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Comment by marcyb5st | Hacker News Reader

As an Italian person (also our life expectancy is really good on average) this hits home. An anecdotal example: I now live in Switzerland and my current doctor was shocked when I ask to get some blood analysis without being sick. He believed that I lied to my insurance company and hid some pre-existing condition.

In Italy, instead, it is pretty common that every couple of years you get a complete blood analysis just to see if everything is ok and whether you need to change something in your lifestyle.

Additionally, Sardinia (another "blue zone" with great life expectancy) also has a different diet compared to mainland Italy. Loads of seafood and relatively small amounts of livestock proteins.

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Anecdotal data - as a Sardinia native, we do eat seafood, but to be honest around me at least that's at most a once a week practice. My grandpas, which lived to 96, 98 and 101, didn't eat much fish either. Lots of veggies though. One of my grandfathers died young due to a heart condition. All of them were regularly checking their health and doing regular blood tests. I can confirm we don't see getting tested as being "obsessed with our health" but as a good (and for many, not very pleasurable) practice, part of the "preventing an illness is better than curing it" philosophy. Having cheap/free healthcare also helps.

Interesting! Some Friends from Sardinia told me that seafood is predominant in their diet! And of course, veggies.

I wouldn't say predominant, but certainly present! But we each represent a different set of connections, as I said, this kind of data is anecdotal ^^ I'd say i eat way more fish here in Japan than back in Sardinia.

seafood is cheap af in greece.

When I was in Athens, a kilogram of fresh caught sardines ran about 2 euro for a kilo. Thats cheaper than canned!

On Crete, it was a bit more expensive at 4 euro per kilo but I never paid more than 4 euro for a pound of fish. thats cheap enough to make fresh caught fish a daily meal

That's not a good thing. The Greeks are over fishing their waters.

https://www.reuters.com/article/us-greece-fishing/as-stocks-...

Goes to show how important culture and religion can be in diet. Eating seafood instead of meat once a week, usually on Friday, is a widespread Christian practice called the Friday Fast. [1]

In Europe, I know a lot of people that still stick to this practice even without practicing Christianity.

1. https://en.wikipedia.org/wiki/Friday_Fast

Oh, there was some people following the Friday thing, but I've only heard about it during lent and not everyone is following it - it's quite going out of fashion esp with younger generations.

Younger people make up a smaller and smaller percentage of the total population every year though.

Ironically though, the young that do practice Friday fasting are much more likely, demographically, to have children. So I imagine the practice will continue for many centuries.

> but I've only heard about it during lent

And even then, it's usually breaded and deep fried. Not sure, I'd qualify it as a healthy alternative to a steak.

> seafood instead of meat

most of that's still meat though?

According to science it should be better than red meat. Additionally, a lot of seafood comes in smaller portions, is full of bones, shells and whatnot, whereas it’s relatively easy and cheap to get large quantities of fully edible red meat. It’s not that you couldn’t have a pound of peeled shrimps, but my own experience with seafood says it’s not very common.

So overall you’re most likely ending up eating less meat, and not just different meat.

Better how? What science? Do you have a citation? Most comparative diet studies are only observational with multiple confounding factors and no proper controls.

E.g.

https://www.nhs.uk/live-well/eat-well/red-meat-and-the-risk-...

and

https://progressreport.cancer.gov/prevention/red_meat

I’m not going to single out studies and pretend that I’m in any way into this field.

Fish have lots of selenium that meat lacks.

Fish can also have lots of mercury that meat lacks. It's probably best to eat a variety of different foods in order to avoid excess toxins and nutrient deficiencies.

There’s some interesting research suggesting that mercury poisoning is in fact just pulling out the availability of selenium for bio chemistry by forming metal ion complexes

https://pubmed.ncbi.nlm.nih.gov/18761370/

The wikipedia page states more correctly: "animal meat, other than fish".

Fellow Italian here: in Sardinia consumption of seafood is not particularly higher than the Italian average, certainly not higher than South Italy (i.e. from Rome downwards) especially Sicily or Naples area.

In Sardinia they eat a lot of blue fish (or oily fish), not surprisingly the European pilchard also called "sardine" of the genus "Sardine" has a very similar name to "Sardinia".

According to some recent study Aristotle himself named the fish after the population of Sardinia Island that were the first ones to trade it in ancient Mediterranean markets (looks like the most popular way to prepare it was in salt, as we still do nowadays).

But that's probably not why they are a "blue zone", an important difference is the kind of meat they eat: there is an abundance of sheep meat but much less beef red meat.

But that's probably no it either, Sardinians have genetic markups that protects them from entire classes of diseases, being a quite homogeneous population from the DNA point of view, they passed them on from a generation to the next.

As an Israeli, are blood tests not a normal thing done everywhere? I did not realize that...

My family doctor asks for a battery of lab tests about once a year (or whenever I get around to scheduling a check-up), including glucose and cholesterol and liver functions and so on. This has been going on since I was twenty something.

Not in my experience. I also lived in Sweden and UK. Blood tests are usually only a reactivate thing. You're sick you get blood tests. As prevention not as common I'm afraid.

The reason Sweden doesn't do regular health checks of the population is because there is no good scientific evidence that it has any effect. And that if a person feels healthy, they most likely are.

I think the similar reasoning is used in other countries.

If you can read swedish/use Google translate, this page explains it very clearly: https://www.1177.se/fragor--svar/nationellt/behandling--hjal...

"And that if a person feels healthy, they most likely are."

Uh, high blood pressure is a typical "silent" disease with major effect on health later.

You don't need a blood test to measure your blood pressure though.

The article says that you should check blood pressure and blood sugar every 5 years. And blood fats "some time". But that's very different from a regular check up.

> The reason Sweden doesn't do regular health checks of the population is because there is no good scientific evidence that it has any effect. And that if a person feels healthy, they most likely are.

I think this is naive: there are a number of reasons people in Sweden don't easily get health-checks, and among these are certainly cost-saving, where the healthcare representatives who you need to contact before speaking to a doctor or nurse act as gatekeepers to the system. This 'rationing' of resources can sometimes have dire consequences, as happened to a former colleague of mine, who was denied the in-person checks he needed and almost died as a consequence.

There's also an enormous amount of peer-pressure in Sweden to be skinny, fit and actively go to the gym several times each week. A fat person is an extreme rarity in Stockholm. Couple this with an ingrained cultural 'guilt-complex' instilled in everyone not to be a 'burden' on anyone else, and the health-service is suddenly transformed into an 'emergency-only' institution.

Naturally that may be seen as a positive - although for some people it may have bad outcomes. It certainly contrasts with my extended family in Spain, who have tests for every possible malady at all times. But otoh that seems to work pretty good too, as one of my uncles died last year at the age of 102.

I feel in UK they are not that common unless you are ill. For company medicals / private health schemes and for certain age groups they do happen.

In Belgium, my general practitioner told me it used to be common practice to simple cross every box on the blood test selection sheet for a client's annual checkup.

Right now there is rightfully pushback against unnecessary testing. Over-medicalization by which people are subjected to treatment without suffering under symptoms is very much a problem. Also the socialized healthcare providers are not happy with this, as you can imagine.

Why conflate over/unnecessary treatment with availability and evaluation of markers? I guess if neither the patient nor the health care practitioner are uninterested in careful consideration of the data, then why bother I suppose. But then why bother at all with seat-belts, environmental laws, or dental visits if there's no value to prevention? We can just react after its too late, for everything.

/s in some of this, perhaps all

There's a multitude of reasons, touched upon in a metastudy of inappropriate lab testing in medicine [1,2]:

> “But, unexpectedly, on a per-test basis, we actually found that the main problem was tests being over-ordered during a patient’s initial examination, rather than during repeat tests. This indicates to us that ordering the right test during the initial evaluation may lead to fewer errors and better patient care,” he said.

a. Tests are not accurate, a false positive causes alarm and follow-up examination where none was present.

b. On the inverse: negative tests provide a false sense of security and good-health. [2] discusses this as the prime motivator for patient blood test requests.

c. Economic cost to the insurer or ultimately patient/taxpayer, not of the tests themselves but of the downstream examinations.

As a general rule in medicine: Don't treat a patient without signs or symptoms. When a persons feels healthy, they usually are healthy.

1. https://hms.harvard.edu/news/unnecessary-testing

2. https://journals.plos.org/plosone/article?id=10.1371/journal...

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769380/

I appreciate all those considerations but prevention of disease is all about identifying issues that may disrupt ones current feelings of and actual healthy state.

We cannot keep waiting for randomized experimental research to identify all the ways health may degrade over time. If we can regularly gather data en masse, we regularly over time can identify more predictors and risk factors for poor (and good) health, and evaluate efficacy of treatments received or effects from lack of treatment.

Again, why pay for seatbelts (and get tickets for not having them) in vehicles if I've have no history of accidents, or receive preventative dental care despite no serious current oral issues, etc.

Why do we have heat sensors in vehicles? The vehicles I've driven in life have never overheated.

Somehow we continue to excuse doctors who practice poorly by treating by markers alone rather than the whole picture (including the patients feelings and desires), or despite contraindications for the treatment being considered.

Somehow the only practical solution is to allow health degradation, and then rush to identify and treat and attempt reversal.

Some tests not only don’t benefit patients when done without reason, they actually harm them. medical interventions and procedures are often invasive and not without side effects, including pain, severe disability, and death. In many cases the studies you allude to us waiting for have arrived, and they show active harm for many cases where you’d think “why not add a test, what’s the harm”. Unfortunately medicine is still way too complex to reason about without the research to back it.

In my field of nutrition alone, there is tons more we could do to individualize and thus improve the targets for macro and micronutrients, as just one example. RDAs are only a rough starting point (when there is an RDA) as we understand more about individual genetics, food environment, etc. Why is all of medicine just invasive procedures and pharma? I'm not convinced that we somehow just need to sit and wait for some future time before we can jnvest and safely make use of markers over ones life to improve behaviors and health outcomes (for the benefit of an individual and others with similar medical characteristics).

Theres room to debate the degree and depth that we would utilize labs and other measures, but a complete non-starter mentality just leaves health outcomes to blind fate and promotes development of complex conditions much more difficult to unwind.

I'm Irish and never heard of someone getting one unless they were checking for something specific. However, I do know that regular health checks are recommended once you hit 45 or so. Not sure if that includes blood tests.

We're currently ranked 16th in the world for longevity, so I doubt regular blood checks is that important - at least, I remember reading previously that there's no evidence regular blood checks are actually useful unless you have an ongoing condition.

Irish too, and I get bloods done every year because I noticed my health insurance covers me for an annual checkup. First time I got them done revealed I had very high cholesterol

I got a funny stare from the doctor in Germany when I wanted to check my cholesterol levels.

My wife OTOH got it done without an issue.

So yeah maybe they don't bother with males or foreigners.

Yep we only care about hot chics and Germans. But seriously, was it the same doctor? Then it would indeed be kinda weird, but otherwise there is a wide range of types of doctors, those who love checkups and prescribing stuff and sending you to a specialist whenever you report the slightest problem, and those that just send you home again no matter what, tell you to get some rest, work less, eat healthier, and maybe come back in two weeks if it doesn't fix itself. And then everything in between.

As an Indian I'll say that annual health check-ups are now normal amongst the privileged class. In my opinion it is a good thing considering how unhealthy our environment and lifestyle is along with a lot of predisposed conditions.

This seems indeed anecdotal.

I would consider a blood test every couple of years a default practice among GPs in Switzerland. Among other measures that fall under the "prevention is better than treatment" scheme such as free skin cancer screening or colon cancer screening from a certain age.

I find the described reaction of your doctor to be out of the ordinary, and with relation to the described accusation unacceptable.

I would have switched GP in that case.

Thanks. I ended up doing exactly what you said for other reasons (Covid). Now I have what is called telemedicine where I call some number where I describe my symptoms and I might get a prescription right away or some tests. I did it to minimize the interaction with people that have an higher chance of having covid due to their line of work.

I remember some research with respect to the U.S.A. where such routine checkups are common, and it concluded that it was close to useless to do so.

Routine checkups never happen where I live. — one visits a healer when one feel sick.

I remember first reading about that as well. That's not to say we don't have preventative care in the Netherlands though, it's just more targeted. For example, women get regular screenings for breast cancer.

Which in itself seems rather odd, given that it's not the most common, most deadly, nor easily screenable ailment.

If there is screening for this specific ailment, then why not for all?

It doesn't strike me as a decision born from strategic thought.

I don't know too much about breast cancer, but it was just an example. There's plenty more preventative care, they're just not grouped together in a single periodic check-up (which also doesn't check for "all" ailments - I don't think we even know of all of them :) ).

Here is a medical editorial which makes the same point and cites the relevant research. Routine annual check ups are probably a waste of resources in most cases.

https://www.nejm.org/doi/full/10.1056/NEJMp1507485

For there to be benefit to an annual checkup, it would need to fall in the window wherein symptoms have not yet occurred, but the disease is already measurable, and also one that is searched for in those checkups.

I haven't visited a general practitioner in a decade, and when I last went it was indeed because of I noticed the symptoms of of an ear-infection that I indeed suffered.

Maybe it's egoist to do so, but if by doing check-ups I can improve the quality of my life when I'm older then I'm all in for that.

Moreover, some preventable conditions don't show symptoms. High cholesterol, for instance, doesn't show any symptoms until one of your blood vessels is clogged, but chances are that by then is too late and you might suffer a stroke/heart attack.

I don't know how much the average treatment for those costs, but I would say way less than few tens of blood/urine tests. Or even more "stealing" a good heart because you need a transplant due to a preventable condition.

By the way now I circumvent the Swiss reluctance to prevention by going to Italy and paying the analysis out of my pocket. It's still very cheap (~100 Euros every 18 month on average).

>I now live in Switzerland and my current doctor was shocked when I ask to get some blood analysis without being sick. He believed that I lied to my insurance company and hid some pre-existing condition.

this is the same kind of situation in Denmark, I've lived most of my life outside of Denmark, after I cam back in my early 40s I went to the Doctor and said innocently "well I guess I'm getting to that age now where I should have an annual checkup." There was no explaining the concept to him.

You should probably change your doctor.

Annual check ups aren't supported by evidence based medicine.

https://www.nejm.org/doi/full/10.1056/NEJMp1507485

thanks for that, I did not know this (obviously). That said, I don't think my doctor knew it either or he could have just said.

As an American with good health insurance, I’ve gotten blood labs with my annual physical since at least the mid-2000s.

Why do you get an annual physical?

I'm also an American with good health insurance (PPO not HMO if that makes a difference). My GP is at Stanford, although she only seems to practice once a week or something (it can be hard to get an appointment).

I go to the doctor when something's bothering me, but that's about it. It's never been suggested that I go regularly. (I'm not quite 40 yet, so maybe that's the difference?)

My dentist on the other hand, sends me a postcard every 6mo.. :)

It’s covered by insurance, and my doctor recommends it. I’ve caught a couple health problems early that could’ve turned into something major.

Once per year in the norm in Argentina.

If you have fancy / private healthcare, you're also encouraged to have the FULL checkup. That is, running on a trend-mill while a doctor controls your heart rate, etc.

Many vegan friends also requested iron and B12 checkups with blood tests, and doctors had no issue with that.

>In Italy, instead, it is pretty common that every couple of years you get a complete blood analysis just to see if everything is ok and whether you need to change something in your lifestyle.

This sounds like a great idea

I agree. Other people here mentioned that sounds like a waste of money, but I honestly am not sure as I don't have good figures about how different treatments cost.

However, I believe that by doing so I can avoid preventable conditions later in my life and it's well worth it both for my quality of life and potentially for other people as I might not need that much medical assistance and leave it for those who need it.

Does the cost of health insurance change in Switzerland with a pre-existing condition?

Not the basic one as it is the same for everyone and prices are mandated by the government, but the premium packages do. For instance, you can add to your package that were you to spend nights at the hospital you'd like a private room. If you have an existing condition that makes it more likely that you'll end up spending nights at the hospital you need to pay more for said premium package.

Annual blood tests are standard for all patients with my current GP in the US. He is a younger doctor, so that might be a factor. I'm a bad patient in that I don't go every year.

Yup. We get told our cholesterol is high, our triglycerides are high, our blood pressure is high, we're pre-diabetic, we ignore it and come back the next year and get prescribed more pills.

I suppose that might be true of a lot of the western world. The good thing about regular blood tests is that, in theory, you can catch things early before you have symptoms and they become serious problems.

Every blood test I've had, has come back with good results. I have low blood pressure, and I don't take anything other than a few dietary vitamins daily. I'm fortunate in that I established good dietary habits back in my early twenties. It can be difficult to break old habits though, so we'll see how I fare now that I've crossed the age where things start going downhill.

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