Martin Gurri on mistaking the state for God; Andrey Mir on platform economics; Jane Psmith on a book about the despair of our Founding Fathers; Marty Makary on the medical profession
The Founders were right to be disillusioned. And they would be far more disillusioned today, given that almost every aspect of the political institutions they established has been completely transformed -- in some cases without bothering to amend the Constitution. The purpose of the document, to protect "the people" (by which they meant the states) from federal overreach, has been inverted and the Constitution now directs the federal government's powers to nullify state laws. The processes by which we choose elected officials would be unrecognizable to them. They would be glad that "we" are still here... but that's about all.
I wasn't aware founders were disillusioned. It's also not clear to me that they would be disillusioned today but for better or worse, the federal-state balance of power has surely shifted much like you say.
In addition to reading Martin Gurri’s piece, I find it helpful to remember how the world has gotten better. For example, more people can read than ever before.
Arnold, please consider including in your Links to Consider, something to be grateful for, or someone to appreciate. Reality is somewhere between our negative bias and the annoyingly positive.
I don't think Makary is positing an alternative to mainstream medicine so much as he is pointing out its failings to consider much that it ought to. Surely he is right about the tendency to quickly prescribe a medication to address a specific complaint, rather than consider the larger background factors that may have led to it. Of course, time constraints make it difficult to do the latter.
On the decline of youth sports league participation, I think parents thinking their kids will be the next superstars and pushing harder and harder in one sport rather than playing several just “for fun” is part of the cause. Some of those parents are also coaches, which makes it less enjoyable for others so they drop out.
Don’t forget the leagues and coaches that downplay competition and winning to such an extent that participating is hardly any fun. Who wants to play when the coach isn’t trying to win? When the coach allows the worst players to play key positions in the final quarter of the championship game? Certainly there are leagues, families and coaches that have found a healthy balance. But most public high schools have become venues for delusional superstardom, while some private leagues have become venues for losers-are-winners-too mentality.
Where is this? I wish my kids could have played in those leagues. I don't know anything about not trying to win, once kids aged out of T-ball, but I would have definitely preferred less win-at-any-cost.
As my daughter advanced in gymnastics, she couldn't continue unless she met a minimum number of gym hours so she ended up quitting.
My son played on a little league team where the coach participated in hazing new team members. At the end of first practice he had the best player throwing heaters in front of the team and announced that's why the team would win the league. Of course the kid also played travel ball and his arm didn't make it halfway through the season.
Please, go away. People with attitudes like you are the reason kids drop out of sports participation like flies. You are the problem.
What a misinformed response Stu. I advocate for a balanced approach to competition for my family. I dislike extremes on both ends. Never once have I pressured other people to win at all costs. I tend to be against the extreme level of competition and commitment in most public high schools and many city leagues. We avoid leagues and sports that are all work, all about winning and no fun. The most important aspect of sport is to learn how to have fun while exercising. Participation should make you feel good and teach how to live a healthy lifestyle. The focus should be on health and fitness. Competition is good because it makes the activity more fun and motivates play. When you take all the competition out of the game, or too much of it, it takes the fun away. We like it when payers and coaches try to win.
Stu, I’m not sure how old you are, but these days, at the younger age levels (13 and under depending on the sport), there are many leagues for every level of competition and commitment. It sounds like your kids grew up in an earlier time, maybe in a small town with few private options? You sound like a victim. There are plenty of options for families that don’t care about winning, that want to downplay winning and that want to steer clear of competition. Try recreational gymnastics. Sounds like you were at a bad gym.
My kids like a healthy competition They are sad when their coach doesn’t try to win. It takes the fun away. So having learned this I no longer put them in leagues in which coaches don’t try to win.
No, I’m not the problem Stu. You just have little idea who I am. Try to be more informed who you’re accusing before you accuse. Show some respect for informed discourse. Try being inquisitive. Ask some questions first.
I read your two posts completely differently. Still lots that is unclear but doubt that matters. You touched a nerve. Sorry.
When my kids got in high school they found their sports and had mostly good experiences. I just thought there was way too much win-at-any-cost at younger ages.
Medicine seems to me a strange combination of things that most people obviously shouldn't be taking but can be talked into taking (most mental health drugs, most drugs related to "pain") and drugs that everyone should be taking but won't (I will put GLP-1s here).
My mother for instance takes way to many drugs, but can't be talked out of any of them.
Meanwhile, having been on Ozempic for two months I can confirm its basically a miracle drug we should be putting in the water supply, but large blocks of society will probably never take it because its "unnatural."
Talked into? I'd bet the house it's far more frequent the patients are begging the Drs. for the drugs. That was my wife's experience. She purposely didn't get a narcotics license so she could tell them she couldn't prescribe them.
And right or wrong, most would say they need their drugs every bit as much as you say you need you Ozempic.
My wife is struggling with Wegovy (which I think works the same way as Ozempic), and I can assure you that it would be more of a curse for unsuspecting recipients. If you aren't already attempting to limit your food intake, and doing it in a proper fashion, it can cause severe gastric distress. It may be a good way to avoid surgical procedures for weight loss but it's far from a wonder drug and it's not a substitute for self-control.
You can't assure him or anyone else of anything. Some people have trouble on the drug and get a form of gastric paralysis, which your wife appears to be suffering. There's no "if...then" of the sort you declare here, and it is a wonder drug whether or not people exercise the self-control you want to pretend is involved in their weight gain.
Wegovy is just a higher dosage of ozempic. I’m taking half the recommended ozmepic dose and I’ve lost over 20lb with almost no side effects. If your on wegovy you are likely taking a dose several times higher then mine
According to wegoby.com, "WEGOVY® (semaglutide) injection 2.4 mg is an injectable prescription medicine". Elsewhere on the website, it says the drug is "once-weekly".
ozempic.com says, "Ozempic® (semaglutide) injection 0.5 mg, 1 mg, or 2 mg is an injectable prescription medicine". Elsewhere on the website, it also says the drug is "once-weekly".
Both websites indicate they are by Novo Nordisk. So why are there two different names and four different strengths?
Forumposter is totally wrong about "default levels of Wegovy" but my guess is his decision to commit insurance fraud is leaving him ignorant. There's no such thing as "default levels". You start at the low doses and build up if you don't have any bad response. Many people can't take the higher doses or even stop entirely. Others are happy with their weight loss and stay at the lower doses, as forumposter is. I'm at the max dose (of Mounjaro) , but then I didn't even begin to have the appetite suppression effect until that max dosage. I lost weight regardless, because the reason I wasn't losing weight was insulin resistance, not overeating. However, I haven't gained any weight in a year and that is definitely because I'm on the max dosage. I know this because I used up some 5 mg I had and also extended the time between doses about a year ago and without eating any more I put on 5 lbs in a month. Went back on the max dose and slowly lost those five pounds and then stabilized again.
Forumposter is also incorrect about branding, but not about coding. Ozempic was explicitly developed for Type 2 diabetes. It was used offbrand for weight loss until they formally did the testing for it. Mounjaro did the same thing--I say I'm on Mounjaro, but I'm actually taking the identical drug under the name Zepbound. I suspect the different names are because these drugs are covered if you have Type II diabetes but not if you are losing weight. That's why it is quite possible Forum is committing insurance fraud. You can't "lie" to a doctor about your glucose and A1C numbers, and if he is on Ozempic he's almost certainly has a diagnosis of Type II diabetes, and he's doing that almost certainly to get the low price.
Now, it's possible that he is paying the full nut for Ozempic but that doesn't make sense. He'd be better off getting Wegovy at a slightly discounted price if he's got an obesity diagnosis.
According to mounjaro.lilly.com, Mounjaro is a weekly injection of tirzepatide, which like Ozempic/Wegovy (semaglutide) works on GLP-1 but also works on GIP. It's from Eli Lilly and the FDA press release says,
"Zepbound activates receptors of hormones secreted from the intestine (glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP)) to reduce appetite and food intake. Zepbound is administered by injection under the skin once weekly, and the dosage must be increased over four to 20 weeks to achieve the target dosages of 5 milligram (mg), 10 mg or 15 mg once weekly. The maximum dosage of Zepbound is 15 mg once weekly."
Zepbound is marketed for weight loss. Mounjaro is the same chemical, just marketed for diabetes. Available doses are 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg.
The different names are a mixture of branding and medical coding. Ozempic can be given for a wider range of coding than Wegovy.
There is what you might call a "default" dosing and a "possible" dosing. If you aren't responding to the default level of Ozempic dosing, they can recommend a higher dose. Wegovy starts at a higher level and has a higher default.
The bottom line personally is I've found that I get great results at a level below even the default level of Ozempic. Someone taking the default live of Wegovy would be at a much higher dosage level. They may experience higher side effects then I do.
You say elsewhere that you lied to your doctor to get the drug. Perhaps that's why you are so ignorant. Wegovy isn't a higher dose of Ozempic and if someone's on Wegovy it has nothing to do with their dosage. They are exactly the same drug.
You are on Ozempic because you lied to your doctor, although it's more likely your doctor is openly conspiring with you. In either way, you are committing insurance fraud, probably because your insurance won't cover weight loss but will cover type 2 diabetes. Which is fine, do whatever, but don't babble on about the drugs becaus you have no idea what you're talking about.
GLP-1 drugs are denied to people with Type 1 diabetes. I had to lie to the doctor about my diabetes and weight to get mine.
It has been completely transformative for my diabetes (cut my insulin intake dramatically and totally evened out my highs and lows), but I would recommend it to anyone struggling with weight (which is like 40% of Americans).
“Perhaps if you were forced to choose between mainstream medicine and Makary, you would choose mainstream medicine.” If only it were possible to determine what is mainstream and what is heterodox. For example, Makary mentions micronutrients. Two of my medical specialists have recommended that I take Centrum Silver so I do. Nevertheless, what I am guessing is the mainstream view is that there is no evidence to support multivitamin usage. (see for example: https://ods.od.nih.gov/factsheets/MVMS-HealthProfessional/ stating that “An expert panel that reviewed this report and participated in a state-of-the-science conference on the use of MVs and MVMs for chronic disease prevention at the National Institutes of Health in 2006 concluded that the evidence was insufficient for them to recommend for or against the use of MVs or MVMs to prevent chronic disease.” and https://www.hopkinsmedicine.org/health/wellness-and-prevention/is-there-really-any-benefit-to-multivitamins ) I suspect that the reason my doctors recommended a multivitamin was that I, like apparently 35% of all Americans, had a vitamin D deficiency per a blood test. Remedying a vitamin D deficiency to produce beneficial outcomes, on the other hand, is apparently a mainstream view (https://my.clevelandclinic.org/health/diseases/15050-vitamin-d-vitamin-d-deficiency ). So go figure. The Centrum Silver has plenty of D3.
And perhaps of particular interest to readers of this substack who have more years behind them than most, when you get into reading the NIH factsheet you discover things like:
“An ancillary study to COSMOS, known as COSMOS-Mind, enrolled 2,262 of the older COSMOS participants (mean age 73 years) to investigate whether the cocoa extract, MVM, or both supplements might improve cognition compared with placebo over 3 years of daily use [44]. Participants completed standardized cognitive tests administered over the telephone at baseline and annually for 3 years. Participants who took the MVM supplement, with or without the cocoa extract, showed improved global cognition, which reflects overall ability across multiple cognitive domains, such as recall, recognition, and learning. The improvement was most pronounced in participants with a history of CVD. Participants who took the MVM also showed improved memory and executive function.
Similar findings were reported from COSMOS-Web, another ancillary study to COSMOS that included 3,562 participants (mean age 71 years) who completed computer-based cognitive assessments [45]. In this study, participants who took the MVM had significantly better memory at both 1 year and across 3 years of follow-up, on average, compared with those who took placebo. A third ancillary study, COSMOS-Clinic, included 573 participants (mean age 69 years) who completed in-person, detailed neuropsychological assessments at baseline and year 2 [46]. Compared with participants who took placebo, those who took the MVM showed an improvement in episodic memory over 2 years, but not executive function or attention. In addition, a meta-analysis of the three ancillary studies (COSMOS-Mind, Web, and Clinic) that included more than 5,000 participants showed that MVM use improved global cognition and episodic memory over time [46]. These findings suggest that MVM supplementation can help maintain or enhance cognitive function in older adults.”
Therefore, since I am already on a gluten free, Mediterranean diet, I plan on continuing taking my multivitamin so long as my doctors recommend it regardless of whatever the mainstream medical view might be. In the end, we all have to think for ourselves.
However, his proposal for introducing digital referenda would guarantee destruction. It also does not comport with the Constitution, but it could be implemented California-style at the state level. I think that he is correct that the mass moaning about "democracy" comes from definitional sloppiness, frustration with representative government (as a mixed system expressly designed to frustrate and channel democratic energies), and a sense of purposelessness isolation. Government by referendum is also likely to lead to popular frustration because the Constitution would frustrate most of what people would want to implement. State legislatures, for example, have committees to cull a large proportion of draft bills because most of what everyone, including elected representatives, wants to do is unconstitutional or legally controversial.
I have a narrow alternative recommendation and a broader general recommendation. My narrow recommendation is to curtail plea bargaining in criminal cases to restore the old prevalence of jury trials. This would provide The People with an outlet for democratic authority at the level of their competence in a way that comports with the Constitution along with history and tradition. My broader recommendation is to devolve more government to the States and to refocus the federal government on defense and international affairs.
Dealing with Greta-Thunberg-global-village-internet-derangement issues requires more creativity, even though it is a related issue.
"And, the path that we're on is not a good path. Pretty soon every teenager is going to be on multiple medications on the trajectory that we have now."
Pretty soon? Really? I get that the trend isn't good. Maybe it's even as bad as stated but does anybody think EVERY teenager will be on at least two prescriptions?
mainstream, heterodoxy and contrarianism - what you say could be taken one step further to explain why the "middle" can't compete against the far left and far right. It includes very different perspectives.
Not sure what Makary means by "the most over medicated generation in history," however, several sources claim that Generation Z does seem to get more mental health diagnoses and are more likely to be prescribed medications, especially attention deficit disorder medications like Adderall, than previous generations. Can't really find any good comparisons with previous prescription medication spikes like Valium in the 60s or Prozac which peaked in the 90's and 00's. The great covid lockdown is mentioned frequently as a cause for much of the Gen Z diagnoses as well as the claim that Gen Z is the first generation to not be overly inhibited in seeking care for mental health problems. It is tempting to link Gen Z's mental health situation to the dysfunctional environment that Gurri describes at the first link as well. Personally, I suspect over-crowding in urban environments and disconnection from physical contact with soil and nature generally might play a role as well. So whether there is over-medication or appropriate levels of medication seems quite likely debatable.
I think it might be helpful to consider at least two gods. One as the physics of the universe (i.e. energy, matter, time, etc. and unknowns); a second as an exemplar and most respected role model. Combining the two drives smart people away from the second, which is really at the root of our societal ills: we badly need to start talking about our best role models. How about you and I start a new religion?
The Founders were right to be disillusioned. And they would be far more disillusioned today, given that almost every aspect of the political institutions they established has been completely transformed -- in some cases without bothering to amend the Constitution. The purpose of the document, to protect "the people" (by which they meant the states) from federal overreach, has been inverted and the Constitution now directs the federal government's powers to nullify state laws. The processes by which we choose elected officials would be unrecognizable to them. They would be glad that "we" are still here... but that's about all.
I wasn't aware founders were disillusioned. It's also not clear to me that they would be disillusioned today but for better or worse, the federal-state balance of power has surely shifted much like you say.
In addition to reading Martin Gurri’s piece, I find it helpful to remember how the world has gotten better. For example, more people can read than ever before.
https://substack.com/@scottgibb/note/c-69904869
Arnold, please consider including in your Links to Consider, something to be grateful for, or someone to appreciate. Reality is somewhere between our negative bias and the annoyingly positive.
I don't think Makary is positing an alternative to mainstream medicine so much as he is pointing out its failings to consider much that it ought to. Surely he is right about the tendency to quickly prescribe a medication to address a specific complaint, rather than consider the larger background factors that may have led to it. Of course, time constraints make it difficult to do the latter.
On the decline of youth sports league participation, I think parents thinking their kids will be the next superstars and pushing harder and harder in one sport rather than playing several just “for fun” is part of the cause. Some of those parents are also coaches, which makes it less enjoyable for others so they drop out.
Don’t forget the leagues and coaches that downplay competition and winning to such an extent that participating is hardly any fun. Who wants to play when the coach isn’t trying to win? When the coach allows the worst players to play key positions in the final quarter of the championship game? Certainly there are leagues, families and coaches that have found a healthy balance. But most public high schools have become venues for delusional superstardom, while some private leagues have become venues for losers-are-winners-too mentality.
Where is this? I wish my kids could have played in those leagues. I don't know anything about not trying to win, once kids aged out of T-ball, but I would have definitely preferred less win-at-any-cost.
As my daughter advanced in gymnastics, she couldn't continue unless she met a minimum number of gym hours so she ended up quitting.
My son played on a little league team where the coach participated in hazing new team members. At the end of first practice he had the best player throwing heaters in front of the team and announced that's why the team would win the league. Of course the kid also played travel ball and his arm didn't make it halfway through the season.
Please, go away. People with attitudes like you are the reason kids drop out of sports participation like flies. You are the problem.
What a misinformed response Stu. I advocate for a balanced approach to competition for my family. I dislike extremes on both ends. Never once have I pressured other people to win at all costs. I tend to be against the extreme level of competition and commitment in most public high schools and many city leagues. We avoid leagues and sports that are all work, all about winning and no fun. The most important aspect of sport is to learn how to have fun while exercising. Participation should make you feel good and teach how to live a healthy lifestyle. The focus should be on health and fitness. Competition is good because it makes the activity more fun and motivates play. When you take all the competition out of the game, or too much of it, it takes the fun away. We like it when payers and coaches try to win.
Stu, I’m not sure how old you are, but these days, at the younger age levels (13 and under depending on the sport), there are many leagues for every level of competition and commitment. It sounds like your kids grew up in an earlier time, maybe in a small town with few private options? You sound like a victim. There are plenty of options for families that don’t care about winning, that want to downplay winning and that want to steer clear of competition. Try recreational gymnastics. Sounds like you were at a bad gym.
My kids like a healthy competition They are sad when their coach doesn’t try to win. It takes the fun away. So having learned this I no longer put them in leagues in which coaches don’t try to win.
No, I’m not the problem Stu. You just have little idea who I am. Try to be more informed who you’re accusing before you accuse. Show some respect for informed discourse. Try being inquisitive. Ask some questions first.
I read your two posts completely differently. Still lots that is unclear but doubt that matters. You touched a nerve. Sorry.
When my kids got in high school they found their sports and had mostly good experiences. I just thought there was way too much win-at-any-cost at younger ages.
Medicine seems to me a strange combination of things that most people obviously shouldn't be taking but can be talked into taking (most mental health drugs, most drugs related to "pain") and drugs that everyone should be taking but won't (I will put GLP-1s here).
My mother for instance takes way to many drugs, but can't be talked out of any of them.
Meanwhile, having been on Ozempic for two months I can confirm its basically a miracle drug we should be putting in the water supply, but large blocks of society will probably never take it because its "unnatural."
Talked into? I'd bet the house it's far more frequent the patients are begging the Drs. for the drugs. That was my wife's experience. She purposely didn't get a narcotics license so she could tell them she couldn't prescribe them.
And right or wrong, most would say they need their drugs every bit as much as you say you need you Ozempic.
I didn’t specify who talked them into it. A drug advertisement, word of mouth, school officials, their doctor or pharmacist.
I simply note that people seem to end up on a lot of drugs.
My wife is struggling with Wegovy (which I think works the same way as Ozempic), and I can assure you that it would be more of a curse for unsuspecting recipients. If you aren't already attempting to limit your food intake, and doing it in a proper fashion, it can cause severe gastric distress. It may be a good way to avoid surgical procedures for weight loss but it's far from a wonder drug and it's not a substitute for self-control.
You can't assure him or anyone else of anything. Some people have trouble on the drug and get a form of gastric paralysis, which your wife appears to be suffering. There's no "if...then" of the sort you declare here, and it is a wonder drug whether or not people exercise the self-control you want to pretend is involved in their weight gain.
Wegovy is just a higher dosage of ozempic. I’m taking half the recommended ozmepic dose and I’ve lost over 20lb with almost no side effects. If your on wegovy you are likely taking a dose several times higher then mine
According to wegoby.com, "WEGOVY® (semaglutide) injection 2.4 mg is an injectable prescription medicine". Elsewhere on the website, it says the drug is "once-weekly".
ozempic.com says, "Ozempic® (semaglutide) injection 0.5 mg, 1 mg, or 2 mg is an injectable prescription medicine". Elsewhere on the website, it also says the drug is "once-weekly".
Both websites indicate they are by Novo Nordisk. So why are there two different names and four different strengths?
Forumposter is totally wrong about "default levels of Wegovy" but my guess is his decision to commit insurance fraud is leaving him ignorant. There's no such thing as "default levels". You start at the low doses and build up if you don't have any bad response. Many people can't take the higher doses or even stop entirely. Others are happy with their weight loss and stay at the lower doses, as forumposter is. I'm at the max dose (of Mounjaro) , but then I didn't even begin to have the appetite suppression effect until that max dosage. I lost weight regardless, because the reason I wasn't losing weight was insulin resistance, not overeating. However, I haven't gained any weight in a year and that is definitely because I'm on the max dosage. I know this because I used up some 5 mg I had and also extended the time between doses about a year ago and without eating any more I put on 5 lbs in a month. Went back on the max dose and slowly lost those five pounds and then stabilized again.
Forumposter is also incorrect about branding, but not about coding. Ozempic was explicitly developed for Type 2 diabetes. It was used offbrand for weight loss until they formally did the testing for it. Mounjaro did the same thing--I say I'm on Mounjaro, but I'm actually taking the identical drug under the name Zepbound. I suspect the different names are because these drugs are covered if you have Type II diabetes but not if you are losing weight. That's why it is quite possible Forum is committing insurance fraud. You can't "lie" to a doctor about your glucose and A1C numbers, and if he is on Ozempic he's almost certainly has a diagnosis of Type II diabetes, and he's doing that almost certainly to get the low price.
Now, it's possible that he is paying the full nut for Ozempic but that doesn't make sense. He'd be better off getting Wegovy at a slightly discounted price if he's got an obesity diagnosis.
According to mounjaro.lilly.com, Mounjaro is a weekly injection of tirzepatide, which like Ozempic/Wegovy (semaglutide) works on GLP-1 but also works on GIP. It's from Eli Lilly and the FDA press release says,
"Zepbound activates receptors of hormones secreted from the intestine (glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP)) to reduce appetite and food intake. Zepbound is administered by injection under the skin once weekly, and the dosage must be increased over four to 20 weeks to achieve the target dosages of 5 milligram (mg), 10 mg or 15 mg once weekly. The maximum dosage of Zepbound is 15 mg once weekly."
Zepbound is marketed for weight loss. Mounjaro is the same chemical, just marketed for diabetes. Available doses are 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, 15 mg.
Yes. That is exactly what I said, is it not?
The different names are a mixture of branding and medical coding. Ozempic can be given for a wider range of coding than Wegovy.
There is what you might call a "default" dosing and a "possible" dosing. If you aren't responding to the default level of Ozempic dosing, they can recommend a higher dose. Wegovy starts at a higher level and has a higher default.
The bottom line personally is I've found that I get great results at a level below even the default level of Ozempic. Someone taking the default live of Wegovy would be at a much higher dosage level. They may experience higher side effects then I do.
You say elsewhere that you lied to your doctor to get the drug. Perhaps that's why you are so ignorant. Wegovy isn't a higher dose of Ozempic and if someone's on Wegovy it has nothing to do with their dosage. They are exactly the same drug.
You are on Ozempic because you lied to your doctor, although it's more likely your doctor is openly conspiring with you. In either way, you are committing insurance fraud, probably because your insurance won't cover weight loss but will cover type 2 diabetes. Which is fine, do whatever, but don't babble on about the drugs becaus you have no idea what you're talking about.
I have the exact opposite view. Mental health drugs have known risks, and glp should only be for people with diabetes
GLP-1 drugs are denied to people with Type 1 diabetes. I had to lie to the doctor about my diabetes and weight to get mine.
It has been completely transformative for my diabetes (cut my insulin intake dramatically and totally evened out my highs and lows), but I would recommend it to anyone struggling with weight (which is like 40% of Americans).
“Perhaps if you were forced to choose between mainstream medicine and Makary, you would choose mainstream medicine.” If only it were possible to determine what is mainstream and what is heterodox. For example, Makary mentions micronutrients. Two of my medical specialists have recommended that I take Centrum Silver so I do. Nevertheless, what I am guessing is the mainstream view is that there is no evidence to support multivitamin usage. (see for example: https://ods.od.nih.gov/factsheets/MVMS-HealthProfessional/ stating that “An expert panel that reviewed this report and participated in a state-of-the-science conference on the use of MVs and MVMs for chronic disease prevention at the National Institutes of Health in 2006 concluded that the evidence was insufficient for them to recommend for or against the use of MVs or MVMs to prevent chronic disease.” and https://www.hopkinsmedicine.org/health/wellness-and-prevention/is-there-really-any-benefit-to-multivitamins ) I suspect that the reason my doctors recommended a multivitamin was that I, like apparently 35% of all Americans, had a vitamin D deficiency per a blood test. Remedying a vitamin D deficiency to produce beneficial outcomes, on the other hand, is apparently a mainstream view (https://my.clevelandclinic.org/health/diseases/15050-vitamin-d-vitamin-d-deficiency ). So go figure. The Centrum Silver has plenty of D3.
And perhaps of particular interest to readers of this substack who have more years behind them than most, when you get into reading the NIH factsheet you discover things like:
“An ancillary study to COSMOS, known as COSMOS-Mind, enrolled 2,262 of the older COSMOS participants (mean age 73 years) to investigate whether the cocoa extract, MVM, or both supplements might improve cognition compared with placebo over 3 years of daily use [44]. Participants completed standardized cognitive tests administered over the telephone at baseline and annually for 3 years. Participants who took the MVM supplement, with or without the cocoa extract, showed improved global cognition, which reflects overall ability across multiple cognitive domains, such as recall, recognition, and learning. The improvement was most pronounced in participants with a history of CVD. Participants who took the MVM also showed improved memory and executive function.
Similar findings were reported from COSMOS-Web, another ancillary study to COSMOS that included 3,562 participants (mean age 71 years) who completed computer-based cognitive assessments [45]. In this study, participants who took the MVM had significantly better memory at both 1 year and across 3 years of follow-up, on average, compared with those who took placebo. A third ancillary study, COSMOS-Clinic, included 573 participants (mean age 69 years) who completed in-person, detailed neuropsychological assessments at baseline and year 2 [46]. Compared with participants who took placebo, those who took the MVM showed an improvement in episodic memory over 2 years, but not executive function or attention. In addition, a meta-analysis of the three ancillary studies (COSMOS-Mind, Web, and Clinic) that included more than 5,000 participants showed that MVM use improved global cognition and episodic memory over time [46]. These findings suggest that MVM supplementation can help maintain or enhance cognitive function in older adults.”
Therefore, since I am already on a gluten free, Mediterranean diet, I plan on continuing taking my multivitamin so long as my doctors recommend it regardless of whatever the mainstream medical view might be. In the end, we all have to think for ourselves.
Hooray for Martin Gurri.
However, his proposal for introducing digital referenda would guarantee destruction. It also does not comport with the Constitution, but it could be implemented California-style at the state level. I think that he is correct that the mass moaning about "democracy" comes from definitional sloppiness, frustration with representative government (as a mixed system expressly designed to frustrate and channel democratic energies), and a sense of purposelessness isolation. Government by referendum is also likely to lead to popular frustration because the Constitution would frustrate most of what people would want to implement. State legislatures, for example, have committees to cull a large proportion of draft bills because most of what everyone, including elected representatives, wants to do is unconstitutional or legally controversial.
I have a narrow alternative recommendation and a broader general recommendation. My narrow recommendation is to curtail plea bargaining in criminal cases to restore the old prevalence of jury trials. This would provide The People with an outlet for democratic authority at the level of their competence in a way that comports with the Constitution along with history and tradition. My broader recommendation is to devolve more government to the States and to refocus the federal government on defense and international affairs.
Dealing with Greta-Thunberg-global-village-internet-derangement issues requires more creativity, even though it is a related issue.
"And, the path that we're on is not a good path. Pretty soon every teenager is going to be on multiple medications on the trajectory that we have now."
Pretty soon? Really? I get that the trend isn't good. Maybe it's even as bad as stated but does anybody think EVERY teenager will be on at least two prescriptions?
mainstream, heterodoxy and contrarianism - what you say could be taken one step further to explain why the "middle" can't compete against the far left and far right. It includes very different perspectives.
Let’s first solve the problem of the forcing, then we’ll worry about the choosing.
Not sure what Makary means by "the most over medicated generation in history," however, several sources claim that Generation Z does seem to get more mental health diagnoses and are more likely to be prescribed medications, especially attention deficit disorder medications like Adderall, than previous generations. Can't really find any good comparisons with previous prescription medication spikes like Valium in the 60s or Prozac which peaked in the 90's and 00's. The great covid lockdown is mentioned frequently as a cause for much of the Gen Z diagnoses as well as the claim that Gen Z is the first generation to not be overly inhibited in seeking care for mental health problems. It is tempting to link Gen Z's mental health situation to the dysfunctional environment that Gurri describes at the first link as well. Personally, I suspect over-crowding in urban environments and disconnection from physical contact with soil and nature generally might play a role as well. So whether there is over-medication or appropriate levels of medication seems quite likely debatable.
Thanks. Good reminder of Valium and Prozac. Sometimes things don't change as much as they seem.
Re spirituality, I dream of a universalist monotheistic religion, one world under G-d
I think it might be helpful to consider at least two gods. One as the physics of the universe (i.e. energy, matter, time, etc. and unknowns); a second as an exemplar and most respected role model. Combining the two drives smart people away from the second, which is really at the root of our societal ills: we badly need to start talking about our best role models. How about you and I start a new religion?
One G-d, indivisible, with liberty and justice for all!
Fine by me if writing metaphorically. What would an impartial spectator do? What would Jesus do? What would Isha Yiras Hashem do?