I see lots of exotic hypothesis being tossed around, but none of them fit Singapore, which is only slightly behind Spain/Japan. The Singaporean lifestyle is one of the most stressful, competitive and insecure in the world. The cuisine isn't particularly healthy... any more so than the cuisine you would find at most Chinese/Thai/Fast-Food places.
My armchair hypothesis is that the quality and availability of medical care trumps most other factors. Singapore is known to have a great medical system, even for those not well off.
This is probably also the reason USA is doing so badly. If you're in the bottom quintile, the quality and availability of medical care is awful. If we ever instituted medicare-for-all, I expect average lifespan would shoot up by a couple years at least.
See also Asian-Americans, who can already expect to live to 86.5 today (ahead of every country) despite stereotypically high stress lives and no universal healthcare.
Longevity is largely correlated with physical activity, obesity, and sleep. There's no mystery here. American's largely strike out on all 3. We get into cars and drive to go one block for an evening latte from Starbucks.
What gives you the impression undercooked meat (which seems to beg the question, let alone dairy) affects longevity negatively? A basic survey of research seems to offer highly ambiguous findings.
It’s very difficult to test diets on humans. Best study to date is the China Study. It looked at Chinese villages that had different diets and shows that eating meat and dairy is correlated to lower life expectancy and more diseases.
While I don’t agree the study is garbage their are limitations and imperfections to every study. Another great example was cancer rates in Norway from 1929-1948. In 1939, Norway lost almost all meat to the Nazi’s and you can see cancer rates drop immediately and significantly. In 1945 after the war ends cancer rates quickly rise again.
Check out the documentary forks instead of knives to see more examples like this.
Norway, along with most other countries during wartime, had severe food rationing going on. It's not a surprise that cancer rates dropped if people were malnourished and dying younger of... everything else but cancer and cardiocirculatory diseases.
While I don’t agree the study is garbage their are limitations and imperfections to every study. Another great example was cancer rates in Norway from 1929-1948. In 1939, Norway lost almost all meat to the Nazi’s and you can see cancer rates drop immediately and significantly. In 1945 after the war ends cancer rates quickly rise again.
Check out the documentary forks instead of knives to see more examples like this.
> Singapore is known to have a great medical system, even for those not well off.
You're spot on with respect to diet. I believe Singapore has the highest rate of diabetes in the developed world.
With respect to supposed excellent medical care, some problems in Singapore that I noticed:
- There is little access to preventative medical care. If you do get preventative medical care it tends to be very expensive (scan all the things!). In my home country, I would get a yearly test for glaucoma as my grandmother was affected and it's genetic, but in Singapore this is quite unheard of (I tried once and was subjected to a battery of tests that cost hundreds of dollars). In my home country most people get yearly dental care, but there's no such thing in Singapore.
- People change doctors a lot, which I think is problematic. However, you're kind of forced to change doctors every time you change companies or if your company switches to a different health insurance provider.
- Strong drugs are available over the counter, no questions asked. GPs also happily give out way too many drugs for minor issues.
- People in Singapore can end up losing all their money if they get a serious illness.
- Strong promotion of pseudo-medicine, such as TCM. It is legitimized even by otherwise respect universities, which may have TCM research centers. After a GP visit, it's also common that you get some pseudo-scientific medicine from the secretary handling your payment (e.g. 'don't eat chicken').
I'm not so much arguing against your hypothesis. However, I worry that optimizing for life span might not mean that people are healthier.
In fact, in some countries, death is sometimes chosen over necessarily prolonging life:
- Euthanasia
- Getting very expensive, painful/dulling medical procedures that end up prolonging your life is discouraged by doctors in some countries
Brushing off TCM as pseudoscience is quite ignorant. There are plenty of legitimate TCM research and verified treatments that have improved the lives of many in the world.
Are you really claiming that TCM and other such pseudosciences have been a net positive for the world? Unproven treatments that may make problems worse, while also encouraging patients to stay away from tested treatments, should play no part in a modern society. If you're in any doubt about this, perhaps you should read 'Bad Science' by Ben Goldacre, which takes a whistle stop tour of such quackery, as well as the various unethical practices undertaken by pharmaceutical companies.
So Goldacre's finding is that unethical practices and unproven treatments exist both in mainstream pharma and "CAM" [1].
So why is your contempt reserved for "CAM"?
> Unproven treatments that may make problems worse, while also encouraging patients to stay away from tested treatments
I keep hearing this but I've only witnessed the opposite.
I've utilised "CAM" for conditions that mainstream medicine couldn't help with (after years of trying to get help from different mainstream practitioners).
Only a combination of treatments from "CAM" modalities (naturopathy, osteopathy, myotherapy, yoga/pilates, limited chiropractic & TCM) has enabled me to get properly well.
Every "CAM" practitioner I saw encouraged me to keep checking in with mainstream doctors, which I did and have continued to do.
My mainstream doctors now look at my test results and just say "whatever you've been doing, keep doing it".
I get that there are horror stories, as there are in many facets of life. But like much of what makes up mainstream news reporting, the very thing that makes them noteworthy is that they are exceptions to the norm.
As someone who has gone about as deep into researching health/medicine as one can without actually undertaking a medical degree, I'm comfortable that the hysterical reactions over "CAM" are overblown.
So, it would seem, are government regulators around the world who are actually looking at the data, otherwise there would be even more stringent controls imposed on practitioners than are already in place.
I know it’s hard to believe and to generalise beyond your own experience but you are one data point. You might have gotten better without any of the things that you mentioned. Most likely it was a placebo effect, strengthened by your own research and belief in the practices.
I’m not sure the lack of government regulation is a valid point. In my experience, and as you’d see if you read Goldacre’s book, government administrators don’t understand statistics. Even if they did, they don’t neccesarily legislate to maximise welfare.
I'm sure you're sincere in wanting to advocate positions that are good for the world. So you'll want to know how your arguments in this comment are flawed.
> Because CAM doesn’t even attempt to be correct.
Practitioners don't stay in business if they don't provide benefits. So unless you're asserting that most "CAM" clients like spending money for zero benefit, this claim doesn't hold up.
> I know it’s hard to believe and to generalise beyond your own experience
If you were committed to intellectually honest discussion, you'd have at least made further enquiries of me before making this assertion.
I have many acquaintances pursuing similar paths through their own health challenges, and have done for many years. I've examined many case reports and research studies, in order to understand the medical basis for what I've observed and experienced. So, yes, I'm one data point, but I've observed and researched many others.
> You might have gotten better without any of the things that you mentioned.
There's no basis for this. My health consistently declined for many years - for reasons that are now easily explained. And it started to turn around only after I started undertaking particular healing practices from the "CAM" sphere - but for reasons that are easily explained using scientifically sound medical knowledge.
> Most likely it was a placebo effect, strengthened by your own research and belief in the practices.
Serious question: do you suggest that my healing was imaginary, or that it was real but caused by beliefs/emotions rather than material factors?
People who invoke the placebo effect in this context often aren't conscious of importance of the distinction, but it matters a lot.
If it's the former, then I guess there's no more to discuss without knowing the details of my case - which you're welcome to enquire about.
If it's the latter, well then I agree with you that my healing has been influenced - indeed mostly driven - by changes in beliefs/emotions, as is the case with the version of the placebo effect that I subscribe to.
I've extensively researched the placebo effect and what is known about it, and how it may be relevant in my case, and I'm happy to discuss it further if it's a topic you're genuinely curious about.
> I’m not sure the lack of government regulation is a valid point. In my experience, and as you’d see if you read Goldacre’s book, government administrators don’t understand statistics. Even if they did, they don’t necessarily legislate to maximise welfare.
My point is not that there is a lack of regulation. There's a lot of regulation in most jurisdictions; professional bodies, health authorities, consumer protection authorities, criminal justice systems.
Governments may not legislate to maximise welfare but they are highly motivated to avoid horror stories on the front pages of newspapers, and the infrequency of such occurrences indicates that the level of harm caused by "CAM" is low.
Sure it would be great if it were lower, as is the case with all aspects of society where any harm occurs.
But striving for a world that only allows the practice of therapies that have been approved in advance by the mainstream medical establishment is not going to lead us to a better world than what we already have.
Do you have anything better than an appeal to tradition to justify your viewpoint, perhaps a book or study that comprehensively justifies TCM without falling into the basic traps of failed statistical reasoning?
Perhaps the missing point is that the TCM approach to illness or health is dramatically different from Western medicine.
Surgery or modern medicine (injection, pills) focuses on one particular manifestation of illness and targets a particular illness.
On the other hand, TCM is not targeting a particular illness, but rather, it sees illness as the symptom of something deeper going off track in the body. Hence it tries to regulate and balance the body so that it can correct itself, without too much intervention.
It's not something that you can quantitatively study easily and get concrete results, as it is more long-term and therapeutic rather than short-term result driven.
Dunno - stuff like acupuncture works for pain relief but is still part of TCM. If you have a bad back it probably has a lot less side effects than being put on opioids as is common in the US.
I was reading a few years back that they didn't have anything like double-blind studies on chiropractic medicine, in part 'cause double blind studies are much more difficult for procedures than for pills.
I mean, I'm not claiming to be an expert here or anything, it's just that last time I read up on that sort of thing it sounded like there was no evidence that chiropractic medicine or acupuncture was more than just placebo. Do you have citations?
To be honest my info was shaky but I just googled and it seems it's kind of like a placebo effect but a good one. There was one study where
>After eight weeks 60 per cent of patients receiving acupuncture, including with toothpicks, reported feeling better. Clinical improvements were reported by just 39 per cent of those who had conventional treatments.
The hard thing about all of this is that, as you pointed out, studies are hard to do. Even if they were funded to the same level as pharmaceuticals, it would be much harder to make conclusive findings. But in the absence of huge companies with profit motives or government bodies with political motives, there's not much funding around for thorough studies.
But some examples of where practices from TCM and CAM are achieving recognition are:
- The Nobel Prize awarded to Tu Youyou for finding artemisinin effective for treating malaria [1]
- A recent NIH review finding acupuncture, yoga and other non-drug therapies effective for common pain conditions [2]
- A study of a chiropractic technique to reduce the physiological effects of emotional stress/trauma [3]
But aside from these studies, surely the market is at least somewhat of an indicator of some level of benefit. Economists generally regard consumers of being capable of making rational decisions about how to spend their money in ways that most benefit them.
Of course it's not a water-tight rule, but nor is it completely false. Yet many people dismiss the entire CAM industry as being fuelled by nothing but stupidity, and dismiss the possibility that at least some of the industry's customers are capable of making rational spending decisions when it comes to their health.
Keeping in mind that some antibiotics were found originally in soil. So there's a good chance many random collections of stuff have produced useful medicine. The claim should be stronger than "it's not entirely valueless". How about: on average is it better or worse than modern medicine? Modern medicine is probably better then soil, on average. That's testable. And I'd wager it's better than any alternative effort. Even all of them put together.
All the meridians and whatnot don't lend more credibility over...soil, say. Until they're tested properly. After which Nobel prizes can be won.
> "on average is it better or worse than modern medicine?"
The vast majority of people using/practicing "CAM" are not claiming "CAM" to be "better" than modern medicine; they take a horses-for-courses approach.
Modern medicine is fine for acute illness where you need a medication or surgery to address an infection, break, blockage, etc.
"CAM" seems to be valuable for chronic non-life-threatening conditions like fatigue, pain, mild hormonal issues, mild auto-immunity, etc. It's also chosen by people who are quite healthy and want to keep it that way by optimising their nutrition, emotions, muscular-skeletal strength/alignment, etc.
So it's not a matter of what is better or worse than the other, it's a question of finding the right tool for the job. Every conventional doctor I've consulted in the past few years has endorsed that approach.
The point is, the parts of traditional medicine that work are adopted by modern medicine. Meaning, although they're still part of traditional medicine, they're no longer distinctive of traditional medicine. Traditional medicine is distinct from modern medicine only by virtue of the parts that don't work.
This is what is meant by the "traditional medicine that works is called medicine" soundbite. The soundbite on its own condenses the argument very imperfectly, and people should be wary of using it.
Please educate yourself with the term TCM (traditional Chinese medicine, 中药) before making such condescending comments. It's a very specific branch of medicine, not related to the generic English term "traditional medicine".
Your argument, to a Chinese person, is equivalent to "JavaScript is old because Java is old." It makes no sense at all.
Edit: It's also worth noting that in Chinese, TCM is simply 中医, which literally means Chinese medicine. I'm not sure who decided to add the "traditional" in front, but it's not actually how it's called in China.
> Traditional medicine is distinct from modern medicine only by virtue of the parts that don't work.
If you say it this way, then maybe we should stop using the term TCM and just call it its original name "Chinese medicine" so we can both be happy.
singapore is a city disguising itself as a country. there's your answer. for comparison, compare singapore to the richest urban areas of its peers and you will see that advantage go away most likely
There's also drug abuse - very low in Singapore (they execute drug dealers), high in the US ("Drug overdoses killed more than 72,000 people in the United States last year – a new record driven by the deadly opioid epidemic").
No, I dont think the medical care is that much of a big factor. I think what matters for countries involved is "family care". I.e. how much are your siblings/relatives/kids going to take care of you as you get old. Compare this with the survival of people who are left alone in nursing homes, they lose many years of their potential lives.
Medical care will only take care of your biology, but that's only half of the battle.
Why don’t you think medical care is a big factor? Do you have any logical reason or data to back that claim up? If what you think is right and family care is more important factor, then life expectancy would have been way higher in the past (which it wasn’t). Moreover countries like Bangladesh would be high in the life expectancy chart along with Singapore.
What I mean is that it's not the biggest differentiator among developed countries. Not talking about developing vs developed countries here. Basically what makes you an outlier in terms of longevity is not medical care.
>>No, I dont think the medical care is that much of a big factor. I think what matters for countries involved is "family care". I.e. how much are your siblings/relatives/kids going to take care of you as you get old. Compare this with the survival of people who are left alone in nursing homes, they lose many years of their potential lives.
Isn't Japan notorious for doing the opposite? At least it made the news....
"Several reasons for the increase in kodokushi have been proposed. One proposed reason is increased social isolation. A decreasing proportion of elderly Japanese people are living in multi-generational housing and are instead living alone.[6] Elderly people who live alone are more likely to lack social contacts with family and neighbors, and are therefore more likely to die alone and remain undiscovered."
https://en.wikipedia.org/wiki/Kodokushi
> Isn't Japan notorious for doing the opposite? At least it made the news....
It's not because it makes the news that it's quantitatively important. Murders make the news in Japan the whole time yet Japan is one of the safest countries around.
> This is probably also the reason USA is doing so badly. If you're in the bottom quintile, the quality and availability of medical care is awful.
I've read several times that medical outcomes across the board are worse in the US than in European countries with national health systems - i.e. even for the richest, privatised healthcare doesn't work (on average).
In a way, that's true of the US too; and various (perhaps most?) european systems have most care provided privately - with whatever regulations apply.
The framing of "privatized" vs. government health care is, IMNSHO a holdover from the cold war when everything needed to be as ideologically distinct from USSR as possible. Now, it's just corrosive. This isn't a dichotomy; it's not even really a gradual scale - it's typically a whole host of choices of how to set up those regulations. Presuming in advance that privatization is a good (or bad) thing simply leads to worse outcomes.
It is probably regulated in a far more complicated manner.
Singapore has forced savings accounts for basic care (out of pocket spending drives costs down), less barriers to entry into the medical profession (thus more doctors at lower wages than the US), less regulation that results in non-competitive hospital and medical practice like in the US.
It's far more effective at delivering high quality at low cost due to more market forces. They spend 3% GDP for excellent results vs 16-20 in the US which is a regulatory death by a thousand cuts.
Catastrophic care is covered by the government but this is far more efficient than universal systems elsewhere.
If you think US Healthcare is a problem of a lack of regulation you don't understand US Healthcare…
The problem is not how much is regulated, it is what parts are regulated and whether they really matter. Opaque pricing is definitely an issue in the US, as is over-reliance on medications [1] which is correlated to shitty workers rights.
Yeah, it's a complex issue with many interlocking parts.
Which is why it's a shame when we get hung up on "privatized" vs. not - on that kind of topic people have often already made up their mind, and you're just not going to get anywhere anymore.
If you consider that Medicaid tends to be quite focused on outcomes (spending money where it's effective) and covers ~1/4 of the country, this isn't surprising.
Better diets and less drug use should both be rather cheap to impact at a policy level. I think much of the problem is that it's popular in the US to oppose the government having policies that would improve the quality of life of poor people.
> The Singaporean lifestyle is one of the most stressful, competitive and insecure in the world.
I'm curious about this. Can you point me to any resources to learn more about that? Or could you elaborate on why it is so, especially the "insecure" part?
I've spent many years living in Singapore. People are very hard working, competitive, materialistic and status conscious. A combination which leads to long works hours and work-stress.
The fact that there's minimal social safety net, certainly doesn't help either.
I recall reading some studies that came to the same conclusions as above, but I don't have them handy at the moment.
Panhandling is literally illegal, and I'm reasonably sure that anyone who's "homeless" gets picked up by the authorities and taken away somewhere. So it's hard to assess how common either is. That said, because the police are extremely effective at keeping out drugs, I don't think it's nearly as common as in America.
Regarding crime, Singapore is one of the safest in the world. A lot of that comes down to effective policing and extremely strict sentencing that puts criminals behind bars for a very long time.
Family ties are a lot stronger, so a lot of people falling on hard times do get substantial help from their family members. But there's minimal governmental safety net of the type you find in Western Europe.
Many jobs on offer in Singapore tend to be limited-time contractual. Also, there are no pensions. If you do get fired, it is not a large country with a lot of alternative opportunities.
absolutely not. The US has some demographic issues. African americans have a very high infant mortality rate that is irrespective of socioeconomic class. African americans also have a very high teen murder rate.
Americans are very obese due to having a terrible diet and our heart disease kills more proportionally than our peer countries.
If you look at life expectancy of various ethnicities they are comparable to their countries of origin. If you look at life expectancy after 40 (where people are using medical care) the gap between the US and europe closes (but not completely).
Teen homicide rate in US is less than 10 per 100,000. So if the 99,990 people live to be 75 and the 10 teens die at 13, teen homicide would lower the life expectancy from 75 to 74.9938. So teen homicide does not contribute any significance to life expectancy
>I don't understand what medicare for all seeks to accomplish that isn't already available with medicaid.
Medicaid is only available for the extremely poor; Many states have expanded this after the ACA passed, but my understanding is that there's still a pretty good gap between where you qualify for medicaid and where health insurance is affordable in much of the country.
American healthcare is so bad that despite being considerably far less wealthy, Mexico and Cuba have a similar life expectancy.
A big part of that is getting the basics right. Diabetics don't need to start gofundmes to afford insulin, they don't get into medical emergencies if they run low on funds, then get swamped with medical debt from having to be hospitalized (further digging their insulin fund hole). they can live healthy and productive lives.
Are there numbers for this? As an American I have enjoyed great health care on-demand all my life at very little or no expense and I pay very little for insurance.
Yes, there are numbers. We spend more than pretty much anyone else and don't have particularly good outcomes among developed countries.
Some of that is explained by efficient outcomes not really being a systematic goal, but we also have a dumb regulatory framework where a bunch of things are highly regulated and prices aren't touched.
Mexico has rampant obesity and type II diabetes. Mexicans simply do not pursue as much treatment as Americans do. It washes out in the lifespan statistics, which call into question the whole point of the healthcare enterprise.
Working in the medical field as an internal medicine physician, I'd say that focused and good-quality healthcare is vital to prolongation of life, and poorly derived, financially-motivated 'medicine as profit' is massively overrated.
You're making the mistake of treating amount spent on healthcare as a proxy for quality of healthcare system. The US spends more per head on healthcare than any other country, but is far down the rankings for health outcomes. This doesn't show that healthcare is irrelevant: it shows that the US healthcare system is so broken that despite spending so much, the outcomes are no better than much poorer countries like Cuba and Mexico. The US is the massive outlier here, and it's no coincidence that the US is also the only rich country without universal healthcare.
> Inborn in the sense that IQ is highly predictive of lifespan
IQ is only a bit more genetic than environmental (about 55-45, from most of what I've seen on the issue), so even if IQ was extremely strongly associated with lifespan, that would be a weak basis for characterizing the latter as being overwhelmingly inborn.
> Americans would clearly live a lot longer than they do if they spent less on healthcare.
That's far from clear; there's reason to suspect American food cut healthcare costs and do as well or better, but there is certainly no guarantee that blindly cutting spending would do that. If
What do the zero kids have to do with it? I don’t follow. No kids to revert to the mean and drag aggregate IQ down? How much immigration is there to Singapore of this type? I can’t imagine it’s some large proportion of the population...
I didn't say otherwise?! Defensive much? IQ is the single best predictor of lifespan. I think this is because ability to perform well on an IQ test means cellular metabolism is operating well in the organism.
Healthcare is not irrelevant, that is a ridiculous statement. Perhaps you mean healthcare spending, but even that is only supported by a few outliers like the US.
Lifespan statistics are heavily influenced by early deaths. Drugs and violence take many more lives in the Western Hemisphere than in Singapore. This is enough to explain a large portion of it. Especially during this opioid epidemic.
I'd argue that diet is significantly worse throughout the Western Hemisphere as well, but nutrition is a difficult science.
This. Life expectancy is a measure of the population's ability to keep the infants from dying, bubble wrap the world so the 15-25yo men don't kill themselves and then provide good medical care so the seniors can squeak by with their oxygen.
I agree, but US healthcare needs cost- and incentive-structure reformation, which medicare-for-all will not accomplish.
Also, SG's are very thin. A big contrast to Americans.
Another point: SG seems to have crazy-lax food service regulation compared to USA. Hawker centers are everywhere. Many make a living serving delicious, inexpensive foods this way. I would propose there is little to nothing to show for some of the US's hyper-aggressive food regulations leading to governments pouring bleach on food, or private charities holding secret events to help homeless people in America.
Food regulation in Singapore is the opposite of "crazy-lax". Every hawker stall is regularly inspected and has the inspection results prominently posted, and despite being outside, the hawker centres are clean and sterilized to within an inch of their lives (there are no flies anywhere!). If people get sick from eating hawker food, it's headline news.
I've seen the inspection notices, but I was thinking of it more from a civil liberties standpoint than an "ability to serve unsanitary food" standpoint. In other words: how practical is it for an Everyperson to own/operate a restaurant?
I haven't personally owned restaurants in both SG and USA, but what I understand is it is way easier in SG in terms of red tape, capital, insurance etc. I think that's a very valid criticism.
My armchair hypothesis is that the quality and availability of medical care trumps most other factors. Singapore is known to have a great medical system, even for those not well off.
This is probably also the reason USA is doing so badly. If you're in the bottom quintile, the quality and availability of medical care is awful. If we ever instituted medicare-for-all, I expect average lifespan would shoot up by a couple years at least.