Live data from Hacker News

Inflammation: Medicine's burning question

newyorker.com

121–130 of 160 posts

Re: Inflammation: Medicine's burning question

#121
post #103
post #6

Earlier quoted context omitted.

> much of it is around a decade old now Has your doctor done any research/training about cholesterol in the last 10 years? I'm being snarky. But I think it's important to consider the lifecycle of doctor careers. If you go to a liver or cholesterol specialist, then I'm sure they will be up to date with even findings from the last year. But I wouldn't expect a GP to be up to date on what every field within medicine ha…

I think you would be saved by rephrasing to indicate a particular computer scientist. People are getting overly pedantic.

It's okay. That's how engineers and computer scientists work. The idea of "generalization" and "hyperbole" and "caricature" is often lost on us.

This is primarily why my technical blogging has slowed down significantly. Writing for an audience that cares more about details than The Point (tm) is often annoying.

Re: Inflammation: Medicine's burning question

#122

Earlier quoted context omitted.

As somebody in the same situation (same age, otherwise healthy, high cholesterol, regular exercise) my read is that trying to influence ldl in a meaningful way through diet alone is essentially pointless. You can knock off a few points, and you can raise HDL a bit, but the likelihood of a dramatic reduction is essentially nil. Going right for the statins kind of makes sense beyond a certain point. That said, I opted…

Could you define "dramatic reduction"?

Based on information I found using clinical resources which I have access to via my employer (I work at a University with a medical school and have access to their tools, although I am not a medical professional) I found this useful note:

> The United Kingdom Lipid Clinics Programme study of 2508 subjects found that, with diet alone, 60 percent of subjects had a mean reduction in body weight of 1.8 percent, which was associated with 5 to 7 percent reductions in serum total and LDL-C.

Key thing here: when I mentioned "otherwise healthy" above that includes "not overweight and exercises." Lifestyle interventions for people with hypercholesterolemia are most effective on people who are both sedentary and overweight (or obese) who have really poor diets. None of that applies to me.

The conclusion that I ultimately came to is that, if your diet isn't awful, your BMI is normal, and you exercise every now and then, there's no dietary change that's likely to benefit by more than 5%, not enough in my case to reach normal levels. This is my "gut" assessment based on personal research and I urge you to do your own research on this matter before making any decisions.

To further complicate all of this and bring things back to the topic of this article: statins seem to reduce the risk of CVD through some means other than simply lowering cholesterol levels. There's a school of thought that even people with normal cholesterol who have other risk factors for CVD should be on statins.

So really, the question of "should I take statins" may end up being less about cholesterol specifically, and more about overall risk of CVD. This is why in my own decision making process I opted not to pursue treatment (yet) since my overall health otherwise is sound.

Re: Inflammation: Medicine's burning question

#123

Earlier quoted context omitted.

> What disappoints me the most here is now that I feel like it's all on me to determine what my real risk levels are and what's appropriate to treat this. A convoluted set of circumstances led me to a quick detour in grad school, to sit in on Anatomy at Harvard Med. This included the dissection portion, in which four med students hunch over the cadaver for 3-4 hours at a time. It lead to some of the best medical conv…

I had an issue a few years ago. I was having frequent acid reflux and 2-3 nights a week, I'd wake up choking on it. This lead to issues with difficulty breathing and shortness of breath. My doctor treated me with an inhaled steroid for the breathing difficulty and a PPI for the reflux. This helped but it didn't fix the problem. I'd wake up choking once every couple of weeks and this was not acceptable to me. I starte…

You still probably have sleep apnea if you are ever waking up fully without the ability breathe. The human mind can wake up from deep sleep to stage 1 sleep in order to breathe better dozens of times an hour without you perceiving a thing. It only wakes up all the way when it's really bad. In fact, the acid reflux is often a symptom of sleep apnea, attempted inspiration with a sealed off airway literally sucks acid out of your stomach. Get yourself a sleep study. If I'm right, get new doctors and dentists, they all should have caught it by now. Good luck.

Re: Inflammation: Medicine's burning question

#124
post #31
post #2

It's great to read things like this... I wish my GP would do the same. I recently had a really high cholesterol reading (both total cholesterol and LDL). Everything else (blood pressure, blood glucose etc) seems fine. I'm 38, fit and healthy and nothing that suspect in my family history. I found the attitude of my doctor in all this quite surprising. It amounted basically to "You definitely have familial hypercholest…

On the other hand your GP examined you and has an actual medical degree while you just read some articles on the internet...

While that is true, the GP (and even specialists) use a different optimization criterion than yourself (proverbial you): You prefer to minimize false negatives with some exceptions about false positives, whereas they prefer to minimize overall error rate with some exceptions -- and that goes very deep into their training, to the point of being blind to this preference.

E.g., while at med school, they are warned against Zebras[0] so much that while practicing they will often ignore anything with a 1-in-a-million-chance unless the false-positive rate is zero. It does minimize the overall error rate, but for the person who has the 1-in-a-million condition, this is no comfort -- and that person is often in a position to evaluate that condition better than the GP (if they are scientifically literate).

I have been told by a senior doctor at one of the leading US hospitals to "cut the internet cord so that I don't confuse myself as I am not trained to understand the articles I find". Turned out said doctor did not understand the statistical inference criterion, and I did -- unsurprisingly, since I have the mathematical background, and they do not.

[0] https://en.wikipedia.org/wiki/Zebra_%28medicine%29

Re: Inflammation: Medicine's burning question

#125
post #23

statins-for-cholesterol is a hugely profitable business pushed hard for decades by BigPharma, going back to a single faulty "study" in the 1950s, after Eisenhower's heart attack. My opinion is that statins-for-cholesterol, obsession with cholesterol is as big of a medical scam, a BigPharma misdirection-for-profit, as BigFood's "low-fat" and "whole grain", and gluten scams. Cholesterol is essential, so much so 90% is…

> An alkalizing, anti-inflammatory diet is key

Can anyone cite a peer reviewed study / documentation of "alkalizing" diets? I've attempted to trace this idea back to anything scientific, and always eventually came up with "well, someone I trust once told me ...".

Re: Inflammation: Medicine's burning question

#126
post #121
post #103

Earlier quoted context omitted.

I think you would be saved by rephrasing to indicate a particular computer scientist. People are getting overly pedantic.

It's okay. That's how engineers and computer scientists work. The idea of "generalization" and "hyperbole" and "caricature" is often lost on us. This is primarily why my technical blogging has slowed down significantly. Writing for an audience that cares more about details than The Point (tm) is often annoying.

Actually, to nitpick on the details, it's both. We care about the details AND the point. The details sometimes take you to The Point.

For example, I on your original post, I was trying to figure out if you meant "Computer Scientists are theoreticians" through the details. If you're not going to outright say something straight to the point, the details better be clear so that one can understand the implication.

Re: Inflammation: Medicine's burning question

#127

Earlier quoted context omitted.

Trigs were fine. Overconsumption is certainly one more thing for me to look at.

Broda Barnes book [1] says, iirc, that high cholesterol levels are basically diagnostic of hypothyroidism. Usually people's superficial thyroid lab #'s look fine (TSH), but their body is not properly activating T4 -> T3. [1] https://books.google.com/books?id=TJXf2ZqoxUIC

Are there some tests we can do to identify this issue?

Re: Inflammation: Medicine's burning question

#128
post #61
post #31

Earlier quoted context omitted.

On the other hand your GP examined you and has an actual medical degree while you just read some articles on the internet...

I've got some friends who do medical research, and from what they say, "translational research" (getting the latest research into the hands of the doctors actually practicing medicine) is a HUGE problem. I have been advised that if I (or a family member) ever gets some medical condition, that if I do a few hours of reading up on the latest research on that condition, chances are that I will be better informed on that…

>I've got some friends who do medical research, and from what they say, "translational research" (getting the latest research into the hands of the doctors actually practicing medicine) is a HUGE problem.

That's a good thing too.

Unless the "latest research" actual distills down to common practice, it's usually unproven junk, even if it managed to get published in "peer reviewed journals".

In fact several meta-studies have found over 80% of the papers that are published in such journals are wrong and/or non-reproducible. As for research results that made it to Nature or similar pop science magazines those are usually even more journalistic than scientific.

Think of a research "getting into the hands of the doctors actually practicing medicine" as a filtering process to weed out the BS.

Here's how it works:

A team of some inexperienced postgraduates hastily follow some idea tossed around by a professor who doesn't really follow their progress or care that much, but who'll gladly slap his/hers name on the final paper. If there's a need to secure grants, the paper will tackle some important topic and better have good results.

In the way, they make one or more methodological errors, and finally send their paper to some journal. The journal editor might be friends or exchange favors to the professor, and will do what he cans to get favorable reviewers, anonymous or "anonymous".

Not that the reviewers will go into much bother checking it out, unless the paper is evidently crap. After its published, some pop science journalistic hack will cover it in the cliched "breakthrough story" format, also giving a full portrait of the professor as a restless scientific maverick (even though he merely signed the paper). The editor will then slap a blockbuster-like title to the story, and readers will enthuse about the possibilities.

Several months/years later, 3-4 other papers will tear down that one, and the cycle continues. Though sometimes wrong papers manage to get cited for decades without anyone bothering to redo and verify the original research.

Re: Inflammation: Medicine's burning question

#129
post #71

Earlier quoted context omitted.

Probably, but your ability to process the information is severely limited to someone who has be trained on how to do so. And I'm not saying that your doctor has been trained to do so.

My faith in Doctors is pretty much at an all time low. I kept having bouts of extreme pain with really strange symptoms, Doc's said Reflux but I kept saying it didn't fit the pattern, a dozen AE (ER) visits later and I got a Doc who told me to insist on an MRI. Turns out I have Syringomyelia, a serious and rare spinal condition which the radiologist spotted by accident as it was on the edge of the scan, he then did a…

I can relate to this.

I feel that the chasm between the lay person and the MD has widened tremendously in our lifetimes (I'm in my 30s).

This also, unfortunately has made the average patient be almost completely uninformed. They demand medication to cure their, self-inflicted, ills, or try to diagnose through Web MD.

I for one will educate my children and will continue to educate myself to not require an MD on every occasion.

But I know that I'm not an MD and I was not trained to diagnose. I'm glad you found doctors who could give you a correct diagnosis that you can lean on to help you through your own search for the truth. I feel this is the best solution at the end of the day, for patients and doctors to be partners.

* My dad is an MD and my wife is a biological scientist which really puts me at an advantage.

Re: Inflammation: Medicine's burning question

#130
post #71

Earlier quoted context omitted.

Probably, but your ability to process the information is severely limited to someone who has be trained on how to do so. And I'm not saying that your doctor has been trained to do so.

My faith in Doctors is pretty much at an all time low. I kept having bouts of extreme pain with really strange symptoms, Doc's said Reflux but I kept saying it didn't fit the pattern, a dozen AE (ER) visits later and I got a Doc who told me to insist on an MRI. Turns out I have Syringomyelia, a serious and rare spinal condition which the radiologist spotted by accident as it was on the edge of the scan, he then did a…

[deleted]
Post reply on HN