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Diet Drugs Work: Why Won't Doctors Prescribe Them?
Hugh Pickens DOT Com writes "Suzanne Koven, a primary-care doctor at Massachusetts General Hospital in Boston, writes in the New Yorker that the FDA has currently approved four drugs that will help patients lose weight but few primary-care physicians will prescribe them. Qsymia and Belviq work by suppressing appetite and by increasing metabolism, and by other mechanisms that are not yet fully understood. 'But I've never prescribed diet drugs, and few doctors in my primary-care practice have, either,' writes Koven and the problem is that, while specialists who study obesity view it as a chronic but treatable disease, primary-care physicians are not fully convinced that they should be treating obesity at all. The inauspicious history of diet drugs no doubt contributes to doctors' reluctance to prescribe them. In the nineteen-forties, when doctors began prescribing amphetamines for weight loss, rates of addiction soared. But in addition, George Bray thinks that socioeconomic factors play into physicians' lack of enthusiasm for treating obesity because obesity is, disproportionately, a disease of poverty. Because of this association, many erroneously see obesity as more of a social condition than a medical one, a condition that simply requires people to try harder. Louis Aronne likens the current attitude toward obesity to the prevailing attitude toward mental illness years ago and remembers, during his medical training, seeing psychotic patients warehoused and sedated, treated as less than human. 'What the hell was I thinking when I didn't do anything to help them? How wrong could I have been?' Specialists are now developing programs to aid primary-care physicians in treating obesity more aggressively and effectively but first primary-care physicians will have to want to treat it. 'Whether you call it a disease or not is not so germane,' says Lee M. Kaplan. 'The root problem is that whatever you call it, nobody's taking it seriously enough.'"
Your diet is a perpetual thing, not something you do for a little while to lose weight. Eat healthy, be healthy. Drugs and short term adjustments in what you eat aren't going to do shit.
Ask yourself the following:
(1) Are you cooking most of what you eat yourself?
(2) Have you cut all sugar, pasta, bread, and other starchy foods, and most saturated fat and meat from your diet?
(3) Have you been tracking your calories and weight daily for the past month?
If the answer to any of these questions is "no", you haven't seriously tried losing weight, and nothing is likely to help you.
The previous post is a fine example of the problem: treating obesity as a moral failing. If you were a "good person" you'd have the willpower, eat right, etc.
Sure, modern lifestyles and diets are a contributor to the problem, but not the entire cause. There is ample peer-reviewed validated research out there that shows that some people are more efficient at metabolizing food, and that you can exercise as much as you like and eat as little, and still not lose weight as much (and suffer a variety of undesirable side effects in the process).
Bear in mind also that the underlying biochemistry of the "average adult" has changed as the result of food and activities during childhood. A travesty to be sure (juvenile onset diabetes, for instance), but now that you have that 20 year old with the screwed up biochemistry (in terms of comparison to 1900s man), you're not going to fix it by changing diet and activity.
And then, there's the practicality problem. If your job, which pays for the food you eat, requires you to sit in a cube with a headset on and a keyboard, no amount of Outside magazine inspired "get out and get fit" exhortation is going to provide an opportunity to "live a healthy lifestyle". Companies talk the talk, but when it comes to adversely affecting productivity, they do not walk the walk: that's why company wellness programs emphasize things like smoking cessation.. it's something you can do on your own time that saves the company money (yes, it's a good thing, but the real point is that the employee is doing the heavy lifting).
And so, after sitting in the cube all day, or inspecting people at a checkpoint, or whatever task there is, you ride the bus to your second job, so you can make the rent on your apartment in the food desert. Not a whole lot of time to prepare that nutritious meal from non-existent ingredients.
So, before exhorting "good healthy ways to eat", let's talk about paying people enough so they can afford to do so (in terms of time available, etc.)
Hello,
I'm a weight loss and weight long term control success story, more or less. But having done it, I know exactly how hard it is.
I'd love it if the US population could dump their extra pounds by taking a pill. It'd just be a win for everyone, and the only people who'd "lose" are those who feel superior because they've managed to do it without the pill.
And even THOSE people will be paying lower health insurance premiums because the population is healthier in general.
If the pills really work, BRING 'EM ON! Who knows, if I can't exercise some day (I'm currently taking a few weeks off because I got rear-ended in my car!), then I'll need them myself!
--PeterM
i am sorry this is not biochemistry this is made up "science". When ketosis is entered (by depleting ready carbohydrate resources) the body can metabolise fat into ketones (via the liver). The reason this myth persists is because for decades medical researchers couldn't imagine the brain running without glucose, which is a necessary condition of ketosis. Then some bright spark pointed out that the Innuit have been living like that for millenia and (shock horror), it works on western folks too!
Diet and exercise works every time. Guaranteed. There are no exceptions. If you are not exercising , a good chance you will lose some "lean mass". Loss of muscle through maintenance also occurs, so these statements are no helpful.
*however* biology is all about homoeostasis. When you look at your paunch and flabby bits, ask yourself the question "why does biology hang on to them". The body stores excess sugars as fat, as sugars in the blood are toxic. The hormone insulin causes this sequestration of the sugars into fat cells. If you go on a crash diet , the body is happy to burn up the fat. But the cells are still there. Returning to previous over-caloried state just fills the cells up again. Only by a gradual change onto a *lower* calorie diet will you lose the weight "permanently". Think 6 months minimum. Believe it or not 2lbs/week is a pretty good rule of thumb as the body gradually reallocates the cells. If you want to get "cut" that requires some more extreme measures...;-)
Recent research is showing that being overweight and diabetes are connected, although the data stretches back decades. The biggest FUD of the 20th century is the daily calorie limits. If they ever applied it was to a population that was more active, but modern folks spend way too much time on computers(!).
Biology is very complicated but the rules are simple. Everything in moderation....;-)
I'm guessing that the one big reason that they aren't prescribing- they are scared of legal action- remember the Fen-Phen debacle. Fen-Phen also worked, but apparently caused cardiac issues, resulting in lawsuits and legal damages of over $13B USD.
My wife is morbidly obese. She for years has tried to lose weight with various diets and drugs. These had temporary weight loss effects, but all ultimately failed.
Why? Was my wife of inferior moral fiber and simply unable to follow through? Is she simply someone who needs to eat from a smaller plate, sit further away from the table, exercise more, eat less sugar, eat less carbs, eat more carbs, follow some arcane points system?
Nope. None of that works.
I'm a software engineer. Failure is a daily occurrence, and when we fail and study the failure, we learn the underlying problems and then we have success; and I've constantly encouraged my wife to keep trying. And she has; for over 10 years.
Two years ago, she contacted a weight counsellor / psychologist in Florida. In that time, they have peeled back the layers of her life, looking for the real, underlying problems. And, they found them. Who knew, for example, that being sexually abused as a 4yo child for years would cause problems? Who would have thought that when the attacker (a family "friend" next door) said things like "you would look prettier if you lost a bit of weight", it causes problems like gaining weight to try and make the pain go away? Why on earth would a narcissistic mother cause problems - especially when a 4yo comes to her bleeding from the vagina and covered in semen, and the mother simply wipes it away and says it never happened?
My wife's weight is far from something to be ashamed of. Instead, it's the mark of a person who came through some of the most horrendous things you can imagine - and lived.
The reason all the diets and drugs failed? Denial of the past and the problems in it. Simply becoming an adult doesn't mean the past will not affect you.
The future? Looking good. Since breaking through and working through all of her past, the underlying need to eat compulsively has gone. Guess what? She's loosing weight without a restrictive diet, drugs, surgery - whatever.
Obesity isn't a "disease" or anything like that. It's the symptom of something else. Medical dollars are best spent for people who are ready to lose the weight AND deal with their pasts by supplying them with competent psychologists, not the latest diet pills.
As a primary care physician, I gave in years ago. I now prescribe assorted appetite suppressants whenever some one asks me, it saves me lots of arguments, and a lot of time.
However, I get them back monthly for weigh ins. The drugs work great for a couple months, losing 4~8kg a month, then tapering off to nothing. Folk then realise that this is not a wonder cure.
The only stuff that works long term is eating less +/- exercising more, or surgery to shrink your stomach (actually the latter works pretty well, better than pills long term, in my experience. little change out of $10K, but probably worth it)
Pills are short term appetite suppressants. The following year, you are back to your previous weight, but your wallet is much lighter. Look to advice that you already know about for long term losses.
You can eat tons of stuff that isn't so good for you, right? Cool. And, how old are you?
I was underweight for much of my life. Around age 25 or so, I FINALLY "bulked up" to 160 pounds. I stayed near that weight right up to about age 47.
Age has some nasty surprises for some of us. One day I looked down, and realized that I had a pot belly. Wow, man! That ain't me!
At the same time, my knees started giving out on me. I don't run any more, can't run. Oh - to be honest, I CAN run, but a quarter mile jog is going to leave me suffering for a week or more.
So, I got a pot belly, I'm far less active, and that pot belly now tips the scales at ~195, has actually reached 200 a couple of times.
At six foot tall, 200 pounds isn't "obese" - but it's unhealthy. For me, at least, YMMV depending on your body build.
When you're over 50, getting close to 60 years old, let us know how easy it is to lose those unwanted pounds. If taking a pill could reduce the number of fat cells for me, I would seriously consider getting some.
However, I do understand the equations very well. Those pills aren't going to do anything good that is permanent. About the only way to remove fat permanently, without serious exercise and diet, is surgery.
I'm NOT willing to go that route.
"Windows is like the faint smell of piss in a subway: it's there, and there's nothing you can do about it." - Charlie Br
What's so funny about this (and reinforced by the other replies to your post) is that people really object to the morality of other people "getting away with something" -- eating too much of the wrong food and not exercising enough.
I'm surprised they don't object to people with infections being treated with antibiotics, since if they had better hygiene they wouldn't get sick.
Why should you care if someone else is healthier by taking a pill?
Stop starving your body by living on quick rushes of carb, and get off your ass.
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Your personal physiology is identical to everyone elses', and so what worked for you will also work for every single other person on earth? Great! Spread the news! With this astounding insight, the obesity epidemic will be cured in no time!
Wait? What's that? You mean the metabolic pathways for storing and releasing energy are complex and very different from person to person? You mean that the body actively fights to retain fat stores when less energy is available resulting in crippling pain, headaches, listlessness, inability to cocentrate and insomnia? You mean to say that obesity is caused by numerous interrelated factors that each require corrective action in concert to be effective? It even says so in TFA? Well shucks!
Who'd have thought an illness that 100 million people are unable to cope with might actually be difficult to cure?? No, no! That can't be it. Let's just say they're lazy gluttonous porkchops so we don't have to find solutions to a difficult problem. So much easier for us to sleep well at night.
Scientists point out problems, engineers fix them
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Im always amazed at the level of anger when the topic of obesity comes up. If there is a pill that helps fat people get skinny, so what? The logic must go like this "I put so much work into being fit, I am upset when someone else gets similar benefits without that same effort."
Manic
Hi mate, I'm a type 1 diabetic in my mid thirties and I empathise completely with your comments and hope you're looking after yourself and keeping your HbA1c levels as low as possible.
In my experience I am constantly surprised by the lack of actual knowledge and education about diabetes. Sure, there's lots of awareness, which is good, but nobody seems to actually know anything. And unfortunately, I have to include doctors in that category. I've had the good (or bad) fortune to have my condition assessed in four different western countries (US, Canada, Australia and the UK) and found that only half the doctors I have seen could actually give me helpful and constructive advice for the treatment of the condition.
Having said all that, I also notice a massive difference between the advice from doctors regarding exercise, dieting, and losing weight. The problem (as I see it) is that the primary goal of diabetes care is to stabilise blood sugars. Which makes sense, and is obviously a good thing. But going beyond that, and wanting to lose weight or be an athlete, is not well supported by the medical field at all.
So, if I could offer some advice for you, don't give up hope and don't accept that you can't lose weight due to the diabetes. The comments you made about planning ahead tell me that you really know your stuff and you are very self aware of the condition and what is at stake. Which is great! Just try and take that to another level and build more exercise into your plan. Yes, your insulin requirements will come down, but you monitor this as you currently do normally, keep an eye on things and adapt. Something to be aware of is that exercise makes me more sensitive to insulin for about 24-72 hours. On top of that, after exercise my blood sugars are high. DO NOT treat post exercise high blood sugar with insulin, you will hypo within an hour. Instead, just chill and drink plenty of water and your sugars will come down quite happily by themselves. Of course, this is what happens to me, and your body may be different. Sorry if any of this is stuff you already know, I don't mean to be patronising, just helpful. Finally, my specialist is a huge fan of Metformin. It has protective benefits against heart disease, makes you more sensitive to insulin, lowers blood sugar over a nice long period of time, and helps to reduce apetite. I was told that 2g per day is the effective dose that's right for me and that patients should take as much as they can "handle". I say it like that because the side effects are stomach upsets, gastric pain and diarrhoea, which as you can imagine isn't the best of fun. So I take my full dose of Metformin and a small (10U) amount of Lantus each day and that keeps my basal blood sugar pretty much perfect. Most importantly I can go to the gym without eating anything and not have a problem with hypos. I only take Humalog for large meals that I have no control over: so a dinner party, or special meal, but in general I eat low carb meals and don't take any Humalog at all. I also gave up drinking about six months ago, which changed my life for the better, though have a glass of red wine every month or so since I love the flavour, and there is a protective effect against heart disease in those low amounts.
To be more active I would encourage you to be firmer with your own personal plans. I set a fixed time for exercise each day and it carries as much value in my day as a meeting with the boss or lunch with the girlfriend. I do not allow it to be moved or messed with, and so I get to the gym (or swim, or jog, or cycle: diversity helps!) every day for my little workout.
Anyway, I just wanted to reach out and say G'Day and let you know that you can do it and you can get your weight down, even with diabetes. Maybe my own experience has been helpful for you, or others here, but regardless, good luck with everything!
His basic assertion that if people eat less calories than they expend they will lose weight is 100% correct. Saying "it's a complex disease and the body wants to store fat and there's different metabolic pathways" is irrelevant - if you eat less, you will lose weight.
Slashdot: providing anti-social weirdos a soapbox, since 1997.
Here are two more 100% correct assertions: you can live forever as long as you avoid death, and you can be wealthy by earning more money than you spend.
During World War 2, the "Minnesota Starvation Experiment" was conducted. 30 healthy men had their maintenance level of calorie intake measured for a month or two, and then had that calorie intake cut in half with no changes to their daily minimum half an hour of exercise. At the end of the study, the participants had an average drop in resting metabolism of 30%, and that's not 30% lower than when they were heavier, it was 30% lower than predicted for someone at their new skinnier sizes. Most of the men had developed an eating disorder, a mood disorder (bipolar, depression, etc...), an obsession with food, or all three.
The devil is in the details.
It is the cause. It IS a social one.
It is because of corporate food production, factory farming and industrial "recipes" that make cheap and plentiful Soylent Soy or Corpulent Corn - with added glutimate to overstimulate appetite generation.
These are the product of an agribusiness that has made this production a part of public policy, through the US Farm Bill and other legislative manipulation.
If you are deliberately misinformed, marketed to death, and underpaid, the last thing you need to solve for the attendant health effects is more pills. It's like plugging your nostrils, because you have a cold.
But I bet the pharmaceutical and health-insurance rackets love the idea...
"Flyin' in just a sweet place,
Never been known to fail..."
Another factor that often gets overlooked in this debate is the role of sugar in our diet. (Here's a written summary of the video.)
Last spring, the convenience stores in my area started stocking fresh fruit, so I switched my habitual breakfast from coffee and a Snickers bar to coffee and a piece of fruit. Around the same time, I saw the video linked above, and started actively avoiding sugar whenever it's convenient. These are the ONLY changes I've made to my lifestyle, but since then I have lost about four inches off my waistline.
Sugar is toxic. Do yourself a favor and avoid it. (Did you know that a 12oz can of coke does as much liver damage as a 12oz can of beer?) And artificial sweeteners are even worse. They mess up your insulin response profile and impede the signals which tell your brain when you've had enough to eat. (If you have a diet coke with dinner, you'll likely eat more food.)
The BBC did a four-part series on the "weight loss industry" earlier this year. It does a pretty good job of exposing the hype and marketing BS behind our current situation. Worth a look.
XML is like violence. If it doesn't solve your problem, you're not using enough of it. --AC
Perhaps doctors don't prescribe them because:
- they don't work very well in the short term and not at all in the long term
- they are expensive
- they have lots of bad side effects:
Qsymia has particular risks for pregnancy, as it can cause birth defects if taken in the first months of pregnancy, even before a woman knows she is pregnant. Women of childbearing age must use effective birth control to keep from becoming pregnant while taking Qsymia.
Qsymia should not be taken by:
Pregnant women
People with glaucoma
People who have been told they have an overactive thyroid
People taking a type of antidepressant called a MAOI
People allergic to phentermine or topiramate
Belviq should not be taken by:
Pregnant or nursing women
People taking drugs linked to valvular heart disease, such as cabergoline (Dostinex)
Belviq should be taken with caution by:
People taking certain medicines for depression; migraine; the common cold; or mood, anxiety, psychotic, or thought disorders
Men with conditions that predispose them to erections lasting more than four hours. These conditions include sickle cell anemia, multiple myeloma, and leukemia
Men with a deformed penis
Qsymia and Belviq each come with a long list of important safety information, but this list is different for each drug.
I don't read your sig. Why are you reading mine?
(tl:dr The drugs work. People think about obesity wrong.)
To those that say they don't work, I would suggest you look at the trials. One of the differences between these regulated prescription drugs and supplements or (most) diets is that there are actual double-blind placebo controlled studies behind them. They do work. There is very good research to show that they do.
Qsymia, which I am on, gives an average of ten percent body weight loss beyond placebo, and the weight stayed off out to two years, which was the end of the study. I went from 269 to 253 in my first six weeks (13 pounds or 4.8%.) I feel much better now, and I have taken up weight lifting again. My weight isn't dropping, but I am clearly losing fat and gaining muscle. My weight is pretty stable, but I can feel ribs that I haven't felt since the nineties. None of my leather belts fit anymore. I'm wearing a belt with a friction buckle until I stop shrinking.
I also just got my quarterly labs back and my A1c is down 1.2% and my lipids are great. I'm getting lightheaded when I stand up too fast (orthostatic hypertension;) I have an appointment next week to talk to my doctor about reducing my blood pressure medication. You don't just lose weight, but the comorbidities go away with about 5% weight loss.
The main problem with obesity drugs can be seen in the comments here. People for whom obesity is not a disease don't understand what it is like to fight the disease. I'm old enough to remember when depression was treated the same way as obesity is treated now. Polite people said "try to think happy thoughts." "Just snap out of it" was a more common response. Today most people understand that some people have broken brain chemistry, and telling a depressed person to work harder at being happy isn't going to work. The researchers understand that obesity is a disease, and telling people to work harder at being healthy isn't going to work either. But most people don't understand that yet.
To the person who said diet pills are short term only, you are right and wrong. When a person who is on medication for a chronic condition stops taking their medication, the condition returns. That is how you know the medication is working. Obesity is a chronic condition. Because obesity was once thought of as something that could be cured, like an infection, pills used to be given for a short period. People would lose weight on the meds, the doctor would pronounce them cured, they would stop the meds, and they would regain the weight (and the high blood pressure, and the diabetes, and the dislypidemia, and all the other fun stuff that goes along with central body fat.) The researchers and educated doctors now understand that obesity is a chronic condition that responds well to medications. (It also responds very well to *intensive* lifestyle modification and surgery. Most doctors miss the word "intensive" in that sentence, which is the subject of another rant.) The current expectation is that you stay on the drug the rest of your life, possibly with drug holidays.
For me, Qsymia has been life changing. I had lost about 100 pounds of fat over about six years, but I was stuck and I still had type 2 diabetes, high blood pressure, and horrible lipid numbers. I was working out, hard, at least eight and a half hours a week plus two 50 minute weight lifting sessions with a private trainer. I watched what I ate, but I was still obese and I still had the health problems. Eventually I got discouraged and stopped working out hard. I still did 300 minutes a week on a treadmill, but I wasn't killing myself in the gym or lifting. Interestingly, I lost muscle and gained a little fat, but it made very little difference to my overall health. With Qsymia my eating changed dramatically, I lost a bunch of fat, and my lab numbers got better.
Whether you prefer anecdote or data, the result is the same. Qsymia is a game changer.
(Some disclosure. I'm a computer guy with no medical training. My girlfriend is an MD wh
You might want to review the full research before posting.
> - they don't work very well in the short term and not at all in the long term
Qsymia gives about 10% weight loss beyond "placebo" (which was a diet and exercise program that all treatment arms got.) Weight loss was maintained out to two years, which was the end of the study. Qsymia is a combination of two medications that have been on the market for a long time. Weight loss docs have been prescribing them together for quite a while and I haven't heard any talk about them not working after a certain point. Qsymia just takes two existing meds and makes one pill out of small amounts (if you want to match the Qsymia doses with generics you have to chop tablets as small as an eighth) and uses a time release formula so the side effects (carbonated drinks taste funny and tingling in the fingers are common. I have the change in taste) aren't as bad. There is no research on Qsymia past two years, but there is experience with the components. Belviq is a 5-HT2C receptor agonist, and I'm on a SSRI. I haven't paid much attention to it, but I assume it has data out two years also.
> - they are expensive
True dat. And not covered by a lot of insurance. I buy mine out of pocket. About $170 per month. It's worth it to me.
> - they have lots of bad side effects:
Other people have pointed out that is not the case, but I thought I would address the pregnancy thing.
First, if I, as a 45 year old man, get pregnant on Qsymia it will be news. Much bigger news than a birth defect.
Second, obesity also increases in risk of birth defects.
Third, this is why they have a program to tell people that if you take Qsymia in the first few months of pregnancy there is an increased risk of cleft lip/palate. This is because Qsymia contains topiramate, a medication prescribed about 10,000,000 times a year. Interestingly you can take 400mg a day of topiramate for neurological conditions without a warning, but if you take 23mg a day for weight loss you have to be warned of the risk. Not that there is a bias against obesity or anything...
I think I have posted more in this one topic than in all the rest of the time I have been on slashdot, but this drug has made such a difference in my life.
Other people have pointed out that is not the case, but I thought I would address the pregnancy thing.
Pregnancy studies are a high risk/low reward proposition, unless you are talking about fertility, anti-miscarriage or other pregnancy related applications, since including pregnant women in a clinical trial has a really high settlement cost if there's a problem with the pregnancy, and an even higher cost if the baby comes out with a birth defect. As an example, women with hair loss get warned against finesteride, since it acts as a 4-5 reductase suppression agent, which, when it occurs naturally (5-ARD), results in conditions from hypospadias needing surgical correction, all the way to full blown X-Y females (sterile of course).
It's fairly common to warn pregnant women not to take a medication, even if in fact it might be perfectly safe because of the exclusionary nature of the studies. This is purely a legal liability/malpractice issue, not necessarily an issue with the medication itself.
I've always found it both disgusting and a bit amusing, the way people get so angry and upset when you dare to suggest that maybe they are not victims, maybe they actually could assert some control over the problem they're having. The earlier posts in this thread did not deserve a "-1, Troll" moderation. Stating what you actually believe in a sincere manner is not trolling. It's not a "-1, MakesMyDenialUncomfortable" mod for fuck's sake.
Everyone I know who successfully lost weight and kept it off for years did it by making permanent, sustainable, healthy changes in their lives. A few of them learned to like veggies and other healthy foods. Others did that and also formed the habit of regular exercise. The point is to consume fewer calories than you burn until you reach a new equilibrium. Like so many other things that upset people, this works every time it's properly tried.
It is a miracle that curiosity survives formal education. - Einstein
Yes - and it can also make you very sick at the same time. People have starved themselves to death whilst remaining obese. To simply say "eat less, you'll lose weight!" makes as much sense as saying "just remove all the microorganisms from your blood stream, and you'll be cured!" Simple, right? Whilst technically correct, unfortunately it is not at all a useful suggestion. The sooner people stop deluding themselves with trivial knee-jerk responses that tacitly blame the patient, the sooner we can make progress to finding an actual solution for a real problem. Remember: if it was that easy, nobody would be fat.
"Eat less" isn't the same thing as saying "eat nothing or nearly nothing while failing to obtain the nutrients you need".
"Blame" is also a small-minded concern. When I personally needed to lose some weight, there was no concern with fault or blame. I (get this) *took responsibility* for my own condition and made some adjustments to it. Some sustainable, permanent adjustments that did not involve neglecting the nutrition I needed. It was never a problem after that. In fact it was one of the easiest things I've ever done. That's because I took responsibility and accepted that the power to change it was within myself, the exact opposite of victimhood. This is exactly what I never see from fat people. They're victims and they are hostile to the idea that they don't need to be. That's because they don't understand the difference between fault/blame and responsibility/power. That's the part that is "not that easy" for so many because we have such a shallow, small-minded culture that doesn't like to think too deeply about much of anything no matter how much better life can be.
All you are saying is that doing something the stupid and careless way won't yield a good result. This was already known.
It is a miracle that curiosity survives formal education. - Einstein