[Greg Boyles]

The debate/argument with John Cuthber in the previous thread is piqued my curiosity about this subject and I have been continuing to dig around.

A search in google scholar has revealed these two items, one published in 2004 and the other in 2006. Not the gradual change in position on alcohol consumption.

http://www.sciencedi...376871685900018

This is entirely inline with John Cuthber's and other's position in here.



A review of the literature on the positive benefits of light and moderate alcohol consumption suggests the following:

• 1. (1) Alcoholic beverages are food, containing approx. 7 calories per gram of ethanol. Beer contains small percentages of the recommended daily allowance of vitamins and significant proportions of the recommended daily allowance of trace metals and minerals. Wine, while possessing significantly smaller amounts of vitamins and minerals than beer, has considerably more iron. Both beer and wine have a favorable potassium to sodium ratio.
• 2. <A name="">(2) Coronary heart disease (CHD) seems to have a negative association with regular alcoholic beverage use. While some report a linear relationship, most studies agree that the relationship is U-shaped. Many studies have suggested that this inverse relationship is due to alcohol's effect of increasing levels of high density lipoprotein cholesterol (HDL), which acts in the removal of cholesterol from tissue. Other explanations for moderate alcohol's cardio-protective effect include: associated diet changes in moderate drinkers, the silicon content in wine and beer, decreased platelet aggregation and coagulation, and the ability to lessen stress and/or alter personality patterns associated with CHD risks.

But note the subtle change in medical opinion in this item from 2006

http://onlinelibrary...4381.x/abstract





This article provides an overview of the most recent evidence on health risks and benefits of alcohol consumption. Not only different types of dose-response curves but also other factors are important to consider when balancing health risks and benefits of alcohol consumption. The association between alcohol exposure and the risk of developing alcohol-related harm is multifactorial; there is a considerable individual variation in risk and a particular female susceptibility. Guidelines on drinking published over the last decade have become successively more restrictive. Whereas guidelines in the 19809 referred to "sensible drinking" or "responsible drinking," more recent guidelines refer to "low-risk drinking." For an increasing number of groups, the recommendation is to avoid alcohol entirely. The need to consider individual risk factors and specific risk situations is increasingly emphasized. The possible net beneficial health effects of moderate drinking may be achieved in less risky ways by refraining from smoking, eating less dietary fat, and doing regular exercise. A number of health risks of moderate drinking have been demonstrated. Yet, for the moderate drinker, various psychosocial problems— especially in the area of productivity and relations—are more likely to develop than organ damage. Also, the risks involved in giving general guidelines on drinking have been widely discussed. If these guidelines were generally accepted and followed, it could have negative consequences on public health.




I put it to people in here that there is a gradual shift taking place in medical attitudes towards alcohol consumption from one of net health benefits for moderate consumption to one of no health benefits or net health detriment of any level of alcohol consumption.

This would be similar to the shift in medical attitudes towards smoking in the decades prior as more and more data accumulated.

Now I enjoy a beer and a wine sometimes as much as John probably does and the above wont result in me turning into a teatotaller.

But I guess we need to not remain in a state of denial about it. Perhaps it will make us all think twice about how many glasses of wine or how many pots of beer we indulge ourselves in.

I will continue to trawl through google scholar and post various items on the subject as I find them in here.

But it is obvious, as it was with smoking, that there is not going to be a definitive study that proves beyond any shadow of doubt that any alcohol consumption is bad for your health. Merely a trend towards more and more restrictions on alcohol consumption by various medical authorities and researchers.

This post has been edited by Greg Boyles: 19 December 2011 - 12:23 PM

[CaptainPanic]

It begs the question whether we live happier when we get really old, but have outlawed all kinds of unhealthy activities, foods drinks and other substances - or if we are happier in the knowledge that we might be living shorter, but we can do whatever the hell we like.

Health is important, but not everything. Some people wish to push the balance still further towards health... but at this moment, the taxes on booze, cigarettes, and strict laws on drugs are already so severe that I think it's enough. Let's stop here.

The ever increasing taxes on booze, cigarettes are not mainly motivated by concern for our collective healths, but very much more by a concern for the state treasury. It's just tax with the purpose of getting money, not tax with the purpose of reducing early deaths.

[Greg Boyles]

CaptainPanic, on 19 December 2011 - 12:05 PM, said:

It begs the question whether we live happier when we get really old, but have outlawed all kinds of unhealthy activities, foods drinks and other substances - or if we are happier in the knowledge that we might be living shorter, but we can do whatever the hell we like.

Health is important, but not everything. Some people wish to push the balance still further towards health... but at this moment, the taxes on booze, cigarettes, and strict laws on drugs are already so severe that I think it's enough. Let's stop here.

The ever increasing taxes on booze, cigarettes are not mainly motivated by concern for our collective healths, but very much more by a concern for the state treasury. It's just tax with the purpose of getting money, not tax with the purpose of reducing early deaths.

I disagree Captain.

It is not about taxes to enrich the treasuries, it is about preventing states from going bankrupt due to unsustainable increases in health costs as populations simulataneously grow, along with public expectations, and become collectively older on average.

My position would be puff and drink away as you please, but perhaps for Australians there should be sliding scale for medicare contributions depending on your preventable health risk factors. Those who smoke pay the highest medicare level while those who neither smoke or drink pay the least medicare levy, not withstanding abuse of other drugs.

This post has been edited by Greg Boyles: 19 December 2011 - 12:26 PM

[CaptainPanic]

Smokers and obese people are cheaper to health care than healthy people. (NYTimes article)

This post has been edited by CaptainPanic: 19 December 2011 - 12:25 PM

[John Cuthber]

It's certainly an interesting question. It's also difficult, partly for scientific reasons but also because practically everyone has a biassed opinion on it. Governments, for example, have to balance the benefits of tax revenue from the harm done by damage to health.
And, whatever this thread finds, there's no question that alcohol is toxic. We might as well accept that at the start.
For example, according to the World Health Organisation, alcohol kills about 2.5 million people each year.
That's roughly twice the number killed by road accidents or roughly par with the deaths from HIV/AIDS.

They also say
"The Global Information System on Alcohol and Health (GISAH) is an essential tool for assessing and monitoring the health situation and trends related to alcohol consumption, alcohol-related harm, and policy responses in countries. The harmful use of alcohol results in the death of 2.5 million people annually. There are 60 different types of diseases where alcohol has a significant causal role. It also causes harm to the well-being and health of people around the drinker."

There is a clear analogy with smoking and, indeed, with other recreational drug use. Fundamentally, who has the right to say what drugs I take? I'm an adult, I can choose to take up hazardous activities if I like.
On the other hand, does the state (who will pay for my healthcare if I misjudge that risk or if I'm unlucky) have the right to decide or at least strongly influence that decision?
Hopefully, in this case the state acts as a proxy for the society, so it's our decision.
The medical authorities also have a slightly double edged role in this. It's clear that too much alcohol is bad for people.
However there is evidence that it is associated with a reduced risk of cardiovascular illness. If that were a rare complaint it would be easy to write off any advantage, but it's one of the world's biggest killers. Even a small reduction of incidence would be beneficial to the health of the world.

[Greg Boyles]

CaptainPanic, on 19 December 2011 - 12:24 PM, said:

Smokers and obese people are cheaper to health care than healthy people. (NYTimes article)

The idea is to get as many people as possible living longer and productive (as in paid work/volunteer work) and confining chronic illness to the last few years of life.

If you keeping fixing the endless health problems of obese people and smokers, thus keeping them alive for longer, then clearly the national health bill will increase.

But if you discourage the vast majority of people from smoking on a permanent basis, i.e. for generations, then eventually as the current smokers and obese people die off then the national health bill must surely reduce over time.

John Cuthber, on 19 December 2011 - 12:26 PM, said:

It's certainly an interesting question. It's also difficult, partly for scientific reasons but also because practically everyone has a biassed opinion on it. Governments, for example, have to balance the benefits of tax revenue from the harm done by damage to health.
And, whatever this thread finds, there's no question that alcohol is toxic. We might as well accept that at the start.
For example, according to the World Health Organisation, alcohol kills about 2.5 million people each year.
That's roughly twice the number killed by road accidents or roughly par with the deaths from HIV/AIDS.

They also say
"The Global Information System on Alcohol and Health (GISAH) is an essential tool for assessing and monitoring the health situation and trends related to alcohol consumption, alcohol-related harm, and policy responses in countries. The harmful use of alcohol results in the death of 2.5 million people annually. There are 60 different types of diseases where alcohol has a significant causal role. It also causes harm to the well-being and health of people around the drinker."

There is a clear analogy with smoking and, indeed, with other recreational drug use. Fundamentally, who has the right to say what drugs I take? I'm an adult, I can choose to take up hazardous activities if I like.
On the other hand, does the state (who will pay for my healthcare if I misjudge that risk or if I'm unlucky) have the right to decide or at least strongly influence that decision?
Hopefully, in this case the state acts as a proxy for the society, so it's our decision.
The medical authorities also have a slightly double edged role in this. It's clear that too much alcohol is bad for people.
However there is evidence that it is associated with a reduced risk of cardiovascular illness. If that were a rare complaint it would be easy to write off any advantage, but it's one of the world's biggest killers. Even a small reduction of incidence would be beneficial to the health of the world.

I guess when it comes to smoking certainly, if you don't want the government poking its nose into your personal habits then you should consider forgoing your access to publicly funded health care.

He who pays the piper calls the tune as they say.

John Cuthber, on 19 December 2011 - 12:26 PM, said:

It's certainly an interesting question. It's also difficult, partly for scientific reasons but also because practically everyone has a biassed opinion on it. Governments, for example, have to balance the benefits of tax revenue from the harm done by damage to health.
And, whatever this thread finds, there's no question that alcohol is toxic. We might as well accept that at the start.
For example, according to the World Health Organisation, alcohol kills about 2.5 million people each year.
That's roughly twice the number killed by road accidents or roughly par with the deaths from HIV/AIDS.

They also say
"The Global Information System on Alcohol and Health (GISAH) is an essential tool for assessing and monitoring the health situation and trends related to alcohol consumption, alcohol-related harm, and policy responses in countries. The harmful use of alcohol results in the death of 2.5 million people annually. There are 60 different types of diseases where alcohol has a significant causal role. It also causes harm to the well-being and health of people around the drinker."

There is a clear analogy with smoking and, indeed, with other recreational drug use. Fundamentally, who has the right to say what drugs I take? I'm an adult, I can choose to take up hazardous activities if I like.
On the other hand, does the state (who will pay for my healthcare if I misjudge that risk or if I'm unlucky) have the right to decide or at least strongly influence that decision?
Hopefully, in this case the state acts as a proxy for the society, so it's our decision.
The medical authorities also have a slightly double edged role in this. It's clear that too much alcohol is bad for people.
However there is evidence that it is associated with a reduced risk of cardiovascular illness. If that were a rare complaint it would be easy to write off any advantage, but it's one of the world's biggest killers. Even a small reduction of incidence would be beneficial to the health of the world.

It will probably come down to a trade off between the reduction of heart attacks and ischaemic strokes and the increase in common cancers.

http://www.nejm.org/...198705073161902

Abstract In 1980, 89,538 U.S. women 34 to 59 years of age, with no history of cancer, completed an independently validated dietary questionnaire that included the use of beer, wine, and liquor. During the ensuing four years, 601 cases of breast cancer were diagnosed among cohort members. Among the women consuming 5 to 14 g of alcohol daily (about three to nine drinks per week), the age-adjusted relative risk of breast cancer was 1.3 (95 percent confidence limits, 1.1 and 1.7). Consumption of 15 g of alcohol or more per day was associated with a relative risk of 1.6 (95 percent confidence limits, 1.3 and 2.0; Mantel extension χ for linear trend = +4.2; P<0.0001). Adjustment for known breast cancer risk factors and a variety of nutritional variables did not materially alter this relation. Significant associations were observed for beer and liquor when considered separately. Among women without risk factors for breast cancer who were under 55 years of age, the relative risk associated with consumption of 15 g of alcohol or more per day was 2.5 (95 percent confidence limits, 1.5 and 4.2).

These prospective data derived from measurements of alcohol intake recorded before the diagnosis of breast cancer confirm the findings of several previous case-control studies. Viewed collectively, they suggest that alcohol intake may contribute to the risk of breast cancer. (N Engl J Med 1987; 316:1174–80.)

Supported by research grants (CA 40356, CA 40935, and CA 42059) from the National Institutes of Health. Dr. Willett is the recipient of a Research Career Development Award (HL 01018) from the National Heart, Lung, and Blood Institute.

We are indebted to the registered nurses who have made this study possible and to Barbara Egan, Susan Newman, David Dysert, Meryl Dannenberg, Laura Sampson, Marion McPhee, Martin Van Denburgh, and Karen Corsano, who assisted in the research.





http://www.nejm.org/...198808043190503



Abstract In 1980, 87,526 female nurses 34 to 59 years of age completed a dietary questionnaire that assessed their consumption of beer, wine, and liquor. By 1984, during 334,382 person-years of follow-up, we had documented 200 incident cases of severe coronary heart disease (164 nonfatal myocardial infarctions and 36 deaths due to coronary disease), 66 ischemic strokes, and 28 subarachnoid hemorrhages. Follow-up was 98 percent complete.

As compared with nondrinkers, women who consumed 5 to 14 g of alcohol per day (three to nine drinks per week) had a relative risk of coronary disease of 0.6 (95 percent confidence interval, 0.4 to 0.9); for 15 to 24 g per day the relative risk was 0.6 (0.3 to 1.1), and for 25 g or more per day it was 0.4 (0.2 to 0.8), after adjustment for risk factors for coronary disease. Alcohol intake was also associated with a decreased risk of ischemic stroke. For 5 to 14 g of alcohol per day the relative risk was 0.3 (0.1 to 0.7), and for 15 g per day or more it was 0.5 (0.2 to 1.1). In contrast, although the number of cases of subarachnoid hemorrhage was small, alcohol intake tended to be associated with an increased risk of this disorder; for 5 to 14 g per day the relative risk was 3.7 (1.0 to 13.8).

These prospective data suggest that among middle-aged women, moderate alcohol consumption decreases the risks of coronary heart disease and ischemic stroke but may increase the risk of subarachnoid hemorrhage. (N Engl J Med 1988; 319:267–73.)

Supported by research grants (HL-24074, HL-34594, CA-40935, and CA40356) from the National Institutes of Health.

We are indebted to the participants in the Nurses' Health Study for their continuing outstanding level of cooperation, and to Stephanie Bechtel, Karen Corsano, David Dysert, Donna Vincent, Meryl Dannenberg, Barbara Egan, Marion McPhee, Pradeep Rana, and Laura Sampson for their unfailing help.




http://psycnet.apa.o.../1993-05282-001

Determined whether there was a relationship between low to moderate alcohol consumption (LMAC) and mortality (MT) in a 5-yr follow-up of 3 groups of elderly Ss (aged 65+ yrs): 2,694 Ss in East Boston, Massachusetts; 2,293 Ss in rural counties in Iowa; and 1,904 Ss in New Haven, Connecticut. LMAC was associated with significant lowered cardiovascular and total MT in East Boston and New Haven. Compared with Ss who consumed no alcohol in the previous year, the Ss with LMAC showed relative risks of total MT and cardiovascular MT of 0.7 and 0.6, respectively, in East Boston and 0.6 and 0.5, respectively, in New Haven. In Iowa, there were no significant differences in total or cardiovascular MT according to alcohol consumption patterns. For cancer MT, there were no significant associations with LMAC in any of the 3 populations. (PsycINFO Database Record © 2010 APA, all rights reserved)

This post has been edited by Greg Boyles: 19 December 2011 - 01:08 PM

[CaptainPanic]

Greg Boyles, on 19 December 2011 - 01:02 PM, said:

The idea is to get as many people as possible living longer and productive (as in paid work/volunteer work) and confining chronic illness to the last few years of life.

If you keeping fixing the endless health problems of obese people and smokers, thus keeping them alive for longer, then clearly the national health bill will increase.

I get the feeling you didn't check out that NYTimes article I posted. Or, you seem to completely oppose that study.

It's the non-smokers and non-obese people who will develop endless problems. What actually happens is that smokers and obese people will develop a disease, and often die of it. In economic terms, that's good riddance. Sounds harsh, and it is - but we're talking economy, not happiness.

People whose hearts and lungs are healthy, will develop problems with their knee, hip, shoulder, eyesight, hearing, etc., in other words, all kinds of non-fatal problems, which cost money in many ways, ranging from the hospital treatments to the construction of elderly homes and scooters for elderly because they can't walk anymore. Our entire society is being adapted to old people who are still "healthy". And that costs a fortune.

You can't keep old people healthy all the time. And if one thing doesn't break down, something else will. It's sad, but that's life. The number John Cuthber presented: 2.5 million deaths annually by alcohol. Sure it's probably true, but what the World Health Organization does not say is that without alcohol, those people would just die soon after of something else!

Imagine a world where health and productivity ARE an actual concern. Why do we allow basketball, cycling and football to be played? Those three sports alone cause nearly 1.5 million injuries per year in the US. Not only does this reduce the productivity, it is also a big bill for the healthcare. Sure, it's not fatal, but we're talking productivity here. You can do another - safer - sport. Like spinning (that's the indoor fitness cycling). It's just as good for your health, but your productivity for society is much less at risk. But I am sure that you agree that we shouldn't ban those sports.

I'm no machine whose productivity rate must be kept at an optimum. I do not want to be fined for catching a cold. I want to be able to cycle, despite it obviously being more dangerous than walking. I like to grab a burger and some fries occasionally, even if the salad was more healthy. And I like to get a couple of beers in the weekend.

People just don't live forever... why can't we go out in peace, while having a glass of cognac - perhaps one too many - and a cigar? Why must my life be extended by 5-10 useless years, which I will likely spend practically deaf, forgetful and in a wheelchair? I'd rather have a blast now, and go out a bit sooner. Why is that not MY decision? Why does my government try to make me go bankrupt if I lead such a life?

[Greg Boyles]

CaptainPanic, on 19 December 2011 - 02:08 PM, said:

I get the feeling you didn't check out that NYTimes article I posted. Or, you seem to completely oppose that study.
life?

I note these two opposing statements.

Quote

"Lung cancer is a cheap disease to treat because people don't survive very long," van Baal said. "But if they are old enough to get Alzheimer's one day, they may survive longer and cost more."

Quote

The study, paid for by the Dutch Ministry of Health, Welfare and Sports, did not take into account other potential costs of obesity and smoking, such as lost economic productivity or social costs.

http://www.neurology...45/6/1161.short

Alcohol consumption is a risk factor for Alzheimer's.

Lack of physical activity is a risk factor for Alzheimer's......smoking and obesity both reduce physical activity.

High blood pressure is a risk factor for Alzheimer's......smoking and obesity are both factors in high blood pressure.

Quote

Multivariate analysis showed that age, prior stroke episodes, systolic blood pressure, and alcohol consumption were significant independent risk factors for the occurrence of VD. In contrast, age and a low score on Hasegawa's dementia scale were significant risk factors for AD, and physical activity was a significant preventive factor for AD. Our findings suggest that asymptomatic stroke is an important factor in the development of VD, with age, prior stroke episodes, systolic blood pressure, and alcohol consumption being independent risk factors for its occurrence. Age and a low scare on Hasegawa's dementia scale are significant risk factors for AD, with moderate physical activity having a statistically significant preventive effect.

This post has been edited by Greg Boyles: 19 December 2011 - 03:11 PM

[CaptainPanic]

Then please provide us with some studies from that Google Scholar where you can find the numbers.

I link to an article about a study of the statistics of the costs of disease, by qualified people, and you replace that by a story of your father in law.
Hardly an improvement of the facts, is it?

I cannot accept that either. All the rest you post is merely a suggestion. I want data.

[Greg Boyles]

CaptainPanic, on 19 December 2011 - 03:03 PM, said:

Then please provide us with some studies from that Google Scholar where you can find the numbers.

I link to an article about a study of the statistics of the costs of disease, by qualified people, and you replace that by a story of your father in law.
Hardly an improvement of the facts, is it?

I cannot accept that either. All the rest you post is merely a suggestion. I want data.

Please refer to my modified post above.

Thought better of it and replaced all that stuff about my father in law with a study detailing the risk factors for Alzheimer's.
Those risk factors are often linked to smoking and obesity.

This post has been edited by Greg Boyles: 19 December 2011 - 03:16 PM

[CaptainPanic]

We're getting a little carried away with the posts #3 and #4 in this thread - a thread which initially addressed the health issues only. Financial issues and economic factors only came in later. Hope that's ok, because I still think that the post I made is the only decent one on that topic.

Greg, you still don't provide an economic study of smokers/obese people vs. people who don't do that. You still cannot show that an unhealthy life is worse for the economy than a healthy one.

You dismiss the data I provide - at first with an anecdote, which you then removed and replaced by circumstantial evidence. From what you show, you cannot conclude that alcohol leads to alzheimer, and therefore the costs of medical treatment of alcohol users is higher. Maybe those people would eventually get alzheimer anyway, and alcohol makes them die earlier which is cheaper (again, looking only at the harsh and dry economic factors, not happiness). There's nothing that shows that my interpretation of that alzheimer data isn't correct, and yours is.

In fact, the study you show says that alcohol leads to Vascular Diseases (VD), and those can itself be often fatal. In some cases, this leads to alzheimer instead of death. We know that cardio-vascular diseases are the #1 cause of death, and most of those people dying from it never develop alzheimer. So, that supports my point that more often than not these people will just die, rather than get alzheimer.

You're gonna have to do better.

This post has been edited by CaptainPanic: 19 December 2011 - 03:33 PM

[John Cuthber]

Lets have a look at what some of those stats mean.
For example this
" Among women without risk factors for breast cancer who were under 55 years of age, the relative risk associated with consumption of 15 g of alcohol or more per day was 2.5 (95 percent confidence limits, 1.5 and 4.2)."
is a long winded way of saying women who drink 2 units of alcohol a day or more are 2.5 times more likely to get breast cancer.

This
http://www.cancer.go...y-breast-cancer
tells me that the risk for women in the US up to 55 years of age is about 1 in 50
Unfortunately, we don't have the original data of proper demographics but I think it's reasonable to say that many women drink. I'm going to guess (and I accept that it's nothing more than that) that they drink, on average 2 units a day (It's probably less- but I have no data and the assumption makes the maths easy).
If those assumptions were right then you could compare two women, one drinks nothing, the other has a couple of units a day.
The first has a risk of breast cancer of rougly 2%
The second has a risk of roughly 5%.
So even the drinker has a 95% chance of "getting away with it" .

You don't have to be that keen on drinking to ignore a risk that's fairly small, only likely to trouble you when you get "old" and also relatively easily treated.

Just to repeat myself- so I don't get shouted at for doing ropey stats; I know that assumption I made are bad.

If anyone wishes to do a better analysis I'd like to see it.
However I think it will still support my suggestion that people don't see that sort of risk as big (men generally don't even know that are at risk from breast cancer) and they don't see doubling that risk as a major issue.

[Greg Boyles]

CaptainPanic, on 19 December 2011 - 03:32 PM, said:

We're getting a little carried away with the posts #3 and #4 in this thread - a thread which initially addressed the health issues only. Financial issues and economic factors only came in later. Hope that's ok, because I still think that the post I made is the only decent one on that topic.

Greg, you still don't provide an economic study of smokers/obese people vs. people who don't do that. You still cannot show that an unhealthy life is worse for the economy than a healthy one.

You dismiss the data I provide - at first with an anecdote, which you then removed and replaced by circumstantial evidence. From what you show, you cannot conclude that alcohol leads to alzheimer, and therefore the costs of medical treatment of alcohol users is higher. Maybe those people would eventually get alzheimer anyway, and alcohol makes them die earlier which is cheaper (again, looking only at the harsh and dry economic factors, not happiness). There's nothing that shows that my interpretation of that alzheimer data isn't correct, and yours is.

In fact, the study you show says that alcohol leads to Vascular Diseases (VD), and those can itself be often fatal. In some cases, this leads to alzheimer instead of death. We know that cardio-vascular diseases are the #1 cause of death, and most of those people dying from it never develop alzheimer. So, that supports my point that more often than not these people will just die, rather than get alzheimer.

You're gonna have to do better.

If it turns out to be true that smoking and obesity are risk factors for Alzheimer's, through high blood pressure and lack of phsyical activity, then that study of yours detailing increased health costs for non-obese and non smokers is flawed.

This study for example suggests that the increase incidence of Alzheimers and other old age diseases, that increase health costs in your study, are the result of smokers quitting before they manage to kill themselves early.

Rather than health costs increasing as a result of never having smoked in the first place.

So I don't doubt that, if all the current smokers, heavy drinkers and obese people rectified their habits and lived longer lives then national health care costs would rise as they succumbed to other old age diseases that have an association with smoking, such as alzheimers.

But once all these people died off and were not replaced due to hypothetical overwhelmingly succesful government stratgeies to discourage smoking, drinking and over eating then it would be difficult to deny that national health care costs would come down signficantly.

http://www.nejm.org/...199710093371506

Quote

BackgroundAlthough smoking cessation is desirable from a public health perspective, its consequences with respect to health care costs are still debated. Smokers have more disease than nonsmokers, but nonsmokers live longer and can incur more health costs at advanced ages. We analyzed health care costs for smokers and nonsmokers and estimated the economic consequences of smoking cessation

So smoking, drinking and over eating cessation would be good for national health budgets in the long term, as long as very low rates of the above bad habits can be maintained, but not necessarily in the short to medium term.

John Cuthber, on 19 December 2011 - 04:47 PM, said:

Lets have a look at what some of those stats mean.
For example this
" Among women without risk factors for breast cancer who were under 55 years of age, the relative risk associated with consumption of 15 g of alcohol or more per day was 2.5 (95 percent confidence limits, 1.5 and 4.2)."
is a long winded way of saying women who drink 2 units of alcohol a day or more are 2.5 times more likely to get breast cancer.

This
http://www.cancer.go...y-breast-cancer
tells me that the risk for women in the US up to 55 years of age is about 1 in 50
Unfortunately, we don't have the original data of proper demographics but I think it's reasonable to say that many women drink. I'm going to guess (and I accept that it's nothing more than that) that they drink, on average 2 units a day (It's probably less- but I have no data and the assumption makes the maths easy).
If those assumptions were right then you could compare two women, one drinks nothing, the other has a couple of units a day.
The first has a risk of breast cancer of rougly 2%
The second has a risk of roughly 5%.
So even the drinker has a 95% chance of "getting away with it" .

You don't have to be that keen on drinking to ignore a risk that's fairly small, only likely to trouble you when you get "old" and also relatively easily treated.

Just to repeat myself- so I don't get shouted at for doing ropey stats; I know that assumption I made are bad.

If anyone wishes to do a better analysis I'd like to see it.
However I think it will still support my suggestion that people don't see that sort of risk as big (men generally don't even know that are at risk from breast cancer) and they don't see doubling that risk as a major issue.

It is not about peoples' attitudes towards these risk factors. It is about the collective effect of these risk factors on the national health bottom line.

It is peoples' perogative to acknowledge or ignore risk factors as they please. But if it is determined that any particular risk factor that they choose to ignore is having a signficant cumulative impact on the health budget then they cannot expect to continue to receive publicly funded free health cared for any health complaints that result from them ignoring that risk factor.

As I said, in Australia, the medicare levy should be a sliding scale based upon lifestyle as well income level.

The amount of you medicare level should be proportional to the number and type of risk factors you choose to ignore and subject to a compulsory annual medical check up.

I suspect this would be the strongest incentive for people to give away the fags, the excess grog and the excess food if there is at least the appearance of them having to be accountable for their lifestyle choices.

Currently there is little or no accountability for lifestyle choices and when people are not accountable they tend to behave badly.

This post has been edited by Greg Boyles: 20 December 2011 - 12:45 AM

[John Cuthber]

"It is not about peoples' attitudes towards these risk factors. "
Oh yes it is.
It's the same people who have that attitude that vote for the political decision.
"As I said, in Australia, the medicare levy should be a sliding scale based upon lifestyle as well income level."
Fine by me: I don't live in Australia.

"Currently there is little or no accountability for lifestyle choices "
Yeah, I mean, like- you know- the only thing I have to worry about is dying. And that's not really important is it?

"The amount of you medicare level should be proportional to the number and type of risk factors you choose to ignore and subject to a compulsory annual medical check up."
With the addition of the word "inversely" this could be taken seriously.

[Greg Boyles]

John Cuthber, on 20 December 2011 - 01:51 AM, said:

"It is not about peoples' attitudes towards these risk factors. "
Oh yes it is.
It's the same people who have that attitude that vote for the political decision.

Well as with your naive and unworldly teenage children, the general public can't always have what they demand. Perhaps parties should start leading rather than capitulating and give the bipartison/tripartison/..... "no" to such demands from the voting public.

John Cuthber, on 20 December 2011 - 01:51 AM, said:

"As I said, in Australia, the medicare levy should be a sliding scale based upon lifestyle as well income level."
Fine by me: I don't live in Australia.

Good for you.

John Cuthber, on 20 December 2011 - 01:51 AM, said:

"Currently there is little or no accountability for lifestyle choices "
Yeah, I mean, like- you know- the only thing I have to worry about is dying. And that's not really important is it?

Yeah except when the health effects of smoking really kick in and their lifestyle and independance is seriously effected and when their death is approaching, most of them expect no expense to be spared in treating them and keeping them alive.

Few take responsibility for their lifestyle choices and refuse treatment that wont buy them that much more time anyway nor make a signficant improvement in their quality of life.

In fact many public hospitals in Australia these days seem to be refusing to give smokers coronary artery grafts unless the quit smoking. So they are increasingly being forced to comply if they wish to be treated in a way that prolongs their life. That has certainly been the case with my father in law any way.

John Cuthber, on 20 December 2011 - 01:51 AM, said:

"The amount of you medicare level should be proportional to the number and type of risk factors you choose to ignore and subject to a compulsory annual medical check up."
With the addition of the word "inversely" this could be taken seriously.

OK inversely proportional then

This post has been edited by Greg Boyles: 20 December 2011 - 05:00 AM

[CaptainPanic]

Greg Boyles, on 20 December 2011 - 12:08 AM, said:

The amount of you medicare level should be proportional to the number and type of risk factors you choose to ignore and subject to a compulsory annual medical check up.

So, to make a long story short: according to you, life would be better if you pay for whatever disease/injury you might get in the future - extrapolated from your chosen lifestyle.

And how exactly will a doctor distinguish between a healthy lifestyle, but an unhealthy physique? Will naturally healthy people naturally pay less? (And people who are born sick pay more? What about parents who deliberately decide to keep a child with disabilities, even if abortion is still an option - that's a deliberate choice - should they pay up?).

And will the doctor (and medicare) praise you for doing sports, or punish you for unhealthy sports? Will you outlaw Australian Football, which is violent and causes relatively large numbers of injuries? Or must players pay more medicare? And what about kids who play? You know how dangerous unhealthy that can be? I can foresee a financial incentive to keep kids indoors, and force them to do their exercises on a hometrainer, rather than on the playground. Playgrounds can be dangerous!

Or what about someone who has a small workshop at home? Building cars or something for which he/she needs heavy machinery? That's riskier than watching TV and doing your 30 minutes mandatory exercise. So, if you have a workshop, up goes the medicare.

And high heel shoes should be taxed more than hiking shoes. And if you don't dress warm on a cold day, you will get fined by the police. And wearing safety gloves and googles becomes mandatory while cooking. Did you know that most accidents happen at home? Maybe being at home should be counted as a risk factor too?

So, how will this ever be a fair system? I hope you don't plan to install cameras everywhere to spy on people to catch them in the act?

[Greg Boyles]

CaptainPanic, on 20 December 2011 - 10:12 AM, said:

So, to make a long story short: according to you, life would be better if you pay for whatever disease/injury you might get in the future - extrapolated from your chosen lifestyle.

No.

You pay your own way for any EASILY PREVENTABLE diseases you end up with as a result of your lifestyle choices.

And obviously it would be only worth while, as far as mass screening etc goes, to cover those disease that effect large numbers of people and require the most expensive medical intervention.
That covers smoking, obesity and heavy alcohol consumption related diseases for which there is good evidence of a causal link.

You could do the same for extreme sports and hoon drivers etc but the cost effectiveness for the health bottom line would be negligeable most likely.

CaptainPanic, on 20 December 2011 - 10:12 AM, said:

And how exactly will a doctor distinguish between a healthy lifestyle, but an unhealthy physique? Will naturally healthy people naturally pay less? (And people who are born sick pay more? What about parents who deliberately decide to keep a child with disabilities, even if abortion is still an option - that's a deliberate choice - should they pay up?).

I said easily preventable diseases related to lifestyle choices, not diseases that people have through no fault of their own.

And only those preventable diseases that would give the biggest bang for the health buck to eliminate.
That would not include disabled children who are kept alive.

It would be a purely exercise in economics and not in eugenics or what ever.

CaptainPanic, on 20 December 2011 - 10:12 AM, said:

And will the doctor (and medicare) praise you for doing sports, or punish you for unhealthy sports? Will you outlaw Australian Football, which is violent and causes relatively large numbers of injuries? Or must players pay more medicare? And what about kids who play? You know how dangerous unhealthy that can be? I can foresee a financial incentive to keep kids indoors, and force them to do their exercises on a hometrainer, rather than on the playground. Playgrounds can be dangerous!

Or what about someone who has a small workshop at home? Building cars or something for which he/she needs heavy machinery? That's riskier than watching TV and doing your 30 minutes mandatory exercise. So, if you have a workshop, up goes the medicare.

And high heel shoes should be taxed more than hiking shoes. And if you don't dress warm on a cold day, you will get fined by the police. And wearing safety gloves and googles becomes mandatory while cooking. Did you know that most accidents happen at home? Maybe being at home should be counted as a risk factor too?

So, how will this ever be a fair system? I hope you don't plan to install cameras everywhere to spy on people to catch them in the act?

Again it would be an exercise in economics. And footballers, hikers and what ever other class you care to throw at me do not impose a signficant burdon of the health system. To include all careers and all sports in the sliding scale, no matter how few people undertake them, would simply not be cost effective.

[CaptainPanic]

Well, it is even better then to privatise the whole medical world. Why would you keep it within the tax system, if you're gonna run the medicare as a company, with "cost effectiveness" in mind... then you are better off to make that a company than a government.

Why not include the sports? What's that nonsense? Because it's harder to sell to the population that you pay more if you do sports? Nonsense. Some sports are extremely unhealthy (fighting sports, like boxing - look at Muhammed Ali in his old days... with Parkinson for the last two decades or so, which is a direct result of the blows to the head).

If you're just gonna be disciminating against alcohol, tobacco and poor food, and not against all other unhealthy things in life, then we might as well stop this discussion. I cannot fight an opinion. You win.

[John Cuthber]

"And only those preventable diseases that would give the biggest bang for the health buck to eliminate.
That would not include disabled children who are kept alive. "
Make up your mind.

[Greg Boyles]

CaptainPanic, on 20 December 2011 - 01:40 PM, said:

Well, it is even better then to privatise the whole medical world. Why would you keep it within the tax system, if you're gonna run the medicare as a company, with "cost effectiveness" in mind... then you are better off to make that a company than a government.

Why not include the sports? What's that nonsense? Because it's harder to sell to the population that you pay more if you do sports? Nonsense. Some sports are extremely unhealthy (fighting sports, like boxing - look at Muhammed Ali in his old days... with Parkinson for the last two decades or so, which is a direct result of the blows to the head).

If you're just gonna be disciminating against alcohol, tobacco and poor food, and not against all other unhealthy things in life, then we might as well stop this discussion. I cannot fight an opinion. You win.

If health care is run by private business then you can do as you please with your life because it is entirely user pays. If your lifestyle is detrimental to your health then you will no doubt pay accordingly for the treatment you end up receiving.

But if you run a public health care system with a flat medicare levi then it is entirely unsustainable if large numbers of people destroy their health through smoking, alcohol and over eating etc. T

herefore you have no choice but to introduce some of the feature of private health care funding if you are not to bankrupt the state in the long term. We want to keep our public health care but we do not want it to end up sending us down the same path as Greece.

I would suggest a series of sliding scales at various income bands. The idea is to strongly discourage poor lifestyle choices through economic coercion rather than bankrupting low income earners.

Perhaps the option should remain to stay on the minimum medicare levi if you smoke etc but then you only get drug based symptom management and pallative care at public hospitals - no major operations etc.

John Cuthber, on 20 December 2011 - 02:46 PM, said:

"And only those preventable diseases that would give the biggest bang for the health buck to eliminate.
That would not include disabled children who are kept alive. "
Make up your mind.

I have not changed my mind - this is what I have been driving at from the beginning.

I suspect you have simply jumped to the wrong conclusion.