oaktrout

Large population based studies tell us what caused the cancer. If smokers are 20x more likely to get lung cancer we know that smoking causes cancer.

I think if people didn't have smoking / drinking / overeating as coping mechanisms they might find healthy alternatives like exercise / altruism / creativity. Look at seventh day Adventists in Loma Linda (not a member myself), they live a long time and are very happy. For many, the last 20 years are only miserable because they didn't take care of themselves. It's possible to be 80 and active / healthy/ happy.

I would look into varenicline (chantix), talk with a doctor. I know some people will bring up incredibly rare side effects as reasons not to try, but I think those are sort of like plane crashes, they happen sometimes and cause a very visceral response, but the majority of people will do fine flying on a plane. Also, smoking will contribute to an early death, so the risk benefit calculation makes sense to me.

Obesity also contributes to inflammation,fat cells release pro-inflammatory adipokines.

POCUS is used commonly in my experience and there are large amounts of curriculum devoted to it. We haven't had affordable access to POCUS for decades so I don't see how doctors have refused to learn it for decades.

Excess fat -> insulin resistance -> higher fasting insulin.

Re studying only women: it's a problem when you are making a claim about all cause mortality but failing to mention that it's all cause mortality "in women", you can't generalize.

"Are you saying that the authors didn't control for them (then why collect data on them and include it?), or that they did so badly (why do you think that), or something else"

Yes, I addressed this above, see my comment on residual confounding, amongst my many other criticisms.

"Is it coming from someone with a lot of experience evaluating the protocols of epidemiological studies?"

It is, but I prefer to not involve my own credentials as a boring appeal to authority and focus on the argument at hand. I mentioned spending time in the sun to show I have no horse in the race. I only bring up melanoma because the cohort is “Melanoma In Southern Sweden”, but I think your point is fair regarding likely multifactorial causes.

“Sunlight (whether too much or too little) affects us in all sorts of poorly-understood ways; that's why it's useful to do a big correlation study instead of just examining melanomas”

Still, if I were designing a study to measure the impact of exercise on all cause mortality, I would not have a question like “Do you frequently jog to the farmers market to pick up vegetables?”. Half of the questions ask about going on vacation, maybe we are seeing that people who have enough time to “go abroad” twice a year live longer, I would believe that. I hope this is obvious and that even someone who doesn’t have “a lot of experience evaluating” these studies can see the flaw.

The study didn’t include any men!!! A study of women only might not generalize to the whole population, especially when it comes to all cause mortality. One obvious example: men have 1.5x higher risk of dying from melanoma than women. The study excluded individuals with a history of malignant melanoma.

The no-exposure group exercised less and had lower education, and there is a large risk for residual confounding that could have likely been accounted for by using categorical variables with more than 3 options.

Further criticisms include the “no exposure group” having much more women aged 55-64 (with likely much more comorbidities). They used length to follow up time to account for this which has no place in an observational study. The study excluded women who had a history of cancer.

I appreciate the work the authors did, but remain unconvinced that it is sunlight that caused lower mortality in their study.

"Outside online" does not seem like an unbiased source on this issue. Asking four questions that pertain to something does not make a good measure of that something. Agree to disagree on this one.

This is coming from someone who spends a lot of time in the sun. Melanoma was never going to have much of an impact on mortality at the population level, the incidence of high grade melanoma is far too low.

I agree. I think it's also reductionist to say sun avoidance increases mortality, at least based on the evidence we have.

My issue with the study wasn't study size or duration, it was the questionarre. People who go to holiday in the mountains or go swimming are probably healthier. They could have just asked about sun exposure "how many days in the past month have you spent more than 2 hours in the sun". Also, why just study women? Did their analysis not pan out when they used men?

True in women according to that study. Also they didn't ask specifically about sun exposure avoidance, they asked things like "Do you go abroad on holiday to swim and sunbathe". People on dialysis don't go abroad and people who can't swim secondary to poor health don't go swimming abroad. A poorly designed study with too many confounders imo.

I'm not sure tbh, this really isn't my area of expertise. Sorry, I was hopeful someone more knowledgeable would reply.

I agree. I see this sort of misunderstanding commonly here. Hacker news is filled with individuals who think computers can solve all our problems, and at the same time they lack the most basic understanding of the complexities of biology.

I have to think that computational models will be infinitely cheaper than animal testing. If they worked as well as animal testing surely some for profit pharmaceutical company would leverage them to reap enormous profits. Because this is not happening I conclude the the models aren't as affective.

The paper linked by bsdz checks for one specific cardiac side effect, it is not anywhere close to being a model for cardiotoxicity as a whole, a very important distinction.

I briefly scanned the paper. This is not a computer model for cardiotoxicity as a whole, it's a model for one very specific type of cardiotoxicity. These things may have their uses, bit they are a long way from replacing animal testing.

This model checks for one side effect in one organ system. Animal testing can check all organ systems for thousands of side effects.

It's also worth noting that cerebrovascular disease can cause a dementia with symptoms just like alzheimers (without actually having alzheimers). It's literally called vascular dementia: https://en.m.wikipedia.org/wiki/Vascular_dementia.

If you're worried about forgetting your loved ones, do your best to control your vascular risk factors.

For the arms at least, they make UV protective shirts, they are essentially just a lightweight loose breathable fabric. Worth considering if you aren't familiar with them.

A surgeon might choose to let you die in a bland but predictable way if they think they might be sued for their heroic (but perhaps not RCT proven safe) efforts.

I agree that bad surgeons and immoral practices need to be stopped but the line between best intentions and unjustifiable risks isn't black and white when you step outside the textbook cases.

Agree, and at some point you have to let the inexperienced surgeon operate or in 20 years there will be no experienced surgeons. Not to mention the "inexperienced" guy has been doing it for 4 years.

This is fascinating, neurosurgery really is something else. I am surprised it takes that long to close.

From the paper "Race prediction performance was also robust across models trained on single equipment and single hospital location on the chest x-ray and mammogram datasets"

I recall seeing a paper in the early 2010s with an algorithm that could discriminate between white and Asian based on head MRI images. I'm having trouble finding it now, but this finding to me is not too surprising.

I would wager you know many people who have gotten better after seeing a "professional". Mental health isn't often discussed openly so you would probably be shocked at how many high functioning people are on SSRIs (doctors, lawyers, engineers, etc).

I didnt find any info on 5HT2C in the linked source above, not saying what you've said isn't true, just that I was interested and didn't find much info.

This will get buried but as far as ssris having "really bad side-effects for most people that take them", I think thats not true. I see lots of people on SSRIs, most deny having any side effects, some have minor side effects that tend to resolve with discontinuation, rarely do I see a "really bad" or persistent side effect.

It's like plane crashes, rare events get lots of focus and thus some people are terrified of flying, but really it's quite safe.

The first flu vaccine came about in 1945. Knowing as much as we did about viruses then, you might think we would have a cure for influenza (or the common cold) by now. Here we are almost 80 years later... big data may be coming but if takes that long it won't be in my lifetime.

I've heard similar anecdotes about missing the highs. The thing is the highs can be scary also, with people doing things like spending their life savings or engaging in dangerous activities.

Medical licensing exams in the US are randomized within the same sitting, even having two examiners in the same room receiving entirely different questions (not just random question ordering).