jodrellblank

> "As an example, consider a hypothetical 2-year wellness program that costs $400 per month per person (say, $13 per day for healthy food) and reduces the risk of heart failure by 1 percentage point, from 5% to 4%. For the first 90 days alone, heart failure treatment is much more expensive at $22 000 than the wellness program, but that doesn’t mean that the wellness program saves money. In this case, 100 people must participate in the 2-year program to reduce the incidence of heart failure by 1, from 5 people to 4 people. In other words, the number of people who must be treated with the prevention program to avoid 1 heart failure is 100 (NNT = 100)"

1. Why is the person's food cost attributed to the wellness program, instead of the person's food budget?

2. Most people are overweight or obese. I would expect $400/person/month of healthy food to lead to weight loss as part of the intervention. This skim-read study of 5000 people[1] concludes that "Modest weight losses of 5 to <10% were associated with significant improvements in CVD risk factors at 1 year". The hypothetical uses 1 percentage point, which sounds insignificant.

3. This Novo-Nordisk page[2] says: "According to a post-hoc analysis from the Look AHEAD trial, individuals with type 2 diabetes who lost ≥10% body weight had a 21% decrease in 4-point MACE incidence (defined as CV death, non-fatal acute myocardial infarction, non-fatal stroke, or hospitalisation for angina). A weight loss of 5% has significant health benefits". Again relatively small weight loss shows significant improvements.

(Comparison: someone 300lbs losing weight at 1 lb per week takes eight months to lose ten percent of their bodyweight. Healthy weight loss is often discussed at twice that rate or 2 lbs per week. In the TV show My 600lb Life Dr Nowzaradan gives morbidly obese people targets of 5-10lbs/week initially. The hypothetical wellness program is two years?).

The improvements from healthy diet which leads to weight loss ought to be more than just reduced risk of heart attack. Reducing hypertension (high blood pressure) leads to reduced risk of stroke and chronic kidney disease. Reduced body fat and healthier diet leads to reduced risk of Type 2 Diabetes and its complications (vision loss, neuropathy, slowed wound healing, worse immune function). Reduced weight leads to reduced risk of back pain, knee pain, sleep apnoeia, non-alcoholic fatty liver disease. Reduced body fat leads to reduced risk of some cancers, better diet reduces risk of other cancers. The hypothetical only considers treatment for heart attack in the savings but there should be a lot more savings.

The hypothetical only considers the treatment cost of a heart attack for 90 days but is that all the treatment they need? Are they not on regular drugs and checkups long term? And someone who survives a heart attack is at increased risk of another heart attack from all the same reasons they had the first one. American Heart Association says "about one in five people who have had a heart attack will be readmitted to the hospital for a second one within five years"[3].

And avoiding the prodcutivity loss from all the time off work from heart attack, back pain, sickness, medical appointments and treatments over years and decades. Intervention may not save money, but it may lead to increased ability for the economy to generate more money than it cost.

There's probably a point in that article, but why use such an easily criticised hypothetical to try and make a point? Not even going into $13/day vs 'beans and rice' or saving a person money on takeaway, cigarettes, alcohol, gasoline, or the costs to a person of moving to a walkable area or joining a gym, or all that kind of lifestyle intervention.

Lifting an Olympic Swimming Pool (2.5 Mlitres) up 1 metre against gravity needs about 7kWh.

7kWh of Lithium battery is tiny, like three shoeboxes. And apparently costs about $1500 on eBay though I was expecting about $5k-$7k.

Surely it costs a lot more to buy two Olympic pools worth of land, dig it out, line it, and buy the turbines and pipes and stuff?

Dinorwig in Wales moves a lake 3.5km long and 26m deep, cost hundreds of millions to build, stores 9.1 GWh and Wikipedia says it’s questionable whether it’s financially viable in todays energy market, estimating 40 years to a return on investment for just arbitrage night to day electricity costs.

It isn't your text. All content is submitted under a Creative Commons license[1][2] which lets StackOverflow 'adapt remix transform' as long as they give credit (username) and indicate if changes were made (edit history). StackOverflow is particularly sucsceptible to this "I imagine the site is something else and I'm making myself mad and blaming them". I don't know why because it's never been a discussion forum which changed, or a personal blog, it's always been a Wikipedia style public edit site. It's like people assume all websites with a textbox and a submit button are required to be the same website and behave the same way.

The first podcast[3] with Spolsky and Atwood from April 2008 has them talking about the site they are designing, and they mention editing other people's answers:

"""Spolsky: Our longer term goal, if we’re successful, is that you're trying to figure out how to do something in Python like how to merge two arrays in Python and you go to Google and you type "merge two arrays python" and submit that, and our goal is to be the number one hit that comes up with a really good edited answer to that question that some individual has contributed and maybe other individuals have edited."""

That article makes good re-reading in the "Penetrate and Patch" section now, in the days of AI exploits popping up faster and faster.