I hear you, but I also think it is this kind of attitude that leads a lot of otherwise intelligent people to not even try. I've talked to people who listened to the Maintenance Phase episode on the complexities of calories in/calories out take the information as an excuse for not even attempting to try to improve their weight problem.
I think this is one of those areas where the translation from research to the public ends up too precise on the details, beyond the cognitive load most people are willing to commit to it day to day.
In the same spirit of upāya from Buddhism, I like to compress this type of topic into a simpler model, even if imperfect.
Here's how I model cancer, and how I judge whether something is likely to give me cancer, without trying (and failing) to memorize a million risk factors individually:
You are a collective of cooperating cells. When cells rebel, the order that holds your body together collapses, and you get cancer. Cells generally don't want to rebel. They're content as long as they get their energy, their paycheck.
But what about activities that cause frequent cell death? A sunburn, smoke in your lungs, alcohol in your bloodstream, radiation (essentially atomic shrapnel flying through your tissue). Anything that causes inflammation, especially chronically. When cells die before their expiration date, the survivors have to keep dividing to replace them, and they start to get pretty mad about it. Maybe even rebellious.
With every round of division, they are in essence "evolving" away from their cooperative nature to cope with a hostile environment. A cell doesn't care whether the collective lives or dies, and it doesn't have the capacity to reason about that in the first place.
So the question becomes: are you keeping your cells safe? Are your activities hurting them? If they're not happy, they'll rebel, and you'll die.
This is where the model earns its keep. Take obesity. It's on every risk list, but excess fat isn't what makes cells rebel. The real culprits are the conditions obesity creates: chronic inflammation, more cells that need to be maintained and replaced, a body that is generally harder to live in.
Weight loss is on the list because it's the easiest way to fix those conditions, not because thinness is protective in itself. Once you see that, you don't need the list. Anything that makes your cells' lives harder, day after day, is raising your odds, whether or not anyone has published a paper on it yet.
The math is real, but a model like this tells you which variables you actually control.
> Couldn't your odds of developing a cancer be sloped to effectively zero if the odds are such that you are very likely to die of something else?
Are you sure that people should try? Will they live longer, or happier lives if they do?
From 1900 to 1950 the average US life expectancy went from about 47 to roughly 68. Penicillin and sanitation did most of that.
From 1950 through present day we added another 10 years. What most folks don't realize is that:
- 70% of those gains, or 7 out of the 10 extra years, came from cardiovascular health. Mostly because we got better at surviving heart attacks, and people smoked less.
- 19% came from infant mortaility gains (2 of the remaining 3 years of gain).
- 11% came from EVERYTHING ELSE that people did to become "healthier." So 1 year.
The US spends $5.3 trillion per year on healthcare, give or take. That's about $15.5k per capita every year. It's roughly 20% of the total GDP of the United States. That's 2 out of every 10 productive dollars going towards healthcare.
In exchange for 20% of every hour you work for your entire adult life you get 1 extra year at the end of your life.
In exchange for constantly worrying, exercising, staying up to date, eating right, etc you buy yourself one year more of life, and it's not even going to be a GOOD year. It's going to be one more year of being 80+ years old with everything hurting and constant medical needs.
Is it really worth 20% of the money you make every year for you entire life to live one extra, shitty, year?
I just don't think people have done the math on this one.
This I can get behind. Quality of life is worth something. Is it worth 20% of the GDP? No, but it's not where we spend those healthcare dollars anyhow. We spend them on trying to extend the lifespan by one miserable year via end of life care, mostly.
> It's roughly 20% of the total GDP of the United States.
As of 2025, it is more like 18%. For other highly developed nations, the average is about 12.5%. I think a lot of that difference can be explained by the very high salaries paid to medical workers compared to those other highly developed nations.
> In exchange for 20% of every hour you work for your entire adult life you get 1 extra year at the end of your life.
This isn't a very apt comparison. Think about it a different way: How much can I keep if I give up that single year of life?
There are a lot of medical problems that can make life miserable that won't kill you that are excluded from your simple objective of "how many years am I breathing."
Not only is this utilitarian nonsense, the "math" here is full logical nonsense.
It shocks me how anyone could string this pile words together and think they sound like anything at all.
> "2 out of every 10 productive dollars"
As if those dollars have anything to do with the time people work, or that they would get those dollars and time back by not caring about health.
As if the tiny portion of those dollars that actually gets spent on patient healthcare isn't dominated by end of life care.
The US healthcare system spend is so far divorced from whatever idea of "productive dollars" anyone has when it's 60-80% admin cost.
The US should not even be mentioned in any conversation about the ROI of health spend.
> The US should not even be mentioned in any conversation about the ROI of health spend.
I would agree with at least this part, if I didn't live here. I'm reminded of the MRI post from a few days back. I think the stat was that Boston had more MRI's than all of Canada combined.
How much healthier are people the United States than Canada - for all that extra spend? I'm fairly certain the number is negative.
EDIT - I googled it. The Canadian life span is four years higher than the average American and they're healthier than the average American when they get there. So, yes, the number is negative.
> Canada has a total of 432 MRI machines according to the latest official national survey.
> Per capita: An average of 10.8 units per million people, which is well below the Organisation for Economic Co-operation and Development (OECD) average of 19.4.
And Massachusetts (specifically Boston and Cambridge) has an insanely high concentration due to multiple medical schools and several very large hospital systems.
Real question and no trolling to Canada: How does Canada have such good healthcare, but so few MRIs? My point: Canada is certainly rich enough to buy and operate more. Do they not need them? Does the US just have way too many? (That is my guess.)
A few things.
1) Canada is not as wealthy, per capita, as the USA. Per Google:
> The GDP per capita in the United States is roughly $94,400 USD, compared to Canada's roughly $60,300 USD (as of 2026 estimates), creating a significant and widening economic gap.
2) Canadian healthcare spends less per capita. Per Google:
> The United States spends roughly double per capita on healthcare compared to Canada.
Cost Comparison Per Capita
• United States: Approximately $14,885 USD per person.
• Canada: Approximately $7,301 USD per person (varies by estimates, with public-only spending around $5,000 USD).
• Percentage of GDP: The U.S. spends about 17.2% of its GDP on healthcare, while Canada spends about 11.3%.
3) The USA believes in diagnostic testing at a higher level than Canada. Per Google:
> Utilization and Intensity: The U.S. tends to utilize higher volumes of intensive diagnostic testing and specialized medical interventions.
4) Related: hospitals are private in the USA, and they buy MRI machines to bill for high-margin diagnostic tests. As you noted, the Boston CMA is a world leader in healthcare and education, and thus has a higher concentration of MRI machines.
5) Canadian healthcare simply is not as sophisticated as the health care in the USA. There have been multiple episodes of high profile / wealthier Canadians going to the US to skip waiting for treatment and getting procedures that are just not available in Canada at the present time.
So it's great, it's saved my life a couple times, but it's not a 1-1 drop in for American healthcare. Every system has trade offs, that's the lesson of engineering.
1) Worrying about your health is mostly useless and probably won't move the needle much unless you have obvious problems.
2) The United States spends 20% of it's GDP to accomplish nothing. That 1 year of life expectancy gain is probably within the margin of error. Certainly modern healthcare can help at the individual level, but the society is so sick that any gains are washed away by the noise and we spend a truly enormous amount of money to get nowhere.
Our worry costs us a fortune, and generally just doesn't accomplish anything worthwhile.
"unless you have obvious problems" is doing a _ton_ of work. Most people _do_ have _obvious_ problems. Their weight, their cholesterol, their alcohol use, and on and on.
Saying "if you're healthy you shouldn't worry about your health" is a meaningless thing to say. The point is that most people _do_ have obvious room for some kind of health improvement, and as other commenters have pointed out, if it's not in the clear "this will help me live an additional N years" way, then very likely it is in the "this will make my life suck less as I age" way. Eg; Being able to walk up a flight of stairs without getting deeply winded.
You can see my reply to a sibling, but: no, of course not.
However, would I regret not being fit enough to go for a hike in my 60s? That's another story, and it is one which many do have the ability to intervene on.
Treadmill time as an enabler of other experiences may well be worth keeping, even if the time spent on it doesn't satisfy some imagined "will I think of it on my deathbed as time well spent?" bar. I imagine there are a great many things I won't think about on my deathbed which on their own are unremarkable or even gasp not very fun, but that is of course not a reliable measure of whether something is worth doing.
