Philosophy Discussion Forums | A Humans-Only Club for Open-Minded Discussion & Debate

[LuckyR]

Nice try, but I didn't say Western medicine can't treat chronic conditions, I said it isn't designed to do so (optimally), and it's not.

Most acute health problems are curable with either surgery (with pain meds and anesthesia helping out) or with antibiotics. Most chronic conditions (such as diabetes, high blood pressure, high cholesterol and depression) are best treated with lifestyle changes. Medications are created for the vast majority who won't/don't make those changes and frankly don't work as well.

While I respect your perspective and acknowledge the crucial role of lifestyle modifications and dietary habit changes in managing chronic diseases such as diabetes and hypertension, I must politely disagree with the assertion that medications are secondary to lifestyle changes and that Western medicine is not optimally designed to manage chronic conditions.

---

I'm interested in hearing your thoughts on how we can better communicate the importance of this integrated approach to chronic disease management, ensuring patients understand the complementary roles of lifestyle modifications and medication in achieving the best possible health outcomes.

You're missing a critical perspective, namely that while lifestyle CHANGES can "manage" chronic disease, that's not nearly as important as the reality that if the patient would have never embarked upon the lousy lifestyle in the first place, they would have avoided the "disease" altogether. Thus lifestyle isn't (only) the solution, it's the cause.

As to the communication, I personally find it inconceivable that there is a smoker (or alcoholic, or overeater etc) who is unaware of the fact that smoking is bad for them and that they should quit. Thus, for me personally, I don't browbeat folks with unsolicited advice and information they already know. OTOH, if someone reaches out and asks "can you help me quit smoking?", I'll talk their ear off. In my experience there is NO positive effect of not being on your patient's side, thus I'm never in an opposing position to my patients.

[Sushan]

Nice try, but I didn't say Western medicine can't treat chronic conditions, I said it isn't designed to do so (optimally), and it's not.

Most acute health problems are curable with either surgery (with pain meds and anesthesia helping out) or with antibiotics. Most chronic conditions (such as diabetes, high blood pressure, high cholesterol and depression) are best treated with lifestyle changes. Medications are created for the vast majority who won't/don't make those changes and frankly don't work as well.

While I respect your perspective and acknowledge the crucial role of lifestyle modifications and dietary habit changes in managing chronic diseases such as diabetes and hypertension, I must politely disagree with the assertion that medications are secondary to lifestyle changes and that Western medicine is not optimally designed to manage chronic conditions.

---

I'm interested in hearing your thoughts on how we can better communicate the importance of this integrated approach to chronic disease management, ensuring patients understand the complementary roles of lifestyle modifications and medication in achieving the best possible health outcomes.

You're missing a critical perspective, namely that while lifestyle CHANGES can "manage" chronic disease, that's not nearly as important as the reality that if the patient would have never embarked upon the lousy lifestyle in the first place, they would have avoided the "disease" altogether. Thus lifestyle isn't (only) the solution, it's the cause.

As to the communication, I personally find it inconceivable that there is a smoker (or alcoholic, or overeater etc) who is unaware of the fact that smoking is bad for them and that they should quit. Thus, for me personally, I don't browbeat folks with unsolicited advice and information they already know. OTOH, if someone reaches out and asks "can you help me quit smoking?", I'll talk their ear off. In my experience there is NO positive effect of not being on your patient's side, thus I'm never in an opposing position to my patients.

While it's undeniably true that lifestyle choices play a significant role in the development and management of chronic diseases, asserting lifestyle as 'the' cause oversimplifies the complex etiology of these conditions. Genetics, for instance, significantly influences the likelihood of developing chronic illnesses, regardless of lifestyle. Consider individuals who maintain a healthy lifestyle yet still fall prey to genetic predispositions for conditions like type 1 diabetes, certain cancers, or autoimmune diseases. This reality challenges the notion that lifestyle alone is the culprit.

For instance, there are athletes and health enthusiasts who, despite rigorous exercise regimes and balanced diets, have been diagnosed with diseases typically associated with poor lifestyle choices. These examples highlight the undeniable influence of genetics and suggest that while lifestyle is a critical factor, it is not the sole determinant.

Regarding the importance of patient insight and motivation in overcoming addiction, I agree that these elements are crucial. However, I wonder how we can more effectively foster an environment that not only encourages patients to seek help but also supports them in sustaining long-term changes. The clinician's role, as you rightly pointed out, is to facilitate rather than to dictate, offering guidance and support tailored to each patient's unique circumstances.

Yet, this raises a question: how do we balance the need for patient autonomy with the reality that some patients may not initially have the insight or motivation to seek change? And in the context of chronic diseases where lifestyle does play a role, how do we navigate conversations about lifestyle changes without implying blame or oversimplifying complex conditions?

[LuckyR]

Nice try, but I didn't say Western medicine can't treat chronic conditions, I said it isn't designed to do so (optimally), and it's not.

Most acute health problems are curable with either surgery (with pain meds and anesthesia helping out) or with antibiotics. Most chronic conditions (such as diabetes, high blood pressure, high cholesterol and depression) are best treated with lifestyle changes. Medications are created for the vast majority who won't/don't make those changes and frankly don't work as well.

While I respect your perspective and acknowledge the crucial role of lifestyle modifications and dietary habit changes in managing chronic diseases such as diabetes and hypertension, I must politely disagree with the assertion that medications are secondary to lifestyle changes and that Western medicine is not optimally designed to manage chronic conditions.

---

I'm interested in hearing your thoughts on how we can better communicate the importance of this integrated approach to chronic disease management, ensuring patients understand the complementary roles of lifestyle modifications and medication in achieving the best possible health outcomes.

You're missing a critical perspective, namely that while lifestyle CHANGES can "manage" chronic disease, that's not nearly as important as the reality that if the patient would have never embarked upon the lousy lifestyle in the first place, they would have avoided the "disease" altogether. Thus lifestyle isn't (only) the solution, it's the cause.

As to the communication, I personally find it inconceivable that there is a smoker (or alcoholic, or overeater etc) who is unaware of the fact that smoking is bad for them and that they should quit. Thus, for me personally, I don't browbeat folks with unsolicited advice and information they already know. OTOH, if someone reaches out and asks "can you help me quit smoking?", I'll talk their ear off. In my experience there is NO positive effect of not being on your patient's side, thus I'm never in an opposing position to my patients.

While it's undeniably true that lifestyle choices play a significant role in the development and management of chronic diseases, asserting lifestyle as 'the' cause oversimplifies the complex etiology of these conditions. Genetics, for instance, significantly influences the likelihood of developing chronic illnesses, regardless of lifestyle. Consider individuals who maintain a healthy lifestyle yet still fall prey to genetic predispositions for conditions like type 1 diabetes, certain cancers, or autoimmune diseases. This reality challenges the notion that lifestyle alone is the culprit.

For instance, there are athletes and health enthusiasts who, despite rigorous exercise regimes and balanced diets, have been diagnosed with diseases typically associated with poor lifestyle choices. These examples highlight the undeniable influence of genetics and suggest that while lifestyle is a critical factor, it is not the sole determinant.

Regarding the importance of patient insight and motivation in overcoming addiction, I agree that these elements are crucial. However, I wonder how we can more effectively foster an environment that not only encourages patients to seek help but also supports them in sustaining long-term changes. The clinician's role, as you rightly pointed out, is to facilitate rather than to dictate, offering guidance and support tailored to each patient's unique circumstances.

Yet, this raises a question: how do we balance the need for patient autonomy with the reality that some patients may not initially have the insight or motivation to seek change? And in the context of chronic diseases where lifestyle does play a role, how do we navigate conversations about lifestyle changes without implying blame or oversimplifying complex conditions?

Several things. First, while I agree with your assessment of the three classes of disorders you cite, they have the hallmarks of acute illness that Western medicine is designed to address. Type 1 diabetes, is the inability to produce insulin, Western medicine is great at figuring that out and figuring out how to obtain alternative insulin and delivering it (which it did). Cancer (when treatable) is currently a classic, acute style Western medicine success story, cut it out, radiate it or poison it with chemo. Now the scientific breakthrough of biologicals continues along that model. Similarly, autoimmune disorders have been reduced to: "block this protein" with the advent of antibody drugs, which is classic acute illness strategy that Western medicine is designed to tackle.

As to avoiding sounding like one is blaming, it's not difficult if one waits until the patient demonstrates interest/motivation, then using the solution to the problem as the focus (rather than the source of the problem).

[Belindi]

Nice try, but I didn't say Western medicine can't treat chronic conditions, I said it isn't designed to do so (optimally), and it's not.

Most acute health problems are curable with either surgery (with pain meds and anesthesia helping out) or with antibiotics. Most chronic conditions (such as diabetes, high blood pressure, high cholesterol and depression) are best treated with lifestyle changes. Medications are created for the vast majority who won't/don't make those changes and frankly don't work as well.

While I respect your perspective and acknowledge the crucial role of lifestyle modifications and dietary habit changes in managing chronic diseases such as diabetes and hypertension, I must politely disagree with the assertion that medications are secondary to lifestyle changes and that Western medicine is not optimally designed to manage chronic conditions.

---

I'm interested in hearing your thoughts on how we can better communicate the importance of this integrated approach to chronic disease management, ensuring patients understand the complementary roles of lifestyle modifications and medication in achieving the best possible health outcomes.

You're missing a critical perspective, namely that while lifestyle CHANGES can "manage" chronic disease, that's not nearly as important as the reality that if the patient would have never embarked upon the lousy lifestyle in the first place, they would have avoided the "disease" altogether. Thus lifestyle isn't (only) the solution, it's the cause.

As to the communication, I personally find it inconceivable that there is a smoker (or alcoholic, or overeater etc) who is unaware of the fact that smoking is bad for them and that they should quit. Thus, for me personally, I don't browbeat folks with unsolicited advice and information they already know. OTOH, if someone reaches out and asks "can you help me quit smoking?", I'll talk their ear off. In my experience there is NO positive effect of not being on your patient's side, thus I'm never in an opposing position to my patients.

Good! However can you help an addict to understand if and when they are rationalising the bad choice ? I who have quite a large vocabulary don't know a popular synonym for 'rationalising'. I wonder if there is one. I hope so.

[Nmesochristabel]

Healthcare is essential, and how we live today has changed the game. Modern life means we're dealing with new health challenges that weren't a thing for ancient humans. Plus, the role of big healthcare companies can't be ignored—they have a huge impact on our access to and perception of medical care. So, it's a bit of both: our needs have evolved, and the business side of healthcare amplifies those needs. It's a fascinating topic—how healthcare has become interwoven with our survival and well-being in today's world.

[LuckyR]

As to the communication, I personally find it inconceivable that there is a smoker (or alcoholic, or overeater etc) who is unaware of the fact that smoking is bad for them and that they should quit. Thus, for me personally, I don't browbeat folks with unsolicited advice and information they already know. OTOH, if someone reaches out and asks "can you help me quit smoking?", I'll talk their ear off. In my experience there is NO positive effect of not being on your patient's side, thus I'm never in an opposing position to my patients.

Good! However can you help an addict to understand if and when they are rationalising the bad choice ? I who have quite a large vocabulary don't know a popular synonym for 'rationalising'. I wonder if there is one. I hope so.

In my experience, folks use "rationalizations" when they are feeling defensive, that is they feel they are being judged. Since I: 1) only get involved when invited and 2) focus on meeting the patient's goal, as opposed to how they got to their current state (since they know that already and resent harping on it), I don't actually deal with any rationalizations.

[Belindi]

As to the communication, I personally find it inconceivable that there is a smoker (or alcoholic, or overeater etc) who is unaware of the fact that smoking is bad for them and that they should quit. Thus, for me personally, I don't browbeat folks with unsolicited advice and information they already know. OTOH, if someone reaches out and asks "can you help me quit smoking?", I'll talk their ear off. In my experience there is NO positive effect of not being on your patient's side, thus I'm never in an opposing position to my patients.

Good! However can you help an addict to understand if and when they are rationalising the bad choice ? I who have quite a large vocabulary don't know a popular synonym for 'rationalising'. I wonder if there is one. I hope so.

In my experience, folks use "rationalizations" when they are feeling defensive, that is they feel they are being judged. Since I: 1) only get involved when invited and 2) focus on meeting the patient's goal, as opposed to how they got to their current state (since they know that already and resent harping on it), I don't actually deal with any rationalizations.

Advertisers well know how to insert rationalisations into minds. There was an advertisement for milk chocolate with the caption "Go on ! You know you deserve it." And there is the plethora of image making that dwells on valiant cowboys and sailors, or aristocratic lifestyle and appearance, or sexual attractiveness, or benign father figure, or pseudoscience .I believe I have seen all of those images in cigarette advertising. I keep banging on about education being the answer to all sorts of problems, and education from primary school level onwards on how to be sceptical would vastly aid the medic in their work, who is trying to help patients ; although maybe not with severe physical addiction to such substances as opiates.

[LuckyR]

In my experience, folks use "rationalizations" when they are feeling defensive, that is they feel they are being judged. Since I: 1) only get involved when invited and 2) focus on meeting the patient's goal, as opposed to how they got to their current state (since they know that already and resent harping on it), I don't actually deal with any rationalizations.

Advertisers well know how to insert rationalisations into minds. There was an advertisement for milk chocolate with the caption "Go on ! You know you deserve it." And there is the plethora of image making that dwells on valiant cowboys and sailors, or aristocratic lifestyle and appearance, or sexual attractiveness, or benign father figure, or pseudoscience .I believe I have seen all of those images in cigarette advertising. I keep banging on about education being the answer to all sorts of problems, and education from primary school level onwards on how to be sceptical would vastly aid the medic in their work, who is trying to help patients ; although maybe not with severe physical addiction to such substances as opiates.

I agree such advertising helps young non-smokers take it up, though IMO if nicotine instead of being the most addictive substance known, was not physically addictive, quitting smoking would be much, much easier and the number of cigarette smokers would be a tiny fraction of what it is currently. Counterintuitively, the number of cigar, pipe and chewing tobacco users would likely be similar.

[Belindi]

In my experience, folks use "rationalizations" when they are feeling defensive, that is they feel they are being judged. Since I: 1) only get involved when invited and 2) focus on meeting the patient's goal, as opposed to how they got to their current state (since they know that already and resent harping on it), I don't actually deal with any rationalizations.

Advertisers well know how to insert rationalisations into minds. There was an advertisement for milk chocolate with the caption "Go on ! You know you deserve it." And there is the plethora of image making that dwells on valiant cowboys and sailors, or aristocratic lifestyle and appearance, or sexual attractiveness, or benign father figure, or pseudoscience .I believe I have seen all of those images in cigarette advertising. I keep banging on about education being the answer to all sorts of problems, and education from primary school level onwards on how to be sceptical would vastly aid the medic in their work, who is trying to help patients ; although maybe not with severe physical addiction to such substances as opiates.

I agree such advertising helps young non-smokers take it up, though IMO if nicotine instead of being the most addictive substance known, was not physically addictive, quitting smoking would be much, much easier and the number of cigarette smokers would be a tiny fraction of what it is currently. Counterintuitively, the number of cigar, pipe and chewing tobacco users would likely be similar.

As to the communication, I personally find it inconceivable that there is a smoker (or alcoholic, or overeater etc) who is unaware of the fact that smoking is bad for them and that they should quit. Thus, for me personally, I don't browbeat folks with unsolicited advice and information they already know. OTOH, if someone reaches out and asks "can you help me quit smoking?", I'll talk their ear off. In my experience there is NO positive effect of not being on your patient's side, thus I'm never in an opposing position to my patients.

Good! However can you help an addict to understand if and when they are rationalising the bad choice ? I who have quite a large vocabulary don't know a popular synonym for 'rationalising'. I wonder if there is one. I hope so.

In my experience, folks use "rationalizations" when they are feeling defensive, that is they feel they are being judged. Since I: 1) only get involved when invited and 2) focus on meeting the patient's goal, as opposed to how they got to their current state (since they know that already and resent harping on it), I don't actually deal with any rationalizations.

Advertisers well know how to insert rationalisations into minds. There was an advertisement for milk chocolate with the caption "Go on ! You know you deserve it." And there is the plethora of image making that dwells on valiant cowboys and sailors, or aristocratic lifestyle and appearance, or sexual attractiveness, or benign father figure, or pseudoscience .I believe I have seen all of those images in cigarette advertising. I keep banging on about education being the answer to all sorts of problems, and education from primary school level onwards on how to be sceptical would vastly aid the medic in their work, who is trying to help patients ; although maybe not with severe physical addiction to such substances as opiates.

I remain puzzled. Is physical addiction always or sometimes a matter of all or nothing(kind) or are there degrees of physiological addiction and if so do these depend on the patient's personality and other variables?
Is behavioral addiction a thing like a broken leg is a thing , or is it an analogy with physiological addiction?
I imagine addiction is not a thing but is a useful heuristic device the parameters of which are set by mutual consent of clinicians and the compliance of patients and others. For instance if a woman walks into a Alcoholics Anonymous meeting and announces " I am Jane and I am an alcoholic" she is compliant with the normal heuristic.

[LuckyR]

I remain puzzled. Is physical addiction always or sometimes a matter of all or nothing(kind) or are there degrees of physiological addiction and if so do these depend on the patient's personality and other variables?
Is behavioral addiction a thing like a broken leg is a thing , or is it an analogy with physiological addiction?
I imagine addiction is not a thing but is a useful heuristic device the parameters of which are set by mutual consent of clinicians and the compliance of patients and others. For instance if a woman walks into a Alcoholics Anonymous meeting and announces " I am Jane and I am an alcoholic" she is compliant with the normal heuristic.

I don't believe it is all worked out, but in my opinion there are pharmacoligic/neurological effects that fall under the label of physical and there are individuals who have "addictive personalities". Could there be a genetic/neurochemical etiology to the latter? Sure. Basically we all know some folks can get addicted to things (like gambling) that have zero chemical effects, that's 100% behavioral or personality based. Other chemicals like nicotine have documented profound chemical (to neurologic) effects. Could nicotine also play into certain individual's personality? Of course.

It wouldn't surprise me if it was determined that both chemical and behavioral sources have a common pathway neurologically.

[Belindi]

I remain puzzled. Is physical addiction always or sometimes a matter of all or nothing(kind) or are there degrees of physiological addiction and if so do these depend on the patient's personality and other variables?
Is behavioral addiction a thing like a broken leg is a thing , or is it an analogy with physiological addiction?
I imagine addiction is not a thing but is a useful heuristic device the parameters of which are set by mutual consent of clinicians and the compliance of patients and others. For instance if a woman walks into a Alcoholics Anonymous meeting and announces " I am Jane and I am an alcoholic" she is compliant with the normal heuristic.

I don't believe it is all worked out, but in my opinion there are pharmacoligic/neurological effects that fall under the label of physical and there are individuals who have "addictive personalities". Could there be a genetic/neurochemical etiology to the latter? Sure. Basically we all know some folks can get addicted to things (like gambling) that have zero chemical effects, that's 100% behavioral or personality based. Other chemicals like nicotine have documented profound chemical (to neurologic) effects. Could nicotine also play into certain individual's personality? Of course.

It wouldn't surprise me if it was determined that both chemical and behavioral sources have a common pathway neurologically.

That would simplify the cure for addiction. Maybe the link is the psychology and neurology of pleasure ;we all need to know how to delay satisfaction. Anger management is a case in point, I don't know how successful these anger management courses are. Then again some physiological addictions are so intensely felt that it's hard to imagine the addict surviving without chemical help from a clinician.

And so I answer the question from the OP : if we retain the ethic to save a life , any life, when reasonably possible then health care is necessary. Pragmatically, health care is necessary if we are to save the lives of the next generation, and also productive adults. Psychologically, health care is necessary unless we decide it's okay to brutalise ourselves or others.

[Sushan]

While I respect your perspective and acknowledge the crucial role of lifestyle modifications and dietary habit changes in managing chronic diseases such as diabetes and hypertension, I must politely disagree with the assertion that medications are secondary to lifestyle changes and that Western medicine is not optimally designed to manage chronic conditions.

---

I'm interested in hearing your thoughts on how we can better communicate the importance of this integrated approach to chronic disease management, ensuring patients understand the complementary roles of lifestyle modifications and medication in achieving the best possible health outcomes.

You're missing a critical perspective, namely that while lifestyle CHANGES can "manage" chronic disease, that's not nearly as important as the reality that if the patient would have never embarked upon the lousy lifestyle in the first place, they would have avoided the "disease" altogether. Thus lifestyle isn't (only) the solution, it's the cause.

As to the communication, I personally find it inconceivable that there is a smoker (or alcoholic, or overeater etc) who is unaware of the fact that smoking is bad for them and that they should quit. Thus, for me personally, I don't browbeat folks with unsolicited advice and information they already know. OTOH, if someone reaches out and asks "can you help me quit smoking?", I'll talk their ear off. In my experience there is NO positive effect of not being on your patient's side, thus I'm never in an opposing position to my patients.

While it's undeniably true that lifestyle choices play a significant role in the development and management of chronic diseases, asserting lifestyle as 'the' cause oversimplifies the complex etiology of these conditions. Genetics, for instance, significantly influences the likelihood of developing chronic illnesses, regardless of lifestyle. Consider individuals who maintain a healthy lifestyle yet still fall prey to genetic predispositions for conditions like type 1 diabetes, certain cancers, or autoimmune diseases. This reality challenges the notion that lifestyle alone is the culprit.

For instance, there are athletes and health enthusiasts who, despite rigorous exercise regimes and balanced diets, have been diagnosed with diseases typically associated with poor lifestyle choices. These examples highlight the undeniable influence of genetics and suggest that while lifestyle is a critical factor, it is not the sole determinant.

Regarding the importance of patient insight and motivation in overcoming addiction, I agree that these elements are crucial. However, I wonder how we can more effectively foster an environment that not only encourages patients to seek help but also supports them in sustaining long-term changes. The clinician's role, as you rightly pointed out, is to facilitate rather than to dictate, offering guidance and support tailored to each patient's unique circumstances.

Yet, this raises a question: how do we balance the need for patient autonomy with the reality that some patients may not initially have the insight or motivation to seek change? And in the context of chronic diseases where lifestyle does play a role, how do we navigate conversations about lifestyle changes without implying blame or oversimplifying complex conditions?

Several things. First, while I agree with your assessment of the three classes of disorders you cite, they have the hallmarks of acute illness that Western medicine is designed to address. Type 1 diabetes, is the inability to produce insulin, Western medicine is great at figuring that out and figuring out how to obtain alternative insulin and delivering it (which it did). Cancer (when treatable) is currently a classic, acute style Western medicine success story, cut it out, radiate it or poison it with chemo. Now the scientific breakthrough of biologicals continues along that model. Similarly, autoimmune disorders have been reduced to: "block this protein" with the advent of antibody drugs, which is classic acute illness strategy that Western medicine is designed to tackle.

As to avoiding sounding like one is blaming, it's not difficult if one waits until the patient demonstrates interest/motivation, then using the solution to the problem as the focus (rather than the source of the problem).

I find myself a bit perplexed by the demarcation you're making between acute and chronic conditions, particularly with your reference to Type 1 Diabetes (T1D) as an example of an acute illness. Could you clarify this distinction further for a more productive discussion?

T1D is widely recognized in medical practice as a chronic illness, not an acute one. Chronic illnesses are defined by their long duration and generally slow progression, whereas acute illnesses are characterized by their sudden onset and typically short duration. T1D involves a lifelong management of blood sugar levels due to the body's inability to produce insulin, which doesn't align with the characteristics of acute illnesses.

Your categorizations and definitions have left me a bit confused.

[Sushan]

Nice try, but I didn't say Western medicine can't treat chronic conditions, I said it isn't designed to do so (optimally), and it's not.

Most acute health problems are curable with either surgery (with pain meds and anesthesia helping out) or with antibiotics. Most chronic conditions (such as diabetes, high blood pressure, high cholesterol and depression) are best treated with lifestyle changes. Medications are created for the vast majority who won't/don't make those changes and frankly don't work as well.

While I respect your perspective and acknowledge the crucial role of lifestyle modifications and dietary habit changes in managing chronic diseases such as diabetes and hypertension, I must politely disagree with the assertion that medications are secondary to lifestyle changes and that Western medicine is not optimally designed to manage chronic conditions.

---

I'm interested in hearing your thoughts on how we can better communicate the importance of this integrated approach to chronic disease management, ensuring patients understand the complementary roles of lifestyle modifications and medication in achieving the best possible health outcomes.

You're missing a critical perspective, namely that while lifestyle CHANGES can "manage" chronic disease, that's not nearly as important as the reality that if the patient would have never embarked upon the lousy lifestyle in the first place, they would have avoided the "disease" altogether. Thus lifestyle isn't (only) the solution, it's the cause.

As to the communication, I personally find it inconceivable that there is a smoker (or alcoholic, or overeater etc) who is unaware of the fact that smoking is bad for them and that they should quit. Thus, for me personally, I don't browbeat folks with unsolicited advice and information they already know. OTOH, if someone reaches out and asks "can you help me quit smoking?", I'll talk their ear off. In my experience there is NO positive effect of not being on your patient's side, thus I'm never in an opposing position to my patients.

Good! However can you help an addict to understand if and when they are rationalising the bad choice ? I who have quite a large vocabulary don't know a popular synonym for 'rationalising'. I wonder if there is one. I hope so.

It's crucial to recognize when individuals are rationalizing their unhealthy behaviors, as it's a common barrier to recovery and change. Rationalizing, or justifying behaviors with seemingly logical reasons, often prevents individuals from seeing the true impact of their actions on their health and life. As healthcare providers or support systems, our role includes helping individuals identify these rationalizations and understand the discrepancies between their justifications and reality. This process requires empathy, patience, and effective communication. We should aim to create a supportive environment where individuals feel safe to express their thoughts and feelings without judgment, enabling them to confront and challenge their rationalizations. Encouraging self-reflection and offering perspective can be invaluable in this context. Would you agree that fostering an open, honest dialogue is key to helping individuals recognize when they're rationalizing their choices?

[Sushan]

Healthcare is essential, and how we live today has changed the game. Modern life means we're dealing with new health challenges that weren't a thing for ancient humans. Plus, the role of big healthcare companies can't be ignored—they have a huge impact on our access to and perception of medical care. So, it's a bit of both: our needs have evolved, and the business side of healthcare amplifies those needs. It's a fascinating topic—how healthcare has become interwoven with our survival and well-being in today's world.

I agree.

Big pharmaceutical companies play a crucial role in developing, manufacturing, and marketing medications that can save lives and improve quality of life. However, their influence extends beyond just making medicines available. They are pivotal in setting prices, determining the availability of drugs, influencing medical research priorities, and shaping healthcare policies. The ethical dilemma arises when the pursuit of profit potentially overshadows the commitment to public health.

For example, there have been instances where companies have been accused of artificially inflating drug prices, withholding generic versions of drugs to maintain monopolies, or aggressively marketing drugs with known risks. The opioid crisis in the United States is a stark illustration, where aggressive marketing practices for painkillers contributed to widespread addiction and overdose deaths. Furthermore, the influence of big pharma in medical research can skew priorities towards more profitable treatments rather than those most needed by public health.

This is not to say that all actions by pharmaceutical companies are nefarious or that they do not contribute positively to healthcare. Many companies invest heavily in research and development of new drugs that address unmet medical needs, including rare diseases that were previously overlooked. The challenge lies in finding a balance between rewarding innovation and ensuring that public health interests are served, particularly in terms of accessibility and affordability of essential medications.

The term "mafia" might evoke images of illicit activities, but in the context of big pharma, it more accurately reflects concerns about the power imbalances and ethical conflicts that can arise in a system where profit and health are so closely intertwined. It underscores the need for robust regulatory frameworks, transparency, and ethical stewardship to ensure that the healthcare ecosystem operates in the best interest of public health while still fostering innovation and growth in the pharmaceutical industry.

I would like to hear your thoughts on this.

[Sushan]

As to the communication, I personally find it inconceivable that there is a smoker (or alcoholic, or overeater etc) who is unaware of the fact that smoking is bad for them and that they should quit. Thus, for me personally, I don't browbeat folks with unsolicited advice and information they already know. OTOH, if someone reaches out and asks "can you help me quit smoking?", I'll talk their ear off. In my experience there is NO positive effect of not being on your patient's side, thus I'm never in an opposing position to my patients.

Good! However can you help an addict to understand if and when they are rationalising the bad choice ? I who have quite a large vocabulary don't know a popular synonym for 'rationalising'. I wonder if there is one. I hope so.

In my experience, folks use "rationalizations" when they are feeling defensive, that is they feel they are being judged. Since I: 1) only get involved when invited and 2) focus on meeting the patient's goal, as opposed to how they got to their current state (since they know that already and resent harping on it), I don't actually deal with any rationalizations.

Advertisers well know how to insert rationalisations into minds. There was an advertisement for milk chocolate with the caption "Go on ! You know you deserve it." And there is the plethora of image making that dwells on valiant cowboys and sailors, or aristocratic lifestyle and appearance, or sexual attractiveness, or benign father figure, or pseudoscience .I believe I have seen all of those images in cigarette advertising. I keep banging on about education being the answer to all sorts of problems, and education from primary school level onwards on how to be sceptical would vastly aid the medic in their work, who is trying to help patients ; although maybe not with severe physical addiction to such substances as opiates.

I wholeheartedly agree with your perspective on the power of advertising to shape our desires and rationalizations, especially in the context of products that may not be in our best interest, like sugary treats or cigarettes.

Expanding on your point, education does indeed play a pivotal role in empowering individuals to critically evaluate the information presented to them, including advertisements. Teaching skepticism and critical thinking from a young age can equip people with the tools to question and analyze the motives behind advertising, understand the impact of these products on their health, and make informed decisions.

Moreover, integrating media literacy into education can further enhance this skepticism by dissecting how advertisements are designed to manipulate emotions and perceptions. Understanding the techniques used in advertising, such as appealing to authority, bandwagon, or plain folks, can demystify these messages and reduce their influence.

However, it's also important to acknowledge the challenges in combating severe physical addiction, as you mentioned. While skepticism and education can help prevent the initiation into addictive behaviors, addressing addiction itself often requires a multifaceted approach, including medical intervention, psychological support, and sometimes, societal change.

The battle against misleading advertisements and the promotion of unhealthy products is ongoing and multifaceted. It calls for a collective effort from educators, healthcare professionals, policymakers, and individuals themselves. Encouraging skepticism and critical thinking is a crucial step, but we must also advocate for stronger regulations on advertising, especially those targeted at vulnerable populations, including children.