risk; and doctors are by nature risk-averse. They also don’t have a lot of time. There aren’t enough doctors and their supporting and administrative infrastructure is generally poor in the NHS.
GPs are also motivated by centralist incentives, linking targets to funding. This is an example of top-down micromanagement from non-medical NHS senior managers who don’t like the idea of providing the resources and trusting what are generally well motivated professionals to do their job. Don’t blame GPs for following NHS central incentives, blame the Stalinist NHS for forcing often inappropriate targets onto them. A GP practice that ignores them will go bust.
So doctors do tend to follow the guidelines by default. They don’t do it because they’re lazy, greedy, stupid, ignorant or in the pay of Evil Big Pharma (if only…).
They do it because they don’t have much time, because the guidelines tend to work and are strongly evidence-based, and because going off-piste involves professional risk and doctors don’t like risk.
I can confirm that most doctors in England do conform to this model of prescribing statins. There is a standard NHS test which is supposed to provide your ‘risk score’ of heart disease due to excess cholesterol. For years I was marginally below the threshold and firmly refused when my doctor wanted to prescribe statins ‘just in case’. Then then threshold was lowered by 25% without explanation and so I was marginally above it.
Although the doctor insisted on prescribing statins I have never taken them. All the evidence suggests marginal benefits, but a high risk of unpleasant side effects. Some practitioners even dispute the link between high cholesterol and heart disease.
I think this is fairly standard across the UK for how GPs operate whether with statins or with other medications. The NHS guidance gives them very little leeway to use their own discretion, hence why I tend to go round and round in circles with mine.
It seems ridiculous to have highly intelligent individuals who spend years learning about medicine and the human body reduced to reading out what their computer tells them after they’ve inputted a series of symptoms, but that is apparently what they’ve been reduced to under the current NHS bureaucracy.
I am not exaggerating. I obviously can’t say that ALL doctors (100%) behave in the same way but most do. If you are intelligent, UnHerd subscribers maybe, you have knowledge and confidence so you might initiate a discussion about health. That, I think, is slightly different.
There’s another factor, more imperative than any of those you’ve mentioned.
GPs who have a certain percentage of their patient population on statins receive a financial bonus for doing so. The main driver of statin prescription is greed, both by the GP and the pharmaceutical companies.
As a very naturally fit male, when i went for a routine GP checkup aged 60 the idiot (yes, the GP) tried to put me on statins. My BMI is bang in mid-range, my cholesterol levels normal. I asked him why: he replied “just in case”. I said i’d get back to him on that, did some basic research on side effects (i have healthcare experience and know what i’m looking at) and made a point of never going near that particular GP again. How GPs are Paid to Prescribe Ineffective Drugs – Patrick Holford
Thanks for the link. I had no idea that GPs were remunerated for prescribing drugs.
Having lived a long time in France I can also confirm that the UK is far from the leader in over-prescribing. No visit to the ‘médecin de famille’ was considered worthwhile unless the patient left with a prescription for 3 or 4 pills, sometimes double that.
The main driver for doctors prescribing statins is that they work if prescribed to the right people. That is, applied to a population of people considered at a higher risk of cardiovascular disease, they result in a significantly lower overall rate of heart attacks and strokes. That’s based on metadata from numerous robust trials, leading to objective evidence: more credible than scattered and colourful anecdote (but, of course, less entertaining!)
The NHS does link statin prescribing to GP target-based funding, but only for patients who fulfil the at-risk descriptors. So, yes, there is a non-medical incentive there for GPs to prescribe for borderline cases, and perhaps there shouldn’t be.
However, cardiologists and general physicians also prescribe statins pretty liberally, and they have no financial incentive to do so.
A few people experience adverse effects from statins that can occasionally be serious. Most don’t, and statins do provide a benefit if prescribed to the right people.
As always, nuance is more valuable than sweeping condemnation or anec-data. The devil – or saint – is in the detail.
I think rather than non-medical’ you should say ‘public health motivated’ – your point of view is spot on, but in fact the decisions about how to (financially) motivate population-based prescribing by independent contractors are taken by clinicians and implemented by managers, not the other way round. Alas the funds are provided by politicians and warped by their motives.
I think rather than non-medical’ you should say ‘public health motivated’ – your point of view is spot on, but in fact the decisions about how to (financially) motivate population-based prescribing by independent contractors are taken by clinicians and implemented by managers, not the other way round. Alas the funds are provided by politicians and warped by their motives.
Thanks for the link. I had no idea that GPs were remunerated for prescribing drugs.
Having lived a long time in France I can also confirm that the UK is far from the leader in over-prescribing. No visit to the ‘médecin de famille’ was considered worthwhile unless the patient left with a prescription for 3 or 4 pills, sometimes double that.
The main driver for doctors prescribing statins is that they work if prescribed to the right people. That is, applied to a population of people considered at a higher risk of cardiovascular disease, they result in a significantly lower overall rate of heart attacks and strokes. That’s based on metadata from numerous robust trials, leading to objective evidence: more credible than scattered and colourful anecdote (but, of course, less entertaining!)
The NHS does link statin prescribing to GP target-based funding, but only for patients who fulfil the at-risk descriptors. So, yes, there is a non-medical incentive there for GPs to prescribe for borderline cases, and perhaps there shouldn’t be.
However, cardiologists and general physicians also prescribe statins pretty liberally, and they have no financial incentive to do so.
A few people experience adverse effects from statins that can occasionally be serious. Most don’t, and statins do provide a benefit if prescribed to the right people.
As always, nuance is more valuable than sweeping condemnation or anec-data. The devil – or saint – is in the detail.
I have only had one discussion with a GP about statins when my cholesterol was slightly high. The GP, a friend, said that although the recommendation was to take statins it was up to me and that they simply shifted the risks a tiny percentage. I chose not to take them. Since he retired I have seldom seen a GP during and after the pandemic and no interest in my cholesterol has been expressed.
I had a check-up just a week ago. Everything was fine aside from a little high cholesterol. My physician didn’t even mention the option of taking statins (but we did talk about possible causes and measures against it). Another physician may have suggested it. In Switzerland there are guidelines but no fixed rules. Doctors should have their opinion and discuss it with their patients. Is that really not the standard in GB or are you exaggerating a bit maybe?
I don’t expect any big scandals in the future around statins, rather something like with antiplatelet drugs (like Aspirin Cardio). They were widely prescribed for a while to basically anyone with risk factors, the standard now is: When it is needed. No heavy damage but also not a high benefit was the conclusion made…
Further, there’s an awareness around polypharmacy nowadays. People are often taking too many pills. Nobody can possibly know all the interactions happening in those cocktails…
There’s another factor, more imperative than any of those you’ve mentioned.
GPs who have a certain percentage of their patient population on statins receive a financial bonus for doing so. The main driver of statin prescription is greed, both by the GP and the pharmaceutical companies.
As a very naturally fit male, when i went for a routine GP checkup aged 60 the idiot (yes, the GP) tried to put me on statins. My BMI is bang in mid-range, my cholesterol levels normal. I asked him why: he replied “just in case”. I said i’d get back to him on that, did some basic research on side effects (i have healthcare experience and know what i’m looking at) and made a point of never going near that particular GP again. How GPs are Paid to Prescribe Ineffective Drugs – Patrick Holford
I have only had one discussion with a GP about statins when my cholesterol was slightly high. The GP, a friend, said that although the recommendation was to take statins it was up to me and that they simply shifted the risks a tiny percentage. I chose not to take them. Since he retired I have seldom seen a GP during and after the pandemic and no interest in my cholesterol has been expressed.
Here in the UK doctors and nurses approve of statins because they have to. When confronted by a patient they have three choices:
1) Prescribe approved tablets – perhaps after routine blood tests. There are fixed rules about when to prescribe or not,
2) Send him/her up the line to a specialist,
3) Both of those.
Nowhere is the doctor allowed to use an independent answer because that could lead to litigation. Lifestyle advice is taboo as well.
Are statins good for your health? Only time can tell.
Interesting discussion. I’ve recently had statins and aspirin added to my daily blood pressure tablets because my cholesterol was “a bit high” (which may have been understatement). I’m not aware of any downside at the moment.
Widowed male in his late 60s, and I must admit being a bit freaked by a number of seemingly fit contemporaries or younger who’ve died of heart attacks or had debilitating strokes in recent years.
Interesting discussion. I’ve recently had statins and aspirin added to my daily blood pressure tablets because my cholesterol was “a bit high” (which may have been understatement). I’m not aware of any downside at the moment.
Widowed male in his late 60s, and I must admit being a bit freaked by a number of seemingly fit contemporaries or younger who’ve died of heart attacks or had debilitating strokes in recent years.
Nils Espenlaub
1 year ago
Lately I have been contemplating here and there about the body cults of our time and their dynamics with class questions. This article helps with its insights of the pharma and medical industry.
Personally, I would like to add that as a former nurse I have solid knowledge about side effects and the problems connected with new treatments or alternative use of long known medication, and I’ve got around quite in my work life. In the places I worked in and patients I treated, both wealthy with private insurance (but seldom celebrities and 1% per centers of the wealthy classes), the work ethic has always been mainly conservative: Don’t use medication or treatment that aren’t really necessary for your overall health. Because of that, I think it is worth noting that despite the dystopic urgency conveyed in the article, the phenomena described are far away from being standard mindset and way to go neither among poor nor rich people.
jane baker
1 year ago
I’m very suspicious ,(always) this new drug is not about blessing poor fat people with desirable slimness. Its allied to food,making you not want to eat food…. I don’t know any more. I haven’t got a theory,(for once) but it’s about something else. I don’t like it.
Now about 20 years ago,cos I was back at our old house there was a light hearted story in a newspaper. It was jolly and funny and it triggered something in my brain. A big rock star,maybe Rod Stewart or Keith Richards was sunning his rock star body on a beach near Nice when he met his either binman or postman . He has a nice friendly chat and a picture was taken by whoever that made a feature in the papers. Rock star and binman holiday on same exclusive beach. And for some strange reason my brain said ” what’s the point of being rich if your service people can live to the same high standard as you”.
That wasn’t my credo I hasten to add. I thought it was wonderful that over a century of campaigning and union in strength had brought about an equable world in which hard working and wits about them working people could live well,which is the point of life,and the whole point of working. But obviously someone was having that same wicked thought that strayed into my head.
jane baker
1 year ago
I’m very suspicious ,(always) this new drug is not about blessing poor fat people with desirable slimness. Its allied to food,making you not want to eat food…. I don’t know any more. I haven’t got a theory,(for once) but it’s about something else. I don’t like it.
Now about 20 years ago,cos I was back at our old house there was a light hearted story in a newspaper. It was jolly and funny and it triggered something in my brain. A big rock star,maybe Rod Stewart or Keith Richards was sunning his rock star body on a beach near Nice when he met his either binman or postman . He has a nice friendly chat and a picture was taken by whoever that made a feature in the papers. Rock star and binman holiday on same exclusive beach. And for some strange reason my brain said ” what’s the point of being rich if your service people can live to the same high standard as you”.
That wasn’t my credo I hasten to add. I thought it was wonderful that over a century of campaigning and union in strength had brought about an equable world in which hard working and wits about them working people could live well,which is the point of life,and the whole point of working. But obviously someone was having that same wicked thought that strayed into my head.
Michelle Johnston
1 year ago
Maybe because my forebears emerged out of a small terraced property next to the River Calder in Dewsbury with an outside toilet the thought of spending all that money, when I can achieve the same result by exercise and a passion for the right food, fills me with no enthusiasm. I also have the mental “get” that I made the effort in both directions and own the result.
Last edited 1 year ago by Michelle Johnston
Michelle Johnston
1 year ago
Maybe because my forebears emerged out of a small terraced property next to the River Calder in Dewsbury with an outside toilet the thought of spending all that money, when I can achieve the same result by exercise and a passion for the right food, fills me with no enthusiasm. I also have the mental “get” that I made the effort in both directions and own the result.
Last edited 1 year ago by Michelle Johnston
Alex Cranberg
1 year ago
Much ado about very little indeed. If some people want to experiment on themselves while the rest of us observe and learn, so much the better.
What are the side effects of this stuff that requires traveling outside the FDA’s purview to obtain? How serious are the cancers that Ozempic causes? The so-called “rich elite” will tell us.
As for “trickle down” name one miracle treatment that the elite of previous generations took that was even modestly effective! And any drug from past generations is today stupidly cheap.
Alex Cranberg
1 year ago
Much ado about very little indeed. If some people want to experiment on themselves while the rest of us observe and learn, so much the better.
What are the side effects of this stuff that requires traveling outside the FDA’s purview to obtain? How serious are the cancers that Ozempic causes? The so-called “rich elite” will tell us.
As for “trickle down” name one miracle treatment that the elite of previous generations took that was even modestly effective! And any drug from past generations is today stupidly cheap.
William Jackson
1 year ago
Question, do the ‘improvers’ live any longer, do we have enough evidence to show any potential harm, finally what happens if/when the money dries up?
William Jackson
1 year ago
Question, do the ‘improvers’ live any longer, do we have enough evidence to show any potential harm, finally what happens if/when the money dries up?
Kirsten Walstedt
1 year ago
Ozempic can cause laryngeal cancer. It’s for this reason doctors recommend their patients only take it in the short term. It’s no panacea for weight loss.
Kirsten Walstedt
1 year ago
Ozempic can cause laryngeal cancer. It’s for this reason doctors recommend their patients only take it in the short term. It’s no panacea for weight loss.
It is hard to understand the stupidity of this narcissism. Even if you can edit out the imperfections in your own body – perhaps downsizing your nose – you’re probably setting up your children to have to do the same (they’ll likely inherit the same “faults” you’ve spent so much money airbrushing out and feel pressure to do the same). So you end up almost imposing unnecessary surgery on your own children.
These are the very same people lecturing us about how they need to take more of money from ordinary working people to hand out to “more deserving” people who are the “victims” of life’s unfairnesses. While blowing fortunes on their vanity and not dipping into their own pockets (and often paying very little tax).
They truly are the Bourbons of the modern age.
Ignore these fools trying to tell you how you should look or behave. Just be yourself.
But what if being yourself is not good enough to get you a stunningly gorgeous trophy wife or a ripped, studly boy toy? It’s all about the sex, nothing more.
Vane, vane, vane
Nobody really gives a shit about you looking like a plastic action man figure, unnatural, super white teeth, skinny….it’s a fashion symbol of thinking you look good…..pride in vanity, history tells us this always goes on. Nobody cares apart from the clique that do it. Rich to poor, there are such cliques.
Won’t resolve your inner self issues, if you have them.
The biggest issue here is the gap between the rich and others, never in history has it been this wide and at some point the masses have to rebel. Laws, regulations, government policy all very very beneficial to take more from us peasants.
Work hard and you’ll hit a glass ceiling….in the past, physically you could take, now it’s shielded by a web of tech. Not to say its right to physically take but that was a means when the rich got too out of control- as mentioned in the article.
Unfortunately it’s not going to improve and the world’s assets will be sucked into the few and the ridiculous gluttony and waste will continue as others suffer.
Sermon over, I’m lucky that I’m at the glass ceiling and only significantly taxed for the privilege of working hard and having a bit of luck. I detest what’s happening and the lack of wealth distribution and advantageous acts of the few, who take take take.
I was astonished by the number of human barrels I saw in costco yesterday – and most of them have obviously picked up bad habits from the indigenous population. They’ll buy the daft jabs, and be surprised when they don’t work.
But what if being yourself is not good enough to get you a stunningly gorgeous trophy wife or a ripped, studly boy toy? It’s all about the sex, nothing more.
Vane, vane, vane
Nobody really gives a shit about you looking like a plastic action man figure, unnatural, super white teeth, skinny….it’s a fashion symbol of thinking you look good…..pride in vanity, history tells us this always goes on. Nobody cares apart from the clique that do it. Rich to poor, there are such cliques.
Won’t resolve your inner self issues, if you have them.
The biggest issue here is the gap between the rich and others, never in history has it been this wide and at some point the masses have to rebel. Laws, regulations, government policy all very very beneficial to take more from us peasants.
Work hard and you’ll hit a glass ceiling….in the past, physically you could take, now it’s shielded by a web of tech. Not to say its right to physically take but that was a means when the rich got too out of control- as mentioned in the article.
Unfortunately it’s not going to improve and the world’s assets will be sucked into the few and the ridiculous gluttony and waste will continue as others suffer.
Sermon over, I’m lucky that I’m at the glass ceiling and only significantly taxed for the privilege of working hard and having a bit of luck. I detest what’s happening and the lack of wealth distribution and advantageous acts of the few, who take take take.
I was astonished by the number of human barrels I saw in costco yesterday – and most of them have obviously picked up bad habits from the indigenous population. They’ll buy the daft jabs, and be surprised when they don’t work.
It is hard to understand the stupidity of this narcissism. Even if you can edit out the imperfections in your own body – perhaps downsizing your nose – you’re probably setting up your children to have to do the same (they’ll likely inherit the same “faults” you’ve spent so much money airbrushing out and feel pressure to do the same). So you end up almost imposing unnecessary surgery on your own children.
These are the very same people lecturing us about how they need to take more of money from ordinary working people to hand out to “more deserving” people who are the “victims” of life’s unfairnesses. While blowing fortunes on their vanity and not dipping into their own pockets (and often paying very little tax).
They truly are the Bourbons of the modern age.
Ignore these fools trying to tell you how you should look or behave. Just be yourself.
I feel a bit sorry for these poor people. All that money and yet so much fear. The joys of existence, simple and plain, swapped for an endless battle with the inevitable.
And how much more anguishing it’ll be for them, when the inevitable happens.
And how much more anguishing it’ll be for them, when the inevitable happens.
I feel a bit sorry for these poor people. All that money and yet so much fear. The joys of existence, simple and plain, swapped for an endless battle with the inevitable.
Momento Mori – don’t underestimate Mother Nature or Father Time – they’ll get you in the end. Remember the cadaver tombs of medieval England. Yes, you can delay the journey to compost but isn’t it better just to face up to it instead?
Spot on. 12 months after we’re dead, we all look the same.
Or in the case of the ancient Egyptian elite, they look like their mummies.
Worms: “They go in thin and come out stout”.*
(*Anon.)
Or in the case of the ancient Egyptian elite, they look like their mummies.
Worms: “They go in thin and come out stout”.*
(*Anon.)
I liked your comment but let’s get our Latin right – it’s ‘memento mori’
Spot on. 12 months after we’re dead, we all look the same.
I liked your comment but let’s get our Latin right – it’s ‘memento mori’
Momento Mori – don’t underestimate Mother Nature or Father Time – they’ll get you in the end. Remember the cadaver tombs of medieval England. Yes, you can delay the journey to compost but isn’t it better just to face up to it instead?
When I gave up drinking, I lost 4 stone in about 5 months: My ” diet advisors” were jockeys, who live ” to the pound” as they are weighed sometimes 32 times a day when evening racing occurs.
I learned from their sage advice that the key to losing weight is to break the ” habit signal” between mind and stomach, and after only 3 days of 1 small meal a day, it starts to kick in. After that its about planning a weekly intake, and adjusting it upwards and downwards. 20 years on, it has worked for me!
Nuli Secundus!
I then proceeded to, in the following 4 years, break 8 ribs, sternum, 3 verterbrae, all my fingers and disclocate my jaw out hunting, proving that swapping an alcohol addiction for the ” buzz” of riding over hedges and fences, ” sans talent” , was just another addict proclivity… but at least I was thin!
I then proceeded to, in the following 4 years, break 8 ribs, sternum, 3 verterbrae, all my fingers and disclocate my jaw out hunting, proving that swapping an alcohol addiction for the ” buzz” of riding over hedges and fences, ” sans talent” , was just another addict proclivity… but at least I was thin!
Nuli Secundus!
When I gave up drinking, I lost 4 stone in about 5 months: My ” diet advisors” were jockeys, who live ” to the pound” as they are weighed sometimes 32 times a day when evening racing occurs.
I learned from their sage advice that the key to losing weight is to break the ” habit signal” between mind and stomach, and after only 3 days of 1 small meal a day, it starts to kick in. After that its about planning a weekly intake, and adjusting it upwards and downwards. 20 years on, it has worked for me!
Humanity’s biggest danger is at its moment of optimum possibility it opts for dumbing down, and superficiality.
Rather like the Classical Roman Empire opting for the ridiculous creed of the Nazarene, otherwise known as Christianity.
Logos and literacy. Change your life.
Opting for? Then, as now, the ‘ridiculous’ creed of the Nazarene has irresistible power to deliver life and liberty.
Sadly, Rome opted largely for the creed. The Nazarene himself is never an instrument of the State…..
Logos and literacy. Change your life.
Opting for? Then, as now, the ‘ridiculous’ creed of the Nazarene has irresistible power to deliver life and liberty.
Sadly, Rome opted largely for the creed. The Nazarene himself is never an instrument of the State…..
Rather like the Classical Roman Empire opting for the ridiculous creed of the Nazarene, otherwise known as Christianity.
Humanity’s biggest danger is at its moment of optimum possibility it opts for dumbing down, and superficiality.
I feel a bit sorry for rich people if this is what they focus on all the time. Not much of a life, is it. All that money and they spend it on cosmetic drugs and procedures? Poor buggers.
All the while lecturing us about equity and inclusion. Now if they donated 10% of their wealth to charity, then I would think differently about them.
Oh they do. More. But of course their “charity” means imposing their vision on the world – i.e. translating money into power ala Bill Gates. There’s only so much money one can consume, so the rest must feed the ego in other ways. Hard to avoid at a certain scale.
The “charitable” stuff often involves huge tax breaks in the US and is often done for financial reasons.
But not always. There is a real and strong tradition of philanthropy by billionaires going back at least to Andrew Carnegie (including building countless public libraries back in the UK).
Sorry, I don’t buy into the Bill Gates conspiracy theories. People’s motivations vary and are not always malign. We should not always assume the worst case.
It’s not that Gates is malign. But he’s a software guy through and through.
RNA, DNA. They’re biologic forms of software. The body can be happily reprogrammed. Hence mrna vaccines.
I didn’t use to until I saw him,Gates doing an interview. It was his facial movements. Smiling inappropriately at the wrong times. Answering too quick or far too slow. When someone says 15K children are going to die all the while self satisfied smiling it just comes across as wrong. If he is autistic or something he’s not doing that community any favours.
It’s not that Gates is malign. But he’s a software guy through and through.
RNA, DNA. They’re biologic forms of software. The body can be happily reprogrammed. Hence mrna vaccines.
I didn’t use to until I saw him,Gates doing an interview. It was his facial movements. Smiling inappropriately at the wrong times. Answering too quick or far too slow. When someone says 15K children are going to die all the while self satisfied smiling it just comes across as wrong. If he is autistic or something he’s not doing that community any favours.
The “charitable” stuff often involves huge tax breaks in the US and is often done for financial reasons.
But not always. There is a real and strong tradition of philanthropy by billionaires going back at least to Andrew Carnegie (including building countless public libraries back in the UK).
Sorry, I don’t buy into the Bill Gates conspiracy theories. People’s motivations vary and are not always malign. We should not always assume the worst case.
Oh they do. More. But of course their “charity” means imposing their vision on the world – i.e. translating money into power ala Bill Gates. There’s only so much money one can consume, so the rest must feed the ego in other ways. Hard to avoid at a certain scale.
All the while lecturing us about equity and inclusion. Now if they donated 10% of their wealth to charity, then I would think differently about them.
I feel a bit sorry for rich people if this is what they focus on all the time. Not much of a life, is it. All that money and they spend it on cosmetic drugs and procedures? Poor buggers.
Plus ça change, plus c’est la même chose. The rich always have and always will divorce themselves from reality – because they can. See Lineker’s recent comments.
The people who can afford to escape real life have to make their own reality.
The own reality would be ok in itself. Problematic are the gated communities (or own worlds) spreading along with it. Despite having a conservative liberal worldview, I conclude with Žižek among others that this is not a thing to wish for if one is interested in keeping civilization intact in some form.
Hm. Yes, we really need to control people…
We’re all being controlled. The question is who you believe it to be by.
Imho it is not about directly or indirectly controlling people. There are a lot of different ways to assess the problem of gated communities (both on the political and the cultural spectrum …). It would take it too far starting discussing them here, but I found it a pity that people seem to have problems imagining possible solutions that go beyond autocratic policies, although I understand the defensive reflex (and know it myself) just assuming something repressive…
We’re all being controlled. The question is who you believe it to be by.
Imho it is not about directly or indirectly controlling people. There are a lot of different ways to assess the problem of gated communities (both on the political and the cultural spectrum …). It would take it too far starting discussing them here, but I found it a pity that people seem to have problems imagining possible solutions that go beyond autocratic policies, although I understand the defensive reflex (and know it myself) just assuming something repressive…
When have the rich not lived in gated communities or walled enclaves?
Sure, the question is to which extent (qualitative and quantitative) and what rich people we’re speaking of. Super rich? Wealthy?
Sure, the question is to which extent (qualitative and quantitative) and what rich people we’re speaking of. Super rich? Wealthy?
Hm. Yes, we really need to control people…
When have the rich not lived in gated communities or walled enclaves?
The own reality would be ok in itself. Problematic are the gated communities (or own worlds) spreading along with it. Despite having a conservative liberal worldview, I conclude with Žižek among others that this is not a thing to wish for if one is interested in keeping civilization intact in some form.
Plus ça change, plus c’est la même chose. The rich always have and always will divorce themselves from reality – because they can. See Lineker’s recent comments.
The people who can afford to escape real life have to make their own reality.
Progresss and technology DO trickle down
Almost every European enjoys access to a level of medication, nutrition and health resources that are inline with the best of the best available a century ago.
Put trickle down is a long process, and probably in 50y middle class people will routinlely get Ozempic like shape enhancing medication while the elite of the future will have brain transplant body rejuvenation
If we do not find other ways to deal with obesity in our societies, then yes, it will unfortunately become a normal thing at some distant point in time. But I also believe there will be a change in thinking on the way, just because it is already happening, that will counter the severity of the development towards the “just fix it with a pill” mentality.
What would drive this change in thinking? I can’t see it. The average person I know lives for treats. Almost all of these treats involve eating or drinking something:
Now I’ve been shopping I deserve a treat – a cup of tea and a chocolate biscuit, or,
I’ve had a hard week – let’s go out for a curry on Friday, or.. It’s John’s birthday tomorrow, let’s take him out for a meal. Etc, etc.
What else is there to look forward to?
It is indeed hard to see. But, hey, we are here talking about at least the possibilities of change.
If you look at it from a historical perspective, the mainstream mind set within a nation or a cultural sphere is constantly changing. I think we are heading forward towards a “dark age” (not in the sense of everything is bad, civilization going to collapse, worlds ending and so on…). Things will be confusing and changes more erratic and less streamlined than in the last maybe 200 years. Society won’t be the same in 50 years as it is now. I do not see the worth in fatalistic thinking regarding the future, regardless of being a rather pessimistic person myself.
A tour of the major Edwardian Castles in say North Wales? Failing that Welsh Cistercian Abbeys perhaps?
I know the MacDonalds in Caernarfon so we could eat as well.
Isn’t it Caernarvon?
Or have you “gone native”?
Definitely ‘f’.
Wasn’t it built on the orders of the King of England, who incidentally was also nicknamed “Hammer of the Scotch”?
Also called, ‘Longshanks’. I believe he imported 20,000 craftsmen from Europe to do the job.
Certainly Master St George of Savoy. But 20,000 others! I would have thought that was logistically Impossible in the 13th century.
These people were NOT Romans after all.
Certainly Master St George of Savoy. But 20,000 others! I would have thought that was logistically Impossible in the 13th century.
These people were NOT Romans after all.
Also called, ‘Longshanks’. I believe he imported 20,000 craftsmen from Europe to do the job.
Wasn’t it built on the orders of the King of England, who incidentally was also nicknamed “Hammer of the Scotch”?
Definitely ‘f’.
Isn’t it Caernarvon?
Or have you “gone native”?
I know the MacDonalds in Caernarfon so we could eat as well.
Oh, there is so much to look forward to beside food and drink!!!! Gardening, enjoying the birds, butterflies, and flowers in your garden, cuddling with your cat, going for a walk with your dog, riding and caring for your horse. A kiss, a hug, holding hands, the sparkle in your partner’s eyes when they look at you, sex of course, painting, listening to music (be it at home, a concert or the symphony – all things I greatly look forward to), making music (this is what my husband looks forward to whenver he is away from his instruments), taking a bath, enjoying fragrances in all kinds of forms – flowers, herbs, fresh cut grass, essential oils. Colors – the blue of the sky, the orange red of a cardinal and the yellow of a goldfinch on my birdfeeder. The sound, scent and beauty of the ocean. Amazing architecture, gorgeous old buildings, the beautiful canopy of my neighborhood’s tree lined streets. And a million more things. I mean, there is SO MUCH to enjoy and look forward to!!!! Food & drink are pretty much at the bottom of my list.
Great reply,exactly my thoughts but I could never have found those great words to express it. Plant a garden,there’s always something to add anticipate
Great reply,exactly my thoughts but I could never have found those great words to express it. Plant a garden,there’s always something to add anticipate
It is indeed hard to see. But, hey, we are here talking about at least the possibilities of change.
If you look at it from a historical perspective, the mainstream mind set within a nation or a cultural sphere is constantly changing. I think we are heading forward towards a “dark age” (not in the sense of everything is bad, civilization going to collapse, worlds ending and so on…). Things will be confusing and changes more erratic and less streamlined than in the last maybe 200 years. Society won’t be the same in 50 years as it is now. I do not see the worth in fatalistic thinking regarding the future, regardless of being a rather pessimistic person myself.
A tour of the major Edwardian Castles in say North Wales? Failing that Welsh Cistercian Abbeys perhaps?
Oh, there is so much to look forward to beside food and drink!!!! Gardening, enjoying the birds, butterflies, and flowers in your garden, cuddling with your cat, going for a walk with your dog, riding and caring for your horse. A kiss, a hug, holding hands, the sparkle in your partner’s eyes when they look at you, sex of course, painting, listening to music (be it at home, a concert or the symphony – all things I greatly look forward to), making music (this is what my husband looks forward to whenver he is away from his instruments), taking a bath, enjoying fragrances in all kinds of forms – flowers, herbs, fresh cut grass, essential oils. Colors – the blue of the sky, the orange red of a cardinal and the yellow of a goldfinch on my birdfeeder. The sound, scent and beauty of the ocean. Amazing architecture, gorgeous old buildings, the beautiful canopy of my neighborhood’s tree lined streets. And a million more things. I mean, there is SO MUCH to enjoy and look forward to!!!! Food & drink are pretty much at the bottom of my list.
What would drive this change in thinking? I can’t see it. The average person I know lives for treats. Almost all of these treats involve eating or drinking something:
Now I’ve been shopping I deserve a treat – a cup of tea and a chocolate biscuit, or,
I’ve had a hard week – let’s go out for a curry on Friday, or.. It’s John’s birthday tomorrow, let’s take him out for a meal. Etc, etc.
What else is there to look forward to?
Quite so. The same went for automobiles, fresh fruit, colored televisions, cell phones and world class health care. All were at one time only in the purview of the rich.
Which is why they are now removing it.
If we do not find other ways to deal with obesity in our societies, then yes, it will unfortunately become a normal thing at some distant point in time. But I also believe there will be a change in thinking on the way, just because it is already happening, that will counter the severity of the development towards the “just fix it with a pill” mentality.
Quite so. The same went for automobiles, fresh fruit, colored televisions, cell phones and world class health care. All were at one time only in the purview of the rich.
Which is why they are now removing it.
Progresss and technology DO trickle down
Almost every European enjoys access to a level of medication, nutrition and health resources that are inline with the best of the best available a century ago.
Put trickle down is a long process, and probably in 50y middle class people will routinlely get Ozempic like shape enhancing medication while the elite of the future will have brain transplant body rejuvenation
Early follow up studies show people gain weight just as quickly after stopping Ozempic as after any other form of weight loss. It’s also suspected of causing Thyroid cancer in animals as well as being teratogenic. There are no free rides in this life.
Yes there are, working for the wretched British Civil Service for one.
And then taking early retirement on a DB pension.
And then taking early retirement on a DB pension.
Yes there are, working for the wretched British Civil Service for one.
Early follow up studies show people gain weight just as quickly after stopping Ozempic as after any other form of weight loss. It’s also suspected of causing Thyroid cancer in animals as well as being teratogenic. There are no free rides in this life.
There’s increasing confusion in unherd articles between UK and USA. On the day I received this one, NHS announced the drug will be available in UK on the NHS, and that rather negates the whole article!
There’s increasing confusion in unherd articles between UK and USA. On the day I received this one, NHS announced the drug will be available in UK on the NHS, and that rather negates the whole article!
The supposition that no “trickle-down” effect will happen is not actually defended here beyond mere assertion. Mainly because as soon as anyone uses the phrase, they automatically place themselves into a logical cul-de-sac because there is not and never has been such a thing as “trickle-down” economics in the modern age.
The modern age has been characterised by mass prosperity, and that prosperity has been driven principally on how to deliver technological gains at a level of resource use that makes it possible for people on modest incomes to afford those gains themselves. There is no reason given in the above article as to why this same mechanism won’t apply in due course to the healthspan extension presently enjoyed only by wealthy people, and the reason is simply that as soon as it becomes technically efficient to produce the various drugs and treatments, the people who own the rights to them will find that they make more money selling millions of treatments for $1000 than they do selling a hundred treatments for a million each.
As to some of the other comments here which dismiss all this as mere vanity, no it isn’t, because what you look like is only part of the issue. The rest of it is about how much longer your life can be while remaining physically robust and vigorous, and wanting that period of your life to last as long as possible is entirely understandable and it’s no surprise that people will pay a lot of money for it if they can.
There is also, of course, possibly a huge economic benefit in making adults live longer by extending the middle part of their lives – when they can work – instead of extending the decrepit part of their lives at the end when they require the economic output of others to live. The possibilities here are actually rather amazing – doctors, lawyers, software programmers, artists, architects etc whose professional careers aren’t just 40 years long but, say, a whole century long. And it would solve the demographic challenge about how a shrinking working age population can support expanding legions of retired people who all want their pensions and healthcare – it would put that trend into reverse. Just a thought.
The supposition that no “trickle-down” effect will happen is not actually defended here beyond mere assertion. Mainly because as soon as anyone uses the phrase, they automatically place themselves into a logical cul-de-sac because there is not and never has been such a thing as “trickle-down” economics in the modern age.
The modern age has been characterised by mass prosperity, and that prosperity has been driven principally on how to deliver technological gains at a level of resource use that makes it possible for people on modest incomes to afford those gains themselves. There is no reason given in the above article as to why this same mechanism won’t apply in due course to the healthspan extension presently enjoyed only by wealthy people, and the reason is simply that as soon as it becomes technically efficient to produce the various drugs and treatments, the people who own the rights to them will find that they make more money selling millions of treatments for $1000 than they do selling a hundred treatments for a million each.
As to some of the other comments here which dismiss all this as mere vanity, no it isn’t, because what you look like is only part of the issue. The rest of it is about how much longer your life can be while remaining physically robust and vigorous, and wanting that period of your life to last as long as possible is entirely understandable and it’s no surprise that people will pay a lot of money for it if they can.
There is also, of course, possibly a huge economic benefit in making adults live longer by extending the middle part of their lives – when they can work – instead of extending the decrepit part of their lives at the end when they require the economic output of others to live. The possibilities here are actually rather amazing – doctors, lawyers, software programmers, artists, architects etc whose professional careers aren’t just 40 years long but, say, a whole century long. And it would solve the demographic challenge about how a shrinking working age population can support expanding legions of retired people who all want their pensions and healthcare – it would put that trend into reverse. Just a thought.
“They are selling you a picture of health that doubles as a picture of wealth” … that doubles as a picture of happiness. In many cases, the reality is the opposite.
“They are selling you a picture of health that doubles as a picture of wealth” … that doubles as a picture of happiness. In many cases, the reality is the opposite.
The other side of this strive for immortality and endless youth is the drugging and chemical engineering by state heath entities -leading to obesity and diabetes etc. Anti depressants ,neuroleptics mood “enhancers” and more. A naturally thin youth can gain 50kg over two or three years medicated with these regularly prescribed drugs.Obesity by prescription. No counter measures to address it. That is why we see so many obese people – not due to diet greed but prescribed by health service professionals. Epidemic in the USA- reaching that point here.
The other side of this strive for immortality and endless youth is the drugging and chemical engineering by state heath entities -leading to obesity and diabetes etc. Anti depressants ,neuroleptics mood “enhancers” and more. A naturally thin youth can gain 50kg over two or three years medicated with these regularly prescribed drugs.Obesity by prescription. No counter measures to address it. That is why we see so many obese people – not due to diet greed but prescribed by health service professionals. Epidemic in the USA- reaching that point here.
So Lizzo is “plus-sized” but Ann Coulter is “skeletal”? Lizzo is morbidly obese, but you didn’t describe her as whale-like. Why such an uneven use of adjectives?
The writer has to make sure he consistently signals his alignment with the left in order to avoid the outrage and ostracism mob from targeting him. This is what too much reliance on a tribalistic political alignment does, it leaves people obfuscating and unable to step beyond the collective narratives of their chosen tribe for fear that they will be rejected and forced to go grovelling to the dreaded others for support.
What’s wrong with plain old ‘very fat’? When did we become so mealy-mouthed?
Just wait a bit and it’ll come round again, as ‘queer’ has.
Alt-wokeness: mandatory speech-codes.
Just wait a bit and it’ll come round again, as ‘queer’ has.
Alt-wokeness: mandatory speech-codes.
The writer has to make sure he consistently signals his alignment with the left in order to avoid the outrage and ostracism mob from targeting him. This is what too much reliance on a tribalistic political alignment does, it leaves people obfuscating and unable to step beyond the collective narratives of their chosen tribe for fear that they will be rejected and forced to go grovelling to the dreaded others for support.
What’s wrong with plain old ‘very fat’? When did we become so mealy-mouthed?
So Lizzo is “plus-sized” but Ann Coulter is “skeletal”? Lizzo is morbidly obese, but you didn’t describe her as whale-like. Why such an uneven use of adjectives?
“For me, glorifying the “natural” in and of itself, then, is little better than writing some trite ode to manual labour.”
This stuff is all just rich people making rods for their own backs. I’ve never been tempted to take steroids, but just go to the gym because I like being quite fit and strong and want to enjoy my old age. And once upon a time I worked as a builder’s labourer and really liked it.
I’m in my mid 50s and have been going to the gym for over 30 years now. Gone are the days when I care what I look like in the mirror, but the benefits of simply remaining strong and fit are enough on their own to make it worth it.
I’m in my mid 50s and have been going to the gym for over 30 years now. Gone are the days when I care what I look like in the mirror, but the benefits of simply remaining strong and fit are enough on their own to make it worth it.
“For me, glorifying the “natural” in and of itself, then, is little better than writing some trite ode to manual labour.”
This stuff is all just rich people making rods for their own backs. I’ve never been tempted to take steroids, but just go to the gym because I like being quite fit and strong and want to enjoy my old age. And once upon a time I worked as a builder’s labourer and really liked it.
Lately I have been contemplating here and there about the body cults of our time and their dynamics with class questions. This article helps with its insights of the pharma and medical industry.
Personally, I would like to add that as a former nurse I have solid knowledge about side effects and the problems connected with new treatments or alternative use of long known medication, and I’ve got around quite in my work life. In the places I worked in and patients I treated, both wealthy with private insurance (but seldom celebrities and 1% per centers of the wealthy classes), the work ethic has always been mainly conservative: Don’t use medication or treatment that aren’t really necessary for your overall health. Because of that, I think it is worth noting that despite the dystopic urgency conveyed in the article, the phenomena described are far away from being standard mindset and way to go neither among poor nor rich people.
Are statins good for your overall health? Most of the medical fraternity will say yes even with marginal high cholesterol.
Here in the UK doctors and nurses approve of statins because they have to. When confronted by a patient they have three choices:
1) Prescribe approved tablets – perhaps after routine blood tests. There are fixed rules about when to prescribe or not,
2) Send him/her up the line to a specialist,
3) Both of those.
Nowhere is the doctor allowed to use an independent answer because that could lead to litigation. Lifestyle advice is taboo as well.
Are statins good for your health? Only time can tell.
I had a check-up just a week ago. Everything was fine aside from a little high cholesterol. My physician didn’t even mention the option of taking statins (but we did talk about possible causes and measures against it). Another physician may have suggested it. In Switzerland there are guidelines but no fixed rules. Doctors should have their opinion and discuss it with their patients. Is that really not the standard in GB or are you exaggerating a bit maybe?
I don’t expect any big scandals in the future around statins, rather something like with antiplatelet drugs (like Aspirin Cardio). They were widely prescribed for a while to basically anyone with risk factors, the standard now is: When it is needed. No heavy damage but also not a high benefit was the conclusion made…
Further, there’s an awareness around polypharmacy nowadays. People are often taking too many pills. Nobody can possibly know all the interactions happening in those cocktails…
I am not exaggerating. I obviously can’t say that ALL doctors (100%) behave in the same way but most do. If you are intelligent, UnHerd subscribers maybe, you have knowledge and confidence so you might initiate a discussion about health. That, I think, is slightly different.
I can confirm that most doctors in England do conform to this model of prescribing statins. There is a standard NHS test which is supposed to provide your ‘risk score’ of heart disease due to excess cholesterol. For years I was marginally below the threshold and firmly refused when my doctor wanted to prescribe statins ‘just in case’. Then then threshold was lowered by 25% without explanation and so I was marginally above it.
Although the doctor insisted on prescribing statins I have never taken them. All the evidence suggests marginal benefits, but a high risk of unpleasant side effects. Some practitioners even dispute the link between high cholesterol and heart disease.
Exactly the same for me.
Exactly the same for me.
I think this is fairly standard across the UK for how GPs operate whether with statins or with other medications. The NHS guidance gives them very little leeway to use their own discretion, hence why I tend to go round and round in circles with mine.
It seems ridiculous to have highly intelligent individuals who spend years learning about medicine and the human body reduced to reading out what their computer tells them after they’ve inputted a series of symptoms, but that is apparently what they’ve been reduced to under the current NHS bureaucracy.
GPs, like hospital consultants, are categorised as ‘independent practitioners’. This means that they aren’t obliged to follow any fixed guidelines or protocols and may deviate from algorithms as much as they please if they consider it’s in the patient’s best interests.
There are 2 hefty provisos here: first, they must be able to justify what they have done; and secondly, if they are going to go ‘off piste’, it must be with the informed agreement of the patient. This takes more time.
Most doctors are motivated by what they feel is their patients’ best interests and guided by well-researched clinical guidelines. In over 20 years’ practice, I have only very rarely met a doctor who didn’t genuinely want to do the best for his or her patients. So they do follow guidelines, which nowadays are very evidence-based. (Note that the benefits of a guideline apply to to a population and may not apply to a particular individual. That’s where a really good doctor will feel it’s appropriate to do something else.)
Deviating from guidelines takes time and may involve professional risk; and doctors are by nature risk-averse. They also don’t have a lot of time. There aren’t enough doctors and their supporting and administrative infrastructure is generally poor in the NHS.
GPs are also motivated by centralist incentives, linking targets to funding. This is an example of top-down micromanagement from non-medical NHS senior managers who don’t like the idea of providing the resources and trusting what are generally well motivated professionals to do their job. Don’t blame GPs for following NHS central incentives, blame the Stalinist NHS for forcing often inappropriate targets onto them. A GP practice that ignores them will go bust.
So doctors do tend to follow the guidelines by default. They don’t do it because they’re lazy, greedy, stupid, ignorant or in the pay of Evil Big Pharma (if only…).
They do it because they don’t have much time, because the guidelines tend to work and are strongly evidence-based, and because going off-piste involves professional risk and doctors don’t like risk.
Thanks to all for taking the time to share the experiences with and opinions about the health care system of England. As a foreigner I read them with a keen interest.
Thanks to all for taking the time to share the experiences with and opinions about the health care system of England. As a foreigner I read them with a keen interest.
GPs, like hospital consultants, are categorised as ‘independent practitioners’. This means that they aren’t obliged to follow any fixed guidelines or protocols and may deviate from algorithms as much as they please if they consider it’s in the patient’s best interests.
There are 2 hefty provisos here: first, they must be able to justify what they have done; and secondly, if they are going to go ‘off piste’, it must be with the informed agreement of the patient. This takes more time.
Most doctors are motivated by what they feel is their patients’ best interests and guided by well-researched clinical guidelines. In over 20 years’ practice, I have only very rarely met a doctor who didn’t genuinely want to do the best for his or her patients. So they do follow guidelines, which nowadays are very evidence-based. (Note that the benefits of a guideline apply to to a population and may not apply to a particular individual. That’s where a really good doctor will feel it’s appropriate to do something else.)
Deviating from guidelines takes time and may involve professional risk; and doctors are by nature risk-averse. They also don’t have a lot of time. There aren’t enough doctors and their supporting and administrative infrastructure is generally poor in the NHS.
GPs are also motivated by centralist incentives, linking targets to funding. This is an example of top-down micromanagement from non-medical NHS senior managers who don’t like the idea of providing the resources and trusting what are generally well motivated professionals to do their job. Don’t blame GPs for following NHS central incentives, blame the Stalinist NHS for forcing often inappropriate targets onto them. A GP practice that ignores them will go bust.
So doctors do tend to follow the guidelines by default. They don’t do it because they’re lazy, greedy, stupid, ignorant or in the pay of Evil Big Pharma (if only…).
They do it because they don’t have much time, because the guidelines tend to work and are strongly evidence-based, and because going off-piste involves professional risk and doctors don’t like risk.
I can confirm that most doctors in England do conform to this model of prescribing statins. There is a standard NHS test which is supposed to provide your ‘risk score’ of heart disease due to excess cholesterol. For years I was marginally below the threshold and firmly refused when my doctor wanted to prescribe statins ‘just in case’. Then then threshold was lowered by 25% without explanation and so I was marginally above it.
Although the doctor insisted on prescribing statins I have never taken them. All the evidence suggests marginal benefits, but a high risk of unpleasant side effects. Some practitioners even dispute the link between high cholesterol and heart disease.
I think this is fairly standard across the UK for how GPs operate whether with statins or with other medications. The NHS guidance gives them very little leeway to use their own discretion, hence why I tend to go round and round in circles with mine.
It seems ridiculous to have highly intelligent individuals who spend years learning about medicine and the human body reduced to reading out what their computer tells them after they’ve inputted a series of symptoms, but that is apparently what they’ve been reduced to under the current NHS bureaucracy.
I am not exaggerating. I obviously can’t say that ALL doctors (100%) behave in the same way but most do. If you are intelligent, UnHerd subscribers maybe, you have knowledge and confidence so you might initiate a discussion about health. That, I think, is slightly different.
There’s another factor, more imperative than any of those you’ve mentioned.
GPs who have a certain percentage of their patient population on statins receive a financial bonus for doing so. The main driver of statin prescription is greed, both by the GP and the pharmaceutical companies.
As a very naturally fit male, when i went for a routine GP checkup aged 60 the idiot (yes, the GP) tried to put me on statins. My BMI is bang in mid-range, my cholesterol levels normal. I asked him why: he replied “just in case”. I said i’d get back to him on that, did some basic research on side effects (i have healthcare experience and know what i’m looking at) and made a point of never going near that particular GP again.
How GPs are Paid to Prescribe Ineffective Drugs – Patrick Holford
However beware at 60 you enter the “beaten zone”!
Thanks for the link. I had no idea that GPs were remunerated for prescribing drugs.
Having lived a long time in France I can also confirm that the UK is far from the leader in over-prescribing. No visit to the ‘médecin de famille’ was considered worthwhile unless the patient left with a prescription for 3 or 4 pills, sometimes double that.
A plea for granularity.
The main driver for doctors prescribing statins is that they work if prescribed to the right people. That is, applied to a population of people considered at a higher risk of cardiovascular disease, they result in a significantly lower overall rate of heart attacks and strokes. That’s based on metadata from numerous robust trials, leading to objective evidence: more credible than scattered and colourful anecdote (but, of course, less entertaining!)
The NHS does link statin prescribing to GP target-based funding, but only for patients who fulfil the at-risk descriptors. So, yes, there is a non-medical incentive there for GPs to prescribe for borderline cases, and perhaps there shouldn’t be.
However, cardiologists and general physicians also prescribe statins pretty liberally, and they have no financial incentive to do so.
A few people experience adverse effects from statins that can occasionally be serious. Most don’t, and statins do provide a benefit if prescribed to the right people.
As always, nuance is more valuable than sweeping condemnation or anec-data. The devil – or saint – is in the detail.
I think rather than non-medical’ you should say ‘public health motivated’ – your point of view is spot on, but in fact the decisions about how to (financially) motivate population-based prescribing by independent contractors are taken by clinicians and implemented by managers, not the other way round. Alas the funds are provided by politicians and warped by their motives.
I think rather than non-medical’ you should say ‘public health motivated’ – your point of view is spot on, but in fact the decisions about how to (financially) motivate population-based prescribing by independent contractors are taken by clinicians and implemented by managers, not the other way round. Alas the funds are provided by politicians and warped by their motives.
However beware at 60 you enter the “beaten zone”!
Thanks for the link. I had no idea that GPs were remunerated for prescribing drugs.
Having lived a long time in France I can also confirm that the UK is far from the leader in over-prescribing. No visit to the ‘médecin de famille’ was considered worthwhile unless the patient left with a prescription for 3 or 4 pills, sometimes double that.
A plea for granularity.
The main driver for doctors prescribing statins is that they work if prescribed to the right people. That is, applied to a population of people considered at a higher risk of cardiovascular disease, they result in a significantly lower overall rate of heart attacks and strokes. That’s based on metadata from numerous robust trials, leading to objective evidence: more credible than scattered and colourful anecdote (but, of course, less entertaining!)
The NHS does link statin prescribing to GP target-based funding, but only for patients who fulfil the at-risk descriptors. So, yes, there is a non-medical incentive there for GPs to prescribe for borderline cases, and perhaps there shouldn’t be.
However, cardiologists and general physicians also prescribe statins pretty liberally, and they have no financial incentive to do so.
A few people experience adverse effects from statins that can occasionally be serious. Most don’t, and statins do provide a benefit if prescribed to the right people.
As always, nuance is more valuable than sweeping condemnation or anec-data. The devil – or saint – is in the detail.
I have only had one discussion with a GP about statins when my cholesterol was slightly high. The GP, a friend, said that although the recommendation was to take statins it was up to me and that they simply shifted the risks a tiny percentage. I chose not to take them. Since he retired I have seldom seen a GP during and after the pandemic and no interest in my cholesterol has been expressed.
I had a check-up just a week ago. Everything was fine aside from a little high cholesterol. My physician didn’t even mention the option of taking statins (but we did talk about possible causes and measures against it). Another physician may have suggested it. In Switzerland there are guidelines but no fixed rules. Doctors should have their opinion and discuss it with their patients. Is that really not the standard in GB or are you exaggerating a bit maybe?
I don’t expect any big scandals in the future around statins, rather something like with antiplatelet drugs (like Aspirin Cardio). They were widely prescribed for a while to basically anyone with risk factors, the standard now is: When it is needed. No heavy damage but also not a high benefit was the conclusion made…
Further, there’s an awareness around polypharmacy nowadays. People are often taking too many pills. Nobody can possibly know all the interactions happening in those cocktails…
There’s another factor, more imperative than any of those you’ve mentioned.
GPs who have a certain percentage of their patient population on statins receive a financial bonus for doing so. The main driver of statin prescription is greed, both by the GP and the pharmaceutical companies.
As a very naturally fit male, when i went for a routine GP checkup aged 60 the idiot (yes, the GP) tried to put me on statins. My BMI is bang in mid-range, my cholesterol levels normal. I asked him why: he replied “just in case”. I said i’d get back to him on that, did some basic research on side effects (i have healthcare experience and know what i’m looking at) and made a point of never going near that particular GP again.
How GPs are Paid to Prescribe Ineffective Drugs – Patrick Holford
I have only had one discussion with a GP about statins when my cholesterol was slightly high. The GP, a friend, said that although the recommendation was to take statins it was up to me and that they simply shifted the risks a tiny percentage. I chose not to take them. Since he retired I have seldom seen a GP during and after the pandemic and no interest in my cholesterol has been expressed.
They weren’t good for me…I was almost crippled by the side effects & it took many months to even get back to being able to walk normally.
Here in the UK doctors and nurses approve of statins because they have to. When confronted by a patient they have three choices:
1) Prescribe approved tablets – perhaps after routine blood tests. There are fixed rules about when to prescribe or not,
2) Send him/her up the line to a specialist,
3) Both of those.
Nowhere is the doctor allowed to use an independent answer because that could lead to litigation. Lifestyle advice is taboo as well.
Are statins good for your health? Only time can tell.
They weren’t good for me…I was almost crippled by the side effects & it took many months to even get back to being able to walk normally.
Interesting discussion. I’ve recently had statins and aspirin added to my daily blood pressure tablets because my cholesterol was “a bit high” (which may have been understatement). I’m not aware of any downside at the moment.
Widowed male in his late 60s, and I must admit being a bit freaked by a number of seemingly fit contemporaries or younger who’ve died of heart attacks or had debilitating strokes in recent years.
Are statins good for your overall health? Most of the medical fraternity will say yes even with marginal high cholesterol.
Interesting discussion. I’ve recently had statins and aspirin added to my daily blood pressure tablets because my cholesterol was “a bit high” (which may have been understatement). I’m not aware of any downside at the moment.
Widowed male in his late 60s, and I must admit being a bit freaked by a number of seemingly fit contemporaries or younger who’ve died of heart attacks or had debilitating strokes in recent years.
Lately I have been contemplating here and there about the body cults of our time and their dynamics with class questions. This article helps with its insights of the pharma and medical industry.
Personally, I would like to add that as a former nurse I have solid knowledge about side effects and the problems connected with new treatments or alternative use of long known medication, and I’ve got around quite in my work life. In the places I worked in and patients I treated, both wealthy with private insurance (but seldom celebrities and 1% per centers of the wealthy classes), the work ethic has always been mainly conservative: Don’t use medication or treatment that aren’t really necessary for your overall health. Because of that, I think it is worth noting that despite the dystopic urgency conveyed in the article, the phenomena described are far away from being standard mindset and way to go neither among poor nor rich people.
I’m very suspicious ,(always) this new drug is not about blessing poor fat people with desirable slimness. Its allied to food,making you not want to eat food…. I don’t know any more. I haven’t got a theory,(for once) but it’s about something else. I don’t like it.
Now about 20 years ago,cos I was back at our old house there was a light hearted story in a newspaper. It was jolly and funny and it triggered something in my brain. A big rock star,maybe Rod Stewart or Keith Richards was sunning his rock star body on a beach near Nice when he met his either binman or postman . He has a nice friendly chat and a picture was taken by whoever that made a feature in the papers. Rock star and binman holiday on same exclusive beach. And for some strange reason my brain said ” what’s the point of being rich if your service people can live to the same high standard as you”.
That wasn’t my credo I hasten to add. I thought it was wonderful that over a century of campaigning and union in strength had brought about an equable world in which hard working and wits about them working people could live well,which is the point of life,and the whole point of working. But obviously someone was having that same wicked thought that strayed into my head.
I’m very suspicious ,(always) this new drug is not about blessing poor fat people with desirable slimness. Its allied to food,making you not want to eat food…. I don’t know any more. I haven’t got a theory,(for once) but it’s about something else. I don’t like it.
Now about 20 years ago,cos I was back at our old house there was a light hearted story in a newspaper. It was jolly and funny and it triggered something in my brain. A big rock star,maybe Rod Stewart or Keith Richards was sunning his rock star body on a beach near Nice when he met his either binman or postman . He has a nice friendly chat and a picture was taken by whoever that made a feature in the papers. Rock star and binman holiday on same exclusive beach. And for some strange reason my brain said ” what’s the point of being rich if your service people can live to the same high standard as you”.
That wasn’t my credo I hasten to add. I thought it was wonderful that over a century of campaigning and union in strength had brought about an equable world in which hard working and wits about them working people could live well,which is the point of life,and the whole point of working. But obviously someone was having that same wicked thought that strayed into my head.
Maybe because my forebears emerged out of a small terraced property next to the River Calder in Dewsbury with an outside toilet the thought of spending all that money, when I can achieve the same result by exercise and a passion for the right food, fills me with no enthusiasm. I also have the mental “get” that I made the effort in both directions and own the result.
Maybe because my forebears emerged out of a small terraced property next to the River Calder in Dewsbury with an outside toilet the thought of spending all that money, when I can achieve the same result by exercise and a passion for the right food, fills me with no enthusiasm. I also have the mental “get” that I made the effort in both directions and own the result.
Much ado about very little indeed. If some people want to experiment on themselves while the rest of us observe and learn, so much the better.
What are the side effects of this stuff that requires traveling outside the FDA’s purview to obtain? How serious are the cancers that Ozempic causes? The so-called “rich elite” will tell us.
As for “trickle down” name one miracle treatment that the elite of previous generations took that was even modestly effective! And any drug from past generations is today stupidly cheap.
Much ado about very little indeed. If some people want to experiment on themselves while the rest of us observe and learn, so much the better.
What are the side effects of this stuff that requires traveling outside the FDA’s purview to obtain? How serious are the cancers that Ozempic causes? The so-called “rich elite” will tell us.
As for “trickle down” name one miracle treatment that the elite of previous generations took that was even modestly effective! And any drug from past generations is today stupidly cheap.
Question, do the ‘improvers’ live any longer, do we have enough evidence to show any potential harm, finally what happens if/when the money dries up?
Question, do the ‘improvers’ live any longer, do we have enough evidence to show any potential harm, finally what happens if/when the money dries up?
Ozempic can cause laryngeal cancer. It’s for this reason doctors recommend their patients only take it in the short term. It’s no panacea for weight loss.
Ozempic can cause laryngeal cancer. It’s for this reason doctors recommend their patients only take it in the short term. It’s no panacea for weight loss.
Death cures all vanities.
Death cures all vanities.